The Feminist Approach to Psychotherapy Integration The Feminist Approach to Psychotherapy Integration Lorena Božac Deležan Abstract: The goal of Integrative Psychotherapy is to establish full inner and external contact (Moursund & Erskine, 2004). The most important goal in feminist therapy is the transformation of an individual as well as the transformation of the society as a whole (Herlihy & Corey, 2004). In my work I attempt to integrate both: to help the client establish inner and external contact, but also help him/her to become aware and recognize inner messages connected with his/her gender and replace them with constructive beliefs of his/her own, as well as for him/her to learn, regardless of his/her gender, to trust his/her intuition and experience. In this article I present my approach to integration in psychotherapy and the way I use feminist principles in Integrative Psychotherapy. Key Words: Feminist principles, Integrative psychotherapy, Contact, Gender ____________________________ My professional path My approach to integration in psychotherapy is under the influence of feminist theory. I work at the Women Counseling Service as a counselor on the program for psychosocial support and help for women that were experiencing or had experienced violence. My work includes individual work with women that have survived different forms of violence. I also coordinate a group for women that have survived sexual abuse in childhood and a group for women that have survived abuse in their relationships with their partner. During all these years I have been active in the field of educating various profiles of professionals who encounter women and children victims of violence at their workplace. I have been also actively engaged in the creation of policies and change of legislation and professional approaches in this field. The gradual changes in my professional career began in 2004, when I began studying Integrative Psychotherapy. After many years of engagement in the social environment on changing prejudices and stereotypes connected with International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 50 violence against women, especially violence within the family, my studies and personal therapy influenced the fact that my interest started shifting more and more towards the field of psychotherapeutic work with people, whether individual or group work. The studies of integrative psychotherapy and personal therapy have significantly contributed to my new orientation. When thinking about my professional identity, the first thought that comes to my mind is that »I am a feminist«. For me personally being a feminist means being a person that continuously strives towards anti-discriminatory practices concerning gender or other differences between people. As a feminist I respect and accept differences between people without judging. In all the years working for organizations, whose member and employee I am, my title was a counselor, more precisely a feminist counselor. This comes with specific knowledge and skills, but also with a specific view of the clients I have worked with as well as of the society and the way it is organized. During the years of studying Integrative Psychotherapy my identity has been complementing itself, and the knowledge and skills I have been gaining took me towards the goal of becoming a »feminist integrative psychotherapist«. All the knowledge and skills I have gained represented an important complement and gave me a new framework in which I could place all my previously accumulated knowledge and integrate it with new contents. The very reason Integrative Psychotherapy fascinated me is in the fact that it is relational, focused on the relationship with the client, and it also allows the integration of different theoretical approaches and methods. The studies of Integrative Psychotherapy and regular supervision have also significantly contributed to my own personal changes. During my studies and personal therapy I started becoming more aware of myself, as well as my knowledge and skills. I increased my self-esteem and became more relaxed and open. Additionally, I learned to take more care of myself and my needs, and to give more meaning to establishing contact with myself and others. For many years, since I have been working in the field of violence against women, I have been regularly attending supervision with different supervisors. After a series of years working jointly with a psychoanalytic therapist supervisor, I continue my work with an integrative therapist supervisor. Their different approaches greatly contribute to broadening my professional horizons and deepening my knowledge. In conclusion, I can hardly imagine high quality psychotherapy work without regular and high quality supervision. Also I myself am a part of my approach, with all my characteristics, knowledge and experience, which I continue to embed in myself with great joy and pleasure. In this way I upgrade myself not just in the professional, but also in the personal sense. International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 51 Feminist theory and Integrative Psychotherapy One of the basic principles of feminist theory and the therapeutic approaches that arise from it is the interlacement of the personal and professional. The goals are to change and accept oneself and society. Regardless of the modality we use in our work, all feminist therapists have some basic guidance, as follows: constant personal and professional growth, continuous observation of own reactions, the emerging of prejudices and stereotypes inside ourselves as well as in society and working on dissolving them. An important dimension of Integrative Psychotherapy is the personality of the therapist. In order to create and sustain a high quality therapeutic relationship, the therapist has to develop her ability to listen together with the client, her ability to observe in the relationship and to be emotionally available to the client. In order to do so, she has to nurture her self-awareness (Moursund & Erskine, 2004). My own personality, self-awareness and involvement in the therapeutic relationship are of the utmost importance in my work. Despite the feminist orientation I do not »preach« feminism when working with my clients (Chaplin, 1999). However, from my complete attitude it is evident that I am aware of gender differences, different processes of socialization among men and women, my attitude towards gender discrimination as well as other forms of discrimination. It is important that the professional and personal life of feminist therapists is in harmony. Herlihy and Corey (2004) believe that the therapeutic role is inseparable from certain personal characteristics and that is why feminist therapists are constantly focused on monitoring their own prejudices and distortions. Both integrative psychotherapists as well as feminist psychotherapists believe that a therapist has to be fully present in the therapeutic relationship, prepared to share herself and act in the client's best interest. One of the basic purposes of Integrative Psychotherapy is reciprocal connection of all aspects of human functioning – emotional, behavioral, cognitive, physiological and interpersonal (Moursund & Erskine, 2004). This principal greatly helps me with my work because it allows me to enter the relationship with the client through the most unsecured door, through the dimension which is most available for the client. By doing this I am aware that dealing with certain parts of the client’s experience means establishing gradual contact also with other parts that are momentarily less available to the client. By building a contact I can help the client to capture more and more dimensions. So, I work where the client is open for contact and through this contact I work with him on constant opening of new contact dimensions. Interpersonal contact is a basis of work in integrative psychotherapy as well as in feminist therapy. I consistently take this interpersonal contact into consideration because I believe that the client can reach changes and integration only through a good contact. International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 52 Principles and methods Both feminist principles of therapeutic work and principles of Integrative Psychotherapy support the position of a client as an expert. As a therapist I respect and consider this position in my work. In my opinion, the position of equality and creating space, where I am constantly aware of different power positions in the relationship, does not mean equality in knowledge. Namely, the client expects from me some knowledge he does not have on his own, but this position of equality means creating and increasing the client’s self-esteem, his trust in his own abilities of exploring himself and respect towards his own strengths. In the therapeutic relationship I achieve good contact, authentic relationship and authentic interest in the client and his story by using the methods of Integrative Psychotherapy of inquiry, attunement and involvement. These methods are very important for me, as my work originates from the feminist context of work. Even though some authors already argue that feminist therapy has its own methodology and is not just an orientation and philosophy characterized by certain working principles (Herlihy & Corey, 2004), I myself missed just that – a method that would give my work a framework, but at the same time allow for all feminist principles of work. Integrative Psychotherapy as a method offers me a theoretical and practical framework in which I can place in the feminist principles. At the same time the methods of inquiry, involvement and attunement provide to me the connection in my concrete work with clients. Inquiry is focused in such a way that it stimulates the external and inner contact in the client. Its purpose is to help the client recognize the ways in which he learned to interrupt contact with himself and others (Erskine, Moursund & Trautmann, 1999). I always consider the client’s perspective and I do not force him into going »where he does not want to go«. Additionally, I attempt to achieve the goals of inquiry, i.e. that the client becomes aware of himself, recognizes certain aspects within himself and in contact with others. By doing that he is able to improve his intrapersonal and interpersonal contact. In Integrative Psychotherapy, inquiry involves all aspects of the client’s awareness: physical sensations, reactions, emotions, memories, thoughts, conclusions, decisions, meanings, fantasies, expectations and hopes (Erskine, Moursund & Trautmann, 1999). Also in the context of feminist principles inquiry has similar goals. As I see it, it also revolves around gender issues and the influence of external reality on the inner world of an individual and the connection between them (Walker, 1990). This means that in my work with clients I consider the perspective that aspects of the client’s awareness are among others connected also with his gender and in this context also with gender socialization and gender roles in the client’s everyday life. When talking about attunement, I perceive as most important the attunement to all the aspects of the client’s experience, especially those that were not accepted. I consider that being in contact with myself and being in contact with the client means to accept and respect the client and to be attuned International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 53 to all dimensions of his functioning; the cognitive dimension – in which way the client speaks about himself and his way of perceiving the world, which words he uses when describing that and in what way he thinks. My feminist perspective is most at the forefront precisely in the field of cognitive attunement. How does the client speak about himself in the context of gender? Does she use the masculine gender form when describing herself, although she is a woman? The use of language in therapy gives an important insight of experiencing oneself and also the possibilities to change the perspective of experiencing oneself as a representative of a specific gender. When speaking, I consistently use a certain gender form, i.e. the feminine form when I am talking about a woman and the male form when I am talking about a man. By doing this I also give the client a chance to shift in this area and to think about what is his way of speaking about himself, without directly influencing and/or correcting his way of speaking. In fact, it is the first and basic literature that I got during the time I was attending the training in integrative psychotherapy, that convinced me that I could combine feminism and integrative psychotherapy. In their books Richard Erskine and his coauthors convey a very important message about the dimension of gender and power in therapy. They consistently use the feminine form for the therapist and both gender forms for the client. I think of the rhythmic attunement to the client’s emotional states, developmental and relational needs as that component of attunement where, in my opinion, the part of integrative psychotherapy that is more »art« than »science« is the most visible. In fact, a crucial part of rhythmic attunement is the therapist’s sensitivity and reciprocal responsiveness to the client’s experience. In my opinion, an important part of rhythmic attunement certainly is perception and my own response to the client’s nonverbal communication, as well as attentiveness to the »here and now needs«, for instance the client’s needs for physical activity. I find it also important for the client to be able to use the therapeutic space in accordance with his physical needs, for instance that he can sit in such a position that suits him best, and for him to be able to choose where he will sit. In fact, in the very possibility of being able to choose his seat, I can also observe my consideration of feminist as well as integrative principles in the sense of decreasing the power position of the therapist. The client’s choice of seating can also be a message for me because it can give me a nonverbal message of how the client perceives me, what his needs are and what kind of position in the sense of power and distance he wants to occupy in our work. Attunement and involvement are closely connected. The therapist is involved in the therapeutic process with her attuned and oriented responses to the well-being of the client and his experience, needs and thoughts. By being involved through validation and normalization the therapist conveys the following message to the client: that she considers and acknowledges his needs, physical sensations and defenses. The therapist’s presence in the therapeutic relationship is the most important aspect of her involvement; namely consideration, validation and the International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 54 normalization of the client’s emotions, needs and defenses are derived from involvement. Being present as a therapist means to be in full contact and at the same time to have the therapeutic intention of »being present for the client’s best interest« and to have therapeutic competences (Erskine, Moursund & Trautmann, 1999). In my line of work I often encounter traumatized women. Many of them have survived different forms of child abuse and are currently living in relationships with abusive partners. That is why I consider that an important part of the therapeutic relationship is the validation of their emotions, defenses and behavior, as well as the normalization of their survival strategies. As a matter of fact, many of these women are still being judged and misunderstood because of their persistence in an abusive relationship. In that sense validation and normalization are helpful, so that each individual woman can, as Zaviršek (1994) says, »define violence or abuse on her own«. These women can then, through the awareness of the use of survival strategies in an abusive relationship, become aware of their own strength that can help them find the way out of a particular situation. Taking into consideration the aforementioned psychotherapeutic working methods I also use various techniques in my work. A part of my psychotherapeutic training is also training in psychodrama which was focused on working with traumatized people. My teacher and supervisor adjusted some of these psychodrama techniques for the needs of working with individual clients. For instance, in my work I use the technique of the »social atom«, where the client can present his current important relationships in his life by using various stones of different shapes and colors. I also use these stones in working with detached parts of the client. The client uses these stones to present different parts of himself and the interactions between them. The symbolic meaning of these stones and the way the client arranges them, gives him an insight into the inner and/or external interactions, while at the same time enabling him to have a greater emotional distance. This is in particular important for those clients who are emotionally overwhelmed. In my work I also use the visualization technique and the »two chair« technique, especially when working with ego states. In their work feminist therapists also use techniques from other modalities, which they adjust in accordance to the feminist principles. They also developed some techniques of their own such as assertiveness training (Herlihy, Corey, 2004). I use this technique in my work and I see it as a technique I could place into the cognitive-behavioral field. Transference and countertransference I consider working with transference and countertransference as an important part of supporting the client’s integration. Namely, exploring the ways how the therapist and client create, distort and interrupt contact with each other, usually increases the interpersonal contact, which supports the increase of intrapersonal contact and awareness (Moursund & Erskine, 2004). While working, I often ask my clients to describe the way in which they see me. I International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 55 explore this also by searching for the connection in the client’s past and present relationships. This can be of great help for the client to become aware and explore certain issues in his relationships that are constantly reappearing, and to find ways of how to start resolving them. The awareness of my countertransferential reactions is most certainly of great assistance to me. In fact, I share them with the client if I conclude that it is in his best interest. I notice that countertransference helps me the most in attuning with the client. In the part that I myself perceive as the “art in psychotherapy”, transfer and countertransference help me gain an insight into the unspoken, i.e. what the client tries to conceal, but expresses with gestures, looks or other forms of nonverbal communication. It also helps me in dealing with emotions where I inside myself sense the emotional response or the echo of the client’s non-verbalized feelings or an appropriate response to them. I also find it very important in my work to share my emotional responses with the client, if appropriate, and in this way to verify whether they are in accordance to the client’s emotions or needs. Mistakes are most certainly an inevitable part of therapeutic work. I experience them as an opportunity for change. By seeing the therapist’s mistakes the client has a possibility to perceive the therapist as a person with all her limitations, which can strongly influence the decrease of idealization. At the same time I believe that it is important to admit my mistakes, which is just another way of showing the client that I am not an expert that has all the answers, but rather his partner in the process, with all my limitations. Furthermore, it is important for the client to know that I am just a person that cannot always be perfectly attuned, absolutely understanding and have ideal contact with him. All of this can also, after all, help the client to learn that there is no such thing as an ideal relationship, but that there is always a possibility to repair the interruptions in contact. Psychotherapeutic relationship and the goals in psychotherapy Integrative Psychotherapy focuses on relationships. The foundation of a relationship is contact. The therapist’s most important task is to help the client establish and maintain inner contact and to be aware of his inner experience, his thoughts, emotions, wishes and sensations. Also, the therapist must help the client to establish and maintain external contact which includes relationships with other people (Erskine, Moursund & Trautmann, 1999). Feminist counselors and therapists focus on empowerment of their clients and help them develop an increased level of self-esteem and control over their own lives (Chaplin,1999). The focus of the therapeutic relationship is on the client and on his exploration of his own life. The therapist’s role is to support him and to fully accept him. At my work I can use and see a connection between both the integrative as well as the feministic focus. In my opinion, contact is the most important part of both focuses because without good contact it is impossible to reach the goals International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 56 that the two approaches consider as a crucial part of the process. The relationship between the therapist and the client is almost identical in the integrative and feminist approach. Both of them consider as crucial the role of the therapist as a partner in therapy who acts in the client’s best interest. In Integrative Psychotherapy, with the awareness about fixated gestalts, the client gradually reestablishes contact with himself and others, as well as replaces old automated patterns of beliefs and behaviors with new ones (Erskine, Moursund & Trautmann, 1999). In feminist psychotherapy the client gradually accepts himself, regardless of the social expectations that are connected with his gender role. By doing this he is more and more able to live in accordance with his own wishes, needs and beliefs (Chaplin,1999). The goal of integrative psychotherapy is to establish full inner and external contact (Moursund & Erskine, 2004). The most important goal in feminist therapy is the transformation of an individual as well as the transformation of the society as a whole (Herlihy & Corey, 2004). In my work I attempt to integrate both: to help the client establish inner and external contact, but also help him to become aware and recognize inner messages connected with his gender and replace them with constructive beliefs of his own, as well as for him to learn, regardless of his gender, to trust his intuition and experience. When I repeatedly ask myself about my way and approach to Integrative Psychotherapy, I believe they are best captured in the thoughts of Richard Erskine (2001): “We love them through our phenomenological inquiry, through understanding their defensive process, through valuing their vulnerability. We connect with them through affective attunement: when they are sad, we meet them with compassion; when they are angry, we take their anger seriously; when they are scared, we create that psychological holding environment that surrounds them with protection; and when they are joyful, we meet them with vitality. Those are the realities of our therapeutic process that make our dreams come true because we share our personal presence in an inter-subjective arena between client and therapist.” References: Chaplin, J. (1999). Feminist Counselling in Action. London: Sage Publication Ltd. Erskine, R.G. (2001). The Psychotherapist's Myths, Dreams, and Realities. International Journal of Psychotherapy, 6, 2, 133 - 140. Erskine, R. G., Moursund, J. P. & Trautmann, R. L. (1999). Beyond Empathy. A Therapy of Contact-in-Relationship. New York: Brunner-Routledge. Herlihy, B. & Corey,G. (2004). Feministična terapija. [Feministic therapy] In G. Corey, Teorija i praksa psihološkog savjetovanja i psihoterapije. [Theory and practice of counseling and psychotherapy]. Jastrebarsko:Naklada Slap. International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 57 International Journal of Integrative Psychotherapy, Vol. 2, No. 1, 2011 58 Moursund, J. P. & Erskine, R. G. (2004). Integrative Psychotherapy. The Art and Science of Relationship. Pacific Grove, CA: Brooks/Cole-Thomson Learning. Muller,G. (2002). Psihodrama v radu s traumatiziranim ženama. [Psychodrama with traumatized women]. Notes from workshops. Walker, M. (1990). Women in Therapy and Counselling. Philadelphia: Open University Press Zaviršek, D. (1994). Ženske in duševno zdravje. [Women and mental health] Ljubljana: Visoka šola za socialno delo. Author: Lorena Božac Deležan is social worker and Certified Integrative Psychotherapist (IIPA). Since 1995 she is working with women, victims of violence in relationships and women sexually abused in childhood. She is co-founder of the first Slovenian Crisis centre for women and children – victims of violence in family. Currently she is working at Women’s Counselling Service as counsellor and psychotherapist and in the private psychotherapy practice. Date of publication: 30.1.2012