the work of the women’s therapy centre a dedicated women’s counselling and psychotherapy service...

The Work of the Women’s Therapy Centre

A Dedicated Women’s Counselling and Psychotherapy Service in Ireland

THE WOMEN’S THERAPY CENTREBACKGROUND

Other Women's Therapy CentresMental Health is a Gender Issue so Gender

Sensitive ResponsesInequality / Poverty / Injustice

Gender-based AbuseWhat Women Want

18/04/23 WTC / Felicity Kennedy 2

THE WOMEN’S THERAPY CENTREVISION

A world where all women experience positive mental health and lead fulfilling self-determined lives.


THE WOMEN’S THERAPY CENTREPRINCIPLES

• AFFORDABLE: For women disadvantaged by poverty. • ACCESSIBLE: For all with mental health distresses.• SPECIALISED: Understanding of violence and coercive abuse.• RELATIONAL: Valuing power with not power over therapeutic

relationship . • CULTURAL: Women live within social context within which there is a

power differential.• FEMINIST: Connection and mutuality gives us meaning.• HUMBLE: In aspiration - listen and learn from clients.• HOLISTIC: A continuity of care from 1st contact with the WTC to last

session.• FLEXIBLE: Recognising the complexity of women’s lives.


THE WOMEN’S THERAPY CENTREOBJECTIVES

1.Counselling and Psychotherapy for Women

2.Specialist Counselling and Psychotherapy for Women Recovering from Abuse in Adult Relationships

Domestic and Sexual ViolencePsychological Coercion

3.Agency Services to Support Work of Others Responding to Abuse

Clinical Supervision: Individual and GroupTraining and Policy Development

4. Dissemination of Knowledge and PracticeInternship, Student Placement and Volunteer Programmes

Research


OVERVIEWSUMMARY ACHIEVEMENTS & LEARNING 2008 to 2014

TODAY’S SPEAKERSTINA – Learning from our clients - clinical outcomes

MARIA – Learning from client’s experiences of helpful and un-helpful moments in therapy

PATRICIA - Violence Against Women: European Perspective

FELICITY – Summary achievements of WTC and Specialist learning


SUMMARY ACHIEVEMENTS(2008 to 2014)

1. Counselling and Psychotherapy for Women• 200 clients over 6 years• 2013: 50 to 60 clients weekly• Defined model of clinical service provision• Introduction of quantitative (CORE) and

qualitative evaluations (Questionnaires)• Closing: 43 clients & 51 on waiting list


WTC SUMMARY ACHIEVEMENTS(2008 to 2014)

2. Specialist Counselling and Psychotherapy for Women Recovering from Abuse in Adult

Relationships• Two thirds of clients recovering from controlling,

coercive, violating relationships• Referrals and collaboration with major domestic

violence services: e.g. DVAS, Women’s Aid, Sonas and Refuges.

• Increasing recognised specialist service: Referrals from St. Patricks Hospital, Order of St. John of God, Social Workers and Therapists.



3. Agency Services to Support Work of Others Responding to Abuse

(a) Clinical Supervision: Individual and GroupAgencies and Individual Helpers Responding to

Domestic Violence

DOMETIC VIOLENCE AGENCIESDirectors, Managers, Project Leaders, Domestic Violence

Practitioners

PSYCHOTHERAPISTS : COUNSELLORS ; PSYCHOLOGISTSMany themselves working as clinical supervisors



(3) Agency Services to Support Work of Others Responding to Abuse

(b) Training: Psychotherapy with Women / Clinical work with Domestic Abuse / Supervising Clinical Work with Complex Trauma / Vicarious Trauma

AGENCIES INCLUDE:•Fordham University, New York. •Trinity College, Dublin.•Psychological Society of Ireland•National College of Ireland, Dublin.•Clanwilliam Institute, Dublin.•Crime Victims Helpline•Parish of Travelling Community•LGBT Helpline•Mercy Law Resource Centre•Longford Women’s Link



4. Dissemination of Knowledge and Practice

PROFESSIONAL INTERNSHIP PROGRAMME FOR COUNSELLORS & PSYCHOTHERAPISTS

9 people over 6 years

PLACEMENTS FOR TRAINEE COUNSELLING AND CLINICAL PSYCHOLOGISTS

Doctorate in Counselling Psychology (Trinity College Dublin)3 people on 8-month placement

Doctorate in Clinical Psychology (University College Dublin)I person on 4-month specialist placement

VOLUNTEER PROGRAMME FOR COUNSELLORS1 person for almost 4 years



4. Dissemination of Knowledge and Practice

PRACTICE TO RESEARCH / RESEARCH TO PRACTICEFormal Collaboration With Trinity College DUBLIN (PSYCHOLOGY

DEPT.)

Conference Presentations and Workshops Psychological Society of Ireland 1.Supervision of Practitioner’s work with Domestic Violence

2.Experiences and Protective Practices of Therapists working in Domestic Violence Counselling

3.Clinical Work with Trauma – Working at the Women’s Therapy Centre

4.Relationship-Building in Therapy: Helpful and Unhelpful Client Experiences as reported by Female Survivors of Domestic Abuse



RelationshipsTRAUMA AND RECOVERY

Working with the extremes of client experience which lies beyond the normal range of human

experience (Page & Wosket 2009, p.239).

Recovery from: Repetitive Sexual Assaults : Physical Assaults : Torture : Deprivation : Violation : Humiliation

For example:Domestic Violence, Trafficking, Prostitution



Relationships

The prevalence of intimate partner abuse and relationship violence, combined with the severity of its impact at many levels, argues for the need

for psychologists who are already engaged in their career, as well as those still in training, to

be knowledgeable about a wide variety of issues related to partner violence.

(American Psychological Association, 2002)


NECESSARY KNOWLEDGE (1 to 8)1. THE ABUSER'S AIM, METHOD and INTENT

AIMDestruction of the authentic self of the victim

SOUL MURDER

METHODAbuser gradually and deliberately deconstructs the victim’s external and internal reality and re-constructs that reality

to mirror that of the abuser

INTENTDominate and control the victim in order to ensure own

narcissistic needs constantly met.


COERCIVE CONTROLTHE PSYCHOLOGY OF ABUSE

There are no bars to physically imprison the victim, therefore the abuser uses psychological tactics to progressively entice and entrap the

victim

Coercive control makes shadows of the most intelligent, independent women

(Kacey Jai Smith, Observer Newspaper 17.11.13 (p.8)


COERCIVE CONTROL : TACTICS USED TO TAKE PSYCHOLOGICAL CONTROL

TARGET:•Identify victim, create specialness:- younger and kinder, meet needs of abuser- take responsibility for both in relationship-put own needs to backgroundGROOM:- charm, protect, shower with gifts – similarly with others 18/04/23 WTC / Felicity Kennedy 17

COERCIVE CONTROL : TACTICS USED TO TAKE PSYCHOLOGICAL

CONTROL

ENTICE AND ENTRAPDeliberately insert false interpretations & perceptions into the mind of

the victim

Abuser presents as the knowing protector in a special relationship (Sanderson, 2010)

•Abuses initially mild – easy to explain away•Abuser suggests victim over-reacting•Victim’s confusion and distress increasing•Fear of losing “love and protection” increasing•No longer trusts own inner self or outer perceptions•Significant others groomed to re-enforce abuser's interpretations


SURRENDER

Complete annihilation of the authentic self(Soul Murder)

All perceptions of self and the world filtered through the perceptions of the abuser

The self experienced as shameful, all bad, sexual object

Dehumanisation – person feels an objectLoss of self-agency, trust, relations with others

Personhood of victim now inauthentic and silenced


NECESSARY KNOWLEDGE2. THE PSYCHOLOGICAL IMPACT OF REPETITIVE ABUSES

Post Traumatic Stress Disorder (PTSD)The mental health impact of a single catastrophic event

such as a death and / or assault.

Complex Post Traumatic Stress Disorder (Complex PTSD) The mental health impacts of repetitive sexual and physical

assaults as well as the psychologically coercive control associated with domestic abuse.

Also experienced by hostages, political prisoners, child victims of abuse, war veterans, concentration camp survivors and

victims of prostitution and / or trafficking


COMPLEX TRAUMAA DEFINITION

A type of trauma that occurs repeatedly and cumulatively, usually over a period of time and

within specific relationships and contexts. The term came into being over the past decade

as researchers found that some forms of trauma were much more pervasive and complicated

than others ... this expanded understanding now extends to all forms of domestic violence

(Courtois, 2008).


NECESSARY KNOWLEDGE2. THE PSYCHOLOGICAL IMPACT OF REPETITIVE

ABUSES & COERCIVE CONTROL• An acute sense of potential danger: high anxiety• Lack of trust in self or others• Constant hypertension leading to poor ability to concentrate,

reflect and make decisions• A confused sense of authentic inner self and external reality• Increasing sense of helplessness • Loss of sense of freedom and hope• An increasingly silenced self• Imbued sense of shame, guilt and responsibility• Possible view of the abuser as more powerful than actually is• Possible dissociation at times of threat• Likely somatic manifestations of silenced self


3. NECESSARY KNOWLEDGE: CLINICAL GOALSRECOVERY

• Restoration of the authentic self of the client• Restoration of the client's perspective of

reality• Trauma processed: understood and integrated• Understanding: a personal narrative/journey• Healing of somatic manifestations• Restoration of confidence, agency and hope• Integrated social connectedness


4. NECESSARY KNOWLEDGE: CLINICAL STAGESSAFETY; REMEMBERANCE, MOURNING AND

RECOVERY RECOVERY

Shame RelievedShame is one of the most profoundly enduring effects of chronic interpersonal trauma.

Isolation ReducedTo reduce the often overwhelming sense of being alone and disconnected from others.

Personal Agency AchievedTo counteract the feelings of helplessness and increase client’s sense of personal worth and

choice.

Healthy Relationships DevelopedThe trusting therapeutic relationship serves as a model for re-developing personal and social

relationships.

Past and Present Experiences IntegratedCounselling provides the safe context for disclosure and making connections between past and

present.

Mendelshoh, M., Herman, J., Schatzow, E., Coco, M., Kallivayalil, D., Levitan. J. (2011). The trauma recovery group: A guide for Practitioners. The Guilford Press, London.


5. NECESSARY KNOWLEDGE: CLINICAL PROCESS

THE POWER WITH NOT POWER OVER RELATIONSHIP

Respect, Information, Connection, and Hope(The R.I.C.H Relationship; Pearlman & Courtois 2005)

Relational-Cultural Theory3 core relational processes that facilitate change and growth:

1. MUTUAL EMPATHY: The capacity to be moved by the experiences of the client and be willing to demonstrate this in the relationship with the client.

2. RELATIONAL AUTHENTICITY: The increasing capacity of the therapist to represent herself more fully in relationship.

3. MUTUAL EMPOWERMENT: A creative process in which the contributions of each person and openness to change allow something new to happen


6. NECESSARY KNOWLEDGE: CLINICAL CAPACITIES

THE HEALING CLINICAL RELATIONSHIP MUST BE THE OPPOSITE OF THE CONTROLING ABUSIVE RELATIONSHIPPRESENCE not ABSENCE

Safety not fearConstantly check-in with client re safety

Talk, Ask, Communicate – not silenceExplore trauma with greatest of care

Be consistent yet flexible not inconsistent and rigidShow exquisite empathy (Harrison & Woodward, 2009)

Mutuality: Take a position of non-expertiseBe consistently non-defensive – trust can take time

Reach outside yourself to the clientAdapt approach to individual experience of clients

Accept ALL aspects of each personStay steady in client's unsteadiness, horror and possible shame


7. NECESSARY KNOWLEDGE: CLINICAL IMPACT ON THERAPIST: REFLECTIVE PRACTICE

Attention To Transference And Countertransference Effects

Possible signs:Overwhelmed by hopelessness and powerlessnessAbandoned, isolated, frozen, silenced

Leading to:- enmeshment; over involvement; uncertainty; need to rescue; inability to modulate feelings (Etherington, 2009)

Exacerbated by:- multiple abuses; body violations; when abuse on-going; and when children involved


8. NECESSARY KNOWLEDGE: CLINICAL IMPACT ON THERAPIST: REFLECTIVE PRACTICE

Attention To Vicarious Trauma•(the consequence of good empathic work): •Personal and Professional:- cumulative- inevitable- individual


NECESSARY KNOWLEDGE: CLINICAL IMPACT ON THERAPIST: REFLECTIVE PRACTICE

Access to regular trauma-informed clinical supervision is vital

Aim of clinical supervision is to ensure a high quality of care for clients

(Courtois & Gold, 2009; Iliffe & Steed, 2000; O’Connor & Wilson, 2005; Prizeman, Donoghue & Harrington, 2001; Robinson, 2009; Ronayne, 2010; Slattery &

Goodman, 2009).


LAST WORD

MAINTAIN HOPE

MAINTAIN JOY

THE WORK CAN BE WONDERFULLY REWARDING FOR YOU AND YOUR CLIENT


the work of the women’s therapy centre a dedicated women’s counselling and psychotherapy service...

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