25 March 2013

My struggles with CBT

I receive a number of enquiries asking whether I do CBT. CBT stands for Cognitive Behavioural Therapy which is an approach which places importance on the thought processes behind dysfunction in moods such as anxiety or depression. I tell people that no, I do not stick to a CBT formula as this would mean having to leave out huge elements of the therapeutic relationship and the way I work. I appreciate that some people would like to have the safe distance to challenge certain aspects of their way of being in a structured way, without going too deep, such as CBT offers. Indeed, CBT can be a useful stepping stone in the counselling journey. But I am unable to leave a huge chunk of myself, my knowledge, intuition and therapeutic tools out of my counselling work. So if somebody wants pure CBT I recommend that they see somebody who's work focuses exclusively on CBT.

My training included CBT and REBT - Rational Emotive Behaviour Therapy (in my opinion more rounded and deeper than CBT as it involves core beliefs - not just the symptomatic thought processes. See this link for my blogpost on REBT vs CBT). I am an integrative counsellor with an emphasis on relational depth, The choice of therapeutic approaches I use is coherent with my humanistic outlook (please see My approach for further details). My baseline approach in the therapy room is Carl Rogers' person-centred therapy which places the importance of the relationship between client and therapist as the indicator of a positive outcome. I use elements of CBT, although I don't refer to them as being 'CBT techniques" - they are simply facets of a highly complex service that I offer to my clients. Challenging thought processes is an important part of the work, but is not the main emphasis.

Here are some elements of my work that a purely CBT approach does not involve:

The relationship as a tool

The therapeutic relationship can be a microcosm of the relationships the client has outside of the therapy room. Once trust and mutual respect has been built then I can give my clients respectful and helpful feedback about why they may be having problems with how they relate to others. This can be about finding it hard to trust others, or assuming that people think the worst of them. I use myself - my emotional reactions to the client, in conjunction with what they tell me about their relationships with others. This is not for the fainthearted therapist. A high degree of self-awareness is required and I believe that therapists should continue to engage in their own personal therapy, as well the clinical supervision (a professional requirement). Some of the most successful counsellors I know engage in personal therapy from time to time to enhance their professional work.

Emotional expression

Irvin D Yalom states that successful therapeutic outcome depends upon there being cognitive and emotional elements of the therapeutic relationship (see Group Therapy - Irvin D Yalom). This correlates with what I know from looking at the work of Antonio Damasio - a neuroscientist who writes extensively about the role of emotions in our lives. He states that emotions are essential not only for survival but to help us make decisions. We are wired to emote and if we bottle up those emotions then they stay with us. What the mind denies the body remembers. There are books on this topic and two that spring to mind are The Body Remembers by Babette Rothschild and The Body Never Lies by Alice Miller (which I review here). So, expressing emotions during therapy helps in a couple of ways:

Processing trauma - trauma can be a huge life event such as abuse or a near death experience. Trauma can also be due to other stressful events such as being diagnosed with chronic or terminal illness, death of a loved one, divorce, loss of job etc. For me, trauma is common in childhood. The trauma of being born for one (from incubated, conjoined bliss to a rude awakening of separateness and sudden onslaught of bright lights, crashing sounds and independent respiratory, circulatory and digestive systems kicking in...). Sometimes we are unable to express the emotions associated with a trauma as we may be in shock, or we may have been in an environment where emotional expression was frowned upon or simply not modelled to us (we learn from experience and from example). Eventually, though, there may come a time when we are ready to express our emotions. Sometimes this is triggered by an event which is some way accesses our repressed trauma which causes it to resurface. Sometimes, we are presented with the opportunity to deal with the past in the here and now and relegate the traumatic incident to where it belongs, in the past, by finally expressing those associated emotions in a safe environment.

We are wired to emote - I see it so many times; clients who have depression and/or anxiety probably due to not being able to express their emotions. This usually takes the guise of feeling uncomfortable burdening others with their problems. Ironically, these are usually the most thoughtful and generous people who are always there for others. But for some reason, it's not okay to take what they give. They find it easier to burden me as it is a professional relationship and I get paid to listen. Even then you may be surprised at how guilty a client may feel burdening me. However, the work for me here is to try and help them to understand that it's okay to be vulnerable and in time, to be able to express that to trusted friends/family.

Emotions help us to learn - it's all very well having cognitive awareness. Our thoughts are wonderful things, but our emotions are not secondary to our thoughts - they are intertwined. Furthermore, the engagement of emotions during learning helps us to apply what we learn outside in the real world (read this neuroscience paper, We Feel, Therefore We Learn for more information).

I have had a few clients who have had a batch of CBT before finding me. As I say, it can be a useful stepping stone until a client wishes to go deeper. It has been fed back to me that their experiences CBT dismisses the emotional element of being. It recognises that emotions are affected by thoughts, but does not utilise emotions in the here and now, as a therapeutic tool.

Creativity in therapy

Thoughts can be the bane of our existence if they are negative and repetitive. Thinking about thinking - switching on cognition is order to try and escape cognition does not always make an awful lot of sense. I believe that sometimes we need to switch off our thoughts processes and integrate a more natural way of living. I often recommend mindfulness based activities such as meditation, yoga, pilates, martial arts (see here for article on martial arts and psychotherapy). These give us a break from our automated thought processes and help to reduce anxiety and improve our brain's neuroplasticity (the brain's ability to change and adapt, see here for definition).

Occasionally I use a creative intervention when the client is unable to access their emotions and "switch off" their negative thoughts. This may involve sandtray work (I rarely use it but it has been very effective where I believe it is indicated - more information on this here), working with miniatures or stones or visualisations. I often ask clients to try and write down the details of any dreams as there is often rich work here. It amazes me how many have dreams the night before therapy! Sometimes we work together using analogous language such as describing the holding of emotions as filling a bag to bursting point.

Something I do as a matter of course now in my work, with almost every client, is to "mindmap" the session. I take notes during the session - jotting down pertinent thoughts of the client's including their use of emotion words, and any revelations. I offer my client to read the notes at the end of the session and, especially for the visual learners, it can be a powerful way of consolidating the session. It is also useful to refer back to these notes as the therapy progresses. Showing a client a session map from a few months ago can really help them see how far they have come. This probably does not clash with the CBT approach as such and is but a small aspect of the way in which I work.

Yalom on CBT

"When a CBT therapist really gets distressed, who does he go see? I just have a strong sense it's not another CBT therapist. I think he wants to go out and search for somebody who's wise and can help him explore deeper levels."

Yalom refers to a "maniacal need to empirically validate everything you do" in an article published on Psychology Today, written by Ryan Howes. Ease of measurement is perhaps the main reason why CBT is so popular with institutions offering time-restricted therapy.

CBT and existential therapy

Finally, my work is based upon my personal philosophy on life, which acknowledges the struggles with human existence. With all the potential joys of life that we may be able to access, there is always the knowledge that ultimately we will die, that we may struggle to find meaning in our lives, and that sometimes we feel a deep sense of loneliness. Chasing those thoughts away by replacing them with positive thoughts will not eradicate those existential issues. Only in honouring and accepting our struggles can we find relief and a sense of not-alone-ness. I would find it hard to leave that part out of my work.

Amanda Williamson is a registered member of the BACP with a thriving private practice in central Exeter, Devon

4 February 2013

Our Mortal Wound: Interesting snippets from Yalom's Staring at the Sun

"In spite of the staunchest, most venerable of our defences, death anxiety is always there, lurking in the hidden ravines of our minds"

Staring at the Sun, inside cover blurb

Our Mortal Wound refers to our knowledge that we humans have, that ultimately, we will die. This book examines our fear of death, conscious and unconscious, and the ways we find to deal with that fear, in particular through therapeutic exploration.

When I first heard about this book, when it was released in 2008, I was very keen to read it. However, due to my being in the middle of counselling training, I decided that I wanted to get a better grip on my own relationship with death before I explored Yalom's work. I wanted to make my own journey and come to my own conclusions, rather than taking on somebody else's construct.

So, a few years later and I have completed counselling training, had extensive personal therapy, life events and a particular confrontation with the concept of the ceasing of my own existence, and I feel in a good place to read Staring at the Sun. I read Yalom's Existential Psychotherapy a month or so prior (my review for which can be found here) which had a huge section on Death Anxiety.

I was ready for the full weight of a book dedicated to facing the fear of death, written by somebody who at (then) age 70 was facing his own fear of death.

I needn't have stressed. I actually found the book quite untraumatic compared to my personal explorations. It was probably something to do with reading Existential Psychotherapy beforehand and I think that, ideally, the best order would be to read Staring at the Sun first.

Rather than review the book I would like to share some snippets that I bookmarked whilst reading. These are useful to me as a therapist and resonate with my way of being in the therapy room.

Chapter 1 - The Mortal Wound

"Death, however, does itch. It itches all the time; it is always with us, scratching at some inner door, whirring softly, barely audibly, just under the membrane of consciousness. Hidden and disguised, leaking out in a variety of symptoms, it is the wellspring of many of our worries, stresses, and conflicts."

"I feel strongly - as a man who will himself die one day in the not-too-distant future and as a psychiatrist who has spent decades dealing with death anxiety - that confronting death allows us, not to open some noisome Pandora's box, but to reenter life in a richer, more compassionate manner."

Chapter 4 - The Power of Ideas

On Schopenhauer's triplet of essays: What a Man Is, What a Man Has, What a Man Represents:

"1. What we have. Material goods are a will-o'-the-wisp. Schopenhauer argues elegantly that the accumulation of wealth and goods is endless and unsatisfying; the more we possess, the more our claims multiply. Wealth is like seawater: the more we drink, the thirstier we become. In the end, we don't have our goods - they have us.

2. What we represent in the eyes of others. Reputation is as evanescent as material wealth. Schopenhauer writes "Half our worries and anxieties have arisen from our concern about the opinions of others...we must extract this thorn from our flesh."....Opinions hang by a thread and make us slaves to what others think or, worse, to what they appear to think - for we can never know what they actually think.

3. What we are. It is only what we are that truly matters. A good conscience, Schopenhauer says, means more than a good reputation....Inner equanimity stems from knowing that it is not things that disturb us, but our interpretations of things."

Chapter 5 - Overcoming Death Terror Through Connection

"The task, then, is not to offer answers, but to find a way to help others discover their own answers. The same principle operated in the treatment of Julia, a psychotherapist and painter, whose death anxiety stemmed from her not having fully realized herself and neglecting her art in order to compete with her husband in earning money. I applied the same strategy in our work when I asked her to assume a distant perspective by suggesting she imagine how she'd respond to a client who behaved as she did. Julia's instantaneous comment - "I'd say to her, you are living a life of absurdity!" - signalled that she needed only the slightest guidance to discover her own wisdom. Therapists have always operated under the assumption that the truth that one discovers for oneself has far greater power than a truth delivered by others."

Chapter 6 - Death Awareness: A Memoir

"In my practice, I've worked with several psychotherapists who, having just finished a graduate program consisting almost entirely of cognitive-behavioural therapy, feel despair at the prospect of working mechanically with patients in a behavioural prescriptive mode. And I wonder, too, where therapists trained to treat patients in this impersonal behavioural mode will turn when they themselves need help. Not to colleagues of their own school, I would wager."

Chapter 7 - Addressing Death Anxiety

"Terence's Maxim and Therapist Self-Disclosure - Terence, a second-century Roman playwright, offers an aphorism that is extraordinarily important in the inner work of a therapist:

I am human, and nothing human is alien to me.

Beginning therapists would do well to use Terence's axiom as a mantra, helping them to empathise with their patients by locating their own similar experiences. This aphorism is particulalry apt to work in patients with death anxiety. If you are to be truly present with such patients, you must be open yourself to your own death anxiety...no training program prepares therapists for this type of work."

"...why is the here and now important? A fundamental catechism of psychotherapy training is that the therapy situation is a social microcosm; that is, patients will sooner or later exhibit in the therapy situation the same behaviour they exhibit in the life outside.....This is the first step in helping a patient assume responsibility for his or her life predicament."

"...the positive therapeutic alliance is a prerequisite for the effectiveness of any therapy. It is not the end, but a means to an end. A major internal shift can occur when patients form a genuine, trusting relationship with the therapist, disclose everything and still be accepted and supported. Such pateints experience new parts of themselves, parts previously denied or distorted. They begin to value themselves and their own perceptions rather than over-valuing the perceptions of others....The intimacy with the therapist serves as an internal reference point. Knowing that they have the ability to form relationships they develop the confidence and willingness to form similarly good relationships in the future."

"I never tire of telling student therapists that their most vital instrument is their own self, and that, consequently, the instrument must be finely honed. Therapists must have a great deal of self-knowledge, must trust their observations, and must relate to their clients in a caring and professional manner. It is precisely for this reason that personal therapy is (or should be) at the core of every therapy training program...they should return to therapy as they progress through life."

These selected snippets do not reflect the content of this book, more, my ideals on the therapeutic relationship.

The book itself is a useful accompaniment to a personal journey in exploring one's relationship with death. However, I already had gone deeper and further than this book took me, and I wish I had read it earlier. It is ideal for those dabbling with the concept, and wondering about therapy's place in such a journey. Referring to my fears expressed above before reading this book, there are no "constructs" to take on. Staring at the Sun is respectful of all the ways we find to deal with our mortal wounds.

Amanda Williamson is a registered BACP Senior Accredited counsellor and EMCC Senior Accredited Coach with a thriving private practice in central Exeter, Devon.

Welcome to Counselling in Exeter

28 January 2013

Counselling and Psychotherapy - Unregulated Professions

I have come to realise that many members of the general public are not aware that counsellors and psychotherapists are in an unregulated profession. I think that may partially be because we supposedly live in an age of litigation and accountability, and it is taken for granted that those with whom we entrust our deepest, darkest secrets would have somebody to answer to if they acted in an unethical way towards their clients.

Look at this typical response from somebody when I tell them that therapists aren't accountable:

"Lack of regulation seems like a recipe for a lot of abuse and misconduct. Who couldn't recognize all the potential hazards considering how vulnerable people are when they seek treatment?"

I CHOOSE TO BE ACCOUNTABLE. I am a member of the British Association of Counselling and Psychotherapy - the UK's largest professional body for counsellors. I attended a BACP accredited course because it made sense to me to start off my career as I meant to go on. The Iron Mill Institute's counselling courses are accredited by the BACP which means, according to the BACP website:

"...that (the course) has been assessed by BACP against the criteria for course accreditation as detailed by the BACP public Accreditation of Training Courses (BACP 2002) and awarded accreditation...that they can offer quality training to a high standard, which is recognised by employers, colleagues and prospective clients."

So it was part of the training from Certificate level (the preliminary training) that we were made aware of the BACP Ethical Framework for Good Practice in Counselling. This is actually a very well written document and far from constraining the profession, I think that it gives a lot of leeway for creativity. Note that it is framework, not a list of rules and regulations. It is very sensible and really, I would be worried if anybody counselling out there had a problem with adhering to the principles set therein as they correlate with the qualities and ethics of any decent person.

I could see from the start the clear advantages to being a member of a professional body, for the therapist and for the client. I have struggled to understand the opposing view - that regulation would restrict the profession such that the service we supply would be impaired. This struggle has increased as a result of my falling victim to unethical practice. I am unable to divulge much about the actual situation and have been threatened with being "put in a cardboard box" (yes by another counsellor, who has recently resigned from the BACP...) if I publish details of who this person is.

I'm happy with that, not the cardboard box bit, but I do understand that official procedures are needed at times like this. It's all very well when counselling and psychotherapy goes well, and everybody behaves and acts professionally, but like doctors, policemen, teachers, priests...every single profession in fact, there are a few rotten apples. So we have the inconvenient issue of, how do we deal with those rotten apples? Well, if they have acted in an illegal way then it is a matter for the police. We all know that this is not foolproof and without overwhelming evidence, and because of the stress of going through the legal system, many people don't bother or give up part of the way through.

Now, unfortunately, the therapist whom I fell victim to chooses not to be a member of a regulatory organisation so, apart from complaining against the organisation which he owns and works for, he is personally unaccountable. He can hide behind the organisation and carry on his private, unethical practice. I assume it will continue to be unethical because he refuses to see that anything he has done is wrong. I think he knows it must be wrong because he is completely denying the truth and is attacking from as many angles as possible anybody who is trying to raise awareness of his behaviour.

If this therapist were a member of a professional body then a formal complaints process could be had and he and the victims would have the opportunity to provide evidence and cross-examine and the body could make a decision on whether it was unethical or not. I know in theory that at least 18 paragraphs of the BACP Ethical Framework for Good Practice in Counselling have been contravened, in my case. It would just be a case of proving it, and given that there are several women who are prepared to write statements of their experiences it should be fairly cut and dry. Except that he isn't accountable. So he can carry on, and the public need not know anything.

I want potential clients to know that this is what can happen if you choose to see a therapist who chooses NOT to be accountable.

Of course no system is faultless and there is the risk of therapists slipping through and of being falsely accused. This is part of parcel of the medical profession so why not the therapy industry? Do we throw the baby out with the bathwater because there might be an unfair sanction? Shall we abolish the whole justice system so that we don't make the mistake of incarcerating an innocent? Of course not. Surely it's possible to have a system that protects clients from unethical practice, and no it won't stop it completely (Harold Shipman keeps getting mentioned in these arguments), but it will provide a process, a safety net, for those that would like to raise awareness of potential unethical practice because they have been on the receiving end of it. And maybe, just maybe, they will receive the validation they need in the face of having had their trust abused.

I would not like to have to go through the complaints process myself, but in doing so, I would be confident that I do run my counselling by the guidelines suggested, I do check out my own motives and my own blindspots regularly, and if it was ever found that I had acted unethically I would want to do the right thing, alter my practice if needs be, and apologise to the person who was on the receiving end of it. This is the very opposite of what I am getting. I do not want anybody else to be in this position.

Here's what the BACP say on this matter: http://www.bacp.co.uk/media/index.php?newsId=1769

22 January 2013

When ethical practice is hard work, and some mini book reviews

The stresses and strains of acting ethically...

I had a week away and decided to lose myself in fiction to really get away from it all. I love my job, I love where I live, but life has thrown me a huge challenge of late. I have a professional and ethical responsibility to report unethical practice (especially when aware that several people have been affected) but whistleblowing carries a huge burden. I know I am doing the right thing, but it has been an ongoing challenge (some 7 months now) with being attacked by way of defence whilst waiting for the wheels of justice to turn and slowly do their thing. This is the way it has to be. If I were to be on the receiving end of a complaint I would hope and expect that both sides would be deliberated at length. Everybody has a different reality and, challenging though it is at times, I appreciate that even people who have abused, or who, for their own subconscious motives were not there but are nevertheless denying the abuse and invalidating the victims' experiences, have their own, unique reality. It can be quite a task for those in positions of power to make decisions about abuse to pick out the "truth" from wildly conflicting versions, or maybe it isn't. They just have to stick to protocol. I am impressed with the integrity and compassion shown by the powers that be thus far, which gives me confidence that good shall prevail.

The week away was a real break from it all. I had no access to phone or email. I did not take any counselling or philosophy books with me....or did I? My choice of novels was perhaps not too far away from either...

The Reader by Bernhard Shlink

"There's no need to talk about it, because the truth of what one says lies in what one does."

I bought this book 3 years ago at a train station. I liked the look of it, then didn't read it. So I decided it was about time so packed it in my suitcase. It is fairly short; 213 pages formatted with quite wide spacing. The Independent on Sunday describes it thus:

"...is a compelling meditation on the connections between Germany's past and it's present, dramatised with extreme emotional intelligence as the story of a relationship between the narrator and an older woman."

The Observer offers:

"...a German novel I have been waiting for: it objectifies the Holocaust and legitimately makes all mankind responsible."

So looking at these comments that were written on the back of the book I was obviously aware that this was not going to be some great escape from the harsher facts of life...although in a way it was...because other people's anguish can sometimes deflect from one's own problems. I was absorbed by this book from the very start and the relationship that develops between a 15yr old boy and a woman 21 years his senior was intriguingly written. I appreciated the lack of cheap thrills - yes it had it's erotic moments but they were described in a visceral and raw way rather than an embellished and titillating manner.

There were many philosophical issues that leapt out at me; such as the concept of love versus attachment, whether we should do something against someone's will for their benefit, whether we all have the capacity to numb ourselves to unethical practice inflicted upon others - by others or indeed by ourselves. The story itself is neat and beautifully told. I had no idea how it was going to end and it ended in a very satisfying way. Note that my idea of a satisfactory ending is not in line with the average person's idea - this is a fairly grim story, peppered with tragedy and exquisite poignancy. It left me with a lot of "what ifs" but in a good way - I still have life to lead and I can learn from albeit fictional accounts of other people's lives, and ask myself questions. I love a novel which is a great story and really has me soulsearching. I hope that this is enough to whet your appetite. I don't want to bang on about the story as I knew very little before reading it and am glad of that.

Next on my list was an old copy of Aldous Huxley's Island

"I do muscular work, because I have muscles, and if I don't use my muscles I shall become a bad-tempered sitting-addict"

"History is the record of what human beings have been impelled to do by their ignorance and the enormous bumptiousness that makes them canonize their ignorance as a political or religious dogma."

Bumptiousness - what a marvellous word.

I read Huxley's Brave New World in my twenties. I immediately loved it and found it interesting philosophically, with some great concepts. Unfortunately I was quite bored with the last third and disappointed with the ending. I had considered reading it again but I think I outgrew it at some stage. So although I had heard that Island was a great novel, I wasn't expecting to be blown away. I was reminded of it's existence last year when I was reading the Forward for "What We May Be" - a book on psychosynthesis by Piero Ferrucci. So when it came time to grab some books for the week, Island got thrown in. I was delighted to find a dramatically more mature work which enthralled me throughout.

The story is essentially a manifesto for a Utopian paradise mixing the best of Eastern and Western cultures. I loved it right away. Okay, so having birds specially trained to say "Attention" to remind people to be mindful is slightly silly, but on the whole, the way of living on the island of Pala is pretty darned close to perfection. They have most things covered (except perhaps the breasts of the teenage girls, but, like The Reader, I appreciated the lack of smut and wonderfully innocent and natural way this fact was portrayed...). Parents can't mess their kids up because everybody becomes members of a Mutual Adoption Club; teenagers take a hallucinogen when they come of age and visit heaven and hell, thus finding them"selves", in an environment that is safe and supportive; people are encouraged to talk about and express their bad experiences which helps them to purge themselves and move on (I particularly liked this one, given my profession!). The only thing that isn't quite perfect is a little nugget of human nature which we refer to as capitalism and thanks to a fancy Sears brochure, the soon to be Raja of Pala, decides to sell the island's soul for the sake of oil. Well, it's not quite that simplistic but the menace of capitalism is hot on the collar of the Utopian ideals described throughout the book.

Meanwhile some thoughts crept in...

So, while I was doing a very good job of really getting away from it all I did have some thoughts about the nature of abuse, the nature of denial and how some people cling steadfastly onto beliefs in the face of overwhelming evidence to the contrary. I think that this was sparked by The Reader and by the Lance Armstrong interview with Oprah Winfrey, as well as a certain amount of fuelling by the current "ethical dilemma" situation back home. The Jimmy Savile thing still casts a shadow too I believe.

Rambling as those thoughts are, this is what I wrote (in my food journal - yes, I kept a food journal and apart from this one page, it really was all about the food consumed over the course of the week):

1. Some abusers believe that what they are doing is for the good of the person they are abusing. Research suggests that professionals who breach sexual boundaries often believe that their actions are salvific. My question is - which is scarier - somebody abusing with the belief that they are salvific, or somebody consciously abusing?

2. Why do some people cling onto a belief in order to protect themselves from a horrible truth (for example a mother denying that her husband is abusing his step-daughter)? In some cases, the person worsens when faced with overwhelming evidence, and may launch an extensive attack on the person who uncovers the truth. I recall Lance Armstrong's behaviour - calling his former friend Betsy Andreu "a crazy bitch" when she told the truth about his doping, and suing the Sunday Times for essentially telling the truth. Amazing what lengths people can go to to defend what they know is a lie. For me, pity overtakes hate, even if the person continually strikes out, because they are clinging onto a flimsy raft of self-deceit made of the pathetic fibres of loyalty, risking everything in order to maintain a fragile construct of self-worth, perhaps even being dependent upon the abuser for a sense of being.

Is it bad of me to feel empathy for those that do wrong to others?

I had to get these thoughts out.

Then finally onto The Time Travellers Wife by Audrey Niffenegger

"Don't you think it's better to be extremely happy for a short while, even if you lose it, then to be just okay for your whole life?"

I can't really review this yet because I am only a third of the way through. It was recommended to me about 4 years ago by the sister of a good friend. Last year a friend was chucking out some books and gave me first dibs. I yanked out The TTW and threw it in the suitcase. As many close to me are aware, my favourite story since childhood is H G Wells' The Time Machine. I wrote my first counselling college essay on it (a kind of cod-philosphical 3000 words on how it intrigued me). I'm a bit geeky when it comes to time travel. It is my favourite genre of sci-fi, along with the sub-genre "Dying Earth" which was actually "invented" by H G Wells in The Time Machine (when the protagonist whizzes far enough into the future to see the dying days of our planet - a chapter deemed too horrific for the audience of the time and not permitted publishing until later).

So far so good. I am rather apprehensive because I get the impression that this story (about a man with a chromosomal disorder that gets chucked about in time who falls in love with a girl, who is 6 when they first meet) is going to be full of heartache. It is an impressive feat of storytelling and I am gripped.

So, that is some of what has been going on for me with regards to personal development.

So, I return rested and ready. Work is going well and I have some exciting prospects on the horizon. More on those in good time. Onwards and, erm, onwards.

Amanda Williamson is a professional counsellor with a thriving private practice in central Exeter, Devon

Welcome to Counselling in Exeter

27 November 2012

Cyber-relating

Becoming Online

When I first went online, I was fearful of the power of the ‘net and had lots of paranoia about having an online persona. Emails and eBay were manageable, and made Christmas shopping much easier. But just before my sister emigrated to Australia in 2006, I saw her clicking away on the social networking site “MySpace”. I decided to set myself up a profile so I could easily keep in touch with her. I liked the easy sharing of pictures and links and the broader opportunity of linking up with others outside of my usual social realm. It took me a few months to put a picture up, and even then it was of me in disguise. Initially my profile was public but I tired of getting rude messages of a sexual nature. So, swiftly making my profile “private” I continued to experiment with online social networking. I decided that I wanted to be very upfront about who I am , including all my quirks and bizarre preferences. I was sure that somewhere out there in the world there would be people with whom what I wanted to say resonated and this absolutely turned out to be the case. I scoured the lists of users for women roughly 10 years either side of me in age and looked at their profiles, sending a friend request if their profiles or blogs piqued my curiosity enough. Occasionally I would receive a friend request from somebody that wasn’t some dodgy bloke asking for private pictures, and so as time went on I accumulated many online “friends”.

Cyberlove

Online romance blossomed where it wasn’t being looked for and whilst on MySpace I was aware that two British "friends" were having online relationships with American men they had “met” on MySpace. It seemed a little crazy at the time, but they are all married now and really happy. One of the benefits to online courting is that you have time and space to really get to know each other without getting physically hooked on one another. Of course, the physical side is a valid and important part of intimate relationships, and I know a few people who “fell in love” online and then when they met in the flesh it was a disappointment, because the chemistry just wasn’t there or because one or both had simply told too many fibs about themselves.

Forming close friendships

I am aware and cautious of the perils of an online presence but having spent a good while socialising in Cyberspace I am as aware of the good as the bad. I have had the privilege of being able to make very meaningful connections with people. My friend Sue, who shares her experience below, has shared ups and downs with me and she helped me through some challenging times through online messaging.

My longest and best online friend has got to be a man who I shall refer to as bollers. He writes a little about our friendship in a paragraph below. We have known each other for nearly 7 years now and I believe that we have provided a lot of mutual support and companionship throughout life’s ups and downs. bollers was kind and trusting enough to share with me the difficulties of his diagnosis of suffering with schizophrenia and I have learned a lot about his experience. He has had his fair share of my issues directed his way so it feels, to me, like a two-way street with plenty of room for us to walk freely side by side. In fact, bollers very generously assisted me with my Counselling Certificate presentation on schizophrenia. As part of my presentation I asked my peers a week or so beforehand what they would ask if they could ask a person with schizophrenia anything. On the day, I handed them back their questions and asked them in turn to read the questions out loud. On a big projector screen was a recording of bollers, answering the questions individually, his face filling the screen, his voice booming around the room, his very presence felt by all. Not bad for a self-professed hermit and such a generous thing to do. After 4 and half years of online friendship we met in the flesh – he came to stay for a long weekend, and it was so fantastic to spend time with him. He was as he is online.

I have made other good friends online. Codename is a marvellous mentor. I first met her on MySpace and was deeply impressed by her intelligence and philosophical leanings. She made the leap to Facebook, when MySpace started to lose what was good about it, and the friendship grew. She helped me with some of my written assignments for my diploma in counselling and gave excellent, supportive feedback. I finally got to meet her in the flesh a year or so ago and she is as sidesplittingly funny, gorgeous and deeply intelligent as her online persona.

From personal experience I am aware that meaningful relationship can be made online and am looking to integrate an element of online counselling into my private practice. For bollers, online relationship was the only feasible option. For me, it was an opportunity to be brave enough to express who I really am, a risk that was very much worth taking.

Here follows a few paragraphs written by people who have kindly agreed to share their experience of cyber-relationship.

Kate

I didn't meet my partner online, though we did start seeing each other and properly getting to know one another shortly before he was due to spend a four month stint in the States.

So when he went away, we were at that crucial 'are we going to carry on seeing each other stage'. Our interaction was quite constant on Skype, and we would talk for (literally) hours every day. It was kind of nice because I had the opportunity to separate the exciting physicality of a new relationship from the actually talking and getting to know each other. Having said that, it was also very frustrating not to be able to touch the other person, and we did engage in a bit of web cam naughtiness. As the months drew on, we both became more and more frustrated with the inadequacy of online contact, and by the end of three months, we were talking less on Skype. Interestingly, talking on the phone became preferable, I suppose because there was a juddering web cam, or slight time delay, it actually felt more real to speak.

Bainz

I met my wife online and though one would think it wouldn’t be the most normal place to meet someone I did and I am glad I did. Never did it before, but if I didn’t I would have never met my wife. If you think of it bars, clubs, stores etc aren't really that good places. It took six months of writing back and forth before she gave me her telephone number, and another two weeks of texts before she allowed me to ring her but it was well worth it. I waited 46ys for the love of my life and I did it online. Crazy as it seems, it worked for me and I wouldn’t have it any other way.

Sue

I was probably the most unlikely person to ever have imagined I’d end up married to someone who I met online, but this is exactly what happened. In 2008 I got talking to a chap in America on MySpace and we messaged for nine months just chatting and catching up on life. Over this time we became really good friends and would ring each other and text, after some persuasion by him, as I was very cautious and doubtful of online friendships being anything other than that. However in 2009 we finally met in person and knew immediately it was going to be a big relationship, we always maintained our online relationship when he went back home and this became a huge part of our courting and when we married in 2011 in Las Vegas the first thing we did was publish our wedding pics on Facebook and MySpace as it has been such a major part in bringing us together over all the miles. Although at the moment my husband cannot live with me in the UK as he has various things to tie up before he moves here permanently, we still communicate by messaging and msn and truly think that online relationships are probably more likely to succeed than randomly meeting people the normal route ie pubs clubs etc... In online relationships you tend to open up more about your life and I think this can either determine if you are suited or not to one another’s lifestyles. So all I can say is I’m very grateful for online messaging as its brought me someone who is wonderful to me and my children. Along the way I’ve met quite a few new friends on it , of course there has been occasional "weird " people but I can say genuinely the majority of friends I’ve made are ones I will keep forever Amanda being one of them as she too has had lot of experience, and has often given us advice and help along the way to which we are extremely blessed and grateful.

bollers

in a land before facebook there lived a magical kingdom called myspace and it was here that i first encountered amanda. she had left a interesting comment about a television “face” and i had felt compelled to write to her, which was saying something as over the prior few years i had turned into a hermit who’d left all his friends long behind whilst learning to live with being schizophrenic. this was a new horizon for me that offered some hope of a future as well as being a worthy new way to pass the time as i convalesced. so “message” amanda i did and thankfully she replied and that is how it began.

what do i like about cyber friendships? well typing keys opposed to chatting face to face allows me to pause for thought, unlike when i am in a “real” life situations, as i have a proven record of putting my foot in it. it also suits my hermit lifestyle, a way of having company in my life without a lot of the hassle. then there’s the possibility of helping other people, which by its very act helps me- not that i ever expect anything back from a online friendship but more often than not it does happen, simple things like someone to hear my space like scream from time to time.

i am no expert on this sort of thing, the number of online friendships i’ve been in is low, but quantity is not the issue, it’s about the quality of the relationship, about creating meaningful relationships and that takes effort and honesty reciprocated both ways and this is something i have found with amanda. she’s straight talking in a gentle way and her words are always the righteous truth. she has much wisdom within her and being part of her life is something i shall always treasure. with cyber friends travelling the galaxy becomes a reality.

My presence on the ‘net as a therapist

The issue of therapist self-disclosure gets batted round from time to time. Should we be “blank screens”? Is it really possible to be “blank screens”? I don’t think so. What I believe, and this works for some people (but I do not claim that it will work for all), is that looking for a therapist is tricky. That there are many homogenised counselling websites out there – how do you choose who to see? Some of my clients have told me that it is purely down to the amount of information I share on my website that makes them choose me. They feel more comfortable knowing more about me beforehand, and I have even heard that they felt a connection with me before meeting me. This fits perfectly with my experience (click here for my blog on my session with the author and psychotherapist and author Irvin Yalom) of feeling a connection of another through reading their written word.

Amanda Williamson is a professional counsellor with a thriving private practice in central Exeter, UK