Posted by Andrew on 18/7/2014, 6:19 pm, in reply to "Re: Improvement"
Hello Ann |
First I apologise for taking so long to reply; due partly to other commitments, and secondly by my feeling that it would not be a quick answer!
But first a health warning: I am not a professional practitioner: what is say is as a layman.
The workshops use a CBT approach to addressing paruresis, as an avoidant condition, so graduated desensitisation is used. In addition we address cognitive elements e.g. the participants’ false beliefs; this is done by explaining the real world, and also our own personal experience. We can also demonstrate some of these. We also instruct them in how the body works, both physically and psychologically. So you see that this is taking the participant where she is now, and working on moving forward.
What we don’t do, because we don’t have the time or the resources, is to deal with whatever caused the paruresis. We do have a session where they can share their experiences, including how it started (if they know); having broken the ice, we find they do talk more about it during the social parts of weekend.
You asked: “how, or if, the UKPT feel that counselling of any sort has an additional or supplementary role to play”.
It certainly can do. I feel the participants could be split into two categories.
1. Those for whom it is something to be dealt with, and who have no hang-ups about it.
2. Those who can identify to causative event, or have a hang-up
I feel the former do not need additional counselling: the CBT approach works for them
The latter however can benefit from counselling. There can be unresolved issues that impede progress with CBT. Vicious bullying in a school toilet can damage a child’s self-confidence; it can mean that entering a toilet can trigger the memory. So whereas for the first group, desensitisation is dealing only with the social aspect, for the second category, desensitisation has to desensitise also that unpleasant memory. Not the best way of dealing with it.
Counselling can unpack the memory, help the subject to unload her anger, help her to realise that the perpetrators are very unlikely to have any memory of the event, also that the subject is now an adult with autonomy, and not a pupil hemmed in by rules etc.
The anger aspect can be helpfully dealt with by sitting the subject facing an empty chair, and asking the subject to visualise the bully as sitting in the chair. Explaining that she is in a safe place with you, invite her to tell the story of what happened from her point of view, and/or to express how she feels about the bully. It needs careful and empathetic handing, and can be cathartic. One the bottled up memory and emotions is released, the subject can feel at peace, and then the CBT work can progress more effectively.
This is only one example. Generalised social phobia can be at the root of paruresis as well, in which case ongoing counselling and support is needed. To understand what GSP can be like, take the case of a young man I was with. A lunch I asked how he was; “not good” he replied. “I am feeling nervous and it is making me sweat. I feel embarrassed that the other guys can see I am sweating profusely and must be wondering why” . The CBT approach is to look for evidence that the anxiety is valid. So I told him that I had not noticed he was sweating. That startled him. I then offered to ask the other three guys, who were talking among themselves, whether they had noticed. He was a bit taken aback by this but agreed. So I interrupted the and others explained how Bill was feeling and why, and asked if any of them had notice Bill was sweating profusely. Of course they able to sincerely express total ignorance of his sweating. Bill was amazed by this; it was a major step forward for him.
So to summarise, where there is a traumatic causative incident, or a generalised anxiety condition, additional therapy is not only desirable but necessary. As to which style of counselling is needed, I am not qualified tot comment.
Hope this helps.