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Monday, 26 March 2012

Some Thoughts About Counselling

Writing as a psychologist who reads the BACP Journal to keep in touch with the world of counselling, I was left perturbed by an article named Who Is This Man? March 2012.

The client C.W. in this article ruminates about the wish to know more about her therapist and thinks that after 3 years of therapy it is “not fair” for disclosures to go only from her to her therapist. She manages to extract from him a confession that he has once lost his temper with a mobile phone as did she. Thereafter the client begins to quest for other ways of getting information from him (along the lines of you show me yours and I’ll show you mine) so that she can feel that her therapist is “real”.

Perhaps it is normal for a client to start wondering about the personality/life of a counsellor. It is more sinister to think it isn’t fair for disclosures to go one way (why not?) and to use the counselling space to manipulate information from the therapist – instead of attending to the process of growth and change. Where does it stop? The client seems to be showing all of the signs of narcissism, the effects of which presumably have got her into therapy in the first place. Why is the counsellor not bringing this into the room? And when a therapy extends 3 years, what on earth is going on?

In an earlier version of the BACP Journal, a similar process was taking place where the client wittered on to the point of indigestion (mine) about whether her therapist would think about her while he was on his holiday. I hope that he did not, but why is this stuff published without comment?

Congruence is important, and I may use some of my own emotional reactions judiciously to help the client validate and develop their emotional vocabulary, to build resilience. But the narcissism/dependency of client submissions in the BACP Journal read distastefully. Does anyone else feel this?

If I want my health addressed, I would choose an expert who knows their job; There is no concern to know the details of their private life. Nor do I mind whether the physician thinks about me once I have left the room. Perhaps counsellors should give their clients an introductory booklet in which conditions of the counselling relationship are laid bare. Disclosures DO go one way; the counsellor does not and maybe should not give the client mental space once the session is finished, the notes are written and the supervision is under wraps. Would that be too difficult to bear?

Wednesday, 21 March 2012

Ghrelin Or Gremlin - To Coin A Phrase

Title with acknowledgement to Richard Robinson
Did anyone see last nights Horizon Programme about Obesity .... the ultimate facts?

The programme pointed to some distinct differences between people in terms of their suceptibility to overweight, with focus on two hunger and satiety hormones, ghrelin and Pyy3-36. The programme suggested that bariatric surgery would correct the appetitive brain and make fatty sugary foods unattractive.

Having watched the programme, I feel that it was unduly reductionist. For example the distinct differences between the hunger and satiety hormones ghrelin and Pyy may have been caused by overeating and may not be endogenous. There are many other less well understood appetitive hormones which play a role in eating.behaviour.

The brain changes in bariatric patients affecting reward systems and the drive to eat high fat/sugar foods might well be influenced by gut function. Bariatric patients do tell me that they feel transformed by their operations. However the programme did not inform us about the cons of surgery.

I have sought the opinion of someone who is overweight and not an obesity professional, who didn't find this programme very useful. He said, I don't want surgery, is this the only thing that I can do?

It might be useful to have people believe that obesity is "not their fault". There are differences between individuals in terms of genes, life experiences, cognitive function, maternal eating habits in pregnancy, emotional resilience, environment and physiologcal makeup. So obesity treatment will remain complex and personal. One day there may well be a brave new world where each child showing risks for obesity can be fitted with a gut implant to control their appetitive brain. Until then, the battle against our fat cells continues.