A week in my . . . family therapy practice:  KAREN LEONARD

‘There’s a lot of expectations on families and parents to get things right’ Karen Leonard, family therapist: “There’s a lot of pressure on teenagers in terms of social media, the points system, their image and their sexuality.” Photograph: Brian Farrell

Irish Times Tue, Jun 23, 2015, 01:00 Colette Sheridan

I lecture full-time at Athlone Institute of Technology, educating future careworkers to work with families, young people and service users such as people with disabilities. And there’s a focus on educating people to work in the early-years sector.

I also have a private practice as a family therapist in Elphin, Co Roscommon, where I live. And I work in the Boyle Family Life Centre.

I do one night a week in my private practice, Crannóg Family Therapy, and I work Friday evenings in Boyle. I have to keep it to that. I talk to a lot to families and clients about boundaries. I have to have a very clear boundary around my down time. I don’t work at weekends.

I’m very disciplined and I suppose I’m an organised person by nature. I have to keep everything clear and planned out so I have an electronic diary and two phones; one is only for work.

Best of both worlds A few years ago, I was thinking that I’d go more into the clinical and practical work but then I thought that really, I have the best of both worlds. Client work can be very draining. I know therapists who do five or six sessions per day, listening to 30 or 40 cases every week. I see six families a week. Altogether, I work a 47-hour week.

The two jobs really help each other. Recently, I was doing up some notes for next year’s class and I found the research I was doing for that was keeping me up to date for my work with clients.

Also, while working with clients, I get ideas and scenarios from them that I can discuss in class but obviously I don’t breach confidentiality.

When I get feedback from the students at the end of the year, what they really like are the real-life examples I talk about. I give them scenarios and dilemmas that we tease out. It brings the theory more into focus for them. The course, in applied social studies in social care, is very much geared towards practice. When the students graduate, they need to be able to do their job.

Unlike training courses where everybody wants to be there, when you’re lecturing students, they may have other things on their minds.  The challenge is to make the work applicable and to make the environment conducive to discussion.

Family therapy For my family therapy work, I get referrals from GPs and I sometimes work with psychiatrists. If, for example, a person is at risk of suicide, I’d need a psychiatric assessment.

Sometimes a young person with, for example, an eating disorder, might need to go to hospital for in-patient treatment so I’d have a good working relationship with psychiatrists, doctors and social workers – and sometimes teachers, too.

Young people can show problems at school in terms of non-attendance, or they can be very anxious. My job is to tease out where the anxiety is coming from. I would also bring in the parents because it’s not always just the young person who needs help. There’s a lot of expectations on families and parents to get things right. With the recession, a lot of families have been under stress with maybe one partner having to be away from home for work in England or farther afield. There’s a lot of pressure on teenagers in terms of social media, the points system, their image and their sexuality.

Rapport with adolescents Working with adolescents is not an area that everybody likes because they’re seen as challenging. But I tend to have a good rapport with them.

If you start by talking to them about what they’re interested in rather than broaching the problem straight away, it usually helps. And I sometimes talk to them one-to-one. My main area of work is with teenagers and their families. Most people who come to me want to get on well with their families. So usually, they’re quite motivated to make changes and that in itself makes the work easier.

Compared with other models of therapy, family therapy is rewarding in that you tend to see results quite quickly. My work is usually about trying to change communication patterns or dynamics within the family. After six to 10 weeks, I would see a big difference in a family.

One of the challenges in my private practice is that I would be likely to carry stuff home from there rather than from my work in Boyle, where I have a line manager to talk to if I need to. But when I’m seeing people on my own, I have to work things out myself or go to see my supervisor.

Supervision is ongoing. It happens when you’re engaging with the course and continues after you have qualified. I trained at UCD and at the Mater Hospital. When I was doing my masters in family therapy, it involved group therapy and clinical supervision.

Once I qualified, I registered as a family therapist which means I have to see my own clinical supervisor. I have peer supervision with other therapists in Boyle. We do that every two weeks. It’s necessary for continuing professional development. It’s an opportunity to reflect on cases.

I’d like to think I know myself very well, flaws and all. I suppose I can be a bit hard on myself sometimes. I probably need to be a bit kinder to myself.

Busy Schdule Monday to Friday is very busy. My husband, Graeme Moore, is at home most of the time. He’s a social care worker and works two nights a week with the Brothers of Charity.

When I talk to my students about how gender roles are changing, I realise that Graeme is doing the more traditional maternal role. We have an eight-year-old daughter, Daisy. Graeme does the school lifts and supervises homework. I have to travel for an hour to get to Athlone, so that adds more time onto my working day.

For my lecturing work, there’s a lot of administration. On the family therapy side, there are case notes to be kept, writing letters, sometimes writing court reports, as well making phone calls to organise appointments. I try to do that in the evening. I don’t mind that side of the work. It fits in with my personality. Writing up case notes puts a bit of closure on the day.

Karen Leonard has an essay on parenting adolescents in Learning on the Job: Parenting in Modern Ireland, which is published by Oak Tree Press

Therapy unlocked: a guide to finding the right therapist for you

There are thousands of therapists out there, but it’s not easy to assess their qualifications, particularly in the throes of a crisis. Here’s our guide to finding help

Irish Times, Saturday 10 January 2015

Kate Holmquist

When you have reached that difficult moment of emotional crisis where you’ve decided to reach out to a psychology professional, you will probably look online. Cue confusion. You see bewildering lists of accreditation letters – ICP, IACP, PSI, IAHIP, FTAI to name a few – and you notice that there appear to be several methods – Psychoanalytic Psychotherapy, Constructivist Psychotherapy, Couple and Family Therapy, Cognitive Behavioural Therapy, Humanistic Integrative psychotherapy.

You may see the words “counselling” and “psychotherapy” and wonder what the difference is. With so many phone numbers and emails you could use, for the uninitiated it’s a bit like putting a pin in an online map and hoping that the person who answers will be kind to you.

This feels like a shot in the dark, and yet you’ve never been more vulnerable because things have got pretty stressful for you to be phoning a complete stranger. As the phone rings, you may visualise yourself reaching Gabriel Byrne’s Dr Paul Weston of In Treatment, or Dr Jennifer Melfi in the Sopranos, Frasier Crane or even Sigmund Freud himself, with his goatee and couch where you will lie for an hour trying to remember your dreams. Who knows?

Finding a therapist is not like finding a dentist. Your friends will always have lists of dentists, and GPs and personal trainers to call. People tend not to discuss their therapists with each other, partly due to a lingering stigma in Ireland and partly because of the deeply private nature of the problem you are trying to solve.

Today psychotherapy in Ireland has developed to a high standard, even though there is no formal State accreditation of psychotherapists. Still, says psychotherapist Brendan Madden, many people still suffer for four or five years before seeking out a therapist and they may be at the end of their tethers, with sleep problems, anxiety or anger issues.

Whatever the reason for considering therapy, there’s no question that people feel extremely vulnerable when they finally decide to make the leap. Can you ask a friend? It’s a good idea, but you may not want to share your friend’s psychotherapist. Your GP may have a psychotherapist or counselling psychologist working in the practice, which can be a good place to start.

Comfortable

Finding a therapist may not seem as straightforward as finding a GP, but it’s actually a good idea to follow the same route. Do you feel comfortable with the person? Have they listened to you on the phone? Are they friendly, clear and otherwise consumer-aware (as in, telling you what they charge)? Are they nearby?

“In the same way we choose a doctor, we should allow ourselves the option of shopping around until we find someone we have a good fit with,” advises Trish Murphy, psychotherapist and Irish Times agony aunt. “This is not always easy and many people choose to stay with the person they first meet and this often works out well.”

Psychotherapists are trained to relate to and treat people who are distressed. They work to alleviate personal suffering and encourage change.

“The therapeutic relationship is very important and you have to be able to trust your therapist,” says Yvonne Tone, a cognitive behavioural therapist, one of the five “modalities” accredited. “It’s about collaborating with the therapist, working in a shared way to understand the problem, such as depression or anxiety, that you want to address.”

But first you have to figure out what all those accreditation letters mean and what the various forms of therapy are. Don’t you? “You can’t say that one therapy is better than another – for example, while CBT (Cognitive Behavioural Therapy) has been shown to be effective, there’s no evidence that it is better than other types of therapy,” says Brendan Madden.

Madden practises solution-focused “brief therapy”, where the client is encouraged to become “a solution detective” and discover their own strengths and solutions to whatever problem they’re facing, empowered by the therapist.

Psychoanalysis, on the other hand, sees the path of self-discovery, in cooperation with the therapist, as an end in itself. “Psychoanalysis respects the individuality of each person,” says Jose Castilho, psychoanalyst and chair of the Irish Council for Psychotherapy.

“It’s not about helping the client to adapt to the world, but helping the individual to adapt to him or herself.”

While it may have a reputation for being the scenic route to wellbeing, since it’s not goal-oriented, psychoanalysis has changed over the years and can help people who are in crisis from a breakup or the loss of a job over a short space of time. Others may remain in “analysis” or other talk therapy for years because of the insights they gain.

The uninitiated may think that any therapist of whatever ilk has a gift of insight into their personality that will eventually be revealed like the third secret of Fatima. You are bound to be disappointed, because like the Wizard in Oz, the therapist hasn’t got the answers, only you do. But an effective therapist will help you figure it out.

“Therapy is not a healing ritual or practice performed by the therapist to cure psychological distress. Recovery and emotional healing comes from the strong therapeutic alliance built over time between therapist and client – and it’s really the client who does all the work,” says Madden. Trusting relationship Murphy agrees that establishing a trusting relationship is the key to the success of the therapy. “It’s the relationship between the client and the therapist, not the particular model of therapy, that is most important.”

In recent years, psychotherapy has moved towards shorter, solution-focused therapies that can help the client get through a rough patch or to make a difficult decision. Some therapies, however, can involve much more time. Where there is a serious issue with depression or anxiety, the therapy could take years to get to the source of the problem, says Dermod Moore, chair of the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP).

What qualifications should a psychotherapist have?  All psychotherapists should be accredited with a professional body that adheres to a code of ethics and has complaints procedures and standards of practice. Currently, the Irish Council for Psychotherapy (ICP) is the umbrella body for all psychotherapy in Ireland, representing more than 1,250 psychotherapists who have undergone in-depth training and are committed to the highest standards of professional conduct. Another professional body is the Irish Association for Counselling and Psychotherapy.

Currently, the qualifications required for ICP is seven years’ training, four of those at post- graduate level dedicated specifically to psychotherapy. Many Irish psychotherapists hold the European Certificate for Psychotherapy which qualifies practitioners to work anywhere in Europe.

What’s the difference between a psychiatrist and a psychologist or psychotherapistst? The key difference is that a psychiatrist has been medically trained and holds a medical degree. The suffix “-iatry” means “medical treatment,” and “-logy” means “science” or “theory.” Psychiatry is the medical treatment of the psyche, and practitioners are therefore qualified to prescribe medication, while psychology is the science of the psyche.

A psychotherapist can be a psychiatrist, psychologist or other mental health professional, who has had further specialist training in psychotherapy which focuses on helping people to overcome stress, emotional and relationship problems or troublesome habits.

What will it cost? Many therapists offer a sliding scale based on your income, so be forthright about what you can afford from the start. The cost varies depending on the psychotherapist but a regular fee is somewhere between €70-€120 per session . Less expensive therapy is available through training programmes or subsidised systems. Many psychotherapists offer a sliding scale for unemployed or retired people. Student therapists need to practise to become qualified, so you can see someone in a training programme for €50 per hour or less. The upside is that student therapists tend to be very enthusiastic, dedicated and well-supervised.

What should my therapist be like? The therapist should empower you to feel more confident, not less. Empathy is his or her most important quality. Trust your gut instinct about whether this particular therapist is right for you. “Keep it simple and don’t be blinded by jargon. It’s the therapeutic relationship that counts – you have to have a sense that the therapist will listen, understand and work with you towards your goal,” says Madden. If you don’t feel it’s good for you or not what you agreed, then don’t be afraid to find another therapist that’s a better fit for you.

How often do I need to see the psychotherapist? Usually the first session is used to see if there is a fit between the therapist and client and to agree what the need is about the number of sessions. The average is probably about 8 weekly sessions. Some psychotherapists work on a twice-weekly basis; these would be in the minority.

Are all therapists neurotic? To train as a therapist, you do need to have therapy and sort out your own issues. However, it’s fair to say that there is a tendency for people to be drawn to psychotherapeutic training to sort out their own problems, which probably leads to a higher proportion of neurosis and issues among therapists than among the general population. But that’s usually a good thing because the therapist has probably developed a good deal of compassion and understanding on their journey to mental wellbeing and personal growth.

I’m still not sure. Why do I need a psychotherapist rather than a friend who is a good listener? A psychotherapist will help to unravel the tangles of the issue and help to clarify what the problem is and what can be dealt with at what time. “Psychotherapy is a safe place to explore and discuss the most difficult of things, even those that are hidden,” advises Trish Murphy.

When should I seek a therapist? “When you are troubled, suffering, shocked, grieved, floundering and unable to reach decisions,” advises Trish Murphy. “When a relationship – at home, at work or elsewhere – is in trouble is another appropriate time. A critical event might be an ideal time to source help: loss, death, accident, injury, change of country/job, rape, hurt and so on.”

How do I know it’s working? Generally, how things are working out early on in therapy is predictive of how things will turn out. “You should feel change and notice progress fairly early in the therapy process, over a matter of weeks rather than months,” says Madden. “By six to 10 sessions there should be some early change.”

There’s sometimes a notion that you have to get worse before you get better. Madden disagrees: “If it’s getting worse, something isn’t effective. You should be feeling more hopeful after six to 10 weeks and start to feel better. If not, discuss this with your therapist and consider doing something different .

How will I know if it’s not working? From the start, the psychotherapist should be professional and organised and give clear, reassuring answers about their qualifications and experience. The time, date, fee and location of the appointments should be fixed and agreed. The psychotherapist should be empathetic and always put the client’s needs first (for clients at risk of self-harm or abuse, safety needs come first). All psychotherapists are guided by their association’s code of ethics that guide practice and meeting client expectations. If clients are not making progress, therapists are obliged to listen to their feedback, change the direction or focus of therapy, or make a referral onwards.You should feel listened to and heard – that is the core of empathy, a necessary condition for change. With the exception of classical psychoanalysis, the client shouldn’t be expected to do all the talking. The therapist should take turns to summarise, paraphrase and clarify what the client is saying.

Are there cases where a couples therapist is better? Where there are difficulties in an intimate relationship, there is often a case for seeing a couples therapist. Where someone is undergoing personal therapy for depression, for example, and relationship issues arise, this does not necessarily mean leaving the individual therapist. Where both parties are willing, the therapist might seek to work specifically with them on couple issues for a period of time, which can be enormously helpful for both the individual’s depression and the couple relationship. Familytherapyireland.com is the professional body for couple and family therapists.

Many family therapists work with people on an individual, couple and family level. Other therapists offering couple therapy would be expected to have additional training or experience in this area.