Friday, April 23, 2010

A Peer-to-Peer Approach to Psychotherapy? Co-Counseling and Beyond

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An interesting article from Michael Bauwens at the P2P Foundation blog. He includes material from John Heron and Independent Practitioners Network. I am actually familiar with one element of this idea, the Co-Counseling program, which is a very effective way for people trained in the model to work on their issues in dyads or small groups.

Here is John Heron's entry on Co-Counseling from the P2P Wiki:

This is a form of peer-to-peer self-help psychotherapy originated by the late Harvey Jackins in the USA in the 1960s and 1970s. Jackins called the method Re-evaluation Counselling, and subsumed the peer process of reciprocal counselling - in which two people take turns as client and counsellor - within an authoritarian cult. In 1974, John Heron and Dency Sargent founded the distinct Co-counselling International (CCI) to affirm the peer principle in mental health liberated from authoritarian constraints. CCI now embraces independent peer organizations in Australia, Belgium, Canada, Germany, Holland, Hungary, Iceland, Ireland, New Zealand, Spain, Switzerland, UK, USA. The following Definition and Principles are currently those adopted by the membership of CCI.

A Definition of Co-counselling International

CCI is a planet-wide association of individuals and local networks committed to affirm a core discipline of co-counselling while encouraging, on an international and co-operative basis, the advancement of sound theory, effective practice, network development and planetary transformation. Local networks of co-counsellors within CCI are independent, self-governing peer organizations, exploring ways of being effective social structures while avoiding all forms of authoritarian control.

Any person and network is a member of CCI if :

• they understand and apply the principles of co-counselling given below

• they have had at least 40 hours training from a member of CCI

• they grasp, in theory and practice, the ideas of pattern, discharge and re-evaluation

The Principles of Co-counselling

1. Co-counselling is usually practised in pairs with one person working, the client, one person facilitating, the counsellor, then they reverse these roles. In every session each person spends the same time in the role of both client and counsellor. A session is usually on the same occasion, although sometimes people may take turns as client and counsellor on different occasions.

2. When co-counsellors work in groups of three or more, members take an equal time as client, each client either choosing one other person as counsellor, or working in a self-directing way with the silent, supportive attention of the group. For certain purposes, the client may request co-operative interventions by two or more counsellors.

3. The client is in charge of their session in at least seven ways:

• trusting and following the living process of liberation emerging within

• choosing at the start of the session one of three contracts given below

• choosing within a free attention or normal contract what to work on and how

• being free to change the contract during their session

• having a right to accept or disregard interventions made by the counsellor

• being responsible for keeping a balance of attention

• being responsible for working in a way that does not harm themselves, the counsellor, other people, or the environment.

4. The client's work is their own deep process. It may include, but is not restricted to:

• discharge and re-evaluation on personal distress and cultural oppression

• creative thinking at the frontiers of personal belief

• visualizing future personal and cultural states for goal-setting and action-planning

• extending consciousness into transpersonal states

CCI takes the view that the first of these is a secure foundation for the other three.

5. The role of the counsellor is to:

• give full, supportive attention to the client at all times

• intervene in accordance with the contract chosen by the client

• inform the client about time at the end of the session and whenever the client requests

• end the session immediately if the client becomes irresponsibly harmful to themselves, the counsellor, other people, or the environment

6. The counsellor's intervention is a behaviour that facilitates the client's work. It may be verbal, and/or nonverbal through eye contact, facial expression, gesture, posture or touch.

7. A verbal intervention is a practical suggestion about what the client may say or do as a way of enhancing their working process within the session. It is not a stated interpretation or analysis and does not give advice. It is not driven by counsellor distress and is not harmful or invasive. It liberates client autonomy and self-esteem.

8. The main use of nonverbal interventions is to give sustained, supportive and distress-free attention: being present for the client in a way that affirms and enables full emergence. This use is the foundation of all three contracts given below. Nonverbal interventions can also be used to elaborate verbal interventions; or to work on their own in conveying a practical suggestion; or, in the case of touch, to release discharge through appropriate kinds of pressure, applied movement or massage.

9. The contract which the client chooses at the start of the session is an agreement about time, and primarily about the range and type of intervention the counsellor will make. The three kinds of contract are:

• Free attention. The counsellor makes no verbal interventions and only uses nonverbal interventions to give sustained, supportive attention. The client is entirely self-directing in managing their own working process.

• Normal. The counsellor is alert to what the client misses and makes some interventions of either kind to facilitate and enhance what the client is working on. There is a co-operative balance between client self-direction and counsellor suggestions.

• Intensive. The counsellor makes as many interventions as seem necessary to enable the client to deepen and sustain their process, hold a direction, interrupt a pattern and liberate discharge. This may include leading a client in working areas being omitted or avoided. The counsellor may take a sensitive, finely-tuned and sustained directive role.

10. Counsellors have a right to interrupt a client's session if they are too heavily restimulated by what the client is working on and so cannot sustain effective attention. If, when they explain this to the client, the client continues to work in the same way, then they have a right to withdraw completely from the session.

11. Whatever a client works on in a session is confidential. The counsellor, or others giving attention in a group, do not refer to it in any way in any context, unless the client has given them explicit, specific permission to do so. It is, however, to be taken into account, where relevant, by the counsellor in future sessions with the same client.

More information on Co-Counseling:

John Heron, Catharsis in Human Development,1998 revision, online at www.human-inquiry.com/catharsi.htm and at www.co-counselling.org.uk/resources/catharsis.html

John Heron, Original Theory of Co-Counselling & the Paradigm Shift, 1995, online at www.co-counselling.org.uk/practice/paradigmshift.html

The most comprehensive website is www.co-counselling.org.uk See also www.co-counselling.info

John Heron, Helping the Client: A Creative, Practical Guide, Chapter 16 ‘Co-counselling’, London, Sage Publications, 2001.

A basic manual for the trainee co-counsellor. This is also available online at www.co-counselling.org.uk/resources/manual.html

John Heron’s Teachers’ Manual (for trainee co-counselling teachers) and Teacher Trainers’ Manual (for trainers of co-ounselling teachers), 1998 revisions, are online respectively at www.co-counselling.org.uk/resources/teachers-manual.html and www.co-counselling.org.uk/resources/teacher-trainers-manual.html

Manuals by other authors are also online at www.co-counselling.org.uk/resources/manuals.html

I kind of like the basic premise - and I have the basic manual for Co-Counseling and find it useful. In fact, I'd forgotten about it until reading this.

Here is the entry on P2P Psychotherapy from P2P Wiki:

P2P Psychotherapy

From P2P Foundation

Contents

Commentary by John Heron

Extracts from Chapter 14 "Forum of Voices: Rising to the Challenge" in Shouldn't I Be Feeling Better By Now: Client Views of Therapy, edited by Yvonne Bates, London: Palgrave Macmillan, 2006.

Several leading writers and theorists in the field were invited to offer suggestions as to how a meaningful collaborative discussion about the future of therapy may be initiated, and how clients can become more involved in the shaping and development of therapeutic theory, practice and policy-making in general.

John Heron writes:

"I believe that clients have a fundamental human right to participate co-operatively in any process that purports to promote their mental well-being. This can best be done in psychotherapy if the therapy is reconstrued as training in emotional and interpersonal competence. And if:

- the principles on which the training is based are made explicit, and applied with the informed consent of the client;

- the client becomes appropriately and progressively more involved in decisions about the actual focus and structure of the training;

- the training extends into concurrent self-directed action research in the client's daily life;

- there are periodic sessions of client-practitioner `peer review' in which the client is encouraged to have somewhat more than equal status in raising issues both of satisfaction and dissatisfaction with what is going on; and in which attention is given to co-operative decisions about the termination or continuation of the sessions;

- the client has access, when the programme with the practitioner is finished, to trained peer self-help networks for continued emotional and interpersonal flour-ishing.

Particularly important in all this is that the dynamic of transference is demystified and made plain as the unaware projection onto others of unprocessed emotions, in ways that distort behaviour. The training offered makes available to the client practical principles of emotional self-management for dealing with these emotions, both within the sessions, and within daily life. And the dynamic of any transference from practitioner to client within the sessions is openly and appropriately addressed and managed. For an account of the kind of practitioner community consonant with this whole approach, see Heron (1997).

More Information

See our entries on the Independent Practitioners Network, a network of UK-practitioners and on the P2P self-help psychotherapy movement called Co-Counselling

Self-generating Practitioner Community: this is a very important article by John Heron, which applies not just to the constitution of peer-based professional communities of therapists, but generally to the governance of peer groups. Strongly recommended.

Heron, J. (1997) 'A self-generating practitioner community' in Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling, edited by Richard House and Nick Totton, Ross-on-Wye: PCCS Books. (Other papers of interest in this anthology are Nick Totton, 'The Independent Practitioners' Network: A New Model of Accountability'; and John Heron, 'The Politics of Transference'.)

More Key Books to Read

  1. Forum of Voices: Rising to the Challenge" in Shouldn't I Be Feeling Better By Now: Client Views of Therapy, edited by Yvonne Bates, London: Palgrave Macmillan, 2006.

See commentary by John Heron above.

Ethically Challenged Professions

  1. Ethically Challenged Professions: Enabling Innovation and Diversity in Psychotherapy and Counselling, edited by Yvonne Bates and Richard House, Ross-on-Wye: PCCS Books, 2003.

An extract from the Foreword in which John Heron writes:

"An ethically questionable degree of control characterises the current dominant world order: the control of commodities and services by large corporations; the control of valid knowledge by academic establishments; the legitimization of professional practice by statutory regulation; and so on. Such control is out of tune with the emerging values of what seems to be a new kind of civilisation, one that is essentially peer to peer. Peer-to-peer developments are afoot, notably on the internet; but also in manufacturing, in politics and social change, in psychological growth, in spiritual unfoldment, and in research and knowledge generation.

In all of these emerging fields, the interdependent values of personal autonomy and social co-operation are paramount; and hierarchy - thinking on behalf of, and proposing social structures and standards for, other people - is validated solely by its ability to enhance these prior values. A key distinction here is between hierarchy that controls autonomy and co-operation in a restrictive way, and hierarchy that provides forms for their liberation and continuous development.

This forthright book is poised very precisely on the leading edge of that distinction, exploring issues where controlling hierarchy and empowering hierarchy confront each other in the field of psychotherapy and counselling. This field provides a crucial test-bed for clarifying and enacting ethically appropriate ways of exercising empowering hierarchy."

This comes from The Independent Practitioners Network: Here is their statement of purpose:
What is IPN?

The Independent Practitioners Network offers an authentic model of best practice accountability through open, committed relationships with peers. We are a nationwide, network of practitioners of equal status rather than a hierarchical organisation. We work together in linked groups to offer each other mutual support and challenge. We believe that high quality ethical practice is grounded in honesty, integrity and transparency. We welcome counsellors, psychotherapists, educators, growth workers and allied practitioners.

IPN structure

Non-hierarchical, low bureaucracy. IPN is inclusive of more or less qualified or registered members, since we recognise that there are many routes to being an effective practitioner. The structure is horizontal and multi-centred rather than vertical and pyramidal. There is no central, standardised code of practice, each peer group creates and circulates its own.

Freedom of practice

We are committed to defending freedom of practice, and to creating a culture of openness and challenge. The Network grows out of the belief that no centralised organisation has the right or the ability to decide who should practise therapy, facilitation or equivalent skills.

Open definitions

Has a commitment to encouraging diverse forms of practice, training or therapeutic relationship, since we value a richly pluralistic and multi-skilled ecology.

The structure provides for:

  • A powerfully effective means of supporting the interests of both client and practitioner.
  • Self and peer assessment and accreditation through a continuing process of accountability.
  • An exciting, stimulating and creative context for ongoing practitioner development.
  • Willingness to own mistakes and take responsibility for constructive approaches to improving situations that may result from them.

Peer validation

The unit of membership is a group of at least five practitioners who know and stand by each others work; who take responsibility for supporting each others good practice and the good practice of other groups in the Network; and who address any problems or conflicts in their work.

The group seeks to establish the quality of its members work through personal ongoing interaction - consistent with our belief that this most effectively facilitates authentic practice. A full member group is required to have formed cross-links with other groups, through which the process of peer support and challenge is widened and deepened.
The material Bauwens posted comes from A peer-to-peer network approach to civic accountability for psychological work. An eIpnosis article by Denis Postle April 2010:

This article introduces The Independent Practitioners Network [IPN] as a thriving example of a peer-to-peer [P2P] organization. It is not an official IPN narrative, no one is entitled to speak for IPN but anyone may speak from IPN.

The article begins with a brief account of the political context out of which IPN emerged and moves on to outline the IPN process of holding civic accountability.1 This is followed by accounts of how network coherence and cohesion are sustained and IPN’s basic protocols. How IPN provides civic accountability for psychological work is described, along with some of the values that inform IPN. I conclude with a short account of an IPN group meeting, some consideration to what I might have left out, and end with a Q&A listing.

UK psychopolitics

Ten years ago I published a series of drawings of the psychological landscape of the UK. Today I see this landscape as a ‘psychological commons’ featuring innumerable ways of working with the delights and vicissitudes of the human condition.

The increasing professionalization of sectors of this psychological commons was represented by some simple animations that showed the commons being fenced off into what I described then, and later, as ‘walled gardens of professional expertise’, literally the ‘professions’ of counselling, psychotherapy and psychoanalysis. Following Max Boisot (ref), these can be seen as ‘fiefdoms’ clustered together in ‘clans’. These clans were and continue to be characterized by intense personal relations and loyalty to hierarchical leadership, practitioners and schools, which compete with each other in a market for trainees and clients.

Around twenty years ago, two options emerged for the evolution of these fiefdoms and clans: one was to seek state regulation, i.e. government recognition and endorsement for them as professions that would put them on a par with psychiatry and medicine. While many practitioners welcomed this, others saw it as an unacceptable colonization of the psychological commons by vested interests. However, the status quo of deference to often very hierarchical forms of training meant that, until recently, for many practitioners the notion that they were supporting exclusive ownership of parts of the psychological commons remained on the margins of awareness.

Origins of IPN

A second option saw the diversity of the Psychological Commons as an essential strength that brought mutual nourishment to practitioners and public alike. For practitioners who saw state regulation of the psychological commons as anathema, a vital piece of innovation by Em Edmondson, supported by Nick Totton, provided a viable alternative.

Em Edmondson proposed the establishment of small autonomous groups of independent practitioners linked together as a network. Founded in 1995, the Independent Practitioners Network, as it came to be called, continues to flourish, gaining in importance now that the reluctant UK state, after much prompting from within the psy field, is attempting to impose a highly codified form of regulation on the counselling, psychotherapy and psychoanalytic clans.

The IPN civic accountability process

In honour of the diversity of the psychological commons, the basic level of involvement with IPN is ‘participation’, and this is open to any practitioner.

IPN is a mix of formal and informal structures; formally it consists of groups of between 5 and 9 practitioners who informally take whatever time and methods of inquiry are necessary to get to know each other so that they can ‘stand by’ each other as practitioners.

Any participant is entitled to gather others together to form a group, or participants may join an existing group. At any point in time there may be a number of ‘forming groups’ going through the process of moving towards being able to ‘stand by’ each other as practitioners.

When the ‘standing by’ process is accomplished, the group is formally required to develop and publish to the network a statement of what they jointly assert is their ethical stance vis a vis clients; in other words, how they define civic accountability. At this point they have become an ‘IPN member group’.

Now another formal IPN requirement comes into play: that the group establishes ‘links’ with two other groups. Their task is to validate the process through which standing by each other is upheld and sustained. In practice this means joint group meetings and/or visits by participants to their link group meetings which feature a mix of support and challenge.

When two ‘links’ are established and the ‘standing by’ process is validated, the group is entitled to describe itself as full member IPN group and group participants, may if they choose, describe themselves as accredited through the IPN process.

Network coherence and cohesion

Network-wide coherence in IPN is expressed mainly through attendance at thrice yearly national Gatherings open to anyone. Developments and difficulties are shared at these usually residential meetings, and newcomers are welcomed.

As I have come to see it, the IPN network runs on high levels of trust founded in high levels of sustained face-to-face rapport in the participating groups. Although primarily an oral culture, theoretical or intellectual communication is conducted via a newsletter, NetCom, published following each Gathering.

The IPN protocols,

The IPN protocols, formal statements of agreed ‘principles and procedures’, required several years of intense consensus based negotiation, and then settled down as a mix of formal non-hierarchical governance and informal local initiatives. As I said earlier, no one is entitled to speak for IPN, however anyone is entitled to speak from their experience of IPN. In recent times IPN has had some significant influence in the processes of resisting state intervention in the psychological commons, not least because of how it has been researching and modeling a potentially exemplary non-statist approach to civic accountability.

IPN values

IPN values that are strongly and consistently expressed include:

• That diversity of practice is vital in sustaining the quality of client experience.

• That governance is by consensus alongside short term local hierarchies of expertise and experience.

• That while innovation is encouraged and supported, network adoption of substantial changes to the formal aspects of IPN requires presentation and agreement of proposals at a Gathering, and for the most part ratification by a later Gathering. However Gatherings are entitled to decide to take any action that is seen as immediately necessary and that would be judged as not requiring ratification by another gathering.

The purposes of IPN

In recent years I have come to see the main purpose of IPN as holding civic accountability for the client experience. A social process that draws on what we know about our own and others’ behaviour so as to minimize, through continuing scrutiny, the likelihood of client/practitioner boundary violations. In contrast to the professional field in which a one-time qualification entitles life-long endorsement, the IPN process holds practitioners in an ongoing but supportive scrutiny that include those dimensions of their personal life that might diminish or distort the client experience.

IPN Live

Outline accounts of organization tend towards dullness and generality. In an attempt to bring this account to life, I’ll end with a brief account of a meeting of the IPN group of which I am a member. Keep in mind that it is a fiction, a composite of multiple actualities.

The door bell rings and S, last of the six people who will show up today locks his bike and comes in to the sunny room over-looking the river where we are meeting. U, K and N have come on journeys of around two hours to be here. For other meetings we travel to them. One person H, is missing.

I provide tea for those who want it, and after an initial flutter of chat about the journey, everyone settles down, and we ease back into a moment of silence, prelude to a check-in routine. Each of us speaks of the current mix of how we are and what has been happening for us, coupled with a more general update on where we are in our lives. Accounts vary in length and intensity, and while none of this is mandatory, a refusal or inability to say anything would very likely merit a lot of attention. A tendency for check-in statements to drift toward discussion is deprecated. Since, as usual, it is around six weeks since we last met, everyone has usually has quite lot to say.

When we have all been heard we move on to gather into an agenda for the remaining four hours of the meeting, any needs that have been expressed, along with other pending issues. When this has been listed, we bring out a picnic lunch and fall on the houmous, salad, bread, and chocolate, usually nourished by back channel gleanings from the grapevine.

The agenda for the afternoon includes: two people who want to raise supervision issues; a report on professional developments in a professional association’s subsection that may be relevant to the IPN network as a whole; and news of the dissolution of one of the groups with which we are linked. Beginning to plan for a new iteration of our chosen route to ‘standing by’, self and peer assessment. News of legal moves challenging the validity of the government appointed regulator. And also, dates for future meetings and money (we share the costs of travel to the meetings). At the point when this seems settled J calls for an additional item: discussion of how we can stop letting anxieties about regulation swamp our meetings.

After lunch has been eaten and cleared we begin to work our way through the list of topics, allowing each item/person whatever time the issue merits. After several people have taken space, we realize that the agenda feels a bit congested and we agree some time limits.

Note that none of this has required an organizer or a facilitator, and the rest of the event proceeds through consensus. If new concerns emerge, we try to find time for them.

Travelling two hours for an afternoon meeting has often seemed a wearing prospect but some 15 years on, I have yet to find the mutuality and depth of rapport of an IPN meeting other than enlivening.

Conclusion

What might I have left out of this account? The first thing that comes to mind is that I believe that sustained cohesion of IPN groups may depend on what I see as an adequate level of emotional competence that enables a capacity for both support and confrontation.

Alongside this, some prior experience or education that favoured self-directed learning and peer evaluation over hierarchical teaching seems important.

While IPN includes a very wide range of practitioners, I have been inclined to see it as attracting people who share an predominantly optimistic yet non-naïve view of human nature; for whom trust is an achievable interpersonal and social option; who are intolerant of duress or coercion; and who entirely reject rule by fiat. This combination of attributes presently seems to attract more practitioners from the human potential, humanistic psychology, and person centered counselling communities, than say, from psychoanalysts or cognitive-behavioural approaches to human condition work. However IPN welcomes people from all approaches provided they are happy to work within its protocols and values.


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