12 Apr 2020

BY: Online Therapy

Clinical Psychologist / Clinical Psychology / Cognitive Behaviour Therapy / Online CBT / Online Clinical Psychologist / Online Cognitive Behaviour Therapy / Online therapist / Online Therapy

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Why Online Clinical Psychologists Using Cognitive Behaviour Therapy are Incredibly Effective

Photo by Gustavo Fring from Pexels and article by Kimberly Yusay

Are you looking to try out online Cognitive Behavioural Therapy?

If you’re unsure and need some facts to help you, we have compiled 3 reasons why online CBT might just be what you need to get your life back on track.

1.    Cognitive Behavioural Therapy is Heavily Backed by Science.

The American Psychological Association indicates that compared to other forms of therapy, there is abundant scientific evidence that backs up the effectiveness of Cognitive Behavioural Therapy (CBT).

Because of this, it is different and even considered more effective than other therapies.

It also treats a vast array of mental illness that includes:

  • Anxiety disorders,
  • Eating disorders
  • Depression,
  • Alcohol and drug misuse,
  • Marital problems,

As stated by UK’s National Health Services it can also provide help people suffering from:

  • Post-Traumatic Stress Disorder (PTSD)
  • Phobias
  • Obsessive Compulsive Disorder (OCD)
  • Panic Disorder
  • Schizophrenia,
  • Borderline Personality Disorder
  • Psychosis
  • Bipolar Disorder
  • Sleep Problems
  • Fibromyalgia
  • Chronic Fatigue Syndrome (CFS)
  • Irritable Bowel Syndrome (IBS)

NHS UK also emphasized that CBT helps you sort through the interplay of your emotions, bodily sensations and behaviours.

It allows you to break through from the cycle of repeated actions, negative thought patterns and unhealthy coping mechanisms.

2.    Online CBT is a Proven Beneficial Treatment.

According to a 2011 study, Online Cognitive Behaviour Therapy is a useful alternative to face-to-face CBT sessions.

In fact, this research which began in 1996, became the basis for the Dutch government. And, since 2005, the costs of online CBT were refunded through their country’s public health insurance.

3.    Online CBT Psychologists Have a Lasting Effect on Wellbeing

In a 2016 article published in the Internet Interventions journal, a total of 42 patients shared how the behaviours of their online clinical psychologists contributed to the improvement of their wellbeing.

  • Affirmation – This particular behaviour of online psychologists helped the patients long after the treatment was over. Its positive effect on depressive symptoms was shown to last even after two years.
  • Encouragement–  The effects of this can be seen right away. It emerged right after the patients have undergone the session/s.
  • Self-disclosure – Similar to affirmation, patients who were able to share their untold stories and vulnerabilities showed vast improvements in depressive symptoms even after some time has passed after the treatment.

Want to get in touch with a Clinical Psychologist who can help you with CBT? Contact below.

23 Mar 2020

BY: Online Therapy

Covid-19 / Online therapist / Online Therapy / Online therapy for Coronavirus

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Where to get Coronavirus Assistance

Are you affected by the Coronavirus?

As New Zealand joins the rest of the world by going into alert levels 3 and 4, many people experience tremendous stress at the thought of losing livelihoods. Remember, you are not alone. Most people are employed by small businesses, and many individuals have the same fears as you. The world is in this together.

Anna offered free online appointments. However, due to high demand, she is unable to accept more new clients. She will continue with the appointments she currently has. We have listed a number of emergency numbers you may need during this time.

Emergency numbers:

Lifeline: 09-522 2999 - text help (4357)
Suicide Crisis Helpline 0508 828 865
Anxiety NZ: 09-522 2999
Depression.org: 0800 111 757
LGBTIQ – Outline:  0800 688 5463
Woman’s refuge: 0800 733 843
Youthline 0800 376 633 (text 234 email talk@youthline.co.nz)
Barnardos NZ 0800 WHAT’S UP (0800 942 8787)
Family services https://www.familyservices.govt.nz/directory/searchresultspublic.htm?searchTerms=&cat1=-1&searchRegion=2&search=Search
Minds and hearts support directory: http://heartsandminds.org.nz/information-support/support-services-directory

Extreme emergencies:

First point of contact 111
Mental Health Crisis Team 0800 800 717.

For Online Counselling Sessions ($150 per session), please contact Sara:

References:

https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12318941

05 Sep 2019

BY: Online Therapy

Acceptance Commitment Therapy / Happiness / Online therapist / Online Therapy / Positive Psychology / Telephone Counselling

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Positive Psychology – choose happiness

Article by Sara Taveira. Sara uses telephone counselling or Zoom counselling to help you work through your difficulties. Would you like to learn more about Sara? Then follow this link. 

Positive psychology – choose happiness

We all want to find happiness, to smile and feel good about ourselves and our lives. This pursuit of happiness is intrinsic to human nature. Several self-report studies reveal that people rated happiness as more important than having meaning in life and being financially comfortable.

It would be great to experience lots of happy moments all the time. However, the belief in a constant state of happiness is not true. Happiness can be hard work and usually implies accepting a new way of reacting to discomforts. Being happy involves being in the moment, here and now, which entails a state of mind, and not a continuous feeling.

Read More “Positive Psychology – choose happiness”

20 Jul 2019

BY: Online Therapy

Introversion / Online therapist / Online Therapy / Shyness / Social phobia / Telephone Counselling

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Telephone Counselling working with introversion, social phobia and shyness

This article, Telephone Counselling working with introversion, social phobia and shyness was written by Sara Taveira.

Am I introverted, socially phobic or just shy?

This article deals with telephone counselling working with introversion, social phobia and shyness. These concepts are often interpreted as semantics and can lead to confusion.

Generally, social phobia, shyness and introversion are viewed in the same light. In this article, I will explain the difference between each concept and what they have in common.

Introversion

Introversion is a personality trait. Introverted people have a higher interest in their own internal world, their thoughts and feelings, and are usually happy to spend time alone. Actually, most introverts need alone time as a self-care tool as much as extroverts need social time to recharge their batteries.

Social Phobia

In contrast, social phobia is a mental health disorder based on a perceived irrational and exaggerated fear in social situations. A person suffering from social phobia is usually interested in social situations. However, their fears of being judged by others or embarrassing themselves lead them to avoid social interactions and facing them with significant distress.

People experiencing social phobia, are usually overly conscious people, perfectionist, and have constant feelings of being “put on the spot” in social interactions. This distress impacts several areas of their lives. It is not hard to imagine that someone struggling with social phobia will have extreme difficulties initiating and/or maintaining relationships, which contribute to social isolated.

Being isolated socially can lead to other mood disorders and may affect future goals. How? Well, think about choosing a university degree or a professional career pathway. If I am social phobic, will I choose a career involving primarily social interactions like public relations, politics, management, etc.? Probably not. Social phobia can vary in intensity and forms: some people only struggle with social situations (being the focus of attention) – performance type – while others will struggle simply with social interaction in groups. Severe forms of social phobia may have both forms present.

Children’s experiences of social phobia

Children’s presentation of social phobia may vary according to their different developmental stages. Due to developmentally appropriate diminished self-awareness, young children usually can only describe several physical symptoms, are extremely clingy in social situations, refuse to participate in social or school activities and do not tend to speak when meeting new people.

Middle school-age children, as they become more self-aware, can say things like “I expect bad things to happen” or “others are looking at me while I am eating” or “others are saying bad things about me”.

Teenagers experiencing social phobia, are usually very hard on themselves and self-critic, thus, will often avoid eye contact, or struggle at an academic level (which can lead to school truancy). They can have difficulty dating and in some cases start at-risk type of behaviours, such as alcohol and drugs experimentation as a coping mechanism for their anxiety.

Shyness

Shyness includes a number of uncomfortable feelings such as awkwardness, stress and worry when interacting with unfamiliar people. Shyness can be present when someone experiences introversion and social phobia.

Since I am a food lover, let me explain it this way: Introversion and social phobia are the two bread slices of a sandwich and shyness can be considered the cheese that connects the slices. Shyness often, but not always, leads to social phobia. Similarly, an introvert may be shy when facing unfamiliar social situations but it does not necessarily mean that he/she suffers from social phobia.

Conclusion

Telephone Counselling working with introversion, social phobia and shyness is possible. Whether you are an adult with a constant feeling of being “put on the spot”, or have a child who displays some of the above symptoms, the more you avoid it, the worse it gets!

Start today by taking the driver’s seat when it comes to your social phobia so that you can learn to park it somewhere and never look back! Talk to us, we can join you in these driving lessons.

Want to learn more about telephone Counselling working with introversion, social phobia and shyness? Feel free to contact Sara. Want to learn more about Sara, follow this link.

Contact Sara Now

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05 Jun 2019

BY: Online Therapy

Clinical Psychology / Depression / Online Depression Counselling / Online therapist / Online Therapy / Seasonal Depression

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Seasonal Depression

Article by Sara Taveira

WINTER IS COMING

Experiencing the Winter Blues (Seasonal Depression)?

What is seasonal depression? We are all familiar with this heading tagline from a famous TV Series. However, the expression is also highly used these days because of the difficulties of “surviving” through the winter, the so-called, winter blues. On a daily basis, we can already notice the slight changes in mood in everyone’s faces, the sense that people are already building up their emotions around the fact that the cold, dark and rainy days are ahead of us.

Why do we feel seasonal depression?

Well, although science has not come up with a specific answer yet, it mentions several contributing factors contributing.

  • Vitamin D: “you are my sunshine, my only sunshine”, indeed! This vitamin is very important to our energy levels and mood as it helps with cell growth, our immune system and many other things in our body. During the winter period, most of us wake up when there is no daylight, go to work, spend all day in the office and then, when it’s time to return home, the daylight is already gone. As a result, we do not have much of this vitamin in the winter when comparing to spring and summer time.
  • Hibernation: this may sound strange but some research talks about a physical slow down process that all mammals go through, during winter. Humans are no exception, although in a lighter way. The problem with this is that we actually cannot hibernate and have to keep going with our busy lives.
  • The relation between body hormones, light, and circadian rhythm: these three dances harmoniously. In detail, daylight differences regulate our internal biological clock through the release of hormones, such as melatonin. Therefore, at night, because daylight ends, our body starts producing this hormone which makes us feel sleepy, decreases our body temperature, and many other modifications to tell us “it is bedtime”. The opposite process occurs every morning. So, if you consider all this, you will find the answer to the common question “why am I still so sleepy and tired every morning?”. That is right, in winter when you wake up, there is no daylight, so melatonin is still running happily through your veins, so you feel very sleepy. The lack of light also decreases another hormone, which is extremely important for mood, appetite, sleep, social behaviour and even sexual appetite regulation – serotonin. So, it makes sense that you feel less happy during dark, cold and rainy days, as our natural mood stabilizer is much less produced by our brain.

What can we do beat Seasonal Depression?

Well, I guess just like olive oil, garlic and onions are the basis of any good recipe, so exercise, diet, and sleep are the basis not only for avoiding the winter blues but for good mental health. For this reason, eat smart by avoiding sugar, alcohol, and caffeine, which can deteriorate your mood, and nourish yourself with chocolate once in a while as it helps to boost your mood. Aim for 8 hours of sleep, and get moving by simply going outside and doing a 30 minutes’ walk. You will kill two birds with one stone: you will exercise and get some natural daylight. Other ideas that may help are expressing your emotions and being near your social support for those harder moments, turning on the radio or other music you like at home to glow the dark rainy days or learn a new skill/new project. If your wallet is “booming”, plan a trip to a sunny place.

What if the above ideas are not enough?

It might come as a surprise to you, but there is in fact a mental health disorder caused by the above alterations in our body, a seasonal depression. Some examples of symptoms are sadness and loneliness, social withdrawn, excessive tiredness, irritability, etc. These symptoms have to cause clinically significant distress and/or impairment in important areas of your overall functioning.

So please talk to us if you are worried you might be experiencing seasonal depression. We can assess if you are, and if so, help you to overcome them.

Want to know more about Sara? Follow this link.

Contact Sara Now

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06 Apr 2019

BY: Online Therapy

Clinical Psychologist / Clinical Psychology / Online Clinical Psychologist / Online therapist / Online Therapy / Online Therapy Clinical Psychologist

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Online Therapy welcomes Sara Taveira Clinical Psychologist

Online Therapy welcomes Sara Taveira Clinical Psychologist to our online family

Sara Taveira interviewed by Anna Keyter:

We are delighted to introduce Sara Taveira to our Online Therapy family,  and this is her story.  Sara is an independent clinical psychologist (Registered with the New Zealand Psychologist Board) joining our small group of therapists. Below is the interview with Sara to get to know her better.

How did you get into Clinical Psychology?

I started my University Degree initially wanting to become a forensic psychologist.  My dream was to be a “Criminal Profiler”. However, in the first years, I was introduced to the multitude of psychology fields and it was with clinical psychology that I connected the most.

I love life, people, smiles, a good laugh and positivity. Possibly, these are the things that motivated me to become a psychologist in the first place. That visceral curiosity about the other, the need to understand the person I am in a therapeutic relationship with, and help them if I can. With clinical psychology and psychotherapy, I can certainly do that.

Where did you do your training and how did you register at the New Zealand Psychologist board?

I completed my studies up to Masters level and psychologist certification in Lisbon, Portugal. In the European Union, the higher education is based on the “Bologna Process”, which in cooperation with all European countries, standardises higher education among all countries, thus strengthening quality assurance and facilitating the recognition of qualifications and periods of study. Therefore, the process to register at the New Zealand Psychologist Board (NZPB) was straightforward as they follow the guidelines from the UK as part of the Commonwealth of Nations.

What work did you do in New Zealand and internationally?

When I moved to New Zealand I started working for the District Health Board’s (DHB).  I attended to patients experiencing moderate to severe mental health disorders. I have worked in many different Hospital Services: Maternal Mental health; Children, adolescents and families services; Eating disorders Specialized Services; Parental intervention and group therapy for children with behavioural disorders Specialized Services and Mental Health Crisis Team.

I accepted a contract as a psychologist and psychotherapist with the ACC in 2015.  At the ACC, I provided services for Sensitive Claims, doing psychological assessments to determine mental injury from sexual abuse trauma.

In Portugal, I started my career as a university counsellor and providing psychological assessment services as a student. After completing my qualification, I gained experience in psychiatric hospitals, schools, private practice and psychosocial projects for children and adolescents with risk-taking behaviours, their families and the school community as a clinical psychologist.

What key functions will you bring to Online Therapy?

As a clinical psychologist, I am hoping to bring a new intervention approach – psychotherapy – to those who are not able to attend on-site consultations.  If you are unable to get to an office, you can contact me online.  The online space is where I can offer assistance for people physical problems and disability, illness, mobility, geographic area, language, difficulty in reconciling schedules and unable to get to an office.

Psychotherapy addresses overall patterns, including chronic or recurring problems in a person’s life, and focuses on feelings and experience. It is an in-depth therapy modality on internal thoughts and feelings and core issues. The main objective is to achieve personal growth and to gain insight into the main areas of a person’s life.

During my 12 years of experience, I have gained qualifications in different specific psychotherapy modalities which could benefit Online Therapy clients.  These qualifications include EMDR, CBT, Mindfulness, ACT, CRT, CBT-E and FBT, evidence-based protocols for PTSD and complex trauma.

I consider myself an eclectic psychologist, focused on adapting the intervention to each person. I don’t follow the trend of labelling with diagnostics and jargon but aim to understand each unique person I am working with, and then adapt working tools accordingly. Over the years of clinical practice, I have found that working with emotions is central to all processes when dealing with transformation and personal growth, which is the focal point in my therapy room.

Why were you brought on board and what is your specialist areas?

I have started my relationship with Online Therapy over a year ago, fuelled by my interest in telepsychology and helping patients who cannot attend face to face therapy.  I am also keen to maintain my bilingual psychotherapy skills. As an eclectic psychologist, I have gained experience and interest over the years in conditions such as anxiety and stress, depression, eating disorders, trauma, relationships, feelings of emptiness, emotional difficulties, life changes adaptation difficulties, parental coaching and personal growth/coaching.

What do you enjoy doing in your spare time?

I will start by saying that I may share DNA with cats since I love sunbathing. Food is another great passion as, in my culture, it means family reunion and connection. I get immense bliss when cooking for loved ones and putting smiles on their faces.

Motherhood has been, without a doubt, the joy of all joys and a highway to happy moments, personal growth and constant self-reflection.

Music provides the background soundtrack to my life. It allows me to personify emotions, it helps me to express myself and enables me to relate to others as well. My most recent personal goal is to learn how to play the guitar so that I can sing and play with my child.

A good conversation undeniably makes my day and time fly.  What else… well, I am a woman, a mother, a daughter, a sister, a wife, a friend, a colleague, a neighbour, a society member, a citizen of the world….

 

 

Contact Sara Now

12 Nov 2018

BY: Online Therapy

Acceptance Commitment Therapy / Acceptance Commitment Training (ACT) / Anxiety / Group Therapy / Online ACT / Online therapist / Online Therapy / Workplace stress / Workshop

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Group Therapy using Acceptance Commitment Training ACT

Group Therapy using Acceptance Commitment Training ACT:

Good news!  Online Therapy will be offering group counselling programmes starting next year (2019) mid-January.  To learn more about our previous workshops, please follow this link.  We have prepared a course that focuses on Acceptance Commitment Training (ACT) which works well with workplace stress and anxiety. The year kicks off with training programs that can provide you with tools to make a positive change to your work environment and family life.

We love group work because it offers members feedback to help recognise personal problems from different perspectives. Within the therapeutic context, it is comforting to hear that you are not alone and that many people have similar ways of processing thoughts.  It is also reassuring to know that group therapy using acceptance and commitment training ACT has a proven track record to address stress and anxiety effectively.

You may ask: Why choose Group Therapy using acceptance and commitment training ACT?

ACT is based on six core processes, acceptance, cognitive defusion, present moment, self-as-context, values and committed actions as discussed below.  During group work, you will learn how to work through these processes and create goals based on their values and then taking committed action.  Below is a summary of the ACT core processes.

Acceptance and Commitment Training or (ACT) six core processes:
Acceptance:

During group work, you will be provided with tools to learn how to accept difficult emotions instead of fighting them.

Cognitive Defusion:

You will learn to change the way you interact with difficult thoughts by creating distance from emotions that are not useful.  In that way, negative thoughts have less power over you.

Being Present:

By learning to be present you are more flexible in your actions and you can start to set goals, based on what is important to you (values). This happens by changing your internal language.  Your new behaviour will be based on your describing events in a non-judgemental way.  Hence, you become “self-as-process” and learn to defuse from ongoing, unhelpful thoughts and feelings.

Self-as-Context:

Due to relational frames (I vs You, Now vs Then, and Here vs There), language shapes our perspective of the world.  Being self-as-context you become aware of how you identify with past and future thoughts.  During group therapy, you will learn techniques to help you become aware of your ‘flow of experiences’ and learn how to detach from unhelpful feelings.  Even with shortcomings we can accept ourselves and live meaningful lives.

Values: 

The group will set goals according to their values.

Committed Action: 

You will be encouraged to take action linked to their values to achieve goals.  After each session, you will receive homework to help you action your goals.

If you would like to learn more about Group Therapy using Acceptance and Commitment Training (ACT), then feel free to contact me using the form below.

Contact Us

To receive more information on Group Therapy using Acceptance Commitment Training ACT, please feel free to subscribe to our newsletter.

References

Mostafa Heydari, Saideh Masafi, Mehdi Jafari,Seyed Hassan Saadat, and Shima Shahyad (2018), Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff

31 Oct 2018

BY: Online Therapy

Couple Counselling / Couples Counselling / Marriage Counselling / Online Skype Counselling / Online therapist / Online Therapy / Relationship Counselling / Video Counselling

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Relationship Counselling Auckland using Video Calling

Photo by J Carter.

Relationship Counselling Auckland using Video Calling:

This article, Relationship Counselling Auckland using Video Calling builds on an essay that discusses attachment theory within relationship counselling. Today’s article Relationship Counselling Auckland using Video Calling focuses on the separation-individuation theory (when children learn to separate from parents emotionally) and considers how the family system can cause family members to attain/not-attain personal authority and how it affects relationships.

Relationship counselling involves an exploration of attachment styles and looks at how people develop relationship communication patterns from childhood into adulthood. For example, have you ever wondered why you and your siblings remember events differently?

People experience circumstances within their contexts which influence how they make sense of themselves and their worlds.  The primary consideration in the separation-individuation process is the smooth transition from one stage to the next. Conversely, disruptions or restrictions during the transition process can have life-long effects in the way we respond to our worlds.

The mother is involved in her child’s changes from dependence, individuation to differentiation (discussed below).  At first the child is entirely dependent on the mother, but eventually, he/she struggles for control to achieve autonomy.  At times, parents are uncomfortable with the child finding his/her individuality, and a power struggle may ensue.   Early experiences affect the way people make sense of themselves over a lifetime and influence how they react in relationships.

Dependence

As discussed in Relationship counselling using Skype, attachment styles develop within the first years (zero to three years) when mother and baby are undifferentiated. In other words, the baby can’t discriminate between I / Not-I and believes mother/baby are one (Mahler, 1986). Furthermore, the mother experiences the baby as an extension of herself. Keep in mind, attachment theory is not developmental and is understood as universal individual experiences that form the basis of family dynamics (Blom & Bergman, 2013).

Individuation

From three years onwards, children start developing their own identities.  Failure to individuate means a person cannot create a sense of self and continues to experience the self in the context of the family.  Individuating too early can lead to coping styles where a person relies on self too much, but prolonged dependence can lead to overdependence in adult life.

A teenager generally individuates around the age of 16 by moving more towards their social circles and developing their own identities outside their family units.  At this stage, the young person is still very much part of the family.  Successful individuation is experienced when parents encourage teenagers to follow dreams, encourage open debate and let go (in a healthy way) of their children at the appropriate time.

Differentiation

Successful differentiation means that the young adult (generally by 35) is fully aware of I / Not-I and can function successfully independent of the parent or marriage partner.  However, I have found in therapy that some couples become fused and start viewing the other as an extension of themselves. This can place tremendous pressure on the relationship.  Once the partners accept that they can function independently within a unit, then the relationship can improve.

Can Relationship Counselling using Video Calling be effectively used with attachment problems?

Absolutely, not only can it be effective, but also convenient when avoiding traffic.  However, not all people are comfortable with the electronic medium and prefer face-to-face counselling.

Below please find the references for the article Relationship Counselling Auckland using Video Calling

Inga Blom and Anni Bergman: Observing Development: A Comparative View of Attachment Theory and Separation–Individuation Theory

Mahler, M. S. (1986b). On the first three subphases of the separation-individuation process. In P. Buckley (Ed.), Essential papers on object relations (pp. 222–232). New York: New York University Press.

Feel free to contact us if you need relationship counselling by completing the Contact us form.

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28 Jun 2018

BY: Online Therapy

Anxiety / Assessment / Counselling / Depression / Online Counselling / Online Counsellor / Online therapist / Online Therapy

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Online Therapist Analysing InTreatment Week 4 | Sophie & Paul

Article by Anna Keyter

Online Therapist Analysing InTreatment Week 4 | Sophie & Paul:

This article is a critical analysis of a therapy session based on an assessment of the HBO episode: In Treatment.  (Disc Four) with Sophie and Paul. The purpose of the session was for Paul to write a report on Sophie’s suicidality. However, the assessment turned into therapy. Sophie presents self-harming behaviour, risky sexual activity and substance use.

Sophie was raped and exhibits the typical acting out behaviour of teenage rape victims. Signs of adolescent rape include conduct such as extreme agitation, anger outbursts, depression, sleep and school problems (NSOPW, n.d.). She also engages in alcohol misuse, promiscuity, eating disorder and running away from home and possibly comorbid depression (DSM5, 2013). Contextual variables, including transference-countertransference, will be discussed first, followed by the strategies Paul used to develop the therapeutic relationship. Ruptures will be addressed firstly by looking at ethical challenges that arose followed by ruptures due to cues Paul missed during the session. Each section describes behaviours/events and recommendations on the ruptures that occurred during the session.

Contextual Variables

The contextual variables will be discussed in terms of countertransference and transference experienced by Paul (therapist) and Sophie (client). From a psychodynamic perspective, countertransference can be defined as the therapist’s subconscious emotional reaction to the experiences of the client. Transference is when the client subconsciously redirects feelings for one person to the therapist. Gelso (2014) refers to a tripartite model of psychodynamic intervention, “asserting that all therapeutic relationships, to varying degrees, consist of a real relationship, a working alliance, and a transference-countertransference configuration”.

Paul | Countertransference

Paul, a middle-aged man with children, is providing therapy to Sophie, a teenage girl who was raped. Sophie’s experiences affect Paul. Countertransference is not necessarily bad and could serve as an internal barometer to assess personal reactions to social interaction when the psychologist is aware of it (Gelso, 2014). During my observation of the session, Paul seemed to assume an almost fatherly role in his interaction with Sophie which could be due to a subconscious need to act as a parent to her. Schaeffer (2007) expresses the importance for therapists to identify transference and countertransference as soon as possible for the therapist to be in control of it and not be controlled by it.

Hence, countertransference could be useful if Paul examines his reasons for the way he behaves. Even though Paul is a psychodynamic therapist, I am uncertain if he is aware of his emotions of countertransference. Paul should pursue personal therapy to distinguish reasons for the countertransference that was evoked by Sophie throughout the session. In particular, Paul reacted strongly when Sophie’s commented on the gymnast that told her sex with her was like having sex with someone who had been sexually abused. Paul responded by saying “Prick”. At one stage Paul also tried to comfort Sophie by putting his arm around her and stroking her shoulder and hugging her (which could have ethical implications).

Sophie | Transference

Sophie is a teenage girl who was referred to Paul after a bicycle accident that was possibly a suicide attempt. She has a strained relationship with her mother and only mentioned her father once. She is a hopeful Olympic level gymnast. However, she had been sexually abused by her coach Sy. Initially, the relationship with Sy’s family seemed close; she spent time at their house, babysitting their daughter Dena.

Sophie was on Sy’s bicycle the night of the accident, and it should have been Paul’s intention to assess possible suicidal behaviour. The helping relationship should be the interaction between the therapist’s intentions and the client’s reactions (Hill, 2014). According to Gelso (2014), the therapeutic relationship is the core of successful psychotherapy, and the two critical elements of the therapeutic relationship are transference and the real relationship. As a psychodynamic therapist, Paul should encourage this transference intentionally to assist Sophie to get insight into her distress through the therapeutic relationship. Transference is the way the client experiences and perceives the therapist. However, the client is shaped by her psychological structures, including past experiences and involves the displacement and carrying the feelings, attitudes, and behaviours to the therapist deriving from earlier significant relationships (Gelso, 2014).

Sophie displayed sexualised behaviour when she entered the therapy room. Paul did not successfully use transference to develop the conversation around transference behaviour. Instead, he played into it by taking her hand and bowing. During the session, Sophie seemed to “transfer” feelings from people in her life to her therapist Paul by the way she interacted with him. It is interesting to note that Sophie tried to commit suicide using Sy’s bike and taking an overdose of Paul’s medication in his office. Is Sophie trying to say something by using something belonging to Sy and Paul to commit suicide?

Therapeutic Strategies and Skills

Paul is a Psychodynamic therapist however, his methods seem more in line with the Rogerian model. Paul’s strategies include empathic reflections, probing for insights and listening. A positive of the session was that Sophie could speak openly and freely about her problems. Paul was listening to Sophie and displayed nonverbal cues such as nodding and using gestures. He prompted for more information by asking open-ended questions and restated comments.   Paul also used alternatives, commenting that Sophie tried to get her mother’s attention by running away from her.

Therapeutic Alliance Ruptures

Safran and Muran (2000) define therapeutic alliance ruptures as impasses or ruptures in the therapeutic alliance. Three roads can lead to an impasse – therapist and client developing a hopeless narrative about presenting difficulties; therapeutic strategy halts; leaving the interaction trapped in a negative pattern. To overcome the impasse, the therapist should become solution-focused and get help during the consultation on developing a new strategy (Safran & Muran, 2000).

Many ruptures occurred during the session as indicated below:
Safran (1993) views ruptures in the therapeutic relationship as the breakdown of the collaboration between therapist and client as indicated below.

Contracting | Privacy and Confidentiality

Problem. Psychologists should be respectful to clients by including them in the decision-making process. Paul called Sophie’s mother behind her back. He did not obtain full and active participation from Sophie on decisions that affected her. Sophie mentioned her mother took her shopping on the weekend because Paul told the mother she was going to “off” herself. Sophie asked Paul why he called her mother. Later on, Sophie expressed anger in an outburst again, telling him how upset she was that he called her mother and told her she was going to kill herself. Paul brushed it off.

Recommendation. During the initial assessment, Paul should have discussed informed consent and the implications thereof. Before involving Sophie’s mother on her suicidal thoughts, Paul should have explained to Sophie that psychologists promote their client’s right to privacy, however, when there is a threat of harm to self and others they are compelled by law to report it. The relationship could repair if the client actively participates in the change process (Horvath, 2009).

Challenges in future sessions. Sophie may become reluctant to share critical information, and risk assessment could become difficult.

Responsible Caring

Issue. Paul seemed oblivious to the harm caused to Sophie as a result of the ruptures in their relationship. He did not clarify what Sophie could expect from the therapeutic encounter. On a number of occasions, Paul pushed Sophie to go on with her story, even when she was not ready to continue. Paul did not handle the situation competently; he was more interested in what happened next than how the event affected Sophie emotionally.

Recommendation. The therapist’s ideas should not be imposed on the client in therapy (Safran & Muran, 2000). Problems should be addressed within the therapeutic alliance so that the client can reflect on problems. Paul needs to discuss this case in supervision to get guidance on how to deal with the situation.

Issue. When Sophie showed Paul a backflip, she started to walk on the back of the couch; Paul did not know how to deal with the situation. He asked her to stop, but instead of addressing his concerns about her safety, after a perfect landing he said, “That was incredible.”

Recommendation. Paul should discuss potentially harmful behaviours honestly and openly with Sophie and establish boundaries within their relationship. In this way, Sophie could model boundary behaviours from Paul.

Issue. During the session, Sophie also disclosed that Sy had a sexual relationship with her, which Paul seemed to miss.

Recommendation. Paul should have addressed the seriousness of the situation with Sophie and worked towards a plan on how to report the case to the police.

Challenges in future sessions. Paul seems to have difficulty understanding serious issues and how to address it in a lawful way as well as safety practices in his office.

Integrity in Relationships

Issue. Paul was not honest with Sophie. When Sophie confronted Paul about his phone call to her mother, he said: “That’s not what I said.” Later on, Paul admitted to Sophie that he told her mother saying “because I was worried about you.”

Recommendation. A therapist with integrity would have an honest approach. Not dealing with Sophie’s question could hamper trust going forward. Sophie could also view this as an empathic failure and end the relationship. However, the relationship could still repair if they work through the trust issues.

Issue. Sophie does not have clear boundaries; she mentioned: “screwing half the Olympic gymnastics team.” She stayed up all night after a party and then walked to her session for her appointment with Paul. He does not seem to pick up on her cues about her excessive drinking and a boy that she felt was ‘eye candy’. Her lack of boundaries are further apparent when she lies on his couch, and it seemed like she was falling asleep.

Paul’s behaviour did not help. A boundary infringement from Paul was when he sat in front of Sophie, his face only inches away from hers and encouraged her to talk. He then got up and sat very close to Sophie. As a therapist, he should be aware of the boundary breakdown experienced by raped teenagers. He moved next to her and stroked her shoulder, which is highly inappropriate behaviour for a therapist.

Recommendation. Paul should understand the underlying issues of boundaries, perhaps attend a course on how to work with teenage survivors of rape. Paul could have used cognitive processing therapy. CPT treatment includes education, exposure and cognitive techniques. Survivors identify sections of the trauma that they battle to process and then work through stuck points (Galovski, Schuster Wachen, Chard, Manson & Resick, 2015).

Challenges in future sessions. Paul did not address the issue of personal boundaries with Sophie. If Paul does not address or respect boundaries, Sophie could remain vulnerable and victimised.

Responsibility to Society

Paul needs to engage in regular supervision to monitor, assess, and report on his ethical practices to safeguard his clients. An honest exploration of his countertransference would resolve the generational issues he possibly experienced. Furthermore, if Paul does not report Sy to the police, Paul would be doing a disservice to society as a whole, especially vulnerable groups.

Feelings of Dissociation.

Sophie tells Paul about a risky sexual encounter; a gymnast took her to his room, as usual, she felt nothing. On another occasion she said, “everything around me was falling apart, disintegrating, turning to ash right in front of me, … But as soon as I started to fall asleep the pasture would turn to rot, it’s terrible.” Sophie further commented on her eating disorder and how she experienced floating on clouds disassociating from her body when she would not eat when she was younger. She felt that same feeling of when she was on the beam, and enjoyed the sense of disassociation; she pushed until it felt like she didn’t have a body at all.

Effect on Relationship. Paul missed the consistent theme of disassociation.

Recommendation. From a behavioural perspective, survivors of rape can be assisted using CBT (Jaycox, Zoellner & Fao, 2002). Paul can help Sophie to get a new understanding of her thinking patterns that can lead to behavioural change and an understanding of underlying assumptions by directly addressing disassociation. According to the DSM5, disassociation is common in people who experienced PTSD.

Feelings of being objectified

Sophie felt that her mother hated that she was a gymnast. Her mother said:“Your boobs won’t grow, you will hate your body, be deformed”. Her mother also decided on the shoes.   “She picked out those Barbie doll shoes” | “Sophie wore those Barbie doll shoes that you bought her…”

Effect on Relationship. Sophie felt objectified by her mother. Paul did not recognise Sophie’s feelings, and he did not explore the Barbie doll comments.

Recommendation. Paul should explore Sophie’s feelings on the shoes and her position as a gymnast. He did not ask her what Barbie doll meant to her. Paul is aware of Sophie’s eating disorder and body image issues. I would recommend DBT strategies which include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness to help Sophie deal with these issues (Cooper & Parsons, 2010).

The desire to run away

Sophie expressed a desire to run away from her mother to the gymnasium. However, she is unable to get away from her mother.

Effects on Relationship. It is clear that Sophie is not happy at home. Instead of addressing her feelings to run away, Paul tells her the Wizard of Oz story.  “…They remind me of, of Dorothy’s shoes. Dorothy discovered that she could go home anytime she wants with or without her shoes.” This was upsetting for Sophie, and she asked him “Why are you infantasizing me?”

Recommendation. Paul did not explore the reasons Sophie wanted to run to the gymnasium. He also did not ask her what she would find there. Exploration (Rogerian approach) could have worked in this instance.

Suicidal thoughts and attempts

Sophie came to therapy to get assessed for suicidal behaviour. The situation that brought her to therapy was when she was on Sy’s bike, and she admitted to Paul that she tried to kill herself. At the end of the session, Sophie went to Paul’s bathroom to vomit, reflected in the mirror, opened the medicine cabinet and removed a bottle of pills and consumed them. Once out of the bathroom, she said she’s going home. Paul told Sophie that they had more time, but she started slurring and fell to the ground.

Effects on the relationship. Sophie attempted suicide using Paul’s medication. This could be due to the culmination of therapeutic ruptures.

Recommendation. Paul did not do a proper risk assessment knowing that Sophie was suicidal. He did not ask her about suicidal plans or how often she had thoughts of killing herself. He should have worked with her on a safety plan. Knowing that he had a suicidal client, he should have removed the medication from his public bathroom.

Conclusion

Therapeutic collaboration stopped when Sophie attempted suicide. Paul did not explore the ruptures that happened during therapy. He did not seem to notice that the therapeutic interaction was blocked. Sophie was unable to cope, and Paul seemed distracted. Behaviours associated with the rupture include Paul’s inability to pick up on Sophie’s cues and the distress she expressed as a result of him speaking to her mother behind her back. When Paul did not know how to respond to issues, he brushed it off or changed the topic. Cozolino (2004) highlights the importance of the psychologist’s intentions to explore the client’s experiences in the moment, which Paul seemed unable to do.

If you want to discuss the article Online Therapist Analysing InTreatment Week 4 | Sophie & Paul, please do not hesitate to contact us at info@onlinetherapy.co.nz.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Code of Ethics For Psychologists Working in Aotearoa/New Zealand. Retrieved May 27, 2018, from http://www.psychologistsboard.org.nz/cms_show_download.php?id=237

Cooper, B., Parsons, J. Dialectical Behaviour Therapy: A social work intervention? Aotearoa New Zealand Social Work, 21 (4), 83-93.

Cozolino, L. (2004). The making of a therapist. New York, USA: W.W. Norton & Company.

Galovski, T.E., Wachen J.S., Chard K.M., Monson C.M., Resick P.A. (2015). Cognitive Processing Therapy. In: Schnyder U., Cloitre M. (eds) Evidence Based Treatments for Trauma-Related Psychological Disorders. Springer, Cham

Gelso, C. (2014). A tripartite model of the therapeutic relationship: theory, research, and practice. Psychother Res, 24 (2), 117-31

HBO Transcript. Macdissi, P. (Producer). (2009). TV Broadcast [Therapy transcript]. https://www.youtube.com/watch?v=5sGCxPFzfDQ

Hill, C. E. (2014). Helping skills: Facilitating exploration, insight, and action (4th ed.). Washington, DC: American Psychological Association.

Horvath, A. O. (2009). How real is the “real relationship?” Psychotherapy Research, 19, 273–277.

Jaycox, L.H., Zoellner. L., Foa, E.B. (2002). Cognitive-behavior therapy for PTSD in rape survivors. J Clin Psychol, 58 (8), 891-906.

NSOPW. US Department of Justice. (n.d.). Recognizing Sexual Abuse. Retrieved May 27, 2018, from https://www.nsopw.gov/en/education/recognizingsexualabuse

Safran, J.D. (1993). The therapeutic alliance rupture as a transtheoretical phenomenon: Definitional and conceptual issues. Journal of Psychotherapy Integration, 3, 33– 49.

Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press.

Schaeffer, J. A. (2007). Transference and countertransference in non-analytic therapy: Double-edged swords. New York: UniversityPress of America.

23 Apr 2018

BY: Online Therapy

Assessment / Counselling / Ethics / Online therapist / Online Therapy / Treaty of Waitangi

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Counselling | Treaty of Waitangi

Te Tiriti o Waitangi and the importance in counselling:

It is essential to understand Māori health and wellbeing and Te Tiriti o Waitangi as it relates to mental health in order to address cultural issues in practice. The treaty was a negotiation between Māori and the Crown to establish New Zealand as a British colony. In modern society, this partnership extends to developing health strategies for Māori to obtain proper health services. This also extends to the protection of Māori cultural concepts and values. Māori communities are encouraged to engage in the planning and development of health strategies that would have an impact on them.

Counselling | Treaty of Waitangi

A counsellor in New Zealand should take into account cultural aspects such as physical, emotional, intellectual and spiritual. Furthermore, therapists need to acknowledge cultural identity when working with Māori communities. Supporting Māori on an emotional level includes a commitment to their identity and counsellors should use approaches that would assist Māori to re-connect with their communities after interventions due to the importance they place on whanau (related and extended families).

Treaty of Waitangi Framework includes but is not limited to:
  • Te Reo Māori: Using Te Reo Māori to show respect, holding onto identity and being guardians of Māori Culture.
  • Tuakiri Tangata: Acknowledges Māori persona, personality and identity. Here we consider principles such as cultural aspects but also physical, emotional, intellectual and spiritual.
  • Tikanga Māori: Involves previous generations and how to live by Māori values. Tikanga comprises values from previous generations but also taking generational advancement into account. Māori expresses underlying principles differently even though the roots remain the same.
  • Whakawhanaunga: There are different interpretations of whānau, that being said, a general meaning assigned to it is family members who share common descent. As a counsellor, it is important to understand the different roles whānau occupy and the responsibilities assigned to each role.
  • Hauora Māori: Perspectives on health and wellbeing. The models and frameworks that underpin Maori health and wellbeing is an inclusive and holistic worldview. What makes these models unique is the relationship Māori have to the land and the link to whakapapa/genealogy.
  • Manaaki: It is required that Māori behave in ways that enhance the mana of others, i.e. be honouring people, providing service, respect and generosity. This highlights the importance of positive service and is specifically relevant to the mental health and addictions contexts.
Conclusion

Counsellors should pay particular attention to multiculturalism and the effect it has on relationships. Culture is more than race and ethnicity, it also includes gender, age ideology, socioeconomic status, religion, sexual orientation, occupation and lifestyle issues. Members of cultural groups may also differ from their group’s description. When working from a cultural framework, it is important to consider enculturation (retaining indigenous culture) and acculturation (adapting to dominant culture). The counsellor should recognise which helping skill is more effective for clients within their cultural framework (Hill, 2014).

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References

Pua Wanaanga course

Hill, C. E. (2014). Helping skills: Facilitating exploration, insight, and action (4th ed.). Washington, DC: American Psychological Association.

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