Transcript PRE-THERAPY
PRE-THERAPY
THEORY AND PRACTICE OF PSYCHOLOGICAL CONTACT
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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PRE THERAPY ROOTS
Person Centred - Psychotherapists, Rogers, Gendlin, (1973)
Rogers Person Centred Psychotherapy
Form of therapy - which promotes self-knowledge and awareness Allowing clients to be their own guide in therapy Clinicians attitudes – congruence, unconditional positive regard, empathy
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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PRE THERAPY ROOTS Gendlin Existential - Phenomenology
Phenomenology
Study of phenomena Scientist being objective • Phenomenologists state each experience is coloured by subjective perspective And no one is able to separate the two perspectives.
Existentialism
Phenomenological study of human existence Respect each person’s current way of being ‘being’ within the world • Surrounds verbal & non-verbal behaviour Existential contact being the right simply to exist & be recognised as a member of humanity
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ROGERS / PSYCHOLOGICAL CONTACT
Concept introduced by Carl Rogers 1957 ‘The Necessary and Sufficient Conditions of Therapeutic Personality Change’ For psychotherapy to progress, ‘two persons must be in psychological contact’
What is Psychological Contact
When two people are affected by & respond to the other Response either negative/positive which is appropriate to shared situation • Reciprocal, mutual, equal balanced relationships require this elemental psychological contact.
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MEANINGFUL BEHAVIOUR EXPRESSIVE CONTACT BEHAVIOUR
Healthy / Fully Functioning Internal Processes – the three Contact Functions: Reality - Affective - Communication
1. Reality Contact Function is Our Awareness
People Places Things Events All part of our living existence • Associated with time All are part of our reality sense.
• Connected to our sense of being within the world.
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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MEANINGFUL BEHAVIOUR
2. Affective Contact Function is Being in Touch 3. Communication Contact Function
Feelings Moods Emotions Living part of the world Inherent part of our existence Essential - Develop our lives to our full potential Convey thoughts and feelings through language In a socially acceptable way so that others can understand Though our internal processes we are in psychological contact with each other
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PROBLEMATIC FUNCTIONING
Low Functioning
Contact Functions: Reality Affect Communication below Psychological Contact.
Clients:
Autism Alzheimer’s Disease Severe Learning Difficulties Regress Emotionally Severe Depression Dissociation Psychosis
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PROBLEMATIC FUNCTIONING PRE EXPRESSIVE BEHAVIOUR or LOW FUNCTIONING
Isolated withdrawn hallucinations delusions, catatonia, frozen terror, emotional regression Bizarre physical behaviour Verbal – fragmented / jumbled Each person presenting their current way of being within the world Verbal & non-verbal expression is communication of clients Pre Expressive Self Highly important & requires respect
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PROBLEMATIC FUNCTIONING Persons out of touch in varying degrees with
: Themselves Other people Their surroundings
GREY ZONE FUNCTIONING
Combination of Expressive & Pre Expressive Behaviour Psychosis presents with expression of psychotic reality & congruent behaviour
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Levels of Functioning
Level of functioning Healthy functioning Expressive, congruent Psychological Contact Problematic functioning Pre-expressive functioning Patient’s level Psychological Contact Client
:
Healthy functioning Expressive, congruent, functioning Grey-zone functioning Client: Problematic functioning Pre-expressive functioning
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Catherine Clarke 2007
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PRE THERAPY CONSTRUCTIVE HELP AIMS
Enable clinical staff to make contact with person in psychosis Regain contact functions of reality, affect and communication Achieved by five interventions known as contact reflections So restoring people – back in touch themselves world other people
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CONTACT REFLECTIONS
CONTACT REFLECTIONS SITUATIONAL REFLECTION (SR)
Focus on person’s immediate surroundings + non – verbal and verbal expressions Concrete repetitive No guessing / interpreting / jumping to conclusions ‘What you can hear clearly and see is exactly what you give back.’ Related with Reality Contact Function Refer to present situation / environment: things, people, place and time ‘ The room is cold’. ‘The sun is shining’ Encourage contact - shared world of reality Acute psychotic crisis - most reality orientating
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CONTACT REFLECTIONS FACIAL REFLECTION (FR)
Related with Affective Contact Function Verbalising person's face 'You look sad' or 'You look scared’ Get in touch with their own feelings
BODY REFLECTION (BR)
Verbally stating body posture 'Your arm is above your head ’ ‘You are lying on your side’ Enhance verbal reflection, mirror his action with my physical body Regains their own sense of self within own body experience
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CONTACT REFLECTIONS WORD FOR WORD REFLECTION (WWR) REITERATIVE REFLECTION (RR)
Reflect words and phrases back to client Develop/ increase the communication contact Reflect only the words that you can clearly hear Principle - a specific reflection achieves response - reflection repeated Psychological contact being achieved & repetition encourages further relating
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IMPLICATIONS OF PRE THERAPY FOR CLINICIANS
Clients are sensitive
Ability to sense those clinicians who are trustworthy and sincere Provides a safe & secure environment for clients Clinicians spoken word together with ‘how’ each clinician is ‘being’ clients affects their interaction
Clinicians need to work in a sensitive manner
Pre Therapy reflections are powerful Entering private phenomenological world of Client Consideration of client’s comfort level is important Reflections practiced to ensure minimal distress for client Facilitates movement towards shared reality
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FINER NUANCES Timing important Space consideration important
Keep with person’s pace - don’t over whelm Room to respond Rapid psychotic expressions clinicians periodic reflections Psychotic clients react strongly to physical closeness of others Intrudes into psychotic space Clinicians to keep distance – avoid inducing distress
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OUTCOME OF CONTACT WORK
Contact Reflections
Persons’ sense of isolation decreases & process of relating increases Shown - person responding to the reflections Communicating increasingly & appropriately within our shared reality
Contact Functions
Reality, affect and communication - strengthened & maintained Person is able to engage with the routine of daily living Psychosis recedes - less overwhelmed by the psychosis When firmly anchored in Expressive Level of Healthy Functioning Informed choice regarding psychotherapy
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PRE SYMBOLIC PSYCHOTHERAPY
Pre expressive functioning is described as ‘the royal road to the unconscious’ Prouty (1994) The psychosis is clients’ expression of deep trauma Delusions/Hallucinations are meaningful to client Hallucinatory experiencing which is ‘reality based’ – not conscious experiencing Integrated into conscious experiencing
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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Person Centred Approach
Key to Therapeutic Healing Relationship
Lies within clinician and client relationship Clinicians who embrace the values of the PCA Provide optimal conditions promote psychotherapeutic growth
It enables clinicians to know
‘what’ to say and ‘how to be’ with clients
Pre Therapy does not deny, collude or smother psychotic distress
Has the potential to bring more clinician safety and satisfaction Pre Therapy is an open door An opportunity for clinicians to assist clients on their path to full recovery.
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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POSITIVE OUTCOME
CLINICIANS
Increased awareness of different types of behavioural functioning Develop an awareness of skills to alleviate hallucinations and delusions Encourage clients to get back in touch within themselves, other people and the shared world Increased ability to engage with clients Increased ability to earn the trust of the client.
Greater potential involvement for deeper personal healing relationships An increase in job satisfaction
PATIENTS
Reduction of psychotic distress Clients become ‘grounded’ and more able to engage in daily life activities Fosters clients’ trust with practitioner Clients’ have a reality based informed consent regarding psychotherapy input Clients’ process facilitated to integrate painful experiences Clients become self-empowered and have the capacity to lead a life that fulfils their potential
www.psychological-wellbeing.co.uk
Catherine Clarke 2007
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SUGGESTED READING
Clarke C., (2005),
Prouty's Contact Work: a Carers Perspective
Mental Health Practice 2005 Vol.9 No.24 p.24-27 Clarke C.,
Pre Therapy: A Carers Perspective of Prouty’s Contact Work
Meriden Newsletter December 2006 Dodds P., Morton I., Prouty G. (2004),
Using Pre-Therapy Techniques in Dementia Care.
Journal of Dementia Care 2004 Vol.12 No.2 p.25-28 Joseph S., Worsley R. (eds.) (2005)
Person-Centred Psychopathology: A Positive Psychology of Mental Health.
PSSC BOOKS: Ross on Wye. Prouty G., (1994) ‘
Theoretical Evolutions in Person –Centered/Experiential Therapy. Applications to Schizophrenic And Retarded Psychoses
’. Praeger Prouty, G., (2001) ‘
The Practice of Pre Therapy
’. Journal of Contemporary Psychotherapy’, Vol. 31. No1.
Prouty G. (2003)
'
Pre-Therapy: A Newer Development in the Psychotherapy of Schizophrenia ', Journal of the Academy of Psychoanalysis and Dynamic Psychiatry, (2003) 31, 1, 59-73 Prouty G., Van Werde D., Portner M., (2002) ‘
Pre Therapy Reaching Contact Impaired Clients
’. PCCS This popular book has been translated into Portuguese, Dutch, German and Japanese.
Rogers, C. R. (1989) The necessary and sufficient conditions of therapeutic personality change, in: H Kirschenbaum & V. L. Henderson (Eds) The Carl Rogers Reader, p221 (London, Constable) Van Werde, D. & Morton, I. (1999),
The Relevance of Prouty’s Pre-Therapy to Dementia Care
. In: Morton, I., Person-Centred Approaches to Dementia Care. Bicester, Oxon, Winslow Press, 139-166.
Van Werde, D. (2005) Facing psychotic functioning: Person-centred contact work in residential psychiatric care. In S. Joseph and R. Worsley
Person-Centred Psychopathology: A Positive Psychology of Mental Health.
PSSC BOOKS: Ross on Wye
Catherine Clarke 2007 www.psychological-wellbeing.co.uk
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