Working With Goals in Psychotherapy and Counselling

Duncan Law is a consultant clinical psychologist at the Anna Freud National Centre for Children and Families and University College London. He is interested in quality improvement across child mental health systems, better collaborative practice, Goals Based Outcomes (GBOs), better use of evidence informed practice, and authentic participation.

Mick Cooper is a professor of Counselling Psychology at Roehampton University. He is the author of Existential Psychotherapy and Counselling (Sage, 2015).

In this blog post, Duncan talks about their new co-edited volume Working with Goals in Psychotherapy and Counselling.

Recent evidence suggests that working with goals in counselling and psychotherapy can support positive therapeutic change. Goals can empower clients and give them hope: helping them feel that they have the capacity to act towards achieving their desired futures. Goals can help focus, and direct, clients’ and therapists’ attention, building a better therapeutic alliance.  Goal-setting and goal-tracking can help to ensure that therapy is personalised to the individual client: so that they are working towards objectives that are of genuine importance to them.

The different motivations for seeking, and offering, counselling and psychotherapy link with the debate around the use and usefulness of goals in therapy.  The best kind of therapy is the one that fits the needs and wishes and preferences and context of the client. But here is the crux of the matter: before therapists can offer the right kind of help or guidance or facilitation, they need to ask the client (perhaps not so bluntly): ‘What do you want?’

‘What do you want?’ is a deceptively simple question that draws on complex psychological processes and requires great therapeutic skills to help a client answer. From the perspective developed in this book, the client’s answer to this question should set the over-arching direction for the therapeutic process itself. Unless we know the client’s reasons for embarking on a therapeutic journey we cannot be as helpful as they or we might wish. 

How we help and how we understand the question, how we support and facilitate the client to find the answer that is right for them and the myriad potential answers to it, is the starting point for how we help and how we go on being helpful. This is about how we help the client start, and how we remain flexible and open to changes in the directions and reasons for travel, and how we seek to work to be as helpful as we can in joining the client on their journey.

Vaccine Hesitancy and Trust

This post is by Elisabetta Lalumera (University of Bicocca, Milan). In this post she summarises a paper forthcoming in Rivista di Estetica, entitled: "Trust in healthcare systems and vaccine hesitancy."

Healthcare systems can positively influence our personal decision-making and health-related behavior only if we trust them. What does it take for the public to trust a healthcare system? I propose that the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also affected by the vulnerability of the pubblic on healthcare matters, and by the system’s credibility.

My proposed analysis of public trust in health care systems can be used to better understand the phenomenon of vaccine hesitancy, the tendency to question vaccine policies, and to seek alternative vaccine schedules or refuse vaccination.

Trust

Trust in health care is a three-place relation, involving an institution (a community’s health care system), a collective entity (the public), and a field of application, which is what the public trusts a health care system for. The public is the varied group of consumers, seekers and providers of health to which a health care system addresses its services, which in national health care systems virtually coincides with the whole population. Examples of fields of application are information (about, for example, the risks of smoking), prevention (as in immunization campaigns, and screening tests), diagnosis, therapy, hospitalization, but also organ and blood donation.

Public trust in health care involves vulnerability in two respects: (1) we trust someone because we cannot personally take care of all our material and immaterial goods and in particular, we trust an institution because we are unable to manage some area of our life by ourselves, as individuals; (2) we trust healthcare systems with our personal health, and the health of our families and our communities. 

When is it appropriate to trust? First, public trust in health care is grounded on the epistemic authority of health care practitioners, and of the system collectively taken. We can’t expect the health care system to promote, maintain or restore our health unless we assume that it embodies sufficient knowledge, competence, and skills to do so. Second, public trust in health care depends on the confidence that healthcare practitioners will act on the knowledge, competence and skills they possess in order to promote, maintain or restore our health, and not with other goals in view.

Though normatively public trust is founded on epistemic authority and value sharing, in fact it correlates with the credibility of the trusted part. Credibility in this context is the capacity to produce in others the impression that one is epistemically authoritative and benevolent. The public is willing to grant trust if the health care system is credible enough.

Memory, Narrative, and the Autobiographical Process

Jens Brockmeier is a Professor in the Psychology department at the American University of Paris. With a background in philosophy, psychology, and language studies, he is concerned with the cultural fabric of mind and language - language understood as a form of life and central dimension of human development.

He is the author of Culture and Narrative (Mimesis, 2014) and a co-editor (with L.-C Hyden and H. Lindemann Nelson) of Beyond Loss: Dementia, Memory, and Identity (OUP, 2014). In this blog post he talks about his latest book Beyond the Archive: Memory, Narrative, and the Autobiographical Process

In recent work, Brockmeier has been investigating narrative as psychological, linguistic, and cultural practice. His main interest is in the function of narrative for autobiographical memory, personal identity, and the understanding of time, issues he has explored both empirically and philosophically – empirically, in various languages and sociocultural contexts, and under conditions of health and illness; philosophically, in terms of a narrative hermeneutics.

Brockmeier has summarized much of his recent work in his book Beyond the Archive: Narrative, Memory, and the Autobiographical Process (Oxford University Press, 2015, paperback version 2018). The book’s basic assumption is that our longstanding view of memory and remembering is in the midst of a profound transformation. This transformation does not only affect our concept of memory or a particular idea of how we remember and forget; it is a wider cultural process. In order to understand it we need to step back and consider what is meant when we say “memory.”

Building on a number of far-ranging studies, Beyond the Archive offers such a perspective. It synthesizes our understanding of remembering in various fields (that most of the time work independently from each other): the neurosciences, social, historical, and digital memory studies, and the humanities. This spectrum of studies also includes analyses of key works of life-writing, specifically of autobiographical literature – by Marcel Proust, Walter Benjamin, Samuel Beckett, W.G. Sebald, and others. What’s more, there even is a memory sculpture/installation by the artist Anselm Kiefer, analyzed as meticulously as neuroscientific experimental data. (In a different work, Brockmeier deals with Picasso’s Les Demoiselles d’Avignon as incorporating both individual and collective memories).

The aim of all this is to radically rethink our very notion of memory as a storage, an archive of the past. In a long history of scientific, philosophical, and cultural reflections, this notion has gained an undisputed solidity, suggesting the natural existence of a distinctive human capacity (or a set of neuronal systems) enabling us to “encode,” “store,” and “recall” (or “reconstruct”) past experiences, as the universal mantra of  neuro(cognitive) psychology goes.

However, this is only half of the story and, in fact, half of Brockmeier’s book. The other half presents a new picture emerging out of this transitional phase. There are, in fact, many cultural forms of remembering and forgetting that are different from the traditional archival model, forms and practices embedded not only in the brain or some of its parts, but in a wide range of human activities and artifacts. They now come to the fore, turning into subjects of inquiry. The emerging picture is more complex than any notion of memory as storage of the past would allow.

That is to say, there now are a number of alternatives to the archival memory. One of them is elaborated in this book under the name of the narrative approach (Brockmeier has outlined a slightly different approach shifting the focus to the conversational structure of much of human remembering in another recent publication).

The narrative approach, as Brockmeier demonstrates in Beyond the Archive, via several case studies of autobiographical narratives, not only permits us to explore the storied weave of our most personal, namely, autobiographical form of remembering. It also sheds new light on the interrelations among memory, culture, and self – which opens to a further field of research (and literature), that of “narrative identity.”

Ageing Stereotypes and False Memories

Today's post is provided by Katya Numbers. She discusses her recent paper "Ageing stereotypes influence the transmission of false memories in the social contagion paradigm", which is forthcoming in Memory.

I am a Postdoctoral Researcher at the University of New South Wales as well as the Coordinator of the Sydney Memoryand Ageing Study. My research focuses on metamemory (our beliefs about our own and others’ memories) and ageing. Specifically, I am interested in whether peoples’ subjective beliefs about memory and age can predict and/or influence actual memory performance, both in younger and older adults.

If two people are recalling a shared event, and one person misremembers that event, it is very easy for their false memory to change the other person’s memory of what occurred. We call this the social contagion of memory.

It has been well established that the social contagion effect is influenced by how credible a person is seen to be. That is, people are more likely to adopt false memories from someone they view as a credible memory source compared to someone they see as less credible. The logic behind this is simple: if we think someone is credible, there is not much reason to pay close attention to what they are saying. This allows false suggestions to sort of seep into our memory without us noticing. Alternatively, if we don’t see someone as credible, then we are motivated to pay closer attention to what they are telling us. This makes it easier to first detect, and then later reject, any false information they might suggest.

In Western cultures, one way that a person’s credibility is challenged centres on stereotypes of memory and ageing. If you ask someone to describe a “typical old person”, words like forgetful, feeble and confused readily come to mind. Importantly, though, stereotypes of ageing are multidimensional. So, it’s possible that you may doubt the memory of an old person while at the same time appreciating the wisdom that comes with age. In this way, on older person can be viewed as either “feeble and forgetful” or “experienced and wise” depending on the type of information we have about them.

In a recent paper, myself and my co-authors examined whether manipulating stereotypes associated with an older person would influence the social contagion effect. To do this, we paired college-aged students with an older “partner” who was actually a confederate (someone who is in on the experiment). Next, we manipulated the type of age stereotype associated with her by providing participants with bogus background information about her.

For our negative stereotype condition, participants were told our confederate was retired, living in an aged care facility, and partook in sedentary activities (e.g., knitting). For our positive stereotype condition, participants were told the confederate was completing her Bachelor’s degree, living independently, and enjoyed challenging activities like learning German (all things that were true, by the way!).

The Natural and the Human

This post is by Stephen Gaukroger, Emeritus Professor of History of Philosophy and History of Science at the University of Sydney.

In the course of the eighteenth century, philosophers, physicians, political economists and others began to think about how the study of human behaviour might be taken out of the hands of metaphysicians and theologians, and transformed into an evidence-based scientific enterprise. These projects fall under the general rubric of ‘naturalization’.

The Natural and the Human looks at late eighteenth and early nineteenth century attempts to naturalize the study of human behaviour, and at the way in which this general programmes lead to the naturalization of religion.

Four forms of naturalization of the human are explored. The first is anthropological medicine, in which traditional philosophical understanding of the human condition is replaced with a medical understanding, not least on the grounds that whereas philosophy confines itself to healthy minds and bodies, what is needed is an understanding of the mind and the body in healthy and unhealthy states. In particular, healing the mind becomes, like healing the body, an empirical matter.