Pre-Therapy with Lesley Dougan and Ann-Marie Wilson

In this episode of Person-Centred Conversations, Ann-Marie Wilson and Lesley Dougan discuss pre-therapy and contact reflections—often overlooked aspects of person-centred practice. They explore the pre-therapy chapter from the latest Tribes of the Person-Centred Nation book and reflect on their experiences. This insightful discussion is accessible to anyone interested in pre-therapy as part of person-centred practice. 

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Transcript

Ann-Marie Wilson: 0:00

Hello, I'm Annmarie Wilson and this is, uh, Leslie Dougan. And, um, welcome to this discussion on the importance and the relevance of pre therapy and contact work. Um, a special thank you to Peter Blundell from uh, PCPC for inviting us to share our reflections on this aspect of the person centered approach. Um, just take through kind of how we're structuring this. Um, we're gonna begin by introducing ourselves a bit about our background, uh, and our interest in the field before sharing some reflections on the chapter in the, uh, third edition of the tribes of the Person centered approach. Um, written by, uh, Dion Vard and with, uh, Pete Sanders. Input from before on the pre therapy and contact work. Uh, and this isn't, this isn't a chapter review, but it's, that's kind of a, it feels like a platform or an opportunity for us to share our thoughts, um, reflections. Um, and then also to add onto that in terms of the work that we've been doing, uh, around pre therapy, the ideas we have, the questions that, um, have come up as a result of the work that we've been doing. Um, and just to. Put it out there and invite people to Yeah. Question. Wonder with us about this part of the approach? Um, so maybe start with yourself, Leslie, say a bit about yourself.

Lesley Dougan: 1:22

Okay. Uh, so, hi, um, my name's Leslie Dougan, uh, and I'm, uh, neurodivergent person centered experiential therapist. I qualified in 2012, so my background is I started working in. Child and adolescent mental health back in 1996. Um, and predominantly working with children and young people with learning disabilities, neurodevelopmental conditions, and their families. And that expanded out. And while I was in, um, working with cams, I got some additional qualifications in autism and special educational needs, psychology, and then my counseling and psychotherapy. I. Qualification, which I, I got in 2012. So since then I've had a variety of different roles, um, both within the NHS and in private practice. Um, and I currently have a very small private practice where I work mostly with people who are neurodivergent. Um. And I supervise, um, a small number of supervisees who work mostly all neurodivergent too. So alongside my private practice, I am currently program lead for the masters in counseling and psychotherapy at Liverpool John Moores University. And when I started in that role, one of the. Key bits I felt was really important was to introduce students to, um, pre therapy and the concept of concept work. I'm sorry, contact work. Yeah, that's me.

Ann-Marie Wilson: 2:55

So, um, I'm Annemarie so I qualified as a person centered experiential exec therapist in 2022 at John mos and completed my MA dissertation, um, last year, 2023. And I was focusing on the attitudes of students. Um, on the course towards using pre therapy and contact reflections. Um,'cause my background is, um, health and social care. So I worked, um, can I still do for over 25 years with people with learning disabilities and variety of support management leadership roles. Um, and in that time I was really aware of how poorly mental health. Um, was understood, was provided and supported for people's learning disabilities. Um, and over time, you know, there was some support, but largely I. The argument was that because of their disability, their learning disability and their, in some case, their inability to communicate verbally, that they wouldn't be able to access talk and therapy wouldn't be able to access therapy at all. And over time I became aware of some of the more creative arts and that are available. So music, art, um, dance movement. So there's a lot more of that. But I was just really aware that there didn't seem to be a lot out there. Um, and in most cases people would end up just on medication or we were just told to manage. Um, and then when I started on the course and um, Leslie had done the lecture on pre therapy, it was like a bit of a light bulb moment going, oh, so there is something out there. But also realizing that a lot of it was, some of the interactions and relationship stuff was stuff I was doing. In my role as, as a support worker. So it was kind of there, kind of instinctively, I guess, or learned just through learning from the people with learning disabilities themselves. But just that actually there was something, there were different ways of working with people, both in the care setting, but also that there was ways of supporting people. Um, and yeah, out of, out of that experience in the first year, I. Decided that would be part of my theme for my research. And out of that came a lot of questions, um, which is why myself and Leslie are regularly in contact and talking about what do we do now with all of this. Um, so yeah, that's kind of a bit about. That was both. Um, so I think we're gonna start by just sharing some initial reflections and thoughts around the chapter. Like I said, it's not a chapter review, but just it felt really important that this chapter was out there. Um, and then some of the things I've come up from us from reading that as well as the work that we've been doing and just generally our thoughts around working with these client groups. So specifically thinking more learning disability and those who are neurodivergent. Um. So, yeah. So I dunno, Leslie, if you wanna sort of kick off with some of your initial thoughts. Yeah. I think one, one of the things that, um, came to me about the new chapter, and it's an expanded chapter, so, um, this is the third edition of the, the tribes of person centered nation, um, that has come out. So first one came out. At the very beginning of, um, the, the two thousands, and then there was a second edition in 20 20 12. And then there was a small chapter by, um, Pete Sanders in that. And it was put under the concept of the new developments. And what struck me was it wasn't a new development because Gary Prouty, who sort of, um, formulated the ideas of, um, pre therapy, had been working on it for. Decades. But nonetheless it felt really important that it was in there. Uh, and what I really like about the fact that the, the new chapter plays a central, has a central place in, um, the. The tribe's book now and more space and time has gone into the talking about and explaining the really important concepts that are related to, um, pre therapy, whether that's looking at different types of contact.'cause one of the things, I think what I feel is that. Fundamental to pre therapy is the notion of psychological contact. And I think we're gonna talk a little bit about that, um, soon and, and how Prouty sort of developed that concept or working with, um, the notion of working with people who, um, may be contact impaired or where contact psychological contact is missing or a bit sort of, um. Like it, it zones in and out. Um, and I think the other thing that I really liked about it is that it was very clear, so it, it feels like a really lovely introduction to pre therapy and contact reflections to someone who may not have come across it before. And from my sense is that even though it's fundamental to me and fundamentally fundamental to you Ann Marie that. I don't know how how many counseling students, person centered counseling students are actually formally introduced to, to pre therapy as, as a practice. So that's, that's when my, my initial thoughts came from, um, reading the chapter. Yeah. And I really echo that because, um, it was one of the comments when I was doing my, my research and I was in the reading the literature and just this, this, um. Well, the lack of connection it seemed in the literature around learning disabilities and, and lack of understanding or lack of recognition of this option of pre therapy and contact work, but also within the person centered field. It felt like it, it just wasn't recognized and, and, and there was bits of it, but it just didn't seem to be seen as a way of working. It just felt like a bit of an, an add on. And I, I imagine it wasn't intentional, but I think because for me, I was very passionate about the fact that I see many, many people suffering with learning disabilities because their mental health isn't taken seriously. Isn't, isn't understood, or there's a fear. So no, so nothing happens. Um, which kind of para a paralysis really. So it was good to then see the chapter and like you said, that it felt really clear. And it's difficult because I spent so much time reading about it. Of course it seems clear to me, but actually it did feel like there was an understanding and explanation of, of it all. Um, and that sense of putting it in with the tribes, this isn't an add-on, this is really part of a way of working and, and I guess some of the fundamentals. Around the person-centered approach. You know, those six conditions and core conditions, and I know we're going to come onto that, but yeah, it was just great to see it. But I think the other thing, I think the thing that stayed with me, or a couple of things that stayed with me most was that being in contact is in and of itself, therapeutic and the questions that come up around what is the purpose of therapy, which again, I think is one of the reasons why. These client groups are often marginalized is that, you know, you come with a problem, we work it through, and you have some tools to manage it. Rather than understanding that where there is no contact, that in itself is causing that individual distress and potentially harm. So that being in contact is the way of enabling the person to feel more whole and seen and, and heard, and, and the value of that. And that comes from. Being in relationship with people with learning disabilities for whom contact was often missing myself and with others. Um, so it's great to see that. But I guess the other thing that really stayed with me was, um, when I was doing my research, I. And although it's a small piece, there wasn't too many contributions. The, the thing that came up was that they needed more examples of how do you put it into practice and a wider range of people that you would use pre therapy and contact work with. And I felt, feel like the chapter really gave that I. And, and therefore, oh, hopefully it's gonna open up for more people. Oh, I'm, maybe I need to know more about this. Um, so yeah, so I think that's kind of where I'm sort of starting from in terms of that. Um, and I know we wanted to talk about psychological contact and I wonder if now is the time,'cause that kind of feels like our foundation, feels like our bedrock on which this is, these conversations are happening.

Lesley Dougan: 11:50

Yeah. And, and, and I think for me that when I, when I was a, um, a, a student when I was learning about psychological contact and that that sense that it's almost when you, when you, when Rogers first started to talk about psychological contact, it was almost like it was a given. Either psycho psychological contact is there or it's not. And actually what, what I've realized through psych work is that there are degrees of psychological contact and Dion talks about, um, gray zone functioning where clients can move in and out of different qualities of psychological contact and. The often a psychological contact alongside client perception of the therapist conditions and the therapist's empathy congruence and UPR, they of themselves are marginalized. They bookend the therapist conditions, so they're often not really considered. Um, so, so when it comes back to the psychological contact side of things, um, it's about what. What do we do as, as therapists, as counselors, if we sense that a client is outta contact? Is that, is that fleeting or is that something about their, their functioning. And as you said before, do we assume that clients with particular presentations unable to, unable to gain that psychological context of therefore they can't engage in therapy? Whereas for me, there's a sense of the responsibility as a therapist to, to work on connection with a client.

Ann-Marie Wilson: 13:49

And, and I think it comes down to, for me, that thing of, you know, that thing was a given, either you're in contact or you're not. And then that opening out of actually the degrees of that. But also for me, that thing of, well, because somebody isn't, doesn't mean they can't. Mm. Yeah. And I think that's the point of pre therapy and content work is what it says is okay, so they're not, so how do we enable, how do we facilitate that? How do we establish and maintain that and that, and in that session it might come and go. So it might be fluctuating. So it's, so there's, I think there's something about understanding, well, what is psychological contact? When it's absent, what can be done to establish it? Because it's not that it can never happen, it's that it's not their ease. It's not readily available to an individual because maybe brain function and then disability trauma. There's so many things where that can can be very difficult to access. And then when you do establish that. How that might fluctuate, either with somebody for whom it is largely impaired or off frequently impaired, or the person in front of us who is recalling us talking about things that are particularly difficult for them and therefore they're disappearing as it were, or dissociating, and then we'd, so really that need to,'cause I think free therapy and contact work. It feels like it's been a bit of a specialization as if it's only with certain people, and I think what we're trying to do is so well hang on. We've gotta go back to contact and actually any one of us can wander off and most of us will come back. But actually sometimes that might, we might need help both to contact with ourselves and the other, and how to look after ourselves in that.

Lesley Dougan: 15:35

Yeah. And also there's that, that third element of contact, you know, the, uh, contact with the well to contact with the. With the environment that you are in. So you, you mentioned sort of like that contact with self, so somebody might be dissociating or they might have a fragmented sense of self because of their life experiences. It might be, it's that interpersonal contact with other people that's impaired. But it might also be around that, you know, when people talk about derealization or de depersonalization that. That lack of contact with, with the world, with the situation, and any of those can impact on psychological contact with in in a therapeutic sense.

Ann-Marie Wilson: 16:22

Yeah. And, and I think then that's the thing is, and then going back that sense of, so there'll be, there are, there are many,'cause I've lived and worked with many people and disabilities who just seem quite lost and you know, there's somebody there, you know, there's a person there and you'll have moments. But actually, whether it's in the care setting. And this is where contact work comes into it rather than sort of pre therapy as, as such when both use contact reflections, but also where somebody's clearly distressed, as you say, presenting with clear distress, whether it's self-harm, whether it's harm to others, whether it's complete withdrawal, depression, whatever is going on, is that it's not okay to just say, well, that's how they are. And I think this is where my. Frustration comes as that actually it is not good enough. It's not good enough for any human being to be told or said, well, that that's just how they are.'cause actually with time, with patience with the right tools for want of a better word, um, things can be different. And we don't know how they can be different, but it's not to give up on those people. Um, and here is a way where we can do that.

Lesley Dougan: 17:41

Absolutely. And I think, I think one of the things that is really important about, um, pre therapy and those contact reflections is that it's all about reflecting the concrete reality of the clients in one given moment. So it's not around like offering a, a reflection or interpretation, it's around their reality. Now

Ann-Marie Wilson: 18:09

Yeah.

Lesley Dougan: 18:10

To enable'em to either regain contact with themselves, um, the world that they're in or with the person that they're with, um, it feels really simplistic to do, but actually it's, it takes a lot of hard work and effort to stay in the concrete because, and I think particularly when, if you're used to working with people who. Who have psychological contact where, where it's not, where it's not fleeting, that it, it's a really hard concept to grapple with because you are used to working with people where there is psychological contact that as you mentioned, that we all, you know, we all lose contact. Now and again, whether that is, uh, like getting distracted by staring out the window at something that's happening and daydreaming, uh, or whether it is around dissociation or whether or not it, it's more to do with, um, a different type of processing style or a learning disability. So how, how do, how, how do we introduce and think about. Pre therapy and contact reflections in a way that isn't, should say, feels like it's, it isn't specialized and it's out there, but it's something that we can all as therapists it. It's something that is fundamental about connection.

Ann-Marie Wilson: 19:48

Yeah. And I think that comes back to this, this question around again. Um, so myself and Leslie are, are working with another group, um, which is now called Ourselves Therapy Fit for All, but exploring, you know, how do we work with and share resources, um, but working with people who have learned disabilities, people with autism, um, another neuro, but particularly autism, but those groups, those groups of people who. Or non-verbal or have less cognition or generally it just kind of went, oh, well they, it doesn't work for them and they're almost feels like they can be written off. So I think there's something about really wanting to explore and open out, and it's not that I'm suggesting everybody will want to and feel able to work with people with disabilities, but that it's not assumed that they can't because actually contact can be lost at any moment. And how do we manage that? Um. And I think the other thing I was just, just sort of, when we were talking before and yesterday I was at, um, a task seminar, uh, run by online events with Sally Polivitz, whose name I hope I haven't said incorrectly, and I'm probably misremembering the quote, but it really struck with me and it was when, um, when injustice becomes law, then resistance is our duty. And I think for me it does feel like that. It does feel like there is a lot of social injustice. I. Around people who are accessing social and healthcare in that, and I don't just mean funding, but just there's a lack of understanding of all. We have a responsibility to support those who, who can't necessarily do that. And as therapists, I believe that we have a responsibility to be aware of how you might work with that group. Mm-hmm. Um, and that's where fundamental comes back to that thing around contact, so that we understand. And I think we've, we've chatted at different times and something you were saying before we started this, that sense of, and it was something that definitely came up in my, um, my own research was how difficult it is to define what psychological contact is. And almost, I wonder if that's why we don't sort of. Look at it too much. I mean, some do, but it still feels like it's on the periphery. Like say the bookends of the core conditions, which are about our, our role as, um, therapists, but actually in this case, we have to intervene. We have to initiate. We're not waiting and following. We have to, we're still following, we're still waiting, but we're naming what we're in. So that the waiting and the following is for them to be able to make contact and then take the lead. But actually what we're saying is in order to be able to follow the lead of an individual, we need to be in contact. So therefore we need to find ways to do that and, and actually naming the space, using those contact reflections and, and seeing what's there, naming what's there and only what's there. Will enable, does enable people to who often aren't seen and often, you know, nothing against care settings are still support in that field, but quite often you're so busy you don't see Okay. Or you, you, you see the task, but you don't always get time to see the person and to keep that relationship. And so how important is that, whether it's contact work in the care setting or contact reflections and pre therapy that we're finding ways to meet. Okay.

Lesley Dougan: 23:14

What, what, what just struck me as we're talking about this, we're, um, we're very familiar with contact reflections. Yeah. But, um, I'm, I'm wondering that maybe not everybody will have read the chapter or know, know what the different contact reflections are, so it might be worth going through. So there's five, yeah. Five contact reflections. So one is situational reflections where you are commenting on the, the physical environment that you and the client are in.

Ann-Marie Wilson: 23:45

Yeah, the shared space. The shared space, yeah. In a sense, sorry, naming it as a shared space. It's kind of a reaching out, it's an invitation to say you are naming it, but you're reaching out saying, I'm here too. Can I come in? That's how I see it. Yeah.

Lesley Dougan: 24:02

Yeah. And, and we can talk about, um. And later on about some, the development we made to help the students at John Moores. Yeah. Whi, which includes a situational reflection. So then there is, um, a, the verbal reflection. So a verbal reflection would be that you would repeat back. The words of the client or maybe the sounds that the client is, has made, if they are non-speaking. Um, and then what you've got is something called a facial reflection. So you either would, um, reflect on, um, a client's facial expression or you might physically reflect. The client's facial expression.

Ann-Marie Wilson: 24:46

So mirroring it, almost

Lesley Dougan: 24:48

mirror mirroring and mirroring it. Yeah. Yeah, yeah. And then what we have is bodily reflections. So that might be you, you are commenting on, um, the client's behavior. You stand up, you walk to the window. Again, like facial expressions, the facial reflections, the, the bodily reflections, um, can also be a physical, um, mirroring of the, of the client's reflections. And then, and then the final one is reiterative reflections. So you might say you've stood up and walked to the window and then said, and when I talked about verbal reflection before the actual accurate. Title is a word for word. Word for word, yeah. Reflections. Yeah. Um,

Ann-Marie Wilson: 25:37

and, and they seem, like you said, they seem really simple and it's something in all the literature says, you know, it seems very simple, but it's not easy to do.'cause and I think that's the problem is that quite often, because it's so simplistic, we think them, it's not enough. Yeah. When actually, when, if, you know, if it was totally disconnected from self or other, other environment, the thing we need is to be enabled to. And, and people may not be ready at that point. This is why, you know, the, that's the thing. The other thing that can put people off is that it can take weeks, months for somebody to do that. You know, you might be spending 15, 20 minutes'cause it won't be a standard session. Um. Or send the length of session every week, same time every week, same space. And you might be doing that for weeks, weeks, months, before the person finally acknowledges you. I think that's where it can be difficult, that sense of, well, we kind of want instant results or we want some sort of feedback.

Lesley Dougan: 26:35

Mm-hmm. Um, and recognizing that actually for this person, they, they can't necessarily give us that immediately, but are continuing to stay faithful.... To stay with. Mm-hmm. Will, is part of that making contact? It is part of that building relationship, which is, I would say therapeutic because we're choosing to stay with Absolutely. And not only I, it is, I, it is deeply respectful. And deeply empathic with Yeah. With the client who's in front of us. Yeah. Because we're not trying to do something to them. We're being with, and I think that, that, that sense that you, you mentioned that, that, that being with and alongside is fundamental in all of that.

Ann-Marie Wilson: 27:22

Yeah, and I was just thinking as well of, um, Marley's partner's work and she writes a lot about using contact reflections in a contact work setting. So not just therapeutically, but with in a setting, which is really important. It's kind of how you work with, so it's not just what happens in this one-to-one space, but that this becomes the norm. But one of the things that she said, and it really steered with me when I was doing the reading, when I was doing research, was actually. Understanding, using contact reflections can help help you have a much deeper lived experience. Phenomenological, I guess, understanding. Of the core conditions because to keep staying with, I'm not trying to push or pull or nudge or manipulate, and I don't mean that in a negative way, but without trying to do that. Being there alongside every week is UPR is unconditional positive regard, but also that reflecting what's happening around. That empathy, you know, the as if is I'm asking, can I be alongside you? Really seek, and I think in some respects it can be a really, just thinking about it now, it can also be a really useful way to understand power dynamics because it's not about me trying to, well, you know, do this or try that, or you're doing, you know, shall we do, you know, it's really staying with, and my experience of doing that. In a care setting. I'm not, I've not done it therapeutic formally and therapeutically yet. But is that, that, and I, I always get emotional. I talk about this, that is just so opening for me as a person to when those moments come, when somebody does open, knowing that how long and how difficult it's been for that person to get to that point. It's such a powerful emotion. But the power dynamics, I think can be key in that.

Lesley Dougan: 29:14

Yeah. And what, what came up for me when you started to talk about that is the trusting in the client's actualizing tendency. Yeah. Which to me is almost like the fundamental bit about person centered practice. That and the actualizing tendency there and how, however long it takes. Yeah. That, that effort to, to be able to be in touch with, with the client.

Ann-Marie Wilson: 29:47

Yeah. And, and I guess coming back to what you're saying before about the first and six conditions there, the, the establishing or reaching out to make contact, but being respectful of that and the moment when there is a response and you get that moment where they look when somebody looks at you and they see that you have heard and seen them. Yes, it's, yeah, and that's, and I think sometimes we don't, we don't always acknowledge that even in the, when we're doing talking therapy, even when we are with people who are verbal and are in contact, I don't think we always recognize the importance of how is this being received? Or maybe that's just my thinking about it. But, um, I think sometimes the. The training is all on the core conditions, but in focusing on the core conditions, and I guess I'm wondering why we're still calling them core, um, is that actually we need to be looking at the whole, it's environmental, but the environmental stuff means nothing if we aren't checking in how it's being received and understood. Yeah. And what, what impact it's having, what's it leading to?

Lesley Dougan: 30:54

Yeah.'cause fundamentally the client's perception. Is the fun, it is fundamental in all of this. Yeah. That not only is psychological contact really important, the psychological change to to happen. Yeah. But actually the client's perception of the therapist conditions, it is key that if, if a client perceives that you are, are with them. But in of itself is therapeutic, which goes back to our initial, so it's like ponderings about what is and isn't therapy, um, therapeutic. And, and if somebody feels like they're being seen and heard, they're more likely to start. The word that comes to mind risking being themselves or becoming themselves, which, you know, going back to the person centered approach is that sort of theory of personality change.

Ann-Marie Wilson: 31:53

And you know, you do that because you connect to parts of yourself that maybe you've denied or have been hidden or have been pushed away or have dominated, and it's kind of becoming more whole. As a person. Um, and we can do that when we feel safe enough to start taking those risks. And so essentially that's what we're saying, pre therapy and contact reflections and contact work can do is, is enable some or facilitate somebody feeling safe enough Yeah. To start becoming themselves. Um, and that's an ongoing journey. Um, and I think because. Particularly thinking now about people with learning disabilities and care setting, because quite often staff turnover is frequent. That's lost. So no wonder so many of these people are often withdrawal or going to, um, lose psychological contact because actually there isn't a mainstay. There isn't. That that person or those people are often, and not all the time. It's, it's very different too. I know 40, 50 years ago, but still for a lot of people, there isn't that sort of core group of people who are alongside you. That I know for myself, I depend on and thank very much to them. But you know, it's that sort and that's, it's a mutual. Yeah, as well. Um, so I'm just really conscious it the ramifications of, of enabling and, and looking at psychological contact with everyone really questioning what we mean by that. So I guess just following on from what we've sort of been saying about, for us, the centrality, the fundamentality of psychological contact and, and, and I guess what we're kind of saying is, or what I'm hearing, and I definitely heard it when I was doing my research, was. It's really, it seems really hard to be able to define psychological contact. And when I was doing my research, um, that was one of the things that came up was one of my questions. You know, what is psychological contact? What do you understand by it? And there was lots of ums and pauses and people not quite knowing how to say it. And that realization that actually on the course we, we hadn't, I mean, I was. Couple of years behind or ahead, but that we hadn't really talked about what we mean by it. What, what is it? Um, and a need then to look at, well, if people don't understand what it is, how is that affecting their willingness, their openness to explore pre therapy, contact work, contact reflections, rather, um. Because that just seemed really, because in the research, the people would definitely, yeah, we'd like to know more, but we want to know a bit more about what it is, how you do it, needed a few more examples. And I think this is where the, the chapter in the tribes is great because it shows, it gives more examples and different ways of working with people, which I think is just so important. And, and I would say that, um. There needs to be sort of visual sort of video case studies. Now how do you demonstrate it in action because it is so simple and yet not. Um, and I guess that takes us then to, I. The work that we started doing? Yes. Um, as a result. So, you know, with my research, what came up was people were open to it, but they needed, they needed a, um, a different footing. They needed a different way into it. Um, and maybe say a bit more. Yeah,

Lesley Dougan: 35:31

yeah. I, I think one of the things that, that came across than me, obviously,'cause I, I'm quite passionate about pre therapy and contact work, and actually I. Having worked with people with learning disabilities and autistic clients and neuro divergent clients and clients, clients who, you know, on, on, on occasion in sessions will, whether they'll be out of contact, and I, and I've act, you know, used contact reflections as a way of re-engage in psychological contact. It. To me, it, it makes complete and utter sense. Mm-hmm. And but what we realized, um, mainly because of your, your reflections, but also reflections of them, fellow student of yours, Maddie Hall, that not, not all students got it because it was so concrete and literal and not moving beyond the, the actual moment by moment reality of a client. It was, it was a really difficult concept to, to grasp. So we were trying to make sense of, well, how, how do we, how do we change the way that pre therapy is spoken about? Is taught on the course.'cause we have one session, so it is only an introduction nonetheless, but there's lots of pre-reading around it. And, but how do we make it more, more real? So that people actually get it. Um, and so following on from your research, your your, your master's dissertation, we, we came up with an idea of developing, um, uh, a video, um, but would demonstrate the variety of different contact reflections. So word for word, situational facial, bodily reiterative, um. In a And so it was actually gonna be developed, co-developed by, um, myself and, and students though. So yourself and Maddie. So do you wanna take it a bit further now about the, the video itself?

Ann-Marie Wilson: 37:44

Yeah, so I guess we were kind of trying to work out what would be a scenario, and it was very short clip, only a couple of minutes in the end. But myself and Maddi sort of. Played those roles. So it was role play. And I guess the thing was when, when we had the lecture and we, we did roleplay or we kind of did works in groups for a lot of people because they didn't know what to expect. It just seemed incomprehensive, but it was just too difficult to go into. Whereas'cause myself and Maddie, because more comfortable with, with pre therapy and contract reflections, we were able to do something. So I, I took the role as, as, um, a client and Maddie was a therapist and effectively she. Followed me. And as much as she stayed with me, she kind of named things that were happening, didn't push or pull, but then essentially what we demonstrated or tried to demonstrate was that over time, and obviously it was a shortened, you know, we did in, in a few minutes what you might do over several sessions and several months even. But that, because the therapist didn't push me, the therapist named what was there, was saying, this is I'm, I'm here. And it felt like an invitation that eventually I felt able to allow myself to be seen and to be heard. Um, but essentially then what happened is we did, we, we did a few minutes where we demonstrated each of the different, um, contact reflections and, and that was recorded, videoed, and then. That was then put on, um, a piece of tech from the university, um, with the department to enable it to be used as a way of demonstrating and asking students, say, what, what do you think has just been demonstrated? What was presented there? Which of the, uh, contact reflections did you see there? And it was, you know, so as an introduction, um, and then. This was shown and then people were asked to say, which one do you think it is? Um, and if they were correct, great. If they weren't try again sort of thing. But it meant that they had time to stop and look at it and wonder and think and process through. Um, but actually to CT people who were comfortable doing it rather than with people who were struggling, I would say with the idea and the concreteness of it, as you say.

Lesley Dougan: 40:00

Yeah. And, and, and. Having, having been able to access that in addition to, um, the, the lecture. Um, has, has really increased students' like confidence in being able to, um, utilize contact reflections. I think the other sense is that, that alongside that it is more of the emphasis on psychological contact on, on what it is to enable the, a more nuanced, um, understanding so that it's not marginalized, that it's pivotal to. Pre therapy work, but also all workers, person centered counselors. And the thing about, um, although pre pre therapy is a development of person centered approach, it's actually trans theoretical. So it's that contact is fundamental across all client groups and all theory it can be applied to to anybody.

Ann-Marie Wilson: 41:05

Yeah.

Lesley Dougan: 41:05

And I think that. In a way, the universality of contact reflections shows the importance of it in terms of being in contact with whoever. Yeah. Whether that's in a therapeutic setting or in everyday life.

Ann-Marie Wilson: 41:23

Yeah. Because essentially if you are, you know, sort of speaking with some colleagues who are not person centered but are working with learning disabilities, is that the first thing you're doing is. Connecting and con contact. Psychological contact is about connection and in order to the news, art therapy or creative arts or sound or plastercine or music or dance or instruments you have to be in, there has to be a connection on which those tools, those means that modality can be used. Um, which then enables the relationship to develop. And then because there's a relationship, then things can deepen and, um, so yeah, I think that's really important. So, while it's come from the person centered perspective, initially, it is actually something that all therapy involves. You know, if you don't have contact, nothing's gonna happen. And it's just two people in a room or in a space or, um, yeah.

Lesley Dougan: 42:25

In, in a way thinking about, um, where contact reflections come, um, in relation to, um, maybe grounding techniques or elements of that that often, you know, people might use grounding techniques as part of a therapeutic practice, but actually sometimes that those grounded techniques are ineffective because the contact isn't there. Yeah. Almost like that, that people. Or moving through too many steps. Yeah. And, and it can never be assumed. And the thing about contact reflections from my experience is that you might sense that somebody is out of contact and you might offer a contact reflection, but given their response to that, you will immediately know whether or not there's contact there or not. So you can, you can, you can, you can move from. Person centered reflections into contact reflections and back almost like seamlessly. And I guess for me, it's something that is so integral to my practice anyway. I just do it. I forget that that's what I'm doing. I'm moving from one to another, but it might feel quite artificial and awkward for the some, especially when there may be. Newly qualified or actually trainee therapists and to, to, then that comes back to is this something that is being taught to on, on counseling and psychotherapy courses? Is, is pre therapy and contact work something that. Is being introduced. Um, if not, why not? And if it is, how is it being introduced? And, and is it, can it, can it evolve? Can, can we improve the way that we teach these concepts to counseling students?

Ann-Marie Wilson: 44:26

And, and I think alongside that is, is two, well, two things. One is, and I'm thinking about, um. One of the contributors to the research really was focusing on, you know, this isn't just about learning disabilities or autism, this is about people who are dealing with trauma.

Lesley Dougan: 44:43

Yeah.

Ann-Marie Wilson: 44:44

And, and so sometimes grounding will help, but actually sometimes if the person is completely. Separated out as it were then actually it's where contact reflections come into it. So then there's a need for that, that where contact is there and it's obvious, but it disappears, that fluctuating. But also for the person who, for whom it has to be established, there's still a need to be aware of the physical presence that's in front of you and that that support, um, but also. I've kind of lost my train of thought then, and this is what often happens to me because there's so much in, in this kind of goes, but I think it's something about if we, if we don't teach this, if we aren't taught this, if we aren't exploring what this means, there are a whole group of people in our society. Who will just get further and further marginalized, will live in places of distress and, and, uh, emotional and psychological distress when there are ways very. Easy ways to, and it's a culture. I mean, this is something speaks, uh, a lot and he's got lots of experience in, you know, but that contact with that, that space, it's about creating a culture. It's about saying this is the way we can interact with one another. This is the way that we relate to one another. Because this benefits everyone. It benefits the individual. My experiences, it benefited me'cause I think it taught me a lot about myself and opened me out. But also as the support worker or the carer or the family member, life does get better because actually there's a way of relating to somebody where. Behaviors that are, are communicating distress, they're understood. So actually then you can start looking at the distress. You can start alleviating. And I'm not saying it makes it perfect by any stretch of the imagination, but in many cases it makes life much easier for the individual, which therefore means that those around them, which means that you can start building more deeper relationships of reciprocity rather than carer power dynamic, the individual being cared for. Yeah. And to me, that's what it means to be human. And that's what the, for me, that's what part of what therapy is for, is about enabling each of us to become the whole human We can be in any given moment, and sometimes that's somebody's really struggling and other times that's where somebody's is flourishing, you know? So it's kind of how do we create that space? And even if people, you know, even if lots of potential therapists aren't necessarily planning to work with that group, that it's not. It's not assumed that they can't, that they'll always be that window. If something happens, they're not gonna kind of go, I can't deal with this. Mm-hmm. Um, because also, what does that say for the individual in front? It's another, it's another example of being rejected because of who I am, when actually there's nothing wrong with the individual. It's about the culture, it's about the environment, what we can do to support and enable that person to, to become whatever it is they can become in that moment. Um, and I realize I'm getting a bit sort of philosophical in this, but for me it is, it is a philoso, in fact, Prouty of himself. Very much rooted in a philosophical, um, sort of space as well. But yeah, so I think there's a real need to almost kind of across all courses that question of. Are you facilitating, introducing, opening up conversations about working with people where contact will either need to be established and maintained throughout, or where it will fluctuate and while it's based in the person-centered approach, this is about. All people in all contexts. Um, which I think is really important. And I, and I get sense that's not necessarily where some people in the person centered field would be okay with that. But for me, this is about the people and these are people who, who, who need to be heard and seen and supported.

Lesley Dougan: 48:48

Absolutely. Yeah. Yeah. Yeah. And, and I, I think as, as, as a, as an educator, as somebody who, who teaches about pre therapy and contact work. It feels having a responsibility to be able to be able to share that, to be able to increase awareness. Um, it, it is really quite fundamental and, and that's why it's part of our program that I, I, I cannot ever envisaged the course running without a session on mm-hmm. Contact work and pre therapy because to me it is so fundamental to everything.

Ann-Marie Wilson: 49:30

And I guess alongside that is, is how do we, or how is psychological contact then taught before you even go on to pre therapy and how you establish and maintain it is, how do we talk about it? How is it described? How is it explained? Um, going back to the person centered context, you know, and you know, I think I mentioned before, but you know, again, Molly's partners work that actually. In establishing contact, you have to really live those core conditions and you'll know if those are being lived. When you see the response, how it's

Lesley Dougan: 50:06

received. Yes. So how you see it as a whole thing, you know, bookends, but without the bookends, there's no structure. The book will fall apart. The page has got nothing to be bound to. So how is this held? Um, I like my metaphors. I I, I like your metaphors too. And I, I think it almost feels like that's a really. A good place to to end. So we, we, we started off talking about how the developments of the, the, the, the, the new chapter in the, the third edition of the tribes and how, and how that in itself has. Evolves so that it does feel as if pre therapy is, has a more central role. And of course, it's not only in the new tribes book. Um, there's a chapter on it in the, the newer edition of the Handbook of Person-Centered Psychotherapies and Counseling as well. Um, which for no 2024, it feels like actually now is the time to embrace. Pre therapy and, and contact reflections. Um, and it's, it's been really, it's been a really great opportunity to talk to you about it. Um, Anne-Marie.'cause you know, you know that we, when we two get together and talk about it, we, we, we are both very passionate about the subject.

Ann-Marie Wilson: 51:26

Yeah. And I think it's also just that opportunity to talk about it. Um, but also to, to offer that conversation and to wonder who else is wondering about who else already is using it or who is working with clients where actually they need to know about this or need to know more about it. So it's kind of, hopefully I. You know, we, you know, we're not here as experts by any stretch of the imagination, but as people who are interested and who want to, want to develop that, and, you know, that goes back to the work that we're doing, uh, with another group specifically around learning disabilities and people with autism around, you know, what resources are out there and how do we share that? Um, and, and how do we keep doing that? How do we network and open that out so that. People who are often already on the margins are not further marginalized and, and hopefully change in some way can, can happen.

Lesley Dougan: 52:21

Absolutely.

Ann-Marie Wilson: 52:21

Yeah. So thank you for those who have tuned in. Uh, and hopefully this is, hopefully if nothing else, it's raised questions, you know, we are not suggesting you necessarily agree with us, but that hopefully it's raised some questions and some thoughts and. Yeah, we'll, we'll see what comes out of that, you know, and we, we definitely will still be looking at this going forward, so, yeah. Thank you everybody. Thank you. Bye.