Nuttall, S. and Scott Stewart, M., 2004. Naming or Shaming?. Reformulation, Spring, p.3.
What is the core, the heart of therapy? Would we agree it is the relationship between therapist and client? The role of the institution is to protect the heart, to help it function and beat strongly. All the systems that surround it, the association, its institutional structures, training, supervision, are created to support the individual relationships, the couplings, that are made in CAT
An important part of this scaffolding is that it should remain strong and safe enough for colleagues, therapists and clients to talk about situations which seem to have gone against the normative values – the exceptions that ‘probe’ the rules, (not ‘prove’, a popular distortion of the logical aphorism.)
The question is, is the structure safe enough for people to come forward if they have concerns about their own situation, or are concerned about the situation between therapist and client that seems to go against the ethical guidelines, to be a transgression of the rules?
The backstory of the proposed changes to the ethical guidelines, discussed and voted on at the AGM in November 2003, is not known, and was not part of the discussion which led to the position being maintained. (see Steve Potter’s helpful letter). Never’ was to be upheld. Was this delicacy a sparing of the feelings of the couple at the centre of the storm or an avoidance of the confronting of an individual case? Their story was strangely absent from the discussion, and yet their relationship was palpably present and the heart of it.
In a small organisation where patients soon become colleagues, we can all find ourselves in groups or work situations with people we were in therapy with, either as therapists or patients. We are thrust, by the nature of the organisation, into adult relationships, assuming autonomy, with people who have been our responsibility, in transference and as dependents. Do we in CAT believe we have created this autonomy through our work? Are we less sure and believe the transference will be active throughout a lifetime? In some way, this seems to question what we do at the heart of CAT. Many small situations where boundaries may be transgressed echo the unnamed couple’s situation, eg; small group workshops, specialist groups, Council, committees, Conference, are all places where therapist and client meet.
How are we to talk about this in the present structure? Is it safe enough to allow for this kind of discussion? Has understanding and possibility of creative discussion has been lost in the silence that has surrounded the present case? Valuable colleagues may have been lost. It is hard to quantify what spin off there has been from this.
A peculiar situation has arisen. The couple who have fuelled anxiety about the guidelines have been exonerated. What can we make of this when we are maintaining rules which seem to be at odds with their position? What reciprocations have we been carrying in relation to what is not known; the imagined particulars of their story? How do we move from the particular to the general? Where is the therapeutic space outside the fantasy of the RR of powerful therapist to powerless patient? Is there the possibility of something else? Recognition and revision? Or is forbidden intimacy always a procedure?
Powerful rule breaking parents to powerless, fearful, enraged, judgemental child. Did these Reciprocal Roles initially apply to the couple involved in relation to Council. Has a parallel situation now come about, where Council is in the parental position, and the membership in the child place?
The fears that have surrounded the case may largely have been created by lack of knowledge and information, but, the details are confidential, and rightly so. Should we have been told more, would that have helped us in our thinking and decision making? This has probably fuelled distress in those who are directly connected to the couple in training, supervision or therapy. It has meant that a figure who has been part of so many people’s experience of CAT may be lost to the organisation, and that the couple has been ostracised and vilified.
The Code of Practice has not been changed, ‘never’ is the crux of the issue. But ‘never’ denies the reality of the constant fraternisation of therapist and client in ACAT and makes it hard for openness in important relationships. Any of us may be in a position where we find ourselves in an adult relationship (which can also be sexual) with a colleague at work. What do we do if we find ourselves transgressing the boundaries of therapy either in a conversational or sexual intercourse with someone to whom we have given therapy?
If there is no space for discussion, it will inevitably go underground. How can we nurture openness to avoid the repetition of this painful situation which has taken a number of years to get to this point?
Mog Scott Stewart
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A Cognitive Analytic Multicomponent Psychotherapy Program, for the Treatment of Severe Personality Disorders in an Intensive Outpatient Unit.
Mirapeix, C., Landin, S. and Alvarez, V., 2004. A Cognitive Analytic Multicomponent Psychotherapy Program, for the Treatment of Severe Personality Disorders in an Intensive Outpatient Unit.. Reformulation, Spring, pp.10-13.
Book Review: Managing Intense Emotions and Overcoming Self Destructive Habits: Lorraine Bell
Hobson, J., 2004. Book Review: Managing Intense Emotions and Overcoming Self Destructive Habits: Lorraine Bell. Reformulation, Spring, p.32.
Untying the knots: relational states of mind in Cognitive Analytic Therapy?
Potter, S., 2004. Untying the knots: relational states of mind in Cognitive Analytic Therapy?. Reformulation, Spring, pp.14-21.
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