MY WORK AS A PSYCHOTHERAPIST

MY WORK

What is Somatic Psychotherapy, why might you think of coming to see me and what might you expect from working with a therapist such as myself?

Soma is a Greek word meaning the body-mind and the term Somatic Psychotherapy, though now quite common, was coined by us here in Melbourne and Sydney in 1986/7 when we formed our association. Somatic Psychotherapy allows for the use of direct body-work and also for the use of touch as and when appropriate. The emphasis is on Psychotherapy with practitioners who have a very strong understanding of the links between body, mind and feeling or emotion. Myself and my colleagues in Melbourne who regard themselves as Contemporary Somatic Psychotherapists are also, these days, well versed in the relationship between attachment or “dependency” disorders and the developmental, emotional and neuro-psychological effects of severe childhood emotional deprivation, abuse or trauma. Therapy is sometimes about learning to make safe and nurturing relationships or about re-discovering or regulating overwhelming feelings that have, up to now, had to be closed off in order to deal with life.

Some of my colleagues do work with what we call Bio-dynamic massage or other formal body techniques as part of the psychotherapeutic process. Personally, I don’t use this active and more formal hands on approach any longer but sometimes, in negotiation with the client, I MAY use touch as part of the long term and on-going therapeutic process. I would always expect that such touch is agreed to mutually, is spoken about and the issues raised, worked through in the therapeutic relationship.

Trained as we were and professionally committed as we are, I and all my colleagues work within the strong ethical code of practice of our original association and of PACFA. I am personally also largely informed by psychoanalytic/ psychodynamic thinking which offers very clear insights regarding boundaries in therapeutic relationships. You can read the ASPA Code of Ethics that we all adhere to on their Web-site. Click on www.http://somaticpsychotherapy.asn.au/

Short Term Work

Within my private practice, my social work qualifications and my experience as a psychotherapist enables me to help clients sort out what it is that they are looking for from me or enables me to assess their needs and make referrals to other therapists, counsellors or health professionals. I see some clients who just “need someone to talk to” about a particular issue or some who need only short term counselling for say, a recent crisis in their lives and some who need just a little general help with handling their lives, their relationships or their work situations. So you could come to see me as a one off interview for free just to get some assistance to think through what it is you want or what it is you need to do. Or you could come for a set number of sessions to explore an issue or work out what path you will now go.

Click here to read PACFA’s Draft Definitions of Psychotherapy and Counselling

Psychotherapy

Because I have specialised in psychotherapy, most of my work has been quite intensive and over the medium to long term, with people who are specifically wanting to explore the deep issues that influence their lives and life choices. These people are usually very much like you and me; people who function well in most areas of their lives and who are often very successful people in terms of the world at large. They may however feel, for instance, that they cannot make successful intimate relationships, or perhaps they earn good money in a job but are otherwise quite unhappy, some may be depressed, anxious or have specific issues that have continued to bother them throughout their lives. Some clients also come specifically because of my training and experience in Somatic Psychotherapy and some of these will have symptoms and illnesses that they know have a psychosomatic element. Many will have some consciousness that their difficulties date back to their childhood.

The work however, focusses on the here and now. The past is seen by me as relevant primarily only, in so much as it impacts on the present. Generally, in the psychotherapy I offer, sooner or later it is the present relationship between me and the client here and now in the room which is relevant and becomes the focus of exploration. This relationship is a microcosm of “out in the world” relationships but it is what is “alive” for both to think about together, in the moment. Allowing the freedom to say what comes to mind within the supportive but challenging framework of the therapeutic relationship opens up the opportunities for a new sense of self, life and relationship. Sometimes the psychotherapy simply gives a new view of life or sometimes it helps by giving a more deeply felt and experienced understanding of how the self or the mind operates as distinct from the mind or self of an other. And sometimes where there has been much deprivation, the therapy can actually go some way toward a kind of re-parenting. A therapist, however, can never totally give someone that which was not given in the first place and this means that, almost inevitably, psychotherapy involves experiencing deep grief for that which has been lost forever.

The Commitment

Establishing an agreement to enter into psychotherapy may take days, weeks or even months depending on the therapist’s and the client’s understanding of their needs. Once agreed upon, the psychotherapeutic contract usually involves an open ended commitment from both parties to a regular time or times in a set place at a set fee which is payable even if, for some reason, the client chooses not to come for the session. Part of the commitment is that the therapist will hold that space available for the client and hold it in an emotional sense as well. The ending of the contract is solely in the hands of the client although part of the contract is usually that the therapy is not ended precipitately and time is allowed for working through the meaning of ending.

Psychotherapy, Psychology and Psychiatry

Before or after they come to see me, some people want to know what is the difference between psychotherapy, psychology and psychiatry. To keep it relatively simple I usually say that a Psychiatrist needs a Medical Degree and often sees extremely ill people who may, for instance be schizophrenic or suffer from other severe psychotic conditions.

A psychiatrist can prescribe medications and some are ” talk” therapists of one kind or another, including some who have trained as a psychotherapist or psychoanalyst. With a client’s permission and agreement, I may sometimes consult with a psychiatrist or a client may consult a psychiatrist as a back-up while undergoing psychotherapy.>
A Psychologist may also be trained as a psychotherapist but many are not though all, in Australia, have an introduction to Cognitive Behavioural Therapy (CBT). Most psychologists work at that cognitive level to help people sort out problems in their everyday lives or give help with specific issues or problems like, for instance, Obsessive- Compulsive Disorder (OCD). Psychologists have a very rigorous academic training and have a wide variety of specialities from say, work with children, families, individual adults or with organizations.

The Issue of Medicare Rebates.

Both Psychologists and Psychiatrists can offer Medicare rebates to cover some of the costs of the work they do. The privilege this gives has long been available to psychiatrists as it was assumed they would be treating extremely ill people. Since the 1980’s psychologists began the long road to gaining this privilege for their own membership and were successful in convincing government some years ago. Social Workers also managed to be included albeit at a lower rebate than Clinical Psychologists. This possibility of having “mother medicare” pay for one’s therapy has now become something that most people regard as their “right”.

There are a small number of my colleagues who have become part of the Medicare scheme but I personally have a very different view and because of my views, I have never been interested in becoming part of that Medicare scheme even though I am a Social Worker and would be eligible. At a practical level, there are definitely some extremely impoverished people who could really make good use of this scheme. However, as was feared initially the vast portion of the funds go to middle class people. So the cost of the medicare rebate scheme has blown out exponentially with the expectation that everyone can get their “Mc. Donald’s” type “quick fix” 5 to 10 therapy sessions a year paid for by the government. This blow- out gives more weight too, to my philosophical bias that I definitely believe this programme should at the very least, be means tested.

However my biggest reservation about this scheme is what it may mean at an in-depth and unconscious level to the people who really need work at that unconscious level. I have a firm belief that, it is questionable whether therapy can work at the deepest level when a third party pays for ones therapy and also is involved in that therapy. For one thing there can be no real privacy when the therapist has to report to a third party (the Referring Doctor). And there is the issue that the person must be given a diagnosis of some sort of mental problem in order to avail themselves of the Medicare benefit.

But most crucial of all is that I believe that the adult in us needs to make the decision that they themselves are worth the effort and money it takes to help oneself. Otherwise we have an adult who actually is not totally committed to giving enough to themselves so that the therapy is quite likely sabotaged from the start. Of course some useful work can be done even when the therapeutic work is not in-depth and long term but there are some people who will never get the treatment they need under that rebate scheme. I have enormous respect for the people who have come to me over the years and who have taken a second and even a third job so as to be able to pay for the therapy they require. And I have therefore sometimes lowered my fee somewhat to help them when I know they are that committed.

For all that, for some people the Medicare rebates to Psychologists and to a lesser degree, Social Workers, has indeed been a necessary boon and has enabled a lot more people to at least find some help with their problems- help they may never have thought possible in the past. And for many who do avail themselves of the sessions to which they are “entitled”, the help available under this programme is enough and good enough for them. For some it may at least introduce them to the concept of therapy and for others it may be just the fillip they need to get on with their lives, so this much is good. But in general, I believe that the programme has meant that many, many people are ultimately short changed by the mirage that they can find the answers to their difficulties in life within this programme. I believe it deters many people who potentially require long and in-depth work within an on-going and committed relationship from even considering what it might mean to make it a priority to finance their own therapy.

Professionalism.

As it currently stands, almost anyone can call themselves a psychotherapist or a counsellor, without any specific training whatsoever. However PACFA was formed to begin the process of recognizing psychotherapy (and counselling) as a separate profession with specific basic training and professional requirements. In recent years however, I am of the belief that PACFA itself has conflated counselling and psychotherapy and wants to diminish any differences between the two. In my opinion they are definitely NOT the same process even though many psychotherapists may frequently be involved in some counselling and some counsellors actually work as psychotherapists.

It is though always a very good idea to check out the qualifications of anyone purporting to be a counsellor or a psychotherapist. Ask what professional association they belong to and whether that association is a member of PACFA. This can give you some confidence. The one most common thread for any well trained psychotherapist is that they have been involved in their own long term process of psychoanalysis or psychotherapy. This combined with a course over several years, supervision and perhaps an experience of Infant Observation is a good start for a psychotherapist.

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