Counselling, Supervision, Training, Research, Teaching, Writing. Providing therapeutic services to the people of East Lancashire and beyond.

Tuesday, 24 April 2012

Crumpled Paper

Tuesday is one of my teaching days at the University Centre, Blackburn College. Mainly on a Tuesday I teach modules on the Positive Practice with Children and Young People Foundation Degree. I enjoy teaching and have been teaching in Further and Higher Education since 1998. At that time I was a PGCE student at Bolton Institute. Returning to Blackburn College to do my teaching practise was a lovely experience, tinged with a sense of homecoming.

When I think of teaching I think of Irvin Yalom's concept of the 'ripple effect' - teaching ideas and skills that learners can use to improve their practice as care professionals out there in my local community. So I love hearing stories from my students, about how they are changing the lives of children and young people as a result of learning achieved in the classroom. Teaching is very much a two way process though and I reckon I learn as much from my students as they do from me.

Today I was working on an assignment with a group of students; a module about mediation, advocacy and counselling. We were talking about bullying and how we can help children understand the effects, including the long term effects, of being bullied. One student told me about a simple but powerful approach used at her school.

The teacher crumples up a piece of paper to symbolise what it's like to be bullied. She then asks the pupils to smooth out the paper and get rid of the wrinkles. Of course nobody can get rid of the wrinkes: you can smooth out the paper but the creases remain. And this is what happens when a child is abused, neglected or bullied. Recovery may take place but the harm inflicted on the child leaves its mark, on the individual and the choices they make throughout their life. It's a powerful metaphor and one I will use in my counselling and teaching.

Thursday, 19 April 2012

Personifying Obsessive Compulsive Disorder (OCD)

In a recent blog post on Psych Central, Janet Singer wrote about her son Dan and his Obsessive Compulsive Disorder (OCD), which became so severe at one point that he was unable to eat. Distressed and confused Janet turned to a psychologist friend for help. He told her that Dan and his OCD were in a 'battle'. On good days Dan had the resources he needed to win the battle, on bad days the OCD over-powered him. This made a lot of sense to Janet and she began to refer to her son's OCD as 'the enemy'. She says it's a common approach to the treatment of OCD and enables the individual living with the condition to separate himself or herself from the 'disorder'. Janet says OCD is an 'insidious disorder' and that some 'battles' in the 'war' will be won and some lost, the important thing is that 'those suffering from OCD keep fighting'.

Over the years I've worked with many individuals living with obsessions, compulsions, and with OCD. I've been mostly successful in my helping, using a pluralistic approach, creating an individual therapy for each of my clients, using counselling, Cognitive Behavioural Therapy (CBT) and Neuro Linguistic Programming (NLP) .

Sometimes though I am unable to help. Often this is because the client has something else stressful happening in his or her life that constantly activates intense episodes of obsessive-compulsive behaviour. It's incredibly difficult to control OCD when the storm is raging. In those circumstances I offer support and I work with the client to resolve these 'external' sources of stress. If stressful life events happen whilst the client is having counselling then it's likely that he or she will have learnt strategies (1) to deal with this 'incoming' stress and (2) to manage their OCD. This usually prevents the OCD from escalating out of control.

In many ways I agree with everything that Janet Singer has said. One of my aims when working with clients living with OCD is to help them recognise and label OCD thinking; and it can be difficult to identify obsessive thinking when one is in the middle of it, the most irrational of intrusive thoughts can seem real when they are accompanied by intense feelings. But recognising and labelling OCD thinking requires the individual to stand outside of the OCD ; it is, I think, the first step towards mastery. It introduces the possibility of choice - 'This is my OCD wanting me to check the doors and windows of my house. Do I comply or do I not?' The next step may be to learn to tolerate the agony of not complying or not seeking re-assurance. There are many more rounds to go in this boxing match, but at this stage, and possibly for the first time, the OCD is on the ropes!

As you can see, it's very tempting to use a martial metaphor when talking about OCD. I've likened OCD to a boxing match, and Janet Singer uses words such as 'battle' and 'war'. Clients often use this kind of language when describing their experience of OCD and the process of recovery. When this happens I will often follow suit, working to create 'critical distance' between the client and their obsessions and compulsions, for the good reasons Janet Singer identifies in her blog post. I do have a reservation though about labelling OCD as the 'enemy'.

I worry that labelling OCD as the 'enemy' in effect creates a state of perpetual war within the individual, or possibly, periods of peace interrupted by fresh outbreaks of conflict.

These concerns come from my belief in the NLP pre-supposition 'all behaviour has a positive intention' and my training in the 'parts work' of family therapist Virginia Satir. In my view OCD is a 'part' of the individual and it has a positive intention. Like all anxiety disorders it is working incredibly hard at keeping the individual safe from harm. For example, when a person obsessively checks to see if their front door is locked there is a positive intention behind their behaviour, it is to keep his or her property and family safe and secure. In this context OCD isn't the enemy, it's the fire service, police force and National Guard all rolled into one. But of course whilst OCD behaviours might have a positive intention they nonetheless create havoc in the life of the individual living with OCD - this is a 'part' that needs retraining and re-assigning.

So, whilst I do help clients to personify their OCD - and use martial metaphors to 'defeat' the disorder - I may also look to re-assign or re-integrate a 'part' that is out of control by re-directing an individual's obsessive and perfectionist tendencies towards the perfection of a skill or hobby - I sometimes refer to the healthy obsession of the concert pianist. This means that time previously spent 'doing' OCD is spent having some fun and creatively filling the space that OCD used to occupy.

Saturday, 14 April 2012

Musical Theatre Review: Wonderful Town

I saw the musical Wonderful Town tonight, performed at the very modern Lyric Theatre inside Salford's Lowry complex. I was in a box and actually had some leg room. What a fabulous piece of entertainment! I knew I'd enjoy the evening because I love the music of Leonard Bernstein - the brassy American sound you hear in West Side Story and Candide - but what I particularly enjoyed this evening was the choreography and the story telling. OK, the plot is pretty corny and there aren't any big hit songs; but the humour, the singing, the acting, the dancing, they were first class. As was the playing of the 17 musicians from the Halle Orchestra under Sir Mark Elder. He gave the audience a laugh at one point by responding to Connie Fisher's song request in a phoney Irish accent. All members of the cast were terrific but I particularly enjoyed watching the supporting cast in their dance routines. I bought the CD from Amazon on my way home so I can spend the next fortnight remembering this evening. You have until Saturday 21 April to see the show, you will not be disappointed.

Wednesday, 11 April 2012

Aversion Therapy at the Judge Rotenberg Centre

An upsetting video was played to a jury in a Massachusetts courtroom yesterday. According to Fox Boston the video 'shows former resident Andre McCollins screaming, writhing in pain, and begging for help'. He was a student in 2002 at the Judge Rotenberg Center, a special needs school for children with behavioural problems. The eighteen year old was screaming because of the electric shocks he was suffering - 31 of them during that day - the first applied because he would not remove his coat.

'For 39 years JRC has provided very effective education and treatment to both emotionally disturbed students with conduct, behavior, emotional, and/or psychiatric problems and developmentally delayed students with autistic-like behaviors'

The JRC Web Site describes the school's behaviourist approach - behaviour modification using a token economy, psycho-education and behavioural contracts. It seems very clinical but it's accepted practice in the treatment of behavioural problems. Behaviourists have effectively demonstrated that if you reward a behaviour you will see more of it. So by praising and rewarding positive behaviour the therapist brings about desired changes in the child.

The Web Site goes on to describe what happens to those children who do not respond to positive reinforcement. It seems they are given 'optional intensive treatment' also described on the Web Site as 'aversive treatments'. We are talking here of electric shocks, but note how this use of medical language provides a cloak of legitimacy and distances the reader from the deed.

This is aversion therapy - electric shocks are 'administered' whenever the individual shows signs of defiance. The Judge Rotenberg Center says this 'treatment' is only considered when other approaches have failed and only after the Center has obtained permission from the child's parents and a court. Andre McCollins's mother says she never consented to this for her son.

I was shocked to see the video, but I was also surprised that formal and systematic aversion therapy was still being used in this way. I had assumed it belonged to the last century, when it was used unsuccessfully in prisons to 'treat' gay men. Electric shocks were applied whenever an individual experienced 'inappropriate' sexual arousal. After a few days most individuals were too terrified to respond sexually to either men or women and were pronounced 'cured'. After a few months, however, these 'treatment gains' were lost as a phenomena the behaviourists call 'extinction' crept in. Even B.F. Skinner, the most radical of the behaviourists disapproved of aversion techniques. Can this really be evidence based practice?

Quite clearly this video shows someone's human rights being abused. It wouldn't be permitted in a prison, so why is it permitted in a special school for autistic children? Why does society think it is OK to treat children in this manner? The Judge Rotenberg Center point to testimonials from former students with happy lives and happy children thanks to the systematic punishment administered by Rotenberg staff. That must be the only justification for this treatment - the end justifies the means.

I was wondering about the position of the staff. I have worked in residential care myself and I've seen the videos of Milgram and the Stanford Prison Experiment. So I guess I'm not surprised when individuals depersonalise and do awful things if there are not adequate structures in place to monitor standards. Did Rotenberg staff lose touch with the morality of the outside world? Look at Abu Graib for an example of what can happen when effective control systems are not in place and power is misused. In this case the treatment meted out to this young man was officially sanctioned - 'we were following his treatment plan' was the phrase repeated in court.

What happens when we apply a theory that reduces human behaviour to stimulus and response? When human values are replaced with a set of medico-scientific values? At the Judge Rotenberg Centre it resulted in an attempt at behaviour modification through the systematic application of pain and stress ... and that's torture.

Tuesday, 10 April 2012

Social Media and Curation for Edupunks

I've been fascinated this evening by the notion of curating, watching videos on the topic by the 'Great Curator' himself, Robert Scoble. Turns out I've been curating for years! It involves reading content on the Internet and then sharing it with others by, for instance, 'liking' it on Facebook or Tweeting it. In the old days if I liked something then I'd share it with friends by copying the URL into an email and sending it to them. Now this process is made easy by applications designed to store and share content.

I've just started using, which allows me to read articles or watch videos on my favourite topic - counselling and mental health - and then share that content with my "community" - of students, colleagues, friends and Twitter followers - by clicking on a 'bookmarklet' on my bookmarks bar. The article is then placed in an on-line feed or 'topic' and presented as a high-quality newsletter, it is automatically posted to Facebook or Twitter depending on my preferences.

So the time I spend on the Internet has become pretty involved. If I read an interesting article I use my button to shorten the link before sending it out on Twitter; I use so the article appears as a topic there and automatically posts to my Marsden Therapy Facebook Page. I then use the Evernote Web Clipper to save the article to a folder in my Evernote account.

So, the question that crosses my mind is, 'What's the point?'

The first thing I would say in response (to my own question) is that I find it enjoyable. I enjoy searching the Web for articles, reading them and sharing the best of them with others. Secondly, I feel part of a community - I read articles posted by counsellors and mental health workers all around the world and I respond by sharing content that I have found interesting. Thirdly, I believe my efforts help establish my credibility as a counsellor: someone with passion for my subject who's engaged in the 'conversation' about counselling, psychotherapy and mental health. Several clients have made appointments because of my blogging and Tweeting. I think it raises my profile. Finally I think that social media and curation has a role to play in teaching and learning and that's what I want to talk about next.

I experimented with Facebook a couple of years ago. I invited all my students to join, thinking I would be able to create a "community of learners" on the Web. I soon realised this was a mistake that crossed professional boundaries. I felt uncomfortable reading about the private lives of students and after one week I explained my mistake, apologised and deleted my account. When I rejoined Facebook a year later I restricted my circle of 'friends' to people I knew, people who really were friends. I then started thinking about how else I could communicate with learners. But the key lesson from my first experience of Facebook was that social media needs to be managed properly and boundaries have to be protected. I think I do that pretty well now.

One of the ways I use curation to promote teaching and learning is by using Twitter. I encourage learners to join Twitter and follow my account. I don't follow back and that helps to maintain clear boundaries. I've had a number of students comment on the links I've posted to relevant articles and videos, but generally the take-up rate amongst students has been pretty low. I'm considering other innovative ways to include Twitter in my teaching: I may try holding classes in one of the computer rooms where I can use Twitter to canvass opinion and assess learning.

Facebook seems to be much more popular amongst the students I encounter and now I've found a way of automatically posting articles to my Facebook Page I shall promote that too as a way of engaging learners. My Marsden Therapy Page allows me to share content on the 'walls' of students who have 'liked' my page but without becoming their 'friends' or seeing their personal posts. I'm going to give this a go in September 2012.

Finally, Scoop-it allows me to share content with my students. First of all it creates a smart looking e-newsletter out of the content I have bookmarked. This comes with its own URL that I can copy into emails or advertise on my other Web Sites. Secondly has a widget that I have been able to install on the University Centre's virtual learning environment - in this case it's Moodle - for all my students to see, and ignore, or click on. My real hope is that learners will also begin using social media to curate about counselling and mental health topics - and that will be very satisfying.

Friday, 6 April 2012

The Marsden Therapy Photostream

Graduation DayGraduation day with DanielleCelebrating achievement with ChrissyThe Curve coffee shop at University Centre Blackburn CollegeI am lucky to be mentoring trainee teacher DebraSmall group work in a lesson at UCBC
Heather enjoys a lesson at UCBCThanks to Colette for this bit of theoryAdam Gibson shows a bit of leg on the Pro-active Carer ProgrammeSarah and Alison get creativeGo Sarah!  My co-facilitator Adam presents Sarah with her certificateSajidah completes another course... Well done!
Mike receives his certificate from AdamCarol receives her certificate from my co-facilitator Adam GibsonCutting out pictures is not only fun it leads to creative thinkingJohn Marsden

A late edition to the family of Marsden Therapy Web Sites, here is the Marsden Therapy Flickr Photostream, with a gallery of pictures celebrating the success of my students at the University Centre Blackburn College and participants on Magic Bean training courses.