client or trainee

[Dr Kate Hudgins]

yes, the article is one I have long used.  Mimi and I will be  
teaching a Director's Practice group in Taiwan next month on working  
with borderlines, so I appreciate any other articles anyone knows on  
about action methods with that dynamic.  Kate

On Sep 6, 2006, at 10:28 AM, PATRICIA DESERT wrote:

> Dear Ann--this sounds like Marsha Linehan's DBT therapy where each  
> client
> works with both a primary therapist in individual therapy and w/a  
> "trainer"
> in a skills training group.  No therapy or processing of any kind  
> around
> issues is done in the group--clients are role trained to take this  
> kind of
> material back to their therapist.  With a few exceptions the group  
> trainer
> focuses only on behavioral skills related to stress tolerance,  
> emotional
> regulation, interpersonal relating, etc. and cts thoroughly learn  
> about
> their diagnosis.  And of course clients have to be motivated to do  
> this
> work.  DBT is a wonderful model with lots of room for action  
> methods.  I'm
> looking into seeing if any groups like this exisit in Baltimore.   
> And thanks
> for the journal info.  I'll look it up.  Best regards, Patti
>
>> From: "Ann Hale" <annehale at swva.net>
>> Reply-To: list at grouptalkweb.org
>> To: <list at grouptalkweb.org>
>> Subject: Re: client or trainee
>> Date: Mon, 4 Sep 2006 20:15:44 -0400
>>
>> Patti, Stephen Sidorsky presented on, and wrote for the Journal an
>> excellent article on the Psychodramatic Treatment of Borderline
>> Personality, vol 37, no 3 (Fall, 1984) pp. 117-125.  There has  
>> also been
>> some succcess in treating a group of about six-8 who are entirely
>> borderline. They spend time in group getting to know their diagnosis
>> backwards and forwards, and prt of the sessions is identifying  
>> aspects of
>> it when it is occuring. The therapists (four) work in tandam of  
>> twos, and
>> the facilitators trade off, in sequence.  And, each person sees  
>> their own
>> therapist. It is an interesting approach. The purpose of the group  
>> is to
>> dilute dependency on the primary therapist.
>>   ----- Original Message -----
>>   From: PATRICIA DESERT
>>   To: list at grouptalkweb.org
>>   Sent: Monday, September 04, 2006 2:24 PM
>>   Subject: Re: client or trainee
>>
>>
>>   Hello Everyone--Adam hit on an area that deeply resonates for me  
>> at this
>> time--that is, characterological disorders.  I am in the midst of  
>> working
>> with two clients exhibiting classical symptoms of Borderline  
>> Personality
>> Disorder.  It continually manifests in rage at me for not fixing  
>> them, for
>> caring more for my other clients, for holding to time boundaries of
>> sessions when they are late, for not giving them 2 hr sessions  
>> whenever
>> they want them, for long phone message between sessions  
>> criticizing all
>> that I haven't done, for not remembering exactly what was said  
>> last summer,
>> last month, last week, etc., etc.  These criticisms are relentless.
>>
>>   I have had 18 years of enormously rewarding work with clients,  
>> mostly
>> Axis I disorders and some with mild to moderate Axis II.  Until  
>> this year,
>> after working with these two for over a year, I have never felt  
>> this sense
>> of frustration, anger, or at times inadequacy.  And for the first  
>> time in
>> my 18 years as a therapist I acted out my anger at one client and  
>> told her
>> with no compassion or empathy that her behavior was both rude and
>> disrespectful to me and to the other client whose session she  
>> attempted to
>> interrupt.
>>
>>   Obviously my stuff got triggered big time and I recognize that I  
>> need
>> supervision around this and am getting it.  However, I'm curious  
>> to hear
>> from anyone else who has had their own similar responses to these  
>> kinds of
>> clients and some action methods that were helpful, besides the TSM
>> Containing Double and mindful breathing, both which are definitely
>> powerfully helpful at times.   Private practice is sometimes a lonely
>> place, with little peer connection, and hearing from you all about  
>> your
>> experiences is helpful.  Thanks.  Patti
>>
>>   ----- Original Message -----
>>     From: Adam Blatner
>>     To: list at grouptalkweb.org
>>     Sent: Tuesday, August 29, 2006 2:11 PM
>>     Subject: client or trainee
>>
>>
>>     Hello All, Responding to an excellent professional question:  
>> Can a
>> group member join a training group: And responding further to Bud's
>> response (attached after this below):
>>
>>     Bud's attitude is understandable and somewhat compatible with  
>> many
>> directors and perhaps even Moreno's generous spirit, but it is  
>> also I think
>> mistaken for the following reasons. Part of this emerged with the
>> difficulties emerging with the encounter group fad of the 1970s:
>>           There are many people who are clearly mentally ill and  
>> just want
>> to get better, have no aspirations to being a therapists.
>>          Some people, on the other hand, are vibrantly healthy and
>> self-sufficient, and while they have some mild issues that need to be
>> worked on, they basically have the character to train and be  
>> therapeutic
>> for others, should they be interested in taking on that task.
>>            A significant number fall between the two, and their  
>> problems
>> are associated more with their interpersonal style. In the APA's  
>> Diagnostic
>> and Statistical Manual, the problems they encounter are noted in the
>> category called personality disorders, also known as "Axis 2"  
>> disorders.
>>             Many people who have depression, anxiety, and other  
>> Axis I
>> diagnoses are also co-morbid, meaning they have more than one  
>> problem--not
>> just their anxiety, but also character or personality tendencies  
>> that set
>> them up for the defeats that then eventuate in depression and/or  
>> anxiety,
>> or other symptoms.  (Another example of co-morbidity is the way  
>> people with
>> mild PTSD--perhaps not fulfilling all the criteria for full  
>> diagnoses--
>> and/or addiction problems may also come crashing into more clearly  
>> Axis I
>> types of symptom clusters.)
>>             The second and most important thing that wasn't much
>> recognized before the mid-1960s is the pervasiveness of varying  
>> degrees of
>> Axis II tendencies, which can be mild, moderate, or severe, and  
>> more, the
>> key here is that these folks don't have primary anxiety--i.e.,  
>> feeling
>> ego-alien or uncomfortable with their own symptoms; rather they are
>> ego-syntonic with their life style, whether it be passive-aggressive,
>> obsessive-compulsive, hypomanic, hystrionic, borderline,  
>> narcissistic, etc.
>> What this means is that they become upset when people get tired of  
>> their
>> behaviors, abandon them, divorce them, fire them from their jobs,  
>> but they
>> don't see what they did that got people so riled up!  Folks with  
>> character
>> problems tend to deny it, minimize it, and so forth. Now we're  
>> getting
>> closer to the games people play in wanting to become "therapists."
>>           It doesn't matter if you buy the diagnostic categories I've
>> mentioned--they're just tools, and I'm not all that attached to  
>> them in
>> their specifics. What we're talking about is, in Eric Berne's  
>> Transactional
>> Analysis language, the "games people play."
>>            I will confess that I have some mild characterological
>> tendencies, and I haven't met anyone yet who doesn't have a bit,  
>> so we're
>> talking about how much, and whether a person is really committed to
>> cleaning up his or her act. Lots of folks don't really get down.
>>
>>          Perhaps another factor here is whether much significant  
>> therapy
>> can happen in a group--especially a training group. The problem is  
>> that
>> there is a dual relationship: On one hand, there is the deal with my
>> problems goal; on the other hand, there's a bit of do you respect  
>> me as a
>> therapist, can you? I confess, there are people with patterns of  
>> behavior
>> that are intense enough, and lack of insight deep enough, and a  
>> kind of
>> resistance to really looking just thick enough, or lack of mental  
>> agility,
>> so that while I might find them okay to work with as clients, I  
>> would never
>> ever consider them capable of actually helping others. We have to  
>> really
>> get clear about this.
>>           I am afraid that there is a kind of humanistic  
>> egalitarianism--
>> in California it used to be called "woo woo," that is post-Hippie
>> "whatever" "it's all good" blind to the actual range of issues in  
>> people.
>> It would be nice to assume that all can be wonderful, but there is
>> absolutely no evidence that supports this assumption.
>>
>>         So back to the problem: I've been in groups, sometimes  
>> with people
>> who were in counseling programs, and it was clear to me that they  
>> were not
>> only miles from being ready to help others, or even begin to; but  
>> were
>> fairly blind to the deficits in their personalities that would be
>> problematical: Some were painfully inhibited, passive, reticent,  
>> highly
>> defended; others were "drama queens," seeking emotional catharses and
>> tending to dominate and exhaust the group. And so forth.  
>> Experienced group
>> leaders could make a list of their most trying group members.
>>
>>          We must also remember that the desire to graduate, to be  
>> seen as
>> being good as the group leader, to be a trainer, is a common  
>> desire of
>> people whether or not they have the talent, ability, experience,  
>> maturity,
>> or other role requirements for the job. To accede to such desires  
>> is only
>> one step away from letting any teenager do brain surgery without  
>> having to
>> go to medical school, much less residency.
>>
>>              So, yes, trainees who have more than the mildest of  
>> problems
>> should indeed have as their primary therapist someone who is out  
>> of the
>> stream of their own vocational guidance, someone who can confront  
>> their
>> manipulations, and someone to whom they don't have to hide those
>> manipulations. They also need someone outside the group to whom  
>> they can
>> complain about the group leader. (This observation is a variation  
>> on the
>> saying, "No man is a hero to his wife's psychotherapist.")
>>
>>             So it's not the "rules," that are the problem, but the  
>> actual
>> principles that acknowledge the reality that transferential  
>> problems will
>> emerge, they are common, and they are made almost impossible to  
>> address if
>> the group has any other agenda than the commitment to explore the
>> interactions themselves, with a view to clearing up blocks and  
>> blind spots.
>> A secondary hope to be appreciated, admired, respected, to prove
>> competence, to gain final approval for vocational advancement, is a
>> significant dual relationship. Add the financial element: What is  
>> the group
>> member paying for, therapy or training? This further muddies the  
>> water.
>>
>>         Well, sorry, but I want to indicate to the group members  
>> that the
>> more conservative practitioners aren't just defending their guild  
>> status,
>> but trying to address actual complexities in dual  
>> relationships.      I'm
>> open to your thoughts. Warmly, Adam Blatner
>>
>>
>>       ----- Original Message -----
>>       From: BARNETT WEISS
>>       To: connie at souldrama.com ; list at grouptalkweb.org
>>       Sent: Tuesday, August 29, 2006 11:52 AM
>>       Subject: Re: Question
>>
>>
>>       Of course, I am not a TEP so I can only answer from my  
>> perspective
>> having trained many persons in the past in some of the work in  
>> many venues.
>>  I really don't see what the problem is in welcoming a person from  
>> one of
>> your groups into a training program. If there is to be a  
>> distinction drawn
>> about this, I am not at all clear as to why there should be.
>>
>>       Psychoanalysis to begin with and many other psychotherapeutic
>> approaches have implicit rules about the relationship of the  
>> therapist to
>> the client that exclude such conversions and even those are  
>> somewhat murky
>> decisions.  In most of the training programs, you have to go  
>> through the
>> therapy yourself to be more completely aware of what your clients  
>> are going
>> to be experiencing when you work. So the trainee has to find  
>> someone else
>> to do the therapy with them.
>>
>>       In the training groups that I have lead, I was doing the  
>> therapy for
>> everyone at first and then working with the more advanced students
>> co-directing the psychodrama's of other members of the group as we  
>> went
>> along with greater and greater hands off as they built their  
>> skills and
>> confidence. I really don't quite see the distinction here. I also  
>> made
>> myself vulnerable at times and became a protagonist briefly  
>> choosing my
>> director and working with it.
>>
>>       I remember a time at Beacon when Zerka asked me to direct  
>> her in her
>> own psychodrama as she needed to get some clarity about some  
>> things. I was
>> happy to do so while others in the group were quite fearful and  
>> actually
>> reacted very intensely when Zerka was working as it brought up a  
>> great deal
>> for them. While dealing with the group became quite a challenge, I  
>> was
>> quite confident in working with this protagonist since I knew that  
>> I had
>> one of the best co-directors ever...Zerka!!
>>
>>       In fact, I see everyone's psychodrama as being co-directed  
>> by the so
>> called designated Director and the protagonist themselves. If you  
>> are not
>> following the direction of the protagonist, in my estimation, you are
>> moving in the wrong direction. Words similar to those from Zerka are
>> emblazoned in my memory.
>>
>>       So again, I don't get why a client couldn't become a trainee  
>> at any
>> time.
>>
>>       Blessings, all, Bud
>>
>>       Connie Miller <connie at souldrama.com> wrote:
>>         Dear Adam:
>>
>>          Muddy?? This is a swamp!
>>
>>         Ultimately it is the decsion of the trainer.  My groups  
>> are for
>> "Training in Aciton Methods"  and they also comprise those wanting
>> psychodrama certification.  This in fact stimulates those in  
>> training to
>> want to get certification later in psychodrama.  Otherwise I feel  
>> like we
>> will never have those certified to do psychodrama increase and
>> psychodramatists will then become a special and exclusive group  
>> and will
>> die.  Also this is why I agree with you about teaching different  
>> parts of
>> psychodrama separately to help spread psychodrama.  And of course  
>> I would
>> never allow anyone in the group who was not using the group  
>> methods in
>> thier own work but only wanted to use the group for therapy.
>>
>>         I however am studying for the written part of the tep exam  
>> where
>> it asks under the ethics part,,, what do you do if someone in your  
>> therapy
>> group wants to join your training group?  Technically I guess the  
>> right
>> anser is not allowing duel relationships but is this what the all the
>> traianers are actually doing?? Right now, I have only met one.   
>> this is why
>> I am looking for group feedback.
>>
>>         Thanks Connie
>>
>>
>>         -----Original Message-----
>>         From: Adam Blatner [mailto:adam at blatner.com]
>>         Sent: Monday, August 28, 2006 08:39 AM
>>         To: list at grouptalkweb.org
>>         Subject: Re: Question
>>
>>
>>         Dear Peter, Connie, and group.
>>                Peter, your open-hearted attitude is commendable,  
>> but I
>> wonder if you have considered the potential for less-than-worthy
>> motivations. There are people who want the status of  
>> professionalism, but
>> are yet unwilling to take on the full responsibility for self- 
>> management
>> that this implies. What I'm referring to is the role of "patient" or
>> "client," in which the therapist has a more non-judgmental  
>> attitude of
>> "I'll try to help you at the level that you are functioning." Some  
>> of these
>> levels can be quite immature, entitled, un-self-modulated, dependent,
>> passive-aggressive, and so forth. Many people are not willing to  
>> live up to
>> the simplest requirements of being responsible enough to pay  
>> regularly and
>> in good faith, to show up regularly and on time, of refusing to be  
>> civil
>> under the excuse of victimhood or the right to emotional  
>> expressiveness,
>> and so forth.
>>                To move to a training group is a kind of graduation  
>> into a
>> recognition by peers and group leader that one has moved into a full
>> process of taking charge of one's life. Not all issues are  
>> resolved--I
>> quite agree with Peter about this-- but there has been a  
>> graduation of
>> sorts that is the equivalent of finishing therapy in the sick or
>> dysfunctional role.
>>
>>              The problem is tricky, and it is a dual role--  
>> clients wish
>> for unconditional regard, but this term is misleading. It confuses  
>> the
>> archetypal maternal unconditionality--I'll draw you forth however  
>> you may
>> be, age 1, age 3, age 8, age 80...
>>                   and the archetypal paternal conditionality: You are
>> recognized as being qualified to swim, do brain surgery, take 2nd  
>> level
>> geometry, only when you have clearly demonstrated your mastery of  
>> the first
>> level or other realistic requirements.
>>
>>            Alas, the actual requirements for training as a  
>> counselor have
>> become hopelessly muddy, and it is quite possible to be excessively
>> immature and still get into a training program somewhere, and even
>> graduate. This is because there are significant financial  
>> incentives to
>> accept all comers, to keep people in rather than wash them out, to  
>> blur and
>> overlook deficiencies. Arguments that the number of training  
>> programs and
>> trainers should be limited evokes counter-accusations of being  
>> elitist and
>> guild-like.  Arguments that call on the belief in the innate  
>> goodness of
>> people confuse the reality of people being a nexus of hundreds of  
>> roles and
>> role components, some of which are more talented, and the ways  
>> strengths
>> often compensate for, and not infrequently disguise weaknesses. So
>> significant discrimination is needed.
>>
>>             In some universities, this graduation - acceptance into a
>> graduate school - problem of transference, dependence, and  
>> approval is
>> circumvented by a general policy that there be a period in which  
>> graduates
>> must travel elsewhere and perform for supervisors who have not  
>> been in the
>> nurturing role, the object of parental transference.  Perhaps  
>> later, having
>> demonstrated clear competence and maturity, they may be re- 
>> considered for a
>> position in the upper graduate or even lower faculty level.  It's an
>> interesting challenge--perhaps one that requires a hard look at  
>> the limits
>> of good feeling, tele, etc.
>>
>>               I hope I haven't muddied the issues too much.  
>> Warmly, Adam
>>           ----- Original Message -----
>>           From: Peter Howie
>>           To: connie at souldrama.com ; list at grouptalkweb.org
>>           Sent: Sunday, August 27, 2006 10:49 PM
>>           Subject: Re: Question
>>
>>
>>           Hi Connie,
>>
>>           It is often a natural step. The psychodrama groups are
>> developmental. The training is developmental. Not all work can be  
>> done in a
>> training groups and hence experiential groups are required as well  
>> for
>> trainees. Not all development can be done in experiential groups  
>> and hence
>> training is available. What does the training do? It expands a  
>> persons
>> functioning, their capacity for warming themselves in a spontaneous
>> fashion, their capacity to role reverse with others and creates  
>> mental
>> models for the process of doing so. While I run the groups  
>> differently the
>> larger purpose is the same - a more spontaneous world.
>>
>>           Cheers
>>
>>           Peter Howie
>>           Brisbane, Australia
>>
>>
>>
>>
>>           At 12:19 PM 24/08/2006, you wrote:
>>
>>             I was wondering what other trainers do when  a group  
>> member
>> wants to join the psychodrama training group. what are your  
>> feelings on
>> them being in both?
>>             Connie
>>     Grouptalk mailing list
>>     List at grouptalkweb.org
>>     http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org
>>
>>
>>
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Kate Hudgins, Ph.D., TEP

Clinical Psychologist
Director of Training
Therapeutic Spiral International, LLC
ww.therapeuticspiral.org
drkatetsi at mac.com



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