Author: Juliusz Wodzianski (LLB PGDip MSC MBACP)
One of the things that doctors and others involved with well-being tell us is that we need to take care of ourselves. We should eat nutritious food, be well hydrated, take exercise, be mindful, take time to relax and have nurturing relationships.
All of that is good advice, but are we all able to do those things? What is the effect of stress and depression on our ability to take care of ourselves, what is the effect of having low self-esteem?
One of the things that I have noticed in my therapeutic work with abuse survivors is that clients often have low self-esteem. This low self-esteem can often manifest in different ways:
‘Being a victim’, is understandable having regard to the patterns established in early life, where silence and acceptance is often the only coping mechanism. Being abused whether physically, sexually, emotionally or mentally leads to psychological scars which can take time to heal. An abusive relationship in later life may appear to be the only relationship that an abuse survivor may feel that he or she deserves.
The positive message though is that the scars can heal, and abuse survivors can overcome the historical issues which continue to play out in their lives. The process of healing can take some time as building a relationship involving trust with a therapist is a delicate act for an abuse survivor. This requires a skilled and empathic counsellor or psychotherapist that can work with whatever an abuse survivor may bring into the therapy room. The transformation for abuse survivors who engage in counselling and psychotherapy can be remarkable. However, this is a process that cannot be rushed as the work can only proceed at the pace that is right for the client. Opening too much trauma before the client has the ability to cope with it might be counter-productive.
There are many approaches to talking therapy based on different theoretical frameworks. The one thing that is common across the board is that they are all based on the element of dialogue, primarily moving from the client. One comment that is made by a number of commentators, and where there is some level of agreement, is that it is the relationship between the therapist and the client that heals. Different therapeutic models may have a different understanding as to how their methods bring about healing, but it is perhaps not necessary to understand exactly how the process brings about healing as long as it does.
People often think of counselling and psychotherapy as a system by which a client lies on a couch with the therapist silently sitting behind him or her or to the side whilst the client talks about their dreams. Whilst that is one approach, it is not the only one. This type of work is the process of psychoanalytic analysis where a client may well see the therapist two or three times a week for many years.
At the other end of the scale, patients referred to a counsellor by their GPs are more likely to be seen within an Improved Access to Psychological Therapies set up, where the number of sessions will be limited to a number, quite typically six, spaced at weekly intervals. Cognitive behavioural therapy is popular within the NHS framework, possibly because its practitioners have carried out the most research.
There is also person centred counselling (where the sessions are effectively led by the client), psychodynamic counselling (where behaviour is looked at from the perspective of the type of relationship that the client had with their parents or guardians and significant other persons when very young), transpersonal counselling (the unexplained or soul dimension being key), existential therapy (considering the meaning of life and our place in it) and so on. To confuse matters even more there are also therapies that involve some level of body work such as emotional freedom technique (where acupressure points are tapped) and eye movement desensitization and reprocessing (replicating rapid eye movement in sleep where memories are stored in the correct area of the brain) which has been shown to be effective in a number of clients presenting with post-traumatic stress disorder.
My own training has been on an integrative basis incorporating a number of different theoretical perspectives and which therefore gives me a greater number of tools with which I can work with. My only concern, and which should be at the core of all therapeutic work, is how can I help this client before me right now.
I personally have not known counselling and psychotherapy to be unhelpful to any client that I have worked with. As with all things however, it is very important to work within the framework of what the client is ready to explore. Rushing in and opening up traumatic episodes at a very early stage may not be the best way to engage in the counselling process.
One of the key areas of distinction between counselling and psychotherapy is that the former is often seen as short term work (for example, six sessions) whereas psychotherapy is often considered to be longer term work. It is sometimes considered that counselling is very helpful at dealing with immediate issues, whereas psychotherapy enables the client and the counsellor to engage at greater depth and encourage understanding of why the client responds to certain things in the way that he or she does.
My own view is that the client is in charge of him or herself, and is the best person to judge what they may need. The counsellor and psychotherapist is, in some ways, a facilitator along a journey.
Talk therapy can be immensely helpful to abuse survivors. The key to successful therapy stems from the relationship between the client and the therapist, and it is therefore of tremendous importance that the client finds a therapist that he or she can trust. It is also very important to check that the therapist is professionally trained and a member of a recognised professional body, and has experience of having worked with abuse survivors. In the UK, the two largest professional bodies are the British Association for Counselling and Psychotherapy and the United Kingdom Council for Psychotherapy, both of which maintain a register of current members. The most comprehensive directory for therapists in the UK is the Counselling Directory (which only lists professionally qualified therapists).
Juliusz Wodzianski LLB PGDip MSc MBACP is a practising counsellor and psychotherapist based in Finchley and Uxbridge, London. Juliusz can be contact via the links below:
Tel: 07973 269356
The views expressed in this article are those of Juliusz Wodzianski alone.