A guide for helpers

THE SERENITY PROGRAMME™

Updated 7th June 2013

SERENE.ME.UK/HELPERS/

#SERENITYPROGRAM

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Contacts

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SERENE.ME.UK/HELPERS

#SERENITYPROGRAM

SERENITY.PROGRAMME

Today …

• The programme• Contracts and goal setting• Phone support• Governance• Therapeutic considerations

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What’s in the programme?

• A series of assessment measures• A series of information pages• A resource page for helpers – training materials and

documentation• A brief self-help programme, open to anyone• A series of interactive workbooks• Audio files• Possibly a bespoke microsite?

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Working with

THE SERENITY PROGRAMME™

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Assessment meeting

Modules 1 and 2 Support call

Module 3 Goal setting meeting Module 4

Support call Module 5 Support call

Module 6 Module 7

Module 8

Module 9

Support call

Support call Support call

Final meeting

The Programme …

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USERNAME:Intentionally blank

PASSWORD: Intentionally blank

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Understanding

CONTRACTS AND GOAL SETTING

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Egan’s five questions about goals

• Why should I pursue this goal?• Is it worth it?• Is this where I want to invest my limited resources?• What competes for my attention?• How strong are the competing agendas?

Egan, G. (1994) The Skilled Helper (5 th Edition). Pacific Grove, CA: Brooks / Cole

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The ‘Three P’s’

• Goals are best when they are:

• Powerful – vivid, clear and striking!• Present tense – even stated as though already achieved!• Positive – what you want, not what you don’t!

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‘Business’ contracts & ‘treatment’ contracts

• Berne (1966) defined a contract as

‘An explicit bilateral commitment to a well-defined course of action’

• Business contracts clarify frequency, time, duration, payment, place etc.

• Treatment contracts identify goals and how we will attain them

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Why contracts?

• Keeps client actively involved• Protects client from being steered towards what ‘should’

change• Keeps image of goals foremost• Provides an end-point• Keeps process ‘on track’

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Steiner’s ‘four requirements’

A valid contract requires

• Mutual consent• Lawful object• Valid consideration• Competency

Steiner, C. (1974) Scripts People Live: Transactional Analysis of Life Scripts. New York: Grove Press.

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Stewart’s five questions about contracts

• Is the contract goal feasible?• Is it safe?• Is it stated in positive words?• Is it observable?• Does attainment mean a move towards greater health?

Adapted from Stewart, I. (1989) Transactional Analysis Counselling in Action p. 96. Sage Pubs.

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Contract ‘let outs’

• ‘I want to work on’• ‘I would like to try’• ‘I could’ (instead of ‘I will’)• The hanging comparative ‘I would like to be more ...’• Incongruence between social and psychological

communication

• The outcome of the communication is determined at the psychological level

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An overview

PHONE SUPPORT

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A hierarchy of engagement...

• Specific software e.g. Fear Fighter, Beating the Blues, LLTTF etc.• No visual or auditory information - asynchronous (e.g. email)• No visual or auditory information – synchronous (e.g. ‘chat’)• Auditory information only (e.g. ‘phone)• Visual and auditory at a distance (e.g. Skype)• Blended methods e.g. Serenity Programme (and many others in

practice!)• Immediacy, contextual richness and sense of presence are key

dimensions17

A Continuum, not ‘either – or’

• The blend can be adjusted to suit the client ...

Practitioner contact time

Computer use

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Controversies ...

• If people can fall in love in chatrooms, by letter or email, then the medium can sustain a relationship and allow therapeutic, affective work

• If you cant see the client, can you still work effectively (ask a visually impaired counsellor!)

• We emote ‘as if’ in virtual worlds – ‘telepresence’ and our suspension of disbelief

• Telepresence entering social consciousness – Tron (1982, 2010), Matrix (1999), The Cell (2000), Gamer, Surrogates, Avatar (2009), Inception (2010), more 3D ... more ‘immersive tech’

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Telephone ‘baggage’

• Telephones mean different things to different people• May bring good news, bad news, a lifeline or curse, may bring

only work!• What meaning does the telephone hold for you?• Take 5 – 10 minutes to discuss with a partner, using

counselling skills to help your partner explore ...• Can we leave this baggage behind when making a call to a

client?

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Interpersonal support – it’s important to CCBT ...

• Andersson G, Cuijpers P. (2009) Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy. 38(4) p196-205

• Included 12 studies found effect size of 0.61 for supported and 0.2 for unsupported CCBT (0.8=large; 0.5=moderate; 0.2=small)

• Attrition is high without interpersonal support• This is ‘support’ in the broadest sense – interpersonal support

and encouragement – a containing relationship• It’s not counselling, though counselling skills are key ... 21

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The Samaritans

• Have been providing visual cue-less synchronous support since 1994, numbers roughly double each year!

• Also provide asynchronous support via email (< 24 hour response time)

• More males email than ‘phone...• People are 3x more likely to mention suicide in email than by

‘phone...

A short film ...

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Telephone support – is it second best? (1 of 5)

• There are benefits to the client

• To the provider

• Possibly to the wider environment too ...• Take 5 – 10 minutes to discuss with a partner, using

counselling skills to help your partner explore ...• What are these benefits?• Who might benefit most?• Why, and who, might choose telephone-support over other

approaches?

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Telephone support – is it second best? (2 of 5)

• Benefits to the client

• Convenience• Access for disadvantaged groups• Cheaper – less travel required• Anonymity

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Telephone support – is it second best? (3 of 5)

• Benefits to the provider

• Less physical space required• Reception and appointment administration• Personal safety• Practitioner anonymity• Cost effectiveness

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Telephone support – is it second best? (4 of 5)

• Who might benefit most (1 of 2)

• Young men – less likely to disclose in relationship• Single parents, people with childcare problems• Older or more physically vulnerable people• People in remote or rural areas (access of confidentiality

issues)• People with caring responsibilities

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Telephone support – is it second best? (5 of 5)

• Who might benefit most (2 of 2)

• People who find movement or transport difficult• People with restricted freedom – children or people in abusive

relationships• People on very low incomes• Certain diagnoses – social anxiety, agoraphobia, shame-based

pathology, issues with authority or dependence, impulse control issues

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Telephone support – is it second best?

• There are of course, disadvantages ...• Reduced visual cues• Caller can terminate the call easily – esp. If dealing with sensitive

subjects• Assessment issues• Potential distractions and interruptions• Can’t ensure client’s privacy – potential recording, others ‘listening in’• Cant absolutely identify the client!• ‘Try some of this while you’re waiting’ – self-fulfilling prophecy

mentality29

Telephone support – remember ...

• Leaving messages with people? Consent to leave messages• Block caller ID with ‘141’• Who may answer the ‘phone? Non-committal introductions• Call recording• Others listening in on extensions• Procedure in the event of repeated ‘no answer’• ‘Last number redial’ breaching clients confidentiality• Procedure for contingencies – drunk / abusive / deteriorating /

suicidal clients30

Telephone support – privacy

• Telling a client their call is confidential, then they hear background voices

• Client becomes hesitant, distracted or monosyllabic – ‘It sounds as though someone has walked in – if they have, just say yes’

• Calls ideally take place behind closed doors – like face-to-face therapy

• Trivialising ‘phone calls – interruptions are thought to be permissible ‘would you like a coffee?’

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Telephone support – reasons for referral• Because of you ...

• Your personal limits• Your professional limits• The limits of your competence / training

• Because of the client ...

• The client needs broader / deeper / more enduring intervention• Because of your agency ...

• Time limits• Restrictions on type of service offered• Organisational policies

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Safeguarding and Governance ...

• What do you think a provider needs to have in place to provide a high-quality telephone support service?

• Take 5 – 10 minutes to discuss with a partner, using counselling skills to help your partner explore ...

• Consider:• Safety• Effectiveness• Acceptability• Equity• Efficiency

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• Telepresence and non-proximal attunement

• Frustration tolerance• Object constancy• Transference to hardware• Disinhibition• Who / what is the

relationship with?

• Dissociation• Reflexive self-function? • Primitive processes• Time distortion• Learning issues• Avoidance• Suspicion and personality

disorder

Some therapeutic considerations

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What we did …

• The programme• Contracts and goal setting• Phone support• Governance• Therapeutic considerations

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Thanks for taking part!

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References• Meltzer, H., Gill, B. & Petticrew, M. (1994) OPCS Surveys of Psychiatric

Morbidity in Great Britain. Bulletin No. 1: The Prevalence of Psychiatric Morbidity among Adults Aged 16-64, Living in Private Households, in Great Britain. London: OPCS.

• Cuijper,s P., Donker. T., van Straten, A., Li, J., Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943-1957.

• Sanders, P. (2007). Using Counselling Skills on the Telephone and in Computer Mediated Communication. 3rd Ed. PCCS Books.

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