You describe a similar trajectory through your career as I’ve experienced Emma (definitely focussed more and more on regulating myself so that I can offer safe co-regulation with clients). The seeds for this, for me, were planted long ago & rather unconsciously - Very early on in my qualified career I would often end up clashing with other (most often in authority) psychologists with my fierce passion to be a human first & to focus on the relationship, rather than targets/models/etc, as well as often pointing out where the care we offered as a NHS service wasn’t safe or containing, due to our own dysregulation/burnout/reactivity rather than coming from us being calm & cared for ourselves, and coming up with thoughtful formulations. So lovely to read your thoughts, and your journey, thank you for sharing this one for free ❤️
This has really got me thinking. First about the idea as models existing to support a level of objectivity, and this having been seen as necessary to centre the client and not the therapist. I think having experienced unethical therapeutic practice, I had a visceral reaction to this idea of throwing away models. The therapist is in a position of immense power, the model is supposed to be an external set of eyes, a defined set of parameters that balance that power. But it's flawed, it's made by humans within a power system, which it reproduces. There's more I'll keep posting as I can...
Thanks so much for commenting Leah and I look forward to hearing more from you. I absolutely don't want to suggest that we should throw away models/approaches, although for a little while I know I had a real urge to stop being a psychologist completely and figure out a different career. Now I think as I've sifted through what I discarded, I know that there are gems there. I think though that models should be held loosely, explained and used in a truly collaborative way - and with this underpinning of co-regulation perhaps. For me, anyway. I don't think I'd appreciated before how much that had been missing in my experiences as a client but also hadn't been something that I had as forefront of my mind as a therapist. A practical difference, for example, is that I now ground myself much more before and after sessions so I know that I'm showing up in a regulated state. That's so different from my work as a newly qualified psychologist where I'd be seeing people back to back without time for a wee break. I fully agree that we need parameters to balance the power of the relationship - not just models but also clear supervision, frequent check ins about whether therapy is having the desired outcomes etc. I mean, we know from all the common factors literature that the model is one of many parts of therapy that can lead to a positive outcome - but models and approaches were still the predominant feature of my training and clinical work.
Yes that example makes a lot of sense to me and sits in line with the trauma informed approach that is being pushed (but not adequately resourced) by the Scottish government. I like the idea of the client being fully aware of the models, and being able to understand their uses and limitations, which would possibly require the self awareness that comes after a lot of therapy. I had been listening to the Radical Therapist podcast for a while and I think that's when I started to think about power structures in therapy, because they talk about I think narrative something therapy...??
Thank you for sharing your thoughts and reflections Emma. I personally haven’t seen a psychologist or a psychiatrist but have had counselling at different times in my life and now have what might be described as somatic therapy. In that there is knowledge shared but very much in a collaborative way and it has helped me move from my head to my body and release old stories/patterns/wounds. As it is with someone who has done the work and continues to do the work I am safely held even in the deepest and darkest moments. I think the knowledge of psychology frameworks, neuroscience and nervous system is really helpful in facilitating our understanding of what has happened or why we behave the way we do. Social media has helped democratise access to that. Sometimes understanding doesn’t go all the way in helping us heal. My indirect experience of NHS psychologists and psychiatrists with my son who is ND has been deeply disappointing and in some ways harmful. The power imbalance has been used to manipulate cooperation in an activity against my better judgement, diagnoses have been made without any real connection and therefore genuine understanding and once diagnoses have been made that has been it. No psycho education, no emotional regulation support, no executive function coaching, no sleep support (other than drugs). That said access to psychologists on social media such as Dr Naomi Fischer has been invaluable. It is so interesting to see how other professionals navigate these questions. I’m a midwife and have been reflecting internally on my own practice/values/behaviours and externally on the system I work in and the wider social context of women’s health. I think whatever we do if we want to be of value it is vital we stop and reflect on what we do, how we do it and whether it’s the wisest most useful way forward. As a life long over thinker moving to my heart and my body is new and crucial. Just my thoughts as a lay person with an interest in all things healing and a deep appreciation for your thoughtful content.
Again, I feel like you have reached into me and pulled out and put into words a process that I have also found myself undergoing. I’m less able to put words in the right order to convey it so well and hearing it out loud (thank you for making these audio accessible) is so validating. I sometimes find I get anxious about moving away from models of working and more toward connection and authenticity in sessions. As if it may mean I am lesser of a therapist for it. Working this way though means I’m not working behind a wall, I feel much more connected to my clients and I dare to say that I love them all a bit harder for it too, because there is now more room for it. Of course with appropriate boundaries, but the connection and authenticity in the room allows for a therapeutic care that is beyond words, or theories or models. I find your words a relief, and comforting. Of course knowing theories, and keeping up to date with best practice development is essential. I suspect though that being a human first will always be best practice for me.
So another thing I'd been thinking about in terms of models is this idea of the model as a prototype or a sketch. A place where processes and forms are tried and tested in a low stakes way. A place that shows up mistakes and limitations, that allows us to practice and perfect a technique or hone a skill. I guess if you think of it as a sketch it's a representation of an object, which is stripped back to some essential denotative components, which may be taken and fleshed out into something with more context and information. Maybe I'm thinking about understanding the model for what it is, it's not the object it's some ideas about an object.
As an Ed Psych working in a system that feels so hard, stuck, and frustrating at many levels, I found this model of working (relating!) to my clients so eye opening. I had a ‘yes, that’s it!!’ moment!! I’ve loved the work of Bruce Perry and the 3 Rs, and the shift in your work from educational (reason) to co-regulation (regulate) has just made me have a penny drop moment. The work I love doing is with staff, who want so desperately the answers and strategies to best support these children with very complex needs… but what I find the most moving experience is ‘feeling with’ these amazing practitioners who just need space to process and be understood. Your writing is beautiful, Emma, and it makes me feel more confident that maybe I don’t need to worry about having all the evidence based strategies to hand, but maybe instead it is about true connection with people that just want to be seen. In today’s climate in education, this seems more important work than ever. It’s made me also think about the moments in my work that I have a ‘gut feeling’ about the best way forward for a child… and the contradictory evidence base that sometimes gets in the way?
Yes, this can be true I think although sometimes it depends on where you're looking for the evidence base! e.g. I'm thinking about autism and the approaches that might be recommended which can make things so much harder for a traumatised autistic child. So I think sometimes our gut feeling is an indication that there's something we're missing in our framing of a situation? Maybe. I wonder if it's something about feeling first - formulation second.
I like that you've said not having all the evidence based strategies, because I think it would be so easy to go down the route of pitching the feeling lead approach against the evidence based (science lead) approach. Because of course our feelings aren't facts, they're subject to a range of psycho-social-systemic factors too right. But they really can be what helps us to cut through the systemic shit for our clients, and create beautiful healing relationships.
Absolutely both. I think sometimes in schools, there can feel an urgency to have the answers and facts (symptomatic at the speed and tight structure of the school day and high demands on staff and children), but I like the idea of pausing to slow down and feel more deeply about the things that come up during consultation. It feels richer and perhaps frees up more space for better (and more compassionate) problem solving.
You describe a similar trajectory through your career as I’ve experienced Emma (definitely focussed more and more on regulating myself so that I can offer safe co-regulation with clients). The seeds for this, for me, were planted long ago & rather unconsciously - Very early on in my qualified career I would often end up clashing with other (most often in authority) psychologists with my fierce passion to be a human first & to focus on the relationship, rather than targets/models/etc, as well as often pointing out where the care we offered as a NHS service wasn’t safe or containing, due to our own dysregulation/burnout/reactivity rather than coming from us being calm & cared for ourselves, and coming up with thoughtful formulations. So lovely to read your thoughts, and your journey, thank you for sharing this one for free ❤️
This has really got me thinking. First about the idea as models existing to support a level of objectivity, and this having been seen as necessary to centre the client and not the therapist. I think having experienced unethical therapeutic practice, I had a visceral reaction to this idea of throwing away models. The therapist is in a position of immense power, the model is supposed to be an external set of eyes, a defined set of parameters that balance that power. But it's flawed, it's made by humans within a power system, which it reproduces. There's more I'll keep posting as I can...
Thanks so much for commenting Leah and I look forward to hearing more from you. I absolutely don't want to suggest that we should throw away models/approaches, although for a little while I know I had a real urge to stop being a psychologist completely and figure out a different career. Now I think as I've sifted through what I discarded, I know that there are gems there. I think though that models should be held loosely, explained and used in a truly collaborative way - and with this underpinning of co-regulation perhaps. For me, anyway. I don't think I'd appreciated before how much that had been missing in my experiences as a client but also hadn't been something that I had as forefront of my mind as a therapist. A practical difference, for example, is that I now ground myself much more before and after sessions so I know that I'm showing up in a regulated state. That's so different from my work as a newly qualified psychologist where I'd be seeing people back to back without time for a wee break. I fully agree that we need parameters to balance the power of the relationship - not just models but also clear supervision, frequent check ins about whether therapy is having the desired outcomes etc. I mean, we know from all the common factors literature that the model is one of many parts of therapy that can lead to a positive outcome - but models and approaches were still the predominant feature of my training and clinical work.
Yes that example makes a lot of sense to me and sits in line with the trauma informed approach that is being pushed (but not adequately resourced) by the Scottish government. I like the idea of the client being fully aware of the models, and being able to understand their uses and limitations, which would possibly require the self awareness that comes after a lot of therapy. I had been listening to the Radical Therapist podcast for a while and I think that's when I started to think about power structures in therapy, because they talk about I think narrative something therapy...??
Thank you for sharing your thoughts and reflections Emma. I personally haven’t seen a psychologist or a psychiatrist but have had counselling at different times in my life and now have what might be described as somatic therapy. In that there is knowledge shared but very much in a collaborative way and it has helped me move from my head to my body and release old stories/patterns/wounds. As it is with someone who has done the work and continues to do the work I am safely held even in the deepest and darkest moments. I think the knowledge of psychology frameworks, neuroscience and nervous system is really helpful in facilitating our understanding of what has happened or why we behave the way we do. Social media has helped democratise access to that. Sometimes understanding doesn’t go all the way in helping us heal. My indirect experience of NHS psychologists and psychiatrists with my son who is ND has been deeply disappointing and in some ways harmful. The power imbalance has been used to manipulate cooperation in an activity against my better judgement, diagnoses have been made without any real connection and therefore genuine understanding and once diagnoses have been made that has been it. No psycho education, no emotional regulation support, no executive function coaching, no sleep support (other than drugs). That said access to psychologists on social media such as Dr Naomi Fischer has been invaluable. It is so interesting to see how other professionals navigate these questions. I’m a midwife and have been reflecting internally on my own practice/values/behaviours and externally on the system I work in and the wider social context of women’s health. I think whatever we do if we want to be of value it is vital we stop and reflect on what we do, how we do it and whether it’s the wisest most useful way forward. As a life long over thinker moving to my heart and my body is new and crucial. Just my thoughts as a lay person with an interest in all things healing and a deep appreciation for your thoughtful content.
Again, I feel like you have reached into me and pulled out and put into words a process that I have also found myself undergoing. I’m less able to put words in the right order to convey it so well and hearing it out loud (thank you for making these audio accessible) is so validating. I sometimes find I get anxious about moving away from models of working and more toward connection and authenticity in sessions. As if it may mean I am lesser of a therapist for it. Working this way though means I’m not working behind a wall, I feel much more connected to my clients and I dare to say that I love them all a bit harder for it too, because there is now more room for it. Of course with appropriate boundaries, but the connection and authenticity in the room allows for a therapeutic care that is beyond words, or theories or models. I find your words a relief, and comforting. Of course knowing theories, and keeping up to date with best practice development is essential. I suspect though that being a human first will always be best practice for me.
So another thing I'd been thinking about in terms of models is this idea of the model as a prototype or a sketch. A place where processes and forms are tried and tested in a low stakes way. A place that shows up mistakes and limitations, that allows us to practice and perfect a technique or hone a skill. I guess if you think of it as a sketch it's a representation of an object, which is stripped back to some essential denotative components, which may be taken and fleshed out into something with more context and information. Maybe I'm thinking about understanding the model for what it is, it's not the object it's some ideas about an object.
As an Ed Psych working in a system that feels so hard, stuck, and frustrating at many levels, I found this model of working (relating!) to my clients so eye opening. I had a ‘yes, that’s it!!’ moment!! I’ve loved the work of Bruce Perry and the 3 Rs, and the shift in your work from educational (reason) to co-regulation (regulate) has just made me have a penny drop moment. The work I love doing is with staff, who want so desperately the answers and strategies to best support these children with very complex needs… but what I find the most moving experience is ‘feeling with’ these amazing practitioners who just need space to process and be understood. Your writing is beautiful, Emma, and it makes me feel more confident that maybe I don’t need to worry about having all the evidence based strategies to hand, but maybe instead it is about true connection with people that just want to be seen. In today’s climate in education, this seems more important work than ever. It’s made me also think about the moments in my work that I have a ‘gut feeling’ about the best way forward for a child… and the contradictory evidence base that sometimes gets in the way?
Yes, this can be true I think although sometimes it depends on where you're looking for the evidence base! e.g. I'm thinking about autism and the approaches that might be recommended which can make things so much harder for a traumatised autistic child. So I think sometimes our gut feeling is an indication that there's something we're missing in our framing of a situation? Maybe. I wonder if it's something about feeling first - formulation second.
I like that you've said not having all the evidence based strategies, because I think it would be so easy to go down the route of pitching the feeling lead approach against the evidence based (science lead) approach. Because of course our feelings aren't facts, they're subject to a range of psycho-social-systemic factors too right. But they really can be what helps us to cut through the systemic shit for our clients, and create beautiful healing relationships.
Absolutely this, using both together
Absolutely both. I think sometimes in schools, there can feel an urgency to have the answers and facts (symptomatic at the speed and tight structure of the school day and high demands on staff and children), but I like the idea of pausing to slow down and feel more deeply about the things that come up during consultation. It feels richer and perhaps frees up more space for better (and more compassionate) problem solving.
As a patient, this feels like a warm blanket, a safe place.
Oh that’s lovely thank you for sharing that
It feels freeing. And very human.
That’s great!