The 10 central tenets of attachment theory are:

1. Attachment is an innate motivating force. Seeking and maintaining contact with significant others is an innate, primary motivating principle in human beings across the life span. Dependency, which has been pathologized in our culture is an innate part of being human rather than a childhood trait we outgrow. Attachment and the emotions associated with it are the core defining feature of close relationships: it is the ‘heart of the matter’ when it comes to relational issues. The fear of isolation is found in every human heart.

2. Secure dependence complements autonomy: According to attachment theory, there is no such thing as complete independence from others or over-dependency. There is only effective or ineffective dependency. Secure dependence fosters autonomy and self-confidence. Secure dependence and autonomy are then two sides of the same coin, rather than dichotomies. Research shows that secure attachment is associated with a more coherent, articulated and positive sense of self. (Mikunlincer 1995). The more secure connected we are the more separate and different we can be. Health in this model means maintaining a felt sense of interdependency, rather than a being self-sufficient and separate from others.

3. Attachment offers an essential safe haven: Contact with attachment figures is an innate survival mechanism. The presence of an attachment figure, which usually means parents, children, spouses and lovers, provides comfort and security, which the perceived inaccessibility of such figures creates distress. Proximity to a loved one tranquilizes the nervous system. (Schore 1994). It is the natural antidote to the inevitable anxieties and vulnerabilities of life. For people of all ages, positive attachments create a safe haven that offers a buffer against the effects of stress and uncertainty, (Mikulincer, Florian & Weller 1993), and an optional context for the development of the personality.

4. Attachment offers a secure base: Secure attachment also provides a secure base from which individuals can explore their universe and most adaptively respond to their environment. The presence of such a base encourages exploration and a cognitive openness to new information. (Mikulincer 1997). It promotes the confidence necessary to risk, learn, and continually update models of self, others and the world so that adjustment to new contexts is facilitated. Secure attachment strengthens the ability to stand back and reflect on oneself, one’s behaviour and one’s mental state. (Fonagy & Target 1997). When relationships offer a sense of felt security, individuals are better able to reach out to and provide support for others and to deal with conflict and stress positively. These relationships tend to be happier, more stable, and more satisfying. The need for a secure emotional connection with a partner, a connection that offers a safe haven and a secure base, is the central theme of couple distress and the process of effective relationship repair.

5. Emotional accessibility and responsiveness build bonds: In general, emotions activates and organizes attachment behaviours. More specifically, the building blocks of secure bonds are emotional accessibility and responsiveness. An attachment figure can be physically present but emotionally absent. Separation distress results from the appraisal that an attachment figure is inaccessible. It is emotional engagement that is crucial and the trust that this engagement will be there when needed. In attachment terms, any response, (even anger), is better than none. If there is no engagement, no emotional responsiveness, the message from the attachment figure reads as: ‘your signals do not matter, and there is no connection between us’. Emotion is central to attachment and this theory provides a guide from understanding and normalizing many of the extreme emotions that accompany distressed relationships. Attachment relationships are where our strongest emotions arise and where they seem to have the most impact. Emotions tell us and communicate to others what our motivations and needs are: they are the music of the attachment dance. As Bowlby, (1979), the creator of attachment theory, has suggested: ‘the psychology and psychopathology of emotion is…in large part the psychology and psychopathology of affectional bonds’ (p 130).

6. Fear and uncertainty activate attachment bonds: When the individual is threatened, either by traumatic events, the negative aspects of everyday life such as stress or illness, or by any assault on the security of the attachment bond itself, powerful affect arises and attachment needs for comfort and connection become particularly salient and compelling. Attachment behaviours, such as proximity seeking, are then activated. A sense of connection with a loved one is a primary inbuilt emotional regulation device. Attachment to key others is our ‘primary protection against feelings of helplessness and meaninglessness’. (Macfarlane and Van der Kolk 1996). This theory helps the couple therapist understand a particular event, such as flirtation at a party or a short period of distance in time of need, can threaten a relationship and begin a downward spiral of distress.

7. The process of separation distress is predictable: If attachment behaviours fail to evoke comforting responsiveness and contact from attachment figures, a prototypical process of angry protest, clinging, depression and despair occurs, culminating eventually in detachment. Depression is a natural response to loss of connection. Bowlby viewed anger in close relationships as often being an attempt to make contact with an inaccessible attachment figure and distinguished between anger of hope and the anger of despair, which becomes desperate and coercive. In secure relationships, protest at inaccessibility is recognized and accepted. An emotionally focused therapist sees the basic dramas of distress, such as demand – withdraw, as variations on the theme of separation distress.

8. A finite number of insecure forms of attachment can be identified: The number of ways that human beings have to deal with the unresponsiveness of attachment figures is limited. There is only so many ways of coping with a negative response to the question: ‘Can I depend on you when I need you?’ Attachment responses seem to be organized along two dimensions, anxiety and avoidance. (Fraley & Waller 1998).

When the connection with a irreplaceable other is threatened but not yet severed, the attachment system may become hyperactivated or go into overdrive. Attachment behaviours become heightened and intense as anxious clinging, pursuit or even aggressive attempts to control and obtain a response from the loved one escalate. From this perspective, most criticism, blaming and emotionally loaded demands in distressed relationships are attempts to deal with and resolve attachment hurts and fears.

The second strategy for dealing with the lack of safe emotional engagement, especially when hope for responsiveness is tenuous, is to attempt to deactivate the attachment system and suppress attachment needs. The most commonly observed ways of doing this are to focus obsessively on tasks and limit or avoid distressing attempts at emotional engagement with attachment figures. These two basic strategies – anxious preoccupied clinging and detached avoidance – can develop into habitual cycles of engagement with intimate others. Angry criticism, viewed through the attachment lens, is most often an attempt to modify the other partners inaccessibility, and as a protest response to isolation and perceived abandonment by the partner. Avoidant withdrawal may be seen as an attempt to contain the interaction and regulate fears of rejection and confirmation of fears about the unlovable nature of the self.

A third insecure strategy has been identified that is essentially a combination of seeking closeness and then a fearful avoidance of closeness when it is offered. This strategy is usually referred to as disorganized in the child literature and fearful avoidant in the adult literature. (Bartholomew & Horowitz 1991). This strategy is associated with chaotic and traumatic attachments where others are, at one time, the source and solution to fear. (Johnson 2002).

In general anxiety and avoidance foster a rigid hypervigilant attitude to novelty and uncertainty and an equation of letting one’s guard down with helplessness. All couple therapists will recognize these factors as preludes to and part of narrow rigid patterns of interaction and a constriction of the flexible openness necessary for closeness and connection.

These insecure habitual forms of engagement can be modified  by new relationships, but they can also mold current relationships and so can easily become self-perpetuating. They involve specific behavioural responses to regulate emotions and protect the self from rejection and abandonment., and cognitive schemas or working models of self and other.

In the attachment literature the term attachment styles, which implies individual characteristics, is often used interchangeably with the term attachment strategies, which implies behaviour that is more context specific. The use of the third term, habitual forms of engagement, further stresses the interpersonal nature of the concept. These forms of engagement can and do change when relationships change and are best thought as continuous, not absolute, (one can be more secure or less secure). The literature on these forms of engagement in the attachment dance helps the couples therapist see past all the content issues and the dramatic subplots to the key moves and stances in that dance.

9. Attachment involves working models of self and other: We define ourselves in the context of our most intimate relationships. As stated above, attachment strategies reflect ways of processing and dealing with emotion. Some spouses catastrophize and complain when they feel rejected, others become silent for days. Bowlby outlined the cognitive component of the representations of self and other that are inherent in these response patterns.

Secure attachment is characterized by a working model of self that is worthy of love and care and is confident and competent, and indeed research has found secure attachment to be associated with greater self efficacy. Securely attached people, who believe others will be responsive when needed, also tend to have working models of others as dependable and worthy of trust. These models of self and other, distilled out of a thousand interactions, become expectations and biases that are carried forwards into new relationships. They are not one dimensional cognitive schemas; rather, they are procedural scripts for how to create relatedness and ways of processing attachment information. These models involve goals, beliefs, and attachment strategies and are heavily infused with emotion. Working models are formed, elaborated, maintained and, most importantly for the couples/family therapist, changed through emotional communication. The couple therapist will recognize in his or client’s emotional self-disclosures the models of self and other that naturally well up in highly charged interactions with loved ones. Once distressed partners step beyond their angry protests, for example, they often begin to disclose fears about their own lovableness and worth.

10. Isolation and loss are inherently traumatizing: Lastly, it is important to recognize that attachment is essentially a theory of trauma. Bowlby began his career as a health professional by studying maternal deprivation and separation and its effects on children. Attachment theory describes and explains the trauma of deprivation, loss, rejection, and abandonment by those who we need the most and the enormous impact it has on us. Bowlby viewed these traumatic stressors, and the isolation that ensued, as having tremendous impact on personality formation and on a person’s ability to deal with other stressors in life. He believed that when someone is confident that a loved one will be there when needed, ‘a person will be much less prone to either intense or chronic fear than will an individual who has no such confidence’ (1973: p 406).

The couple and family therapist knows the stress of deprivation and separation well. It is an essential part of the ongoing drama ‘ordinary’ relationship distress. Indeed clients often speak of such distress in terms of trauma, that is, in life-death terms. As a theory or trauma, attachment theory specifically helps us to understand the weight behind emotional hurts such as rejection or perceived abandonment by a loved one. Distressed partners who are dealing with the traumatic helplessness induced by isolation and loss tend to adopt stances of flight, fight or flee that characterize responses to traumatic stress. The trauma perspective, with its focus on the power of helplessness and fear, helps the couple therapist tune in to the reality of distressed partners and deal with that reality constructively.

Adapted from:

Johnson, S. (2004). The Practice of Emotionally Focused Couple Therapy.

Brunner-Routledge: New York and Hove.

 BIBLIOGRAPHY:

Bartholomew, K. & Horowitz, L. (1991). ‘Attachment styles among young adults’ in Journal of Personality and Social Psychology, 61, 226-244.

Bowlby, J. (1973). Attachment and Loss: Vol. 2: Separation. New York: Basic Books.

Bowlby, J. (1979). The Making and Breaking of Affectional Bonds. London: Tavistock.

Fonagy, P. & Target, M. (1997). Attachment and reflective function: Their role in self-organization in Development and Psychopathology, 9, 679-700.

Fraley, C. & Waller, N. (1998). ‘Adult attachment patterns: A test of the typographical model in Simpson, J. & Rholes, W. (Eds). Attachment Theory and Close Relationships. New York: Guildford Press.

Johnson, S. (2002). ‘Marital problems’ in Sprenkle, D. (Ed.). Effectiveness research in Marriage and Family Therapy. Alexandria VA: AAMFT.

Macfarlane, A. & Van der Kolk, B. (1996). ‘Trauma and its challenge to society’ in Van Der Kolk, B., MacFarlane, A. & Weisaeth, L. (Eds). Traumatic Stress. New York: Guildford Press.

Mikulincer, M. (1995). ‘Attachment style and the mental representation of self’ in Journal of Personality and Social Psychology, 69, 1203-1215.

Mikulincer, M. (1997). ‘Adult attachment style and information processing: Individual differences in curiosity and cognitive closure’ in Journal of Personality and Social Psychology, 72, 1217-1230.

Mikulincer, M., Florian, V., & Westler, A. (1993). Attachment styles, coping strategies and post traumatic psychological distress in Journal of Personality and Social Psychology, 64, 817-826.

Schore, A. (1994). Affect Regulation and the Organization of the Self. NJ: Erlbaum.

SITUATIONS, EMOTIONS AND ADAPTIVE ACTIONS:

These are situations, (Column 1), which lead to primary emotional responses, (Column 2). The adaptive actions which follow from the emotional responses are in Column 3.

This handout supports individuals/couples to understand their emotional processes, their needs and how to communicate them.

It outlines a sequence where a:

• (i) a situation leads to an
• (ii) emotional reaction which leads to
• (iii) a behavioural reaction which hides a
• (iv) deeper feeling and an
• (v) underlying need

Understanding this sequence and being able to communicate the information it provides is vital, I believe, to: 

• (i) cultivate intimate relationships
• (ii) to manage conflict well
• (iii) to understand what your needs are in particular situations
• (iv) to own your experience and hence your part in an interaction.

On reading the diagram:

Read the diagram from left to right.

-Get a sense of the sequence of situation, experience, reactions and underlying emotions and needs.

-Then read the general and specific boxes, try to get a sense of your own emotional reactions to situations and interactive responses and how they could be improved by following the communicative sequence outlined below.

Note:

* Behind anger often is a hurt, and accompanying each hurt is an unmet longing or need.

WAYS OF GETTING THE MOST FROM YOUR GROUP EXPERIENCE:

(This is handout I give to participants of my interpersonal support/ exploration groups). 

• Recognize that trust is not something that ‘just happens’ in a group but that you have a role in creating it. If you are aware of anything getting in the way of a climate of safety, share your hesitation with the group.

• Commit yourself to getting something from your group by focusing on your personal goals. Before each meeting, make the time to think about how you can get involved, what personal concerns you want to explore, and other ways to use the time in the group meaningfully.

• Rather than waiting to be called on, attempt to bring yourself into the interactions at the beginning of each session by letting others know what you want from this particular meeting. Although it is useful to have a tentative agenda of what your would like to discuss, don’t cling inflexibly to your agenda if other issues surface spontaneously within the group. Be open to pursuing alternative paths if you are affected by what others are exploring.

• An important part of group process is expressing how you are being impacted by other group members. If you are able to identify with the experience of others, it generally helps both you and them to share your feelings and thoughts.

• Decide for yourself what, how much, and when you will disclose personal facets of yourself. Others will not have a basis for knowing you unless you tell them about yourself. If you have difficulty in sharing yourself personally in the group, begin by letting others know that you are experiencing difficulty disclosing and, if you are able, what makes it hard for you to self-disclose.

• Don’t confuse self-disclosure with story-telling. Try to avoid getting lost and overwhelming others with lots of information about you or your history. Instead, express what is on your mind and on your heart presently. Reveal your current life-experiences and what is significant to you at this time in your life, especially as it relates to what others are experiencing.

• Express feelings, thoughts, reactions that relate to what is emerging in the group in the here and now. If these thoughts, feelings are recurring than it is likely they are significant so feel free to express.

• Practice your attending and listening skills. If you can give others the gift of your presence and understanding, you are contributing a great deal to the group process.

• Use the group to experiment with new behaviours. Allow yourself to try out different ways to of being to determine how you may want to change. Discover how to extend new ways of thinking, feeling and acting into your outside life.

• Give yourself your own homework assignments and let the group know how you are doing.

• Attempt to make personal and direct statements to others in the group that are grounded in your own experience. Try not to give advice or make intellectual interpretations about other group members. Speak for yourself and about yourself.

• In giving feedback to others avoid making judgements about them ie. labeling or categorizing them. Tell them what you are observing and how their specific behaviours are affecting you.

• Provide support for others by expressing your care for them yet be aware of tendencies to ‘rescue’ or re-assure people. Too much of these behaviours may hinder group members from taking the space to express what they need to.

• Respect yourself, your limits and practice self-care at all times. Some group sessions you may be more vocal than others. Realize that you have changing needs and respect these.

• Be aware that some group sessions may provoke you. Be aware of this possibility and try to gain some learning from the experience. As always, use the group as support.

• Take responsibility for what you are accomplishing in the group. Spend some time thinking about what is taking place at these meetings and evaluating the degree to which you are attaining your goals. If you are not satisfied with your group experience vocalize this and/or look at what you can do to make the group a more meaningful experience for you.

• Be aware of respecting and maintaining the confidentiality of what goes on inside your group. Be aware of how easy it is to breach confidentiality, unawares, in inappropriate talk to others not in the group.  

• Be prepared if your friends and loved ones don’t understand, accept or support you as you change. Some people may find some of your new behaviours/attitudes challenging. Take care of yourself and be open to using the group as a form of support.

• Keeping a personal journal to record impressions of your explorations and learning in the group can be useful.  A journal offers a further tool of self-exploration where further clarification, of group insights, can occur.

• And…above all, be aware of the pleasure that arises through a more authentic contact with others.

 ______________________________________________________________________________

Psychiatrist

A psychiatrist is a qualified medical doctor who has specialized in a medical understanding of mental health. As a result, Psychiatrists primarily focus on the biological/neurological facets of psychological distress which involve the use of  various ‘chemical imbalance’ theories of mental illness. Psychiatric treatments, therefore, primarily involve prescribing medication. Psychiatrists are able to diagnose and are often used to conduct formal mental health assessments. Mostly psychiatrists do not provide counselling.

Psychologist

A psychologist is someone who has completed a Psychology degree and the requisite qualifications/supervision to belong to a psychology registration board.  Psychologists are primarily trained in a medical model of managing psychological distress which focuses on symptom reduction. The most common psychological approach utilized by psychologists is CBT, (Cognitive Behavioural Therapy) which focuses on changing behaviour and thinking styles and developing improved strategies for dealing with problematic situations.  Many psychologists, though, have trained in other, non-CBT, ways of working. Psychologists work mostly short term with clients.

Counsellor

Counsellors train in the traditions of what is known as the ”talking therapies”.  The counselling profession is broader, compared to the psychological profession, in its  approach to emotional distress and psychological growth. A great variety of counselling approaches, with long traditions of practice and efficacy, can be found practiced by counsellors. Whereas psychiatrists focus on medication and the biological/neurological facets of psychological distress, and psychologists primarily focus on teaching cognitive and behavioural strategies of change, counsellors often work integratively: utilizing various counselling approaches according to client need. Counsellors work mostly short term with clients.

Psychotherapist

The word psychotherapist is often used to imply 3 things (i) practitioner who has undertaken extensive training in working with clients from an emotional perspective, (ii) this training involving the practitioner undergoing their own therapy as a requisite to working with clients deeply, (iii) and that the focus of the work is longer term. Psychotherapists often focus on working on developmental deficits of clients, including enduring personality characteristics, that are not amenable to change through short term counselling/psychological strategies. An important area of focus of psychotherapeutic work is on the therapeutic relationship between client and therapist; this being an important space for creating change.

BRIEF COUNSELING:

Brief counseling can range from anywhere from 3 sessions to 20 sessions, although some schools of therapy may claim 20 is actually long term whereas other schools of therapy may claim 20-40 sessions is a relatively short amount of counselling! It depends on what schools of counseling are defining these terms.

In general brief counseling is often problem and solution focused. A client may have some symptoms, various particular problems they would like solved and the counseling stays focused on achieving the goals negotiated between client and counselor. Brief counseling is, what is often called, ‘directive’ counseling in that the counselor is mostly task oriented and works in a direct and active way in motivating the client to achieve their goals.

The focus of brief counseling is less an understanding of one’s personality dynamics but more on achieving quick changes in one’s life. This involves working more on cognitions and actions and less on emotions. There are limitations to brief counseling as often we have psychological patterns which are enduring enough as to require deeper and longer work to change. Yet, much therapeutic work of value can be engaged in brief counseling.

LONGER TERM PSYCHOTHERAPY:

Psychotherapy, or longer-term counseling, can be anything from 20-40 sessions to over 25 years of weekly sessions. (Irvin Yalom, the famous existentialist psychotherapist, saw a client for this long!). This form of work is more oriented towards a deeper exploration of personality dynamics. Rather than focusing on problem solving particular issues current in one’s life, although this can be part of the work, psychotherapy involves an exploration of enduring themes in one’s life. Although the focus is still on how these enduring themes are played out in the client’s life now, the therapeutic work often involves an awareness of past developmental issues and how they effect the present.

Psychotherapy often focuses on personality and relationship issues, especially how these manifest in the relationship between the client and the psychotherapist. The key to psychotherapy can often involve a close exploration of the relationship between the client and the therapist and how the client’s enduring themes of relating to others manifest in their relationship with the therapist. In this work the relationship between the client and the therapist is seen to mirror the client’s relationships to others outside of the therapy space. Gradual working through of what arises within the therapeutic relationship provides the opportunity for gradual change in this relationship and in the client’s other relationships.

In contra-distinction to the brief and more active/directive counselor the psychotherapist is less active, in being directed to helping the client achieve goals, but more focused on creating a ‘holding environment’ where the client feels safe and trusting enough to allow old wounds to arise and to be healed through the therapeutic relationship. The focus on this work is thus not on cognitions and behaviour, as in brief counseling, but more on the emotions underlying the latter.

Counselling is a confidential and ethically protected relationship with a trained and qualified practitioner who will take your personal concerns seriously.

There are different counselling styles or approaches. Some are more non-directive and the counsellor will mainly listen or strive to understand your deepest feelings; others are more active and perhaps directive and the counsellor may make suggestions or ask you to try certain activities.

Knowing which direction to take (for example, exactly what to talk about in the session) depends largely on you, on your intuition about what is most important, current or vital, but your counsellor may also prompt you or make suggestions. Don’t just wait for the counsellor to initiate things; and don’t treat your sessions as ‘just a chat’.

Counselling is mainly based on listening, understanding and responding; in other words, it is psychological therapy. Depending on training, each counsellor may emphasize thoughts, feelings or actions. Many counselors will address all these diminesions.

Counselling aims to help you understand yourself better and improve the parts of your life that have become stuck or painful. But it isn’t always smooth, predictable and painless; it will require patience and commitment on your part, as well as skill and knowledge on the part of the counsellor.

Counselling is a disciplined, ethical and professional activity but it is quite different from medicine, law, accountancy, and so on. This is because it focuses on each individual and their unique cluster of concerns, it includes emotions, and it sometimes works via feelings that are stirred up between you and your counsellor.

Counselling is a fallible activity. Counsellors are closely supervised. They should be ready to hear your views about the process of counselling and you have avenues for making complaints if not satisfied.

In my work there are certain modes of working and domains of exploration which are important. The following expresses some of these:

Faith in the client’s expertise, ability to self-regulate and to change: I approach therapeutic work as a facilitator of change whereby I help to create a certain environment, a certain relationship and utilize my skills in a way which empowers the client to create the changes they want in their life. I understand the client as having untapped resources of wisdom and clarity about what they would like out of life and how to regulate themselves in attaining this. My role is not to impose what I feel the client needs but to cultivate a certain space where the client accesses their own needs, power, self-regulation and ability to change and for them to create this change in their own way and at their own pace.

The client/therapist relationship: Many of the problems we experience in life are linked to relations to people and our challenges in having satisfying relationships. Often this is related to the dynamics of our relationships to our early attachment figures. Working through and healing many of our concerns often involves doing so in relationship. I attempt to provide an empathic, non-judgmental and authentic relationship with the client which allows for a safe exploration of the client-therapist relationship as a way to explore early attachment deficits. This way of practicing is based on the notion that the client-therapist relationship mirrors how the client relates to others. This exploration can be the key to therapeutic growth.

Emotion focus: I believe that therapeutic growth is helped through counselling that is grounded in an awareness of the emotions underlying our thoughts, (cognitions), and our behaviours. Accessing and working with emotions, rather than solely trying to change thoughts, allows a greater spectrum of the client’s life to be engaged in the change process. The psychotherapist Leslie Greenberg states that ‘you cant move on until you have arrived’. Often we carry wounds which have not been processed and are still having an impact on our lives. In order for us to move on we need to arrive at these wounds, feel them, process and make meaning out of them before we can let them go. My work as a therapist involves creating a safe and holding environment within the therapeutic relationship where whatever needs to arise and move on does so.

Mindfulness: Mindfulness is a word that arises out of the meditation traditions of the east. The theory behind mindfulness is that it is our attachment to emotions/ thoughts that create un-necessary suffering in our lives. Becoming mindful and less attached is a key to increasing freedom and peace in our lives. Mindfulness is used in western counselling/psychotherapy in two, general, ways: (i) as a strategy for clients to learn and practice outside of therapy, (ii) as a climate to be cultivated within the therapeutic encounter. In my work a key to letting go of old unsatisfactory ways of being involves ‘sitting with’ one’s experience, including one’s wounds, without reacting or becoming self-judgmental, and learning to accept oneself and one’s experience as it is. This mindful acceptance, paradoxically, allows for the creation of therapeutic movement and is often the basis for growth and the changing unproductive habits.

Body awareness and somatic orientation: The current psychotherapeutic world, especially the field of trauma studies, is strongly influenced by neuro-biological and brain-cognitive studies which are problematizing the idea that the mind and the body are separate. What is arising out of these studies is that we, humans, ‘are/have’ an ‘embodied mind’ or a ‘mindful body’ and that thoughts and emotions inhere in our bodies in various ways. These studies, and the schools of body-oriented psychotherapy, such as Somatic Trauma Therapy, claim that attention to body processes and increasing awareness of our experience of our body is vital in accessing not only our wounds but our potential. In my work mindful exploration of body-awareness can be an important and powerful way to free constrictions and stuck areas in one’s life. As there is a relationship between the mind and the body working through the body allows emotional and cognitive change to arise thus creating space for novel change in one’s actions in the world

Cultivating self-support: More often than not we are divorced from our own needs. Cultivating self-support involves being in touch with one’s needs and finding ways to support oneself in having these needs met. This may be through learning how to relax wherever you are in order to better manage day to day stress, creating the support for yourself that allows you to ask your partner/family/friends for what you need without feeling ashamed, learning to walk away from a situation when you know it is nurturing to you, learning to support yourself through healthy habits and not through destructive addictions and so on. Counselling and psychotherapy involves the internalization of the ability to self-support and a safe space where this self-support can be practiced. I find that engaging the client in a on-going conversation around what they feel they need in life and how they can have this need met is powerful and healing work.

Socially aware cognitive re-structuring: All counselling and psychotherapy involves cognitive re-structuring; changing how we see the world is correlated with psychological change. In this process I attempt to be aware of the ethical, social, ecological and political dimensions of the types of thoughts and linguistic structures client’s may be internalizing. Language has power and how we articulate the world has ethical, social, ecological and political consequences: the worldview we internalize becomes the world we live in. In my work with clients I find it important to raise awareness around such issues while engaging in conversations around socially aware and compassion based narratives.

Homework and experimentation: Much growth occurs in counselling ‘simply’ through the therapeutic relationship, talking and working things out during the session. Yet, experimenting with new ways of feeling, thinking and acting during the therapy session and outside it can only increase awareness around one’s patterns of being, possible novels ways of experience and help one to internalize one’s growth. I find it useful to negotiate with clients experiments during sessions in order to raise awareness around patterns of being and also to negotiate various forms of homework; creative tasks and experiments to be engaged in as a way to empower the client in their own self-exploration and growth.

Systemic/field focus: As much as we try to become independent we are, on many levels, inter-dependent with others. We exist and live within systems and fields of relationships such as families, peer-groups, work environments, organizations and political systems. Often clients come to counselling thinking/feeling that they are the carriers of all their problems and it is all their fault. Frequently it is the systems and relationships we find ourselves in which have problematic dynamics which create suffering in our lives. In my work I find it important to assess the systems in which people find themselves in and often the work involves raising awareness about and creating change within the systems people exist in. Often this involves empowering clients with a political orientation to their life-world.

Exploring, affirming and celebrating strengths, successes, connections, joys: Lastly, it is important to deconstruct counselling and psychotherapy as being solely about pain and suffering. Therapy can be and is so many things. Processes of change involve facing ‘unfinished business’, (old pain), facing truths about how one is that are difficult to digest, learning to act in the world in a way which is new, learning to let go old and dear habits which are no longer useful and so on. These processes can be challenging. Yet, a big part of this process is accessing vital, healthy and empowering resources that lie within one. Finding oneself thinking, feeling and relating to others in healthier ways is a joyful experience. At the heart of my work is a strong focus on therapy not as bunch of techniques to fix broken people but as a growth process which, in most cases, is a fundamentally positive experience.

 (This is a handout I give to clients at the initial session. Feel free to print it our for yourself, copy and pass it on if you are thinking of referring me to someone you know).

NAME:     Pedro Campiao

ADDRESS:

Lismore: Suite 3, 95 Molesworth Street Lismore. 2480 NSW.

Mullumbimby: Suite 2, (upstairs), 108 Stuart Street (Stuart stArcade) Mullumbimby 2482. NSW.

Postal address: PO Box 1237 Lismore NSW 2480

WEBSITES: www.pcampiao.com www.integrativecounselling.com.au www.northernriverscounselling.com.au

EMAIL: pedro@pcampiao.com

TELEPHONE: 0402 632 541. Call anytime and if I don’t answer please leave a message with the best time to return your call

PERSONAL PROFILE: Male. Married. 43 years old. First baby on the way.

TRAINING AND QUALIFICATIONS:

• Bachelor of Arts (USyd)
• Graduate Diploma (Adult) Education (UniSA).
• Graduate Diploma Counselling (UWS)
• Masters Gestalt Therapy (GTB)
• Cert Somatic Psychotherapy (426 hrs/2 years) (A.S.I.A.)
• Certificate IV Training & Assessment.

I am continuously updating my skills by attending professional training workshops.  

PROFESSIONAL MEMBERSHIPS AND AFFILIATIONS:

Clinical Member of CAPA (Counselling and Psychotherapists Association of NSW). Member No. 3825. www.capa.asn.au.

Associate Member of GANZ (Gestalt Therapy AustraliaNew Zealand). Member No. A477 www.ganz.asn.au

Both CAPA and GANZ are Member Associations of PACFA: the Psychotherapist and Counsellors Federation of Australia. (www.pacfa.org.au). Clinical Member PACFA. Reg. No. 21661.

 CODE OF ETHICS: I abide by the code of ethics of the above associations.

CURRENT EMPLOYMENT: 

• Private practice: counseling, psychotherapy, facilitation. Part-time.
• NSW Health,Northern NSWLocal Health Network: Counsellor. Part-time. 
• Director of Stuart St Practice Rooms, Mullumbimby.

WORK EXPERIENCE:  I have 14 years experience as a therapist. I have worked  for NSW Health and non-government organizations as a caseworker/counsellor in the areas of chronic illness, drug and alcohol, sexual health, mens’ issues, family support, mental health crisis, homelessness  In private practice I have worked as therapist in the areas of somatic/embodied therapy and in short and long term counselling/ psychotherapy with individuals and couples. I also have experience in the area of education and group facilitation including group therapy from a gestalt/relational perspective.

CLINICAL EXPERIENCE: I have interest and experience working with anxiety, depression, stress, low self-esteem, relationship difficulties, men’s issues, (including parenting, relationship, identity issues), GLBT clients, polyamoury, grief and loss, legacies of trauma and abuse, somatic/psycho-physiological complaints, attachment and developmental issues, family of origin concerns, issues of life purpose and direction, life transitions, self-actualization and growth oriented concerns, accessing creativity, integrating spiritual concerns

CONFIDENTIALITY: All counselling is confidential except in the following instances:

1. I must discuss my work with supervisors. 
2. If I feel that the client is a danger to himself or others, in which case breaking confidentiality will be discussed with the client.
3. If there are child protection issues the client is implicated in.
4.  If a Court of Law should subpoena my records.

All issues of disclosure of information would be discussed with the client beforehand.

SUPERVISION: My work is supervised in group and individual supervision.

CLIENT FILES: I keep short written notes on sessions. They are stored securely.

RECORDING SESSIONS: I may ask your permission to record sessions (audio) which will allow me to reflect on our work. With your permission I may take these recordings to supervision. These recordings are deleted after being used for the above purposes.

PUBLISHING CASE MATERIAL: I publish in academic journals in various counselling/therapy /educational areas. I may ask your permission to use details from our work which will be deeply disguised and unrecognizable. You have the right to refuse.

SESSION LENGTH: Sessions are 1 hr duration. 1.5 hrs can be negotiated if that is your preference.

SESSION FREQUENCY: I prefer to see clients weekly. Fortnightly sessions are possible. I prefer to see you for a few weekly sessions before beginning fortnightly sessions so that we have a strong working alliance in place.

DURATION OF WORK: I work short-term to long-term with clients; from less to 3 sessions to years. I like to negotiate and contract an initial number of sessions with you. Often this is 6 sessions, sometimes longer depending on the issues you bring. This provides us with an initial block of work, which is reviewed at the end of the contract. I have regular reviews of the work with you as we go along to assess whether your needs are being met.

FINISHING UP: When our work extends beyond 12 sessions, I recommend that we contract a number of sessions in order to end. Attending to endings and completion can allow a greater integration of the work.

APPROACHES INFORMING HOW I WORK:

• Relational psychotherapy.
• Contemporary gestalt therapy.
• Emotion focused/process-experiential work.
• Somatic/embodied psychotherapy approaches.
• Trauma studies.
• Mindfulness/Acceptance practices and Inquiry.
• Transpersonal maps.              

FEES: Appointments are $70 an hour. I have several concession places in my practice so feel free to discuss your financial situation with me and we can create a payment structure suitable to you.  

PAYMENT: Cash, cheque or bank deposit.                                                                                             

My bank details for bank transfer/deposit are: are:                                 

Pedro Campiao                                                                                                                           Commonwealth Bank:    

BSB:                 062 426    ACCOUNT:     1001 0590   

                                                                                                                                                                                                                                                                          RECEIPTS: I can fill out a receipt after every session, fill one out after a series of sessions or at the end of the counselling work.

CANCELLATION POLICY: It is important that I receive 24 hrs cancellation notice. If not an absolute emergency, cancellation on the day or not showing up to the session incurs a $50 fee.

INTOXICATION: I ask that clients do not come to session if intoxicated in any way.

The very existence of bad feelings within you is evidence that your body knows what is wrong and what is right. It must know what it would be like to feel perfect, or it could not evoke a sense of wrong.

Eugene Gendlin: Focusing.