The Serenity Programme™

1. The Serenity Programme™ A guide for helpers Updated 7th June 2013

2. Contacts SERENE.ME.UK/HELPERS #SERENITYPROGRAM SERENITY.PROGRAMME serene.me.uk/helpers/#SERENITYPROGRAMfacebook.com/serenity.programme This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

3. Today … The programme Contracts and goal setting Phone support Governance Therapeutic considerations

4. 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?

5. Working with The Serenity Programme™

6. The Programme … Assessment meeting Modules 1 and 2 Support call Module 3 Goal setting meeting Module 4 Support call Module 5 Support call Module 6 Support call Module 7 Support call Module 8 Support call Module 9 Final meeting

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8. Understanding Contracts and goal setting

9. 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 (5th Edition). Pacific Grove, CA: Brooks / Cole

10. 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!

11. ‘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

12. 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’

13. 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.

14. 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.

15. 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

16. An overview Phone support

17. 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

18. A Continuum, not ‘either – or’ • The blend can be adjusted to suit the client ... Computer use Practitioner contact time

19. 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’

20. 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?

21. 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 ...

22. 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 ...

24. 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?

25. Telephone support – is it second best? (2 of 5) • Benefits to the client • Convenience • Access for disadvantaged groups • Cheaper – less travel required • Anonymity

26. 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

27. 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

28. 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

29. 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 mentality

30. 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 clients

31. 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?’

32. 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

33. 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

34. Telepresence and non-proximal attunement Frustration tolerance Object constancy Transference to hardware Disinhibition Who / what is the relationship with? Some therapeutic considerations • Dissociation • Reflexive self-function? • Primitive processes • Time distortion • Learning issues • Avoidance • Suspicion and personality disorder

35. What we did … The programme Contracts and goal setting Phone support Governance Therapeutic considerations

36. Thanks for taking part!

37. 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.