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Editorial – Second edition of the Psychotherapy and Counselling Journal of Australia (PACJA)

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Petra Bueskens, PACJA Editor

This second volume of PACJA begins with an article by Denis O’Hara and Fiona O’Hara on the need for an integrative approach to psychotherapy and how this will help with our collective, albeit fractious, identity. The basic argument―and it is one I adhere to―is that the discipline of counselling and psychotherapy is both eclectic and united, a broad church that can come together under one professional umbrella while embracing our internal diversity. However, not content to accept a token pluralism, O’Hara and O’Hara promulgate a non-dualistic stance founded in philosophy. Drawing on the meta-theory of critical realism they provide an illuminating account of how to hold together opposites (theoretical, conceptual, experiential) while eschewing the pitfalls of relativism.

It is clear from our unitary beginnings in psychoanalysis, psychotherapy and counselling now has numerous schools―cognitive behavioural, existential, psychodynamic, narrative, person-centred, solution-focused, to name but a few. To this we can add the multifarious paradigms that psychotherapists and counsellors inculcate prior to becoming therapists and the typically “advanced” age (often over 30, sometimes over 40) at which many commence training. This means that it is not uncommon for psychotherapists and counsellors to bring ten or twenty years of adult life experience with them into the field (McLeod 2013, p.42).

As O’Hara and O’Hara contend, it is precisely because we―the profession of psychotherapy and counselling―are so internally diverse that an integrative paradigm is important; it is this diversity however that is also our professional distinction and strength. Our newly emerging profession is poised to set its own terms, to make declarations about what direction we want to take, what our identity is and what is important. Critical questions are arising concerning the epistemological and ontological foundations of the discipline: are we a positivist discipline defined by quantitative research and medical approaches to mental health or are we humanists drawing on a long tradition of inter-disciplinary knowledge in the humanities and social sciences?

It would be disingenuous at this point not to declare my own allegiance: I am positioned primarily in the latter “school”―trained as a sociologist (with undergraduate degrees in politics and gender studies) long before training as a psychotherapist with affinities to a more hermeneutic and critical theory tradition and also to qualitative research. On the other hand, and hoping I don’t sound like too much of a “fence sitter”, it is in fact the bringing together of both of these paradigms that define the real richness of psychotherapy and counselling as a discipline. It is in this space that we can define our unique contribution to practice, to scholarship, to training and supervision. As O’Hara and O’Hara note, psychotherapy is both an art and a science.

The research articles in this second volume of PACJA showcase this wonderful diversity. In our second article, “Therapy in supervision” Zoë Krupka articulates a nuanced auto-ethnographic account of supervisory practice asking where supervision ends and therapy begins. She invites us in to a focused discussion on where and how to draw the line incorporating case vignettes and her own reflective voice to interrogate a literature (and a supervision frame) “that is at times sparse, vague, simplistic, punitive and rigid”. Here the specific integration is twofold: firstly, Krupka is asking us gently―beginning with her Rumi epigraph―to consider expanding the “rules and guidelines” of supervision to encompass a sense of “co-creation” in the supervisor/supervisee relationship and; secondly, at an epistemological level, she invites us into her own internal process as she uses her subjective experience, across disparate biographical territory, to traverse the complex boundary between supervision and therapy.

In adopting auto-ethnography, Krupka is stretching the conventional methodological frame for while we accept that the self is a tool, indeed the tool, for the therapist, in our scramble to gain professional recognition on the basis of bona fide research evidence, we are less inclined to accept the self as a research tool. The self is often―though fortunately not always―defined as an epistemic pollutant, a “bias” muddying the pure positivist waters of objectivity. Krupka challenges this assumption and invites us into her private musings, engaging an inquiry into her own process alongside her analysis of the scholarly literature. What Krupka integrates in her article, then, is the subjective lens, albeit a disciplined one, with scholarly enquiry.

The theme of integration arises again when considering Robert King’s article on e-mental health. For King the transition to online psychotherapy and counselling need not be considered mutually exclusive with face-to-face therapy. For King, the two modes of therapy are complementary rather than conflictual and bring together important new questions regarding how we practice therapy. With the impending roll-out of government e-mental health services (with King himself on the government advisory committee) some of the challenges to service delivery he outlines can perhaps best be ameliorated by keeping in mind this emphasis on integration. Clearly a model that blends face-to-face therapy with additional online services (or the other way around as also happens) creates a shift in both the content and process of therapeutic work. But there remain concerns, as King outlines, with “diffusion of responsibility, therapy splitting and over-servicing”. Clearly counsellors and therapists need to remain cognizant of the limitations of e-mental health and assess its suitability in each case while also keeping in touch―where possible―with online service providers.

Also on the subject of internet therapies Pieter Rossouw and Francesca Reddington furnish us with a rich literature review and propose a new model of e-mental health for the “brain wise therapist” incorporating both the insights of attachment theory and neurobiology with the innovations of “internet supported psychological interventions” (ISPIs). They highlight the research that shows consistent positive treatment effects for ISPIs, while also identifying similar problems to King with “support, attrition, usability, and theoretical approach” concluding that it is the maintenance of a human connection alongside ISPIs that has proven most efficacious. In the end, they too, advocate for an integrated approach.

Many therapists (myself included) are inclined to resist the implementation of e-mental health for fear that they or their role will be usurped or simply out of a belief that only a “real” relationship has the capacity to heal. However, after reading Hannah Baker’s recent harrowing account of her own childhood sexual abuse (Baker, 2014), I can see just how important anonymous counselling is for some; indeed, she credits the phone counselling service at Kids Helpline with saving her life. Moreover, e-mental health makes sense in the context of what many of us with internet connections and smart phones are already doing in terms of education, work and socialising: we are already living a mix of the “real” and the “virtual”. As the Spanish sociologist Manuel Castells argues, the social world is now defined by a culture of “real virtuality” (as opposed to the more familiar and potentially pejorative “virtual reality”). This idea collapses the crude distinction between the “real” and the “virtual” arguing that our virtual (online) lives are real and our real (physical) lives are increasingly intersecting with the virtual (Castells, 2010). This more nuanced approach defines the two modes as coterminous, mutually constitutive and dynamic rather than static opposites.

As someone who engages in virtual teaching, virtual (phone) supervision as well as face-to-face therapy work and the corporeal messiness of mothering young children (while sometimes Facebooking with friends about it), it is impossible to maintain these arcane and dated distinctions between our “online-“ and our “real-” lives, so why should it be any different with therapy? The online and face-to-face worlds are increasingly integrated producing a new experience of the social and, inevitably and necessarily, of counselling and psychotherapy. Clearly nothing can replace face-to-face work, but e-mental health can complement it.

In the fourth article on Emotionally Focused Therapy, Maria Gray invites us into detailed case work of a video-taped session elucidating her concept of the “four layers” of EF work. Drawing on the metaphor of the Babushka doll, with its internal replicas who are both the same but different, Gray outlines the multifaceted layers of self that are engaged with in EF work. In particular, she examines the outer person-centred layer through to the client’s relationship with self, their inner conflict and, finally, how the therapist invites the client into “respons-ability” and agency. The focus in EF work is on the subjective experience and self-concept of the client rather than the external problem. As Gray respectfully points out “the problem is wrapped, in some way, in the person’s self-experience”. Working with the subjective realm connects the client into his or her emotional self and, ideally, into a sense of agency and hope.

Our final article by Robert Brandenburg and Kurt Lushington on men in midlife offers insight into the role of personality type on the developmental process of midlife transitions. Like Gray’s paper, Brandenburg and Lushington’s is positioned as assisting psychotherapists and counsellors to better understand their clients and, in turn, to provide more sensitive services. In midlife it is not uncommon for men to re-evaluate their lives and relationships and to seek deeper meaning and fulfilment; for some a “crisis” may ensue as they engage this developmental milestone. Brandenburg and Lushington conducted a pilot study based on the Myers-Briggs Type Indicator® and compared two personality types―an “Intuitive-Feeling” type with a “Sensing-Thinking” type―locating ten men for each group between the ages of 40-55. They found that men in the latter group, more accustomed to instrumental and rational modes of being, were also more likely to have “experienced an existential crisis”. Having watched Brandenburg present a version of this paper at the recent PACFA conference (June2014), one can see his work has resonance with those in and beyond midlife. It was also interesting to hear of his own searching experience and its final result: the pursuit of psychotherapy and counselling as a profession―certainly a positive resolution (though I readily confess to bias on this matter)!

In this edition we also have six book reviews on a kaleidoscope of fascinating topics: “phototherapy”, climate change from a psychoanalytic perspective, complex trauma, play therapy, counselling and critical psychology and a review of a new SPSS statistics manual.

In addition to our peer reviewed articles and book reviews we also have two literature reviews: “The effectiveness of psychodynamic psychotherapy” by Cadeyrn Gaskin and “The effectiveness of expressive arts therapies” by Kim Dunphy, Sue Mullane and Marita Jacobsson. As per the PACFA research committee’s commitment, these reviews are commissioned to enhance the evidence base for the profession and provide practitioners with authoritative reference material on their own and other therapeutic modalities.

I hope you enjoy this second volume of PACJA. It has been the culmination of work by many people including the reviewers on the editorial advisory board, the PACFA office staff, in particular Maria Brett and Julia Bilecki, and the PACFA research committee who have supported me as an editor and continue to develop the national research agenda for psychotherapy and counselling. To this end, I would like to thank in particular Elizabeth Day and Ione Lewis. We encourage practitioners and researchers to contribute papers for the next edition of PACJA (volume 3) due out in December and please look out for our call for papers on a themed edition on psychodynamic psychotherapy for volume 4.

References:
Baker, H. (2014). Dealing with sexual abuse: A young person’s insights. Retrieved from https://www.smashwords.com/books/view/439132
Castells, M. (2010). The rise of the network society: The information age: economy, society and culture (2nd edition). London: Wiley-Blackwell.
McLeod, J. (2013). An introduction to counselling (5th edition). Berkshire, UK: McGraw-Hill.


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