PRETHERAPY THEORY AND PRACTICE OF PSYCHOLOGICAL CONTACT Catherine

PRE-THERAPY THEORY AND PRACTICE OF PSYCHOLOGICAL CONTACT Catherine Clarke 2007 www. psychological-wellbeing. co. uk 1

PRE THERAPY ROOTS Ø Person Centred - Psychotherapists, Rogers, Gendlin, (1973) Rogers Person Centred Psychotherapy Ø Form of therapy - which promotes self-knowledge and awareness Ø Allowing clients to be their own guide in therapy Ø Clinicians attitudes – congruence, unconditional positive regard, empathy Catherine Clarke 2007 www. psychological-wellbeing. co. uk 2

PRE THERAPY ROOTS Ø Gendlin Existential - Phenomenology Ø Study of phenomena l Scientist being objective • Phenomenologists state each experience is coloured by subjective perspective l And no one is able to separate the two perspectives. Existentialism Ø Phenomenological study of human existence l Respect each person’s current way of being ‘being’ within the world • Surrounds verbal & non-verbal behaviour l Existential contact being the right simply to exist & be recognised as a member of humanity Catherine Clarke 2007 www. psychological-wellbeing. co. uk 3

ROGERS / PSYCHOLOGICAL CONTACT Ø Concept introduced by Carl Rogers 1957 - ‘The Necessary and Sufficient Conditions of Therapeutic Personality Change’ l For psychotherapy to progress, ‘two persons must be in psychological contact’ What is Psychological Contact Ø When two people are affected by & respond to the other l Response either negative/positive which is appropriate to shared situation • Reciprocal, mutual, equal balanced relationships require this elemental psychological contact. Catherine Clarke 2007 www. psychological-wellbeing. co. uk 4

MEANINGFUL BEHAVIOUR EXPRESSIVE CONTACT BEHAVIOUR Ø Ø Healthy / Fully Functioning Internal Processes – the three Contact Functions: Ø Reality - Affective - Communication 1. Reality Contact Function is Our Awareness Ø People Places Things Events l All part of our living existence • Associated with time l All are part of our reality sense. • Connected to our sense of being within the world. Catherine Clarke 2007 www. psychological-wellbeing. co. uk 5

MEANINGFUL BEHAVIOUR 2. Affective Contact 3. Communication Contact Function is Being in Touch Ø Ø Feelings Moods Emotions Ø Living part of the world Ø Inherent part of our existence Ø Essential - Develop our lives to our full potential Function Convey thoughts and feelings through language Ø In a socially acceptable way so that others can understand Ø Though our internal processes we are in psychological contact with each other Catherine Clarke 2007 www. psychological-wellbeing. co. uk 6

PROBLEMATIC FUNCTIONING Low Functioning Ø Contact Functions: Reality Affect Communication below Psychological Contact. Clients: Autism Alzheimer’s Disease Severe Learning Difficulties Regress Emotionally Severe Depression Dissociation Psychosis Catherine Clarke 2007 www. psychological-wellbeing. co. uk 7

PROBLEMATIC FUNCTIONING PRE EXPRESSIVE BEHAVIOUR or LOW FUNCTIONING Ø Isolated withdrawn hallucinations delusions, catatonia, frozen terror, emotional regression Ø Bizarre physical behaviour Ø Verbal – fragmented / jumbled Ø Each person presenting their current way of being within the world Ø Verbal & non-verbal expression is communication of clients Pre Expressive Self Ø Highly important & requires respect Catherine Clarke 2007 www. psychological-wellbeing. co. uk 8

PROBLEMATIC FUNCTIONING Persons out of touch in varying degrees with: Themselves Other people l Their surroundings l GREY ZONE FUNCTIONING Combination of Expressive & Pre Expressive Behaviour l Psychosis presents with expression of psychotic reality & congruent l behaviour Catherine Clarke 2007 www. psychological-wellbeing. co. uk 9

Levels of Functioning Level of functioning Healthy functioning Expressive, congruent Psychological Contact Problematic functioning Pre-expressive functioning Patient’s level Client: Healthy functioning Expressive, congruent, functioning Psychological Contact Grey-zone functioning Client: Problematic functioning Pre-expressive functioning Catherine Clarke 2007 www. psychological-wellbeing. co. uk 10

PRE THERAPY CONSTRUCTIVE HELP AIMS Enable clinical staff to make contact with person in psychosis Ø Regain contact functions of reality, affect and communication Ø Ø Achieved by five interventions known as contact reflections Ø So restoring people – back in touch themselves world other people Catherine Clarke 2007 www. psychological-wellbeing. co. uk 11

CONTACT REFLECTIONS Ø Focus on person’s immediate surroundings + non – verbal and verbal expressions Ø Ø Related with Reality Contact Function Ø Refer to present situation / environment: things, people, place and Concrete repetitive time No guessing / interpreting / jumping to conclusions Ø SITUATIONAL REFLECTION (SR) Ø ‘ The room is cold’. ‘The sun is shining’ Ø Encourage contact - shared world of ‘What you can hear clearly and see is exactly what you give back. ’ reality Ø Acute psychotic crisis - most reality orientating Catherine Clarke 2007 www. psychological-wellbeing. co. uk 12

CONTACT REFLECTIONS FACIAL REFLECTION (FR) Related with Affective Contact Function Ø Verbalising person's face Ø 'You look sad' or 'You look scared’ Ø Get in touch with their own feelings BODY REFLECTION (BR) Verbally stating body posture Ø Ø 'Your arm is above your head ’ ‘You are lying on your side’ Enhance verbal reflection, mirror his action with my physical body Ø Regains their own sense of self within own body experience Catherine Clarke 2007 www. psychological-wellbeing. co. uk 13

CONTACT REFLECTIONS WORD FOR WORD REITERATIVE REFLECTION (WWR) Ø Ø Reflect words and phrases Ø (RR) Principle - a specific reflection back to client achieves response - reflection Develop/ increase the repeated communication contact Ø REFLECTION Ø Psychological contact being Reflect only the words that you achieved & repetition can clearly hear encourages further relating Catherine Clarke 2007 www. psychological-wellbeing. co. uk 14

IMPLICATIONS OF PRE THERAPY FOR CLINICIANS Ø Clients are sensitive l l l Ø 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 l l l 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 Catherine Clarke 2007 www. psychological-wellbeing. co. uk 15

FINER NUANCES Timing important Space consideration important Ø Keep with person’s pace - don’t Ø Psychotic clients react strongly to physical closeness of others over whelm Ø Room to respond Ø Intrudes into psychotic space Ø Rapid psychotic expressions - Ø Clinicians to keep distance – clinicians periodic reflections Catherine Clarke 2007 avoid inducing distress www. psychological-wellbeing. co. uk 16

OUTCOME OF CONTACT WORK Contact Reflections Ø Persons’ sense of isolation decreases & process of relating increases Ø Shown - person responding to the reflections Ø Communicating increasingly & appropriately within our shared reality Contact Functions Ø Reality, affect and communication - strengthened & maintained Ø Person is able to engage with the routine of daily living Ø Psychosis recedes - less overwhelmed by the psychosis Ø When firmly anchored in Expressive Level of Healthy Functioning Ø Informed choice regarding psychotherapy Catherine Clarke 2007 www. psychological-wellbeing. co. uk 17

PRE SYMBOLIC PSYCHOTHERAPY Ø Pre-expressive functioning is described as ‘the royal road to the unconscious’ Prouty (1994) Ø The psychosis is clients’ expression of deep trauma Ø Delusions/Hallucinations are meaningful to client Ø Hallucinatory experiencing which is ‘reality based’ – not conscious experiencing Ø Integrated into conscious experiencing Catherine Clarke 2007 www. psychological-wellbeing. co. uk 18

Person Centred Approach Key to Therapeutic Healing Relationship Ø Lies within clinician and client relationship Ø Clinicians who embrace the values of the PCA Ø 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 Ø Has the potential to bring more clinician safety and satisfaction Ø Pre Therapy is an open door Ø An opportunity for clinicians to assist clients on their path to full recovery. Catherine Clarke 2007 www. psychological-wellbeing. co. uk 19

POSITIVE OUTCOME Ø CLINICIANS Ø Ø 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 Ø PATIENTS Ø 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 Ø Ø Ø Ø Catherine Clarke 2007 www. psychological-wellbeing. co. uk 20

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. No 1. 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, p 221 (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 21