Tag Archives: therapy

To train or not to train, THAT is the question!

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I’ve been working therapeutically online, alongside face to face counselling, for around six years now providing therapeutic interventions via VOIP, synchronous and asynchronous text and over the phone.  I’ve worked with groups, one to one and supported an entire global online therapeutic community.  Believe me when I say the switch incurred a steep learning curve in the early days and I’m still learning now!

So, when I hear other practitioners saying that they’re qualified to work online because they’re qualified counsellors, therapists, psychologists or psychiatrists I break out in a cold sweat and develop a bit of a twitch!  Is it true that the BACP don’t tell you, you HAVE to undertake additional training to work on line?  Well…yes it is, but what they actually say is:

“Practitioners who offer online services need to ensure that they are suitably trained and qualified for their work and BACP recommends (Anthony, K. And Jamieson, A., 2005) that online work should be considered as a specialist area and practised only by those with extensive post-qualification experience of face-to face work. In addition, appropriate further training or professional development is strongly recommended before deciding whether to use the Internet for provision of therapy.” (BACP, October 2007)

And in my opinion we need to take their recommendation very seriously.

To work online, particularly with text, you need to find beauty and power in the words you use to sculpt your responses.  You need to be able to find the hidden meaning (where one exists) in a pause or typo and you need to enjoy creating vivid pictures, and indeed worlds, with your text.

Now….it will be of no real surprise to you that I love words :).   I’ll reread a well crafted phrase and the insights it allowed a client to reach with a sense of deep satisfaction and reflect on things I could have said differently to promote further development for the client.  There is a clarity provided by a complete transcript of a session that can’t be obtained through the subjective reflection on a face to face session that I relish.

To work online takes passion, and faith that this type of therapy works…it also takes preparation and training because you’ll feel things you didn’t know where possible, you’ll be frustrated at times and you’ll be surprised and even shocked if you haven’t done your research!

Imagine for a moment that you’re in your counselling room sitting opposite an acutely distressed client…they hold their head in their hands and clutch a tissue as tears stream uncontrollably down their cheeks.  Struggling to breath, and on the verge of the disclosure you’ve been working towards for several months, they promptly disappear…into thin air…..POOF!  How would you feel and what would your concerns be?  What would you have in place to make sure that client was safe?  Of course this doesn’t happen outside of the realms of sci-fi but when you’re working online a disconnection (deliberate or otherwise) will feel very much as I’ve described.

The considerations involved in working online are numerous they include the technology you would need to look into, a difference in the way we practice, the law, insurance issues and many other areas.  In all honesty it’s a minefield…but it’s worth it.

If you’d like to contact me to talk about the subject please e-mail me at jane.fahy@hushmail.com and if you’d like to learn more about some of the training that’s out there please go to http://onlinetherapyinstitute.com/ .

Thanks for reading 🙂

Jane Fahy (RMBACP)

 

Clinical Services Manager, Gambling Therapy

Tutor, Online Therapy Institute

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The Forgotten Friends and Family

Many organisations that work with problem gamblers focus mainly on the problem gambler themselves however, the effects on those around them can be devastating. Just take a look at how people are affected by the problem gambling of someone close to them for an idea of how much of an impact problem gambling can have on families:

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The partner or husband/wife of a PG

  • My PG often causes rows to give him an excuse to go out and gamble
  • My wife is too busy gambling online to attend family functions
  • My boyfriend no longer showers or takes care of himself in the way that he used to
  • My fiancé is moody all the time and I don’t know what to say for the best
  • My husband is often withdrawn and won’t talk to me about what is bothering him
  • I worry about the emotional health and security of my children

The child of a PG

  • I worry about the constant fights my parents have
  • My dad isn’t getting any younger and I am concerned about the effect this might be having on his health
  • I never seem to be able to do anything right, all I get is criticism
  • My mom is embarrassing me in front of my friends with her appearance and behaviour
  • I never expect anything for my birthday anymore but it hurts me when my dad forgets about his grandchildren
  • We don’t spend time together anymore
  • I can’t get the uniform and other things I need for school and I am being made fun of because of it

The parent of a PG

  • My son is always lying to me and manipulating me so that he can get his own way
  • My daughter regularly takes money from my purse and has now been caught shop lifting
  • My daughter frightens me sometimes because she can become violent if I don’t give in to her
  • My son can take off for days at a time and I don’t know where he is
  • My son has lost his job and now I feel that I have to help him to provide for his family
  • My daughter tells me that this addiction is all my fault

The friend of a PG

  • My friend is always asking me for money
  • My friend often lets me down when we are supposed to be going out
  • My friend asks me to lie for him when anyone asks where he is or what he is doing
  • My friend has stolen from me

Counselling, or otherwise supporting, the friends and family of problem gamblers often feels harder to me that supporting the gambler themselves. Each time I speak to someone new to the online service I work for I feel the same sense of powerlessness being transmitted through the Wi-Fi. I hear the same woeful cries of “If I could stop gambling FOR them I would” and the question that pulls at my heartstrings the most… “Is it my fault?”

As practitioners we have to fight through the feeling of powerlessness, there ARE ways in which friends and family can protect themselves and there are ways in which we can support them. Sometimes the most liberating thing we can say to a friend or family member is “It can happen to anyone, at any time, from any background so no, this isn’t your fault”.

Our role is to provide a safe outlet for the confusing emotions pouring out of our clients and give them the information they need to make sense of their situation. Of course the more practical advice around separating finances etc. is important but it’s secondary to the most valuable tool in our toolkit, acceptance. That might sound pretty common sense but given that problem gambling is still not widely understood, or in some cases even accepted as an addiction, those that love a problem gambler might have a battle on their hands when it comes to getting the support they need outside of their relationship with us.

In my remote training course, Counselling Problem Gamblers Using Blended Technologies, I talk more about the specifics around supporting the friends and family of problem gamblers online. You can find more information about this training course via the following link:

http://www.kateanthony.net/cpdspecials/

Thanks for reading 🙂

Jane Fahy (RMBACP)

Turtor, Online Therapy Institute

Clinical Services Manager, Gambling Therapy

Unleashing the Training Brain

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I was recently called upon, by Kate Anthony CEO of the Online Therapy Institute, to empty the contents of my brain, concerning working with problem gamblers, into a platform for remote training. It’s an odd sensation trying to pick over the knowledge and experiences you’ve accumulated over six years to try and determine what information might be interesting and useful and help others to support a client group you’ve developed quite a passion for. I think part of me was initially reluctant to share too much, what if everyone started supporting problem gamblers and I had no one left to work with?!? But then I thought about that, what if many more counsellors, social workers, support workers and addiction specialists started to support problem gamblers? Surely that would mean the client group I cared so deeply for, and frequently commented there wasn’t enough support globally for, DID get more support? That’s exactly what I want! 🙂

So here I am, after weeks of wondering… “Will they want to know about this” and hunting down other online resources each time asking myself…”Will they find that useful?” I’ve finally finished writing the course content! I’ve tried to cover as many of the aspects of working online, offline or both, with problem gamblers as I could fit into a ten hour course. I feel it will give anyone with an interest in working with problem gamblers by blending face to face and online support a robust grounding in the subject.

The areas covered are:

  • How do you know if someone has a gambling problem?
  • The theory of problem gambling
  • Working with problem gamblers
  • Working with friends and family
  • Online support for problem gamblers
  • Gaming and internet use for problem gamblers
  • Managing suicide and risk online
  • Using blended technology in a face to face and residential setting

If you’re interested in helping problem gamblers and you want to know more about the course please drop me a line at the following e-mail address, I’m eager to share my passion for working with this remarkable client group with others!

If you want to learn more about online therapy in general, the Online Therapy Institute have some amazing short courses that might be of interest to you 🙂

jane.fahy@hushmail.com

 

Merry Christmas?

christmasgambling

We’re coming up to a time of year that’s typically very tricky for problem gamblers and the people that love them. So I put together a Christmas recovery journey based on bits and pieces I’ve heard or read over the years, I hope you like it and take something from it.

Christmas Zero

Christmas creates panic….gut wrenching, soul destroying panic that steals the breath from your lungs and leaves you in a heap on the floor….paralysed. You’d managed to save a little, not a lot; to get the few things you wanted to get for the people that mattered most. You wanted to prove to them that you’re ok now and they can let you back into their lives……but the moneys gone. The urge was so strong you felt like your feet had a mind of their own and before you knew it you were stood outside the bookies with nothing……your Christmas hopes bob and weave on the back of the crumpled betting slip you threw into the flooded gutter.

You can’t believe it’s happened again, but you don’t know if you can change…you don’t know if it’s even possible. You switch your phone off and head back to your cold flat alone and on the walk you make a decision. Next year will be different.

There’s hope.

Christmas One

Christmas seems like a bloody big mountain to climb! It’s only been a matter of weeks since your last bet and although you’re feeling quietly confident you don’t relish the idea of being tested like this. “What if’s” buzz around in your mind seeking to derail you and erode your confidence and as you look down you notice your knuckles have turned white because you balled up your hands with the strain of it all.

You don’t trust yourself with money yet so you’re waiting for a friend to turn up with the money he’s holding for you so you can both crack on with a little Christmas shopping…the little you’ll be able to get this year still makes you feel a bit of pride when you think about it. But your mate’s late and the bus stop you’re waiting for him at is over the road from the arcade…sweat trickles down your neck as you pick up your phone and punch in his number.

“Where are ya mate?” you almost shout…as he hops off the bus right in front of you. You breathe a sigh of relief. You did it…you got through it….

There’s hope.

Christmas Two

Christmas means family but someone’s missing from yours. Your son hasn’t called for about three months now and you’re desperate to know where and how he is but when he called and asked for money you told him “No” and now you’re frightened you won’t see him again. You know you’re doing everything you’re “supposed” to do, what people told you to do…but it goes against every fibre of your being. As you lay the table with one less place setting than normal, you start to cry.

A few months ago he seemed better, he seemed to really be trying, but after he lost his job all the fight went out of him and he was back down the bookies as though nothing had changed. He said he didn’t know if he had the strength to get back on the wagon…you said you didn’t have the strength to be around him if he didn’t. Despite the ultimatums, tantrums and recriminations on both sides you really thought he’d be back on track by Christmas.

Your phone rings and you pick it up….there’s a moment of silence and then,”Hi mum, room for one more?”

There’s hope.

Christmas Three

Christmas seems like one big stress…got to get the kids the latest iPad…mum wants a nice perfume and HOW much is the works Christmas meal going to cost? You’re managing your debts and you’ve been paying them off for a while now but this kind of expense is really pushing you to your limits! You wonder to yourself if there will ever be a time when things are “normal”…sometimes it seems like you’ll never escape from the consequences of your gambling.

A single white envelope rattles through the letter box and plops on to the mat….you know that hand writing, and even if you didn’t the word “Daddy” is a big give away! It’s an uphill struggle, and there are days when you question whether it’s all really worth it, but looking at the card you know it is. Today it’s good to be in recovery.

There’s hope

Christmas Four

Christmas has a new meaning since you stopped gambling a few years ago and each time it comes around it reminds you of why did :). You look at those around you and the smiles on their faces when they open gifts you were able to buy for them and you’re momentarily transported back to a time when things were altogether different. You let the remembered sadness wash over you and then pass….and you’re relaxed, happy and stuffed to the gills with all kinds treats.

Christmas hasn’t been stress free…it rarely is….but it’s another year of being gambling free and when you reflect on that, you smile.

When you share the story of your recovery, you give others a lot of hope!

Thanks for reading 🙂

Same Day…Different Username :)

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Do you meet people in online therapy groups over and over that seem familiar?

 

People using online support often adopt online personas or “roles” within groups that coincide with an associated set of behaviours which can often appear unhelpful at the time. These sets of behaviours are referred to, in counselling terms, as “Games”. What I’ve attempted to do for the purpose of this blog is to identify some of these patterns of behaviours, using the Transactional Analysis Model as a loose framework to look at ways of working with them.

I’ve experienced a degree of psychological game playing in some of the groups I’ve facilitated and in one to one online therapy sessions over the years. They can be both frustrating and confusing at times, especially when I was new to all this :), because I might have had a sense of a game being played, but it felt like no one had told me the rules!

So….what I wanted to do was to blog about my perception of the kind of roles that seem to be reoccurring most often in my groups to see if anyone else had experienced similar things. During my group work I’ve spotted some of the following roles and the games they typically play, let me know if they sound familiar:

The Lurker – The lurker will spend most of his or her time saying nothing. Attempts to involve them in the group discussion will receive monosyllabic responses, if they respond at all. Whilst they may outwardly appear to avoid receiving attention their behaviour indicates a strong need for attention which others provide as they become “hooked” into the game and repeatedly attempt to elicit a response. The game usually ends when the lurker has received enough attention, positive or negative, when they will abruptly log out.

The apparently contradictory behaviour can be very frustrating so it can be easy to make numerous attempts to engage this person and effectively “play the game”. In order to manage the flow and dynamics of the group it’s important to fight this urge and ask only once or twice whether the individual has anything to contribute to the group.

What I’ve found is that if the individual isn’t getting the desired outcome they’ll choose to either log out, or engage with the people around them…of course we always hope for the latter outcome 🙂

Now, I KNOW that many people are shy and don’t really know how to use therapy groups when they first arrive and they’re not the people I’m talking about…of course it’s ok to be shy or reserved and all efforts should be made to encourage new people to feel at home. A Lurker is someone who carries out the above behaviour repeatedly over time without considering the impact it may have on others in the group which I feel is something completely different.

The Monopoliser – This person will talk (type) a great deal. They will often ignore what’s being said by others and carry on with their own train of thought regardless of any questions they’re asked. The aim of the monopoliser during this game is to receive collusion and sympathy. Ultimately to offload without being challenged in order to continue doing what they‘ve always done.

As no other comments have been made, or if they have been made they may not have been “heard”, the monopoliser can reassure him or herself that no one can help them to change their situation and there’s nothing to be done.

In order to counteract the game, the facilitator will need to involve others in the group by asking if they’ve ever been in a similar situation. The facilitator is required to manage the flow of the group to ensure that others all have a chance to share.   This might mean explicitly stating that time is limited and others in the group might be in need of support. If forums are available, it can be a good idea to direct the monopoliser toward them so they can share at length without being restricted by the group format. They’re then also unable to “block” responses from others by simply continuing to type.

The Joker – Diversion, distraction, smoke and mirrors are the currency of the joker. During this game the Jokers intention is to feel that he or she is working on their emotional wellbeing by attending the group whilst avoiding any meaningful discussion about the issues at hand. As their name suggests, the Joker will make jokes and potentially inappropriate comments during the group which can often derail the conversation and upset other group members.

It’s my job to tentatively challenge this behaviour by acknowledging that it can be very difficult to discuss emotional issues and making light of the situation can make it feel less intimidating.

Whilst we would like the Joker to engage on a deeper level they might not feel able to do so at this stage so we’re only able to manage their input to a certain degree and exclude them as a last resort if they become too distracting or offensive.   Terms and conditions, a contract or code of conduct are useful tools when it comes to challenging inappropriate behaviour online.

The Rebel – The rebel will appear averse to any suggestion. Ideas that the rebel is presented with by the facilitator or other attendees will typically be responded to with the words “Yes but….” before they go on to list the reasons why the idea wouldn’t work.

….”Yes but I couldn’t get to that meeting because….”

.…”Yes but I tried that and it didn’t work because……”

….”Yes but I would have done that if….”

My own experience of providing support online would seem to suggest that this is the most common game played by the people accessing online help. Individuals who are not ready to fully engage in recovery may use a site to “dip a toe in the water” but when faced with suggestions that could appear too difficult or even frightening they’ll discount them.

It’s important not to simply keep putting forward a myriad of ideas for the Rebel to discount as this leads to frustration on both parts. This could lead the Rebel to feel misunderstood or even bullied, potentially leading them to discount counselling altogether.

The facilitator can put an end to the game by reassuring the Rebel that recovery is a very personal thing and not all suggestions will suite everyone. The rebel should then be encouraged to take a creative look at their recovery and use groups to seek feedback on the ideas they come up with.

Online psychological games are common place, perhaps even more prevalent than during face to face support or counselling. The games people play are their way of confirming the facts as they see them whether that is that no one understands, that no one can help or that no one cares and our role is to attempt to show people that this perception is incorrect.

It can be frustrating when faced with any of the games I’ve talked about here and this frustration will only be exacerbated if we allow ourselves to be hooked into playing. With these, and many other psychological games, the only way to avoid frustration and hurt feelings is not to play.

The idea of psychological games is an integral part of the Transactional Analysis model for counselling. For further information on this please visit the following site: http://www.ericberne.com/Games_People_Play.htm

Thanks for reading 🙂

Running Online Support Groups

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Making the move from musician to conductor

I love all of the therapeutic work I carry out online, the one to one interventions are both challenging and rewarding due to the speed with which they progress, and the forums allow for the intervention of a therapeutic online community which complements the support I, and my team, provide.   By far and away my favourite method of support and therapy online though is group work. For the purpose of this blog “group work” refers to a synchronous, text based, group of up to nine attendees and one practitioner.

I run a range of online groups from structured therapy groups to themed groups and groups for people new to me and to recovery from addiction. Each group has a different feel to it dependent upon the group type, who’s in it and how many people are there.

Small groups require a lot of practitioner participation…at times I find myself posing hypothetical questions or sharing something about my own experiences to get the ball rolling (so to speak). In other small groups I might find myself in a situation where I have to remind people that others entering the group (if the group’s access isn’t restricted in some way) may be able to see some of what they have typed in order to ensure they’re mindful of the depth of material they’re sharing. I do this because it’s easy for people talking about intense emotions online to lose track of “where” they are and get drawn in by the anonymity of cyberspace and the feeling of intimacy created when talking to only a few people. In these kinds of groups I feel like a musician in an orchestra…playing along and harmonising to make sure the overall effect is what it needs to be.

A larger group is a different beast altogether 🙂 it takes focus and fast fingers to facilitate a large group and keep them on track…at times it feels rather like trying to herd cats but most of the time it’s captivating. It’s my role to make sure the flow of the group makes sense and that everyone has the opportunity to share. Of course this is something that counsellors do in a face to face group but online we have the disadvantage of not being able to see who’s leaning forward…chomping at the bit with a desire to share…or who’s been upset by a comment and may need support or clarification. Part of what I do is to involve people and clarify what is meant and understood by comments throughout the session. At times I encourage people to explicitly state what their bodies are doing so the group can see a mental image of how a discussion is affecting them. It’s up to me to spot if someone has withdrawn from the discussion and involve them again if appropriate. I also have to manage potential group monopolisation in a sensitive way. Ultimately I have to make sure people feel safe and heard in groups and to do this I make the transition from musician to conductor as I view the group as a whole and pay attention to the nuances in the conversation to better direct the symphony.

If you’re a counsellor considering trying online groups I can’t recommend them highly enough but I would strongly urge you to ensure you have taken part in the appropriate training before hand. Training providers I used, and was very happy with, are http://onlinetherapyinstitute.com

Thanks for reading 🙂

When Worlds Collide (First Published in TILT Magazine in May 2013)

Ok, so I’m not a techie, not really a techie, although I am married to a techie 🙂 but I do like online gaming and social networking and I have been known to frequent chat rooms in my distant past.  But all of that, well it’s just childishness really, just harmless escapism with no useful application; I wasn’t learning anything or developing any skills whilst engaging in these frivolous activities….or so I thought!

2014-04-08 17.53.26This is me 🙂

But I’m getting ahead of myself. I started my training as a counsellor about nine years ago, before that I worked in banking which is all very dull and irrelevant so I won’t bore you with that! At the time I had an eighteen month old daughter and I was working part time so I thought, well this is it, now or never, let’s do something that I really care about and my foray into counselling began.  I loved it every bit as much as I thought I would but with coursework and placements everything got a little bit stressful and I needed a way to unwind which is when my lovely (techie) husband said “Well why don’t you give World of War craft a go?”

So I did 🙂 by day I was a mild mannered (somewhat) trainee counsellor, mother and wife and by night I was a spell slinging uber mage with a penchant for turning monsters into sheep (Seriously you can’t make this stuff up). I loved the double life, the responsibilities I had for my personal and professional growth and development, for my clients and for my family were tucked away safely in the back of my mind while I romped through a fantasy world where I could be, or do anything.

But what did you learn, I hear you cry? Well my typing speed increased first and foremost! I learnt to work with large groups of people and communicate clearly with them via text.  I learnt that relationships forged online have value, my fellow players were not merely pixels on a screen they were mothers and soldiers and students, they laughed and cried and became frustrated (often with me, because in all honesty I wasn’t that great at the game!) and they were friends.  Eventually however I simply didn’t have the time to dedicate to the game and so with reluctance WoW and I parted ways.

Let’s move on a couple of years….

Having worked with compulsive gamblers for two years in a land based venue I was approached by an organisation that delivered support and therapy to problem gamblers online.  I’ll be honest here, I wasn’t convinced! How could I convey empathy, compassion and understanding via a computer screen?  How could I work with body language without a body to observe?  But that’s when it occurred to me, all of those times when I had understood others that I had only ever met online, I had shared things with those people whilst running away from goblins or trying to stop the zombie apocalypse.  Those connections had been real; those feelings had been real and those relationships had existed beyond and outside of cyberspace. So in that moment I understood that if I could recreate the strength of those connections with clients, albeit as part of a therapeutic alliance rather than a friendship, I could provide effective support and therapy.

I would like to say here that the epiphany didn’t mean that I was magically able to deliver effective online support just because I used to be a gamer.  Far from it! Certain ways of expressing things online are simply not appropriate when you are working therapeutically yet my fingers wanted to type the words anyway so I had to be very aware of that to start off with.  So I reached the decision to do things properly.  Proper training a high level of dedication and a wholehearted belief that I can really make a difference to others by delivering therapy online are what I need and whilst I have two out of three it is the first of these things that led me here.

I look forward to learning more and I know it won’t be easy but this is important to me so I’m prepared or work for it!

This article was first published in TILT Magazine (Therapeutic Innovations in Light of Technology) and I am pleased to say I have since qualified and continue to work therapeutically online.