Experiencing Difference: Game of change, the use of novelty and expanding boundaries of therapeutic space.

Lynette Toms, Jocelyn Harper and Bronwyn Seaborn

Clients’ experience of therapy would ideally be one of experiencing difference and change, of safety, relationship and containment. Increased awareness, imagination and the sense of joy that comes with ‘playing of games’ allows a reimagining of their lives, and their future. Successful therapeutic alliance requires attunement, egalitarianism, mental flexibility and flow, as well as stillness and courage from the clinician, to support a client’s therapeutic movement and ‘game of change’. A Personal Construct Psychology framework encourages these nuanced practices.

Over the past 20 years the Australian Government has funded and reviewed countless mental health programs, but all this activity has had little impact on the mental health of minority groups in the population, which continue to be chronically underserviced. This has led to a call for a fundamental shift in the way Mental Health Services are delivered. (National Mental Health Commission, 2014)

During this same period there has been a decline in the teaching of Personal Construct Psychology in Australian Universities whilst less nuanced, prescriptive modalities have become the norm in mainstream psychology in Australia. In my practice, I regularly encounter clients who come with a sense of hopelessness because they have not received adequate help from mainstream psychology services. These clients are often amazed at the difference Personal Construct Psychotherapy (PCP) makes in their lives, and as a long-time practitioner in PCP, I, too, know the theory’s worth in assisting people to thrive rather than simply survive.

This understanding came over a period of time and with assistance from two unusual sources: one was using horses in therapy; another was experiencing the wisdom of Australian Aboriginal people.

For the past eight years, I have conducted an Equine Assisted Psychotherapy practice at my farm. During this time, a PCP colleague, Bronwyn Seaborn, also became a facilitator of equine assisted psychotherapy sessions. Many Aboriginal people were drawn to this practice, finding the natural outdoor setting a perfect fit with their innate sense of connection to the earth. They responded exceptionally well to the location, equine therapy and the PCP approach, all of which brought them healing and strength. The activities (or the games played) at Equine Time offer many avenues for “embodied cognition” and genuine change, demonstrating the potency of a psychology of possibility, and the transformative power of the human brain (Langer, 2009; Barsalou, 2008; Niedenthal, et al., 2005).

This successful relationship with our indigenous people led me to work (for the past five years) at the Tharawal Aboriginal Medical Centre in South Western Sydney. The centre, named after the First Nation people of the region, provides health services to the largest Urban Aboriginal community in Australia. In a delightful synergy, the local Aboriginal community have come to feel at ease at Equine Time, while at the same time my equine assisted psychotherapy practice has enhanced the trust I have gained in my counselling practice at the Aboriginal Medical Centre. This harmonious situation led to another PCP therapist, Jocelyn Harper, being invited to join the Tharawal counselling team. Aboriginal people have rejected the Western medical model of Mental Health and prefer to use the term “Social and Emotional Wellbeing”.

I brought together all these emerging understandings in a paper I wrote in July 2016, which described my Therapeutic Model of Intervention for the Improvement of Social and Emotional Well-being. The model was subsequently endorsed by the Board of Governance of the Tharawal Aboriginal Corporation. It is this model I wish to share with you today.

The model is built on a solid foundation of Personal Construct Psychology (Walker, 1993; Leitner, 1993; Viney, 1996; Carter, 2004), and years of careful listening to my clients’ stories. My interventions have been enhanced by tools gathered along the way from Narrative Therapy, Emotionally Focussed Therapy, Interpersonal Therapy, Cognitive Behaviour Therapy and Dialectical Behaviour Therapy. My approach has been further strengthened by more recent findings in neuroplasticity and the sequential development of the human brain (Seigal, 1999; Cozolino, 2002; Perry, 2009; VanderKolk, 2014).

The model is trauma-informed and recovery oriented. It is flexible, being client-centred, strength-based and solution-focussed. It aims for self-mastery and reflective self-awareness. It is about “getting down to the blood and guts level in order to discover the deepest needs of an individual” (Short, 2015, p. 53). The model’s ultimate goal is to guide the person towards their optimal self.

Personal Construct Psychology views the optimal person as having the capabilities to be:

  • Able to construe and reconstrue, i.e., make sense of and then re-order, change, redefine, reflect on and make changes to personal meanings in view of insights gained.
  • Able to reflect on their construing of events, reflecting and revisiting them with new insights. This is assisted by the therapist standing sufficiently back to allow them to see their own constructions for themselves; to give the client “optimal therapeutic distance” (Leitner, 1993 p. 357).
  • Able to withstand some invalidation
  • Able to take initiative in change
  • Able to have differentiated and dispersed dependency
  • Able to elaborate, to be “aggressive” (pro-active) in actively elaborating their worlds
  • Able to experience a wide range of feelings as they develop new meanings as they find themselves stretched beyond their normal range of convenience
  • Free of threat – i.e. open to change, free of stuckness, able to be flexible in their views
  • Able to construe both tightly and loosely – the creativity cycle (CPC cycle)
  • Able to construe the construing of others, and keep their pre-emptive construing positive (especially in relationships).

(Epting & Amerikana, 1980; Winter, 1992)

Optimally, there is a cyclical and balanced interplay of contrasting strategies…(Winter, 2003: p. 202)

The model has five broad modalities:

1. Building a therapeutic alliance.

2. Validation of a person’s emotional experience.

3. Emotion regulation.

4. Reflective Self Awareness.

5. Dispersion of Dependency.

1. Building trust and therapeutic alliance (safety and relationship)

The therapeutic alliance is a truly bidirectional relationship, consisting of three interlocking components:

  • • bonds (interpersonal attachments),
  • • tasks (agreements as to what is to be done in therapy and how various activities in therapy will contribute to the resolution of the client’s problem), and
  • • goals – consensus on the short and long-term expectations between the therapist and client. (Bordin, 1979)

The therapeutic alliance is in fact so central and transcendent that commentators have used terms like “reverence” and “sacred space” to describe therapeutic relationship and its context. (Leitner, 2010; Lancia, 2017)

“Joint creative endeavours are harmonious and often playful in nature; thus, the interaction should be enjoyable and must remain centred on the immediate need of the patient. Co-inception does not occur until the preconceived notions of how things ‘should be done’ are abandoned in favour of a creative process that is stimulated by the uniqueness of the moment and of the person seeking help.” (Short, 2015 p. 52-3).

During her first three months of working at the Aboriginal Medical Centre, my PCP colleague, Jocelyn, discerned that people there have less structure, more chaotic lives, a different sense of time, poorer education and literacy levels, lower self-worth, and more vulnerability to a sense of threat. People we see in therapy talk about being trusted and respected as a novel experience for them. While they have been the givers of trust in the past, the experience of receiving trust and respect is powerfully different. This may be because trust is a major issue for Aboriginal Australians. Aboriginal people have rarely been seen as trustworthy, but have been expected to trust governments and non-indigenous Australians, despite the heritage of deep losses of Country and culture. A client remarked that having access to psychological assistance (a safe place) was very beneficial, and having a sense of being trusted, respected and safe was assisting his improvement.

2. Validation of a person’s emotional experience (Containment and context)

One of the tensions of therapy is that people require validation of their meaning making process, even when some of their individual meanings don’t serve them well (Carter, 2004; Caputi et.al., 2006). Kelly argued that there is no division between cognition and emotion and that emotion signifies “constructs relating to transition” (Kelly, 1955/1991: p.391). Emotions are people’e experiences of, or resistance to, change (Bannister and Fransella, 1986).

Consequently, in my model, the therapist is led by the client, and takes the role of the “interested learner” (Schultz & Stuart, 2015, p.15), especially in cross cultural situations. Therapy takes place within individual differences of meaning and meaning-making, use of words and symbols, spiritual elements and values, as well as concepts of “how healthy relationship are defined” (Schultz & Stuart, 2015, p.15).

The therapist brings an understanding of what it is to be human, a broad knowledge of typical human responses, especially those around equity: justice and injustice, well-being and trauma, trust and distrust. We provide a reflective, compassionate stance with our client as well as towards them and to others in their lives. We understand that our client is a being whom we can never truly know but only guess at from their stories and interpretatively read via body language, as an evolving seeker of wholesomeness.

So PCP therapists use their knowledge of what forms an optimal person, and of the normal desire of humans towards social interaction, wholeness and belonging, and the innate attraction to good rather than evil (Leitner, 2010; Pfaff & Sherman, 2015) to assist their clients.

3. Emotion regulation which includes:

a) Fear – discernment between current threat and perceived threat due to trans-generational trauma – interventions are solution focussed towards safety, self-protection and self-care (Fisher, 1999).

b) Anger – discernment in regard to injustice – interventions are solution focussed towards improved communication, assertiveness and empowerment towards improving wellbeing of self and others (Cummins, 2006).

c) Sadness – represents the body’s response to loss, both physical and perceived losses. Grief is the active expression of sadness. Healing comes from the expression of grief (Wanganeen, 2016) Grief requires a sense of safety (comfort) and resolution of injustices for the active expression of grief and for healing to occur (Neimeyer, 2003).

d) Joy – the experience of play and laughter provides the contrast necessary to create a conduit for change in a person’s life (McCoy, 1977).

4. Reflective Self Awareness:

Through creating a story of events and the associated meanings of those events, people develop a greater sense of internal agency (purpose) (Butt, 2004; Metcalfe, Winter & Viney, 2007). This process includes mindfulness (Gendlin, 1979), spirituality and dadirri. Dadirri is an Australian Aboriginal practice that involves inner, deep listening and quiet, still awareness. Dadirri recognises the deep spring that is inside us which calls to us as we call on it. It is somewhat akin to contemplation (Ungunmerr-Baumann, 2002).

5. Dispersion of Dependency (Community integration):

People need social connection and a sense of belonging. The model aims to assist people to build a sustainable support network to maintain their well-being (Walker, 1993).

The Model’s Utility

The model has significant utility in the counselling room; however it truly comes to life in the paddock through equine assisted psychotherapy. The therapeutic intervention is delivered through the playing of games, which is safer for the client, as, initially, the learning from the game is not “playing for keeps” but will be integrated into the person’s construct system when they are ready to internalise it (Kelly, 1955/91; Levine, 2010). This internalisation of meaning will occur when the client finds some worth and adaptability of their new awareness and for the skills they learned in the paddock. While this is taking place the therapist remains curious about the client’s process, within a framework of respect for the client’s self-discovery. The therapists’ attunement or resonance with the client and their world “transmits a feeling of safety” (Perry, 2009; Pearson & Wilson, 2015, p. 97).

At Equine Time we use many games to engage the client in the experimental space. Groundwork games are played with the horses to increase the person’s awareness and provide them with the opportunity to observe other possible behaviours that they may not previously have considered. They may also see in visual space, a valid representation of something they have been grappling with in their life. Therapeutically, the technique of playing of games is psychologically safe because it is foreign to the person’s life, it is novel, and the game and its metaphors provide the canvas for a re-imagining of life, or a re-imagining of an aspect of life, without the same fear of loss anticipated in their “real” life. The novel environment is one which they need not revisit if their experiments do not offer them anything of value; it can be put aside as “just a game”.

Because the value in the game is understood in metaphor, it is often remembered by the person when they need a more useful construct to employ in a new life situation. The lesson is often held by the person as a larger than life visual picture that brings clarity to an otherwise murky awareness.

The game also represents a full embodiment of the experiment. Not just language-based cognition, but learning from doing (Cooper, Hoffman, & Powell, 2009; Barsalou, 2008; Niedenthal, et al., 2005). To fully engage the body in the game makes the experience more real, more visceral and more fully remembered, and therefore more accessible during distress (Fisher, 2003; Van der Kolk, 2014).

An Example of a Session.

The example session provided a game played by a person and a horse, in which the person, guides the horse, by way of a lead rope, through a line of bollards in a weaving pattern. This activity was set up to allow the person to experience constancy and consistency which are essential elements for regulated brain development (Leitner, 2010).

Video of the game 1. With support. https://youtu.be/mkZI-nebdFE

I use the word constancy to mean connection, “I am here, whichever way you turn”, “you are connected to me and I will guide you.” The lead rope becomes a metaphor for attachment. The rope provides direction and motivation. The goal is attunement (Perry, 2009). The relationship is the focus of the activity, and that relationship is in the present moment. This is akin to scientific validity. People need validation from others.

Video of game 2. Self mastery. https://youtu.be/mQviLMScUnE

The word consistency is used to mean predictability, “it is the same pattern over and over again”. This is akin to scientific reliability. The experience of rhythm and structure are necessary for the development of self-regulation. From a neurological developmental perspective, the game provided the person with the opportunity to experience rhythm. A dysregulated person finds the regularity of routine very difficult to maintain, and yet for a well-regulated person, the regularity of routine provides the necessary security to engage in more interesting cognitive pursuits.

The weaving game was a metaphor for the experience of routine and rhythm to assist the person to regulate themselves. Emotional understanding/appreciation/regulation occurs by “doing it”, reflecting on it and seeing it mapped visually and cognitively (Circle of Security, Path to Secure Attachment handout, p.52, Cooper, Hoffman and Powell, 2009).

This is at its most basic level. Note that considerable relationship with the horse needs to be established before this game can be played.

Video of game 3. Relevance. https://youtu.be/awPmjYRd-58

This video is a demonstration game, played by the Horse Specialist who has an ongoing respectful relationship with this horse.So now I want you all to stand up and face your horse. We are reminded that we are always in relationship in the present. Hold your rope in the forward hand to provide direction into the future. Your hands are upturned with open palms. Now I want you to turn your navel towards the future. Take a step into the future, return to being in relationship in the present, then turn your navel towards the past while continuing to move into the future. Turn to the present again, and then face your future again. All the time moving into the future.

As the game is played, other levels of metaphor can be added to the game. Where was your gaze when moving into the future or the present or the past? How did you gaze differ in each dimension?

Now turn and travel in the opposite direction. Was this easier or more difficult?

This rhythmic repetition takes on its own sense of flow, as the person is continually moving into the future, but takes the turn of being in the present and reflecting on the past along the way. The hands represent an openness to the relationship and the leading hand maintains direction.

We called this game ‘The Ebb and Flow of Life’.

The authors of this paper acknowledge the First Nation people of Canada and North America and Australia, and pay our respects to the Elders, past, present and future.

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