A guide for helpers
THE SERENITY PROGRAMME™
Updated 7th June 2013
SERENE.ME.UK/HELPERS/
#SERENITYPROGRAM
FACEBOOK.COM/SERENITY.PROGRAMME
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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 3Goal setting
meetingModule 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 level15
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
dimensions
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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’19
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 policies32
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.37