 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Welcome back to The Therapy Show behind closed doors and we're up to, I'm looking on my list here but we're up to episode 148. Now. This one is 148. You sound shocked. Yes, I mean I was I was listening to the first ever therapy behind closed doors when we were introducing ourselves. We were babies, Bob. I was 70 and I'm 73 now and we were talking about what we wanted to do, well what we wanted from the podcast and I enjoyed listening to that because you're talking about your history and also talking about your vision for the podcast which I think we've achieved. I was just about to ask you, have we achieved it? I need to go back and listen to what we said. Yeah it was talking about demystifying what we were talking about, our objectives of demystifying what was you know what happened in the therapy room and I was talking about the importance of that and you were talking about that as a major goal and we're talking about the co-created nature of these podcasts which you know stand us out really. Yeah, I think so. We're spreading far and wide, Bob, I think. Oh yeah, you were saying that they've listened to us. Who has said that? When I do ice water therapy so I go out and swim in you know Ponzi and everywhere. Be careful, be careful. Yeah and I'm always careful, I don't do it on me own but yeah I was talking to somebody and just happened to mention the pod you know that I do podcasts and they listen to it so there you go. I know you said that you visited I think Spotify which said that we had we've had 61,000 hits so far. Yeah more than that now, yeah. That's quite good, that's very good. It is absolutely and it's all down to the listeners. Obviously the content and the titles that you come up with help of. So talking about the titles, what we're going to be looking at this time is the pressure cooker effect in therapy. Another good one. Yes, yes. What I meant by it is that when I was a kid going out my mother had this huge silver massive pressure cooker. I don't know if you still buy them that way. Yeah with the lid that clicks short. Yeah and of course what happens with pressure cookers is that the pressure builds up, pulls up and builds up and then all of a sudden it sort of goes if that's the right sound anyway and there's a cathartic release or perhaps on the pressure cooker button when I think of it in terms of psychotherapy and I think psychotherapy is a bit like that. Yeah when people first come to therapy they don't really know what to expect unless they've had some therapy before and they still then don't know what to expect because they're usually at a different developmental phase but they don't know what to expect and so their defences are usually quite stoic if you like. They're usually testing the therapist out. They're usually kind wary of sharing their vulnerabilities. Absolutely yeah and it's a different type of therapy right at the beginning. It's much more about listening to their story, being a witness to their story, helping them believe in us and getting their trust so they can actually start letting those defences down which were so necessary years ago but perhaps doesn't help in terms of where they want to go now. Yeah and I think that sort of process as they start to get to trust us and believe in the process of psychotherapy and the therapist in front of them is a bit like the beginning of a pressure you know pressure cooker effect. Yeah and when I read this title because once I usually you know before we do it have a quick think about what comes up for me with the titles that you've got because I don't think we're always on the same wavelength sometimes but for me I was thinking about you know potential confrontation in the therapy process when we're challenging our clients maybe because in the early days when I first trained I hand on heart can honestly say I didn't challenge my clients at all I was frightened to challenge my clients whereas now I will I want to say pick them up on certain things when I think they're people pleasing me or they're saying what they think they should say I will challenge them and say is that actually true you know when they say that they're okay but the body language is telling me something completely different. And what do you think that confrontation does always it aimed at? Well I'm very careful on when I do it I wouldn't be confrontational at the early stages of therapy I've already built up you know a therapeutic alliance let's say with my clients or whatever but it's more about them being okay with their authentic feelings rather than the things that they think they should be doing or they should be saying in a way of reflecting on things maybe. So are you also saying that's you know with the sort of confrontation which is a psychoanarchical term I'm talking about positive confrontation here. Absolutely yeah sort of adds to sort of pressure cooker effect. I think so that my understanding is yeah that sometimes you know emotions can build in the therapy session and it's how one we acknowledge that and how we can release that through the therapy if there is something. So in a way you are you are tweaking their defense systems aren't you? Yeah I'd like to think so I'm thinking you know this week in particular I was seeing a couple who were saying very nice things but the body language was saying that they were really frustrated with each other so I kind of challenged that what they were saying and said do you know what I mean that I'm seeing some annoyance or aggravation in the body language is that what's going on and it opened up a whole different area for us to discuss. Oh that's good that's a very good way of looking at these things and I often use I usually use the term a lot of therapeutic practice and I've talked to clients specifically in groups actually use this analogy more and I say okay so we can see what's going on here and perhaps at a later time we might get back to it and perhaps looked at how that's makes me up how you find difficulty expressing emotions for example yeah and as I think timing is key in psychotherapy I might say something okay we'll come back at a later day and just allow your pressure cooker to just mull over yeah yeah because it's a really good metaphor absolutely yeah it's a smile about the same time because it's like just by saying that then you know it's ranking up the pressure in terms of how how stoic are the defense systems yeah it's another another way of measuring um their defense systems and I'm only talking about you know in this case you know we're talking about 2024 defense systems I'm not talking about so much when those defense systems were first originated because they were originated for survival reasons and we're now in I don't know how many years later where the defense defense systems perhaps are maybe stronger or even less stronger and they need to break the habit yes the repetitive process so they can integrate a new process or a new idea yeah and they've almost forgotten now to allow themselves to be vulnerable and let those defense systems down because they were built for survival purposes yeah so there's no way the a therapist goes through the front door you know it's like they need to allow themselves to get to know the clients and xxx and then the clients in their own time will start to allow themselves to be vulnerable or allow the pressure cooker to be released if you know yeah yeah and it doesn't need to all be done in one go you know on the pressure oh there is a little knob where we can just release a little bit of pressure over over time yeah oh yeah my favorite sort of phrase is going to come out now Jackie which you've heard thousands of millions of times oh yes I do see it's a process a never an event it's not just like we you know this is about really seeing therapy as a process yeah and you know you're using the analogy of the pressure cooker is kind of you know we can look at how our clients regulate their emotions or the intensity or you know strong feelings in the therapy room as well yeah I mean I think I think it's a really good point there in terms of emotional regulation yeah and if they've never been modelled or they haven't got appropriate emotional regulation then their pressure cooker will just burst off or steam out really quickly yeah absolutely in inappropriate ways I think it's a very common theme in scientific therapy where a person may come because they don't find it or they aren't able for whatever reasons to appropriately regulate their emotions yeah it needs to therapy it's not only to model how to do that for the crowd but also to look at what happened in a process where they weren't learned or weren't able to regulate their emotions in an appropriate healthy way yeah and it's an ideal opportunity to model that you know to me now we can do that yeah and of course they're in charge of their own pressure cooker yes it isn't the therapist is in charge of it no the therapist does in a way is stoke that and and what you often a technical word anyway for this is called paradoxical interventions you know what in other words a ta terms another word would be to tweak the impasse yeah so an impasse is where there's two opposing psychological forces I don't want to do it uh and then the voice says what do you better do it I'm not going to do it yeah I'm not I am so you've got two opposing voice forces so somehow if you can help the client go through this impasse or two stuck places then their pressure cooker can often ease off yeah see when when you're talking about an impasse and things like that I automatically think about the internal critic do you know what I mean when we want to do something and there's that voice inside us that says no you you can't do that but you really want to do it so there's like you said there's this internal dialogue that's going on all the time yeah yeah so for a lot of people they may have positive yeah voices were in a healthy system what you're talking about and the clients we see often who have low self-esteem or might have a tendency over over depression or have a tendency for overthinking or be agitated anxiety and all these things where their self-agency is limited what they often report is what you're saying here is intensity of a critical narrative in other words as part of themselves where they're saying oh gosh I could have done it that way I should have done it that way how stupid I am I XXX and it gets more intense and gets more intense and they tell themselves off more and more so they feel more anxious and they start overthinking and their self-esteem goes down they think they've got no value they feel worthless they go to a dark place they've got depression and then this negative critical voice gets even more intense and more intense and the pressure cooker builds up but builds up and they have no way to regulate stop yeah quick the intense and often they go to a place of shut it off completely they might go to a place of self-harm they might go to a place where they do extremely unhealthy things and attempt to stop that pressure cooker building up with these intense negative voices that you're talking about yeah and in therapy one of the methods if you like or a way of thinking about this is to help the client ease off that pressure cooker in a healthy way so they can start regulating desensitising you know the intensity of those voices and prick the boil which is growing and growing and they feel powerless and lose self-agency yeah that's quite a long narrative but that's well how I see it yeah yeah absolutely and I think that's that's the important thing is that they start to learn that they can control the response and their reaction yeah that in a dialogue might still be there but we don't need to listen to it you know to me there are ways that we can understand what's going on yeah and usually you know Jack at the beginning of this pressure cooker I'd have is the beginning it is that they lose sight or become a you know they're unaware that that voice is someone else's they feel it's themselves yeah and one of the big steps in psychotherapy as you and I know is to help the client be aware that it's not their voices those voices come from somewhere else and that is such a crucial time in psychotherapy where they can take ownership yeah of the the voices yeah absolutely because I think what you know when I can remember lots of instances when I started talking with clients about the you know the internal dialogue and the voices that we hear and everything and I always do a caveat on it that we all have that in a dialogue it doesn't mean that we're schizophrenic it doesn't mean that we've got a split personality it's understanding exactly what you've just said whose voice is that and where does it come from yeah I I remember once where I was doing therapy we were doing therapy and um we were talking about I think it was I think it was these voices she was hearing or the all the negative things that she used to say about herself and she went off to the toilet she's kind of just went off the toilet anyway she'd been off quite a while I don't know four or five minutes but I got a real concern that she you know she hadn't come back in the time I thought was supposed to I went back anyway went out the door and she was in the corridor banging her head against the wall wow and when I you know got her to stop that and grounded her she said I'm attempting to get rid of these voices which I'm hearing all the time so the pressure cooker had been building up and building up and the parental voices becoming stronger and stronger and we need a therapist to help her deal with the you know desensitization of that pressure cooker and get to help them realize but it's not their narrative yeah yeah and I think that's that's really valid and important because then it's about them you know being able to self-regulate that and understand the process and you know be able to take the the pressure off the pressure cooker themselves outside of therapy yeah that's that's that's that's the outcome that's the goal yeah I used to run five day what I called psychotherapy intensives back in the day so people would come to my institute would start at nine o'clock till six o'clock five days a week they'd go home I mean they'd go up and come back yeah and I used to use that phrase a lot because you know I could see the pressure building up with somebody and I knew that if I tackled the defense systems or the voices or building up or whatever was going on on the first day that it wouldn't be so as effective as perhaps four days later yeah so another phrase I used to say was okay well I hear what we've got we're contracting here let's allow things to percolate and we'll see where we get to the four days time and we'll come back to that yeah timing I can see how that would work as well because you know that's a really good word for it because when we're learning about these things things do percolate we do need to mull over them and explore things and it's a new a new way of being so it's not going to happen overnight it's kind of I often talk about osmosis do you know what I mean it kind of seeps in slowly sometimes that's right no one level that I said earlier in the podcast just say something else please and one over there in control of their own pressure cooker yeah at another level they're in therapy because they feel they're not in control of the process yeah do you think people are always in control they just don't know it it's a really good question of course the way I was thinking about in was in terms of psych psychological time and real time right in other words we take back if we think developmentally and we go back to when you know when they were younger the power dynamics often in the family system or where they were were so against them in other words the significant other people or the parents or the toxicity it was very much one up one down yeah so they felt they had no power you know so it's like Hobson's choice which is it it's like if you're in a dangerous situation where the power dynamics are so highly against you you'll do whatever you can to do survive so at that level maybe you have a choice so you may switch off you may associate you might go crazy you might do lots of things so in that sense they've got a choice but that people in that level of trauma don't believe they have a choice absolutely yeah yeah so yes and no it's my answer to that and they come to therapy sort of 20 years later 25 years later and start talking about how they are today in the PTSD PTSD automatic stress disorder or or whatever the symptoms are they come with even though I know the work is back in their history doesn't matter where we start really what it does we have to start with their story in the present the they can only get to a place of being aware that they actually do have choice now now in the present day yeah by realising what they didn't have all those years ago yeah yeah I can remember when I was going through my training and one of the reasons why I love transactional analysis and being a psychotherapist because at the time I was fostering and there was a lot of doom and gloom about fostering you know what I mean that the damage is done and they'll never get over it and it was all you know write them off they're never going to go to university they're not going to amount to all this sort of stuff and what transactional analysis and psychotherapy taught me was that we can go back and fill in the gaps we can repair we can learn about all of this stuff you know and it doesn't necessarily have to impact us for the rest of our life whatever trauma we've been through yeah and that made me very hopeful what a wonderful way to put this there's a wonderful book written by the originators of redecision psychotherapy from the transaction analysis movement and they were Mary and Bob Goulding and they wrote a book there were several books but they wrote a really fantastic book in 1973 called the powers in the patient now in American language the patient is the client right yeah firstly often I think many therapists forget that they may often think the powers in them and it's not it's actually in the client in the patient will do that way and I think it's really important therapists remember that but and also on the same level if we do this developmental work then they often don't feel they have any power so it's important for therapists to remember that that's true and a lot of the time that is the therapy in other words they don't feel that the power yeah the therapy is going to do a place where they can take back the power that perhaps they gave away lost or put in a very precious compartmental place in their psychological spirit so they can be different today yeah I would recommend that book every time and through many of my clinical journeys I remember that phrase because sometimes and I like to think didn't happen that often I could get carried away with my own ego yeah but we don't have power we make an impact to help people find their own power yeah alongside them and then witness on their journey and we help them take ownership of their own agency and self-power however in the end it's the client that needs to take the power for the new decisions to reintegrate and to be able to discover their own self-agency and we help them on the way absolutely yeah I see it as we kind of shine a light on certain things that then they can explore and like you say integrate into their life or yeah now of course I don't want to I don't want any of the therapist counsellors was listening to this podcast to think counsellors don't do anything they are pivotal in helping the client discover the power that perhaps they have put away or even forgot they had yeah I see you know a big part of my job rightly or wrongly is to provide a safe space for people to explore this stuff to put it bluntly you know what I mean oh like to be in control of the pressure cooker yeah absolutely yeah and to feel safe knowing that they I think for some clients it can be really scary and they teach it on the edge of making a new decision or doing something different and I think part of my job is to support them in stepping over into that knowing that I've kind of got the back yeah it's a very good phase that you've got their back yeah it's okay because it's a massive it's a big thing making changes in therapy you know when when I think of me you know 40 years or 40 plus years before I started doing my my training that there's a lot of stuff in there for me to be changing yeah and you've helped a lot of people and there's another very good book written by the same person or people Bob and Mary Goulding after the power and the patient I think that's I've got it the long way around 1974 called redecision psychotherapy and they talk I think it is the one after the patient but they're talking there about how they help people take ownership of their own power to make new redecisions and they couldn't do it and they wouldn't be able to do it if they didn't feel they were in a safe secure place to explore this to be able to with the therapist's help find the power that often disavowed yeah I think also the therapist needs more powerful than the toxic people in their head yeah I always remember that for my training is it protection permission and potency or permission protect where you I don't know what order they come in but yeah that's always stuck in yeah because you'll repeat history with the client if you're not yeah just one of those thousands of other people who haven't been able to stand up to the negative critical parents in their own heads yeah what an interesting topic Bob oh yeah I think we're talking about the real mechanics of effective psychotherapy here yeah and it all comes from that title about a pressure cooker which I think is a brilliant metaphor for a lot of things that go on in everyday life yeah and you know from helping them understand they have a pressure cooker in the first place and then helping them regulate the pressure cooker system and then help take ownership you know in a much more bigger way they can then go they're on the road to what I would call um positive self-agency yeah because I was thinking you touched on group therapy before and I for some reason have no idea why but I'm seeing an awful lot of couples at the moment but the therapy room can be seen as a pressure cooker when you're dealing with more than one person when there's couples you know they're both bringing the the issues that they've got and it can be quite a heated discussion that goes on sometimes well those two people often with interlocking scripts or posing scripts who trigger off their own internal pressure cookers or the others and you imagine that multiplied by eight people yeah many many pressure cookers get triggered off group therapy is an extraordinarily powerful mechanism for effective psychotherapy to change as is couples therapy um so I'm glad you've got more couples because um there I think there's not enough people who specialize in couples work and group work for whatever reasons in 19 you know the early 19 I want to say 19 early 90s group psychotherapy in the UK was much more popular than it is now I've been toying with the idea Bob I shouldn't put this out there but I have been toying with the idea purely and simply because I think a lot of people struddle and can't afford individual therapy and it's a way of them accessing lower cost when they're in a group so I have been toying with the idea if you do have a discussion about it please do and if you do do it make sure they've spent a bit of time in individual therapy with you first otherwise you'll lose them yes but I do think it's an effective um type of therapy group therapy and all these pressure pressure cookers can often get triggered off and that's when the therapist can help the client not only be aware of the pressure cookers that have been triggered off but also what triggers the pressure cookers and hopefully eventually not only do they regulate the pressure cookers but they can actually take charge of that process and develop a new healthy integrated process yeah because just to finish up on this topic as you were talking then I was thinking you know that you've got a room of eight people and they've all got the pressure cookers everybody's life up to this point is unique and individual to them yeah but do you think that from our point of view there's lots of similarities in what people go through in their upbringing does that make sense oh yeah definitely you know we know this as I was just thinking of articles people will know like the eight stages of men the Eric Averickson's developmental articles where they talk about people going through different or similar stages you know and you know yourself in that wonderful book that you quote by you know the I'm living yeah Pam Levin the cycles of power yes yeah so so definitely we do Freud used to talk about different developmental stages yeah that's a taken as red I think we have similarities that we go through different psychological stages that if they have been missed out or there's been a fixation or there's been trauma then that obviously may result in challenging consequences later yeah I think by definition and then I think about and I need another podcast for this but you know when we're born when the day we're born you know I think there's an element of trauma yeah yeah but yeah yeah so certainly trauma from the point of giving birth this wonderful womb which is very secure and hopefully being wrenched out or coming out to this very different world can be seen as traumatic absolutely yeah you know from the very beginning of psychological life I think there can be challenges of trauma and if they aren't dealt with in a healthy way then consequences could be psychologically may be difficult later on so yes I think there are similar thematic developmental problems traumas that people may occur yeah and how we deal with them often well there are unique our own unique experiences aren't they absolutely I think that's where the uniqueness comes in is the decisions that we make around those things and how we're going to be in the world yeah I mean Richard Erskine another mentor of mine and the chair or past chair anyway who certainly was the founder of the international integrative psychotherapy association he wrote a whole series of articles around what he called relational needs or unmet relational needs and permissions that need to be given almost universally by the therapists to enable the clients if you like to deal with these unmet needs and the developmental deficits that occurred but in that how the client experiences and defends against the developmental deficits are unique yes yeah I've really enjoyed that Bob thanks very much does that make sense that last bit absolutely yeah that's really important for therapists because if therapists just think well I've read this article I've done all this lot I can do this a bit like chess like I was talking about in the last podcast then x will happen well that's one way of looking at and I've talked about in the last podcast another way and a much more important I think we need to see the clients have their own unique experiences attuned to those unique experiences and go with that in terms of patency potency permissions and everything else because in another process altogether it's not like chess yeah I'm a great fan of relational psychotherapy so another way to call me at my work in a way it's relationally developmental in nature for effective psychotherapy yeah that's a mouthful isn't it it certainly is but it's a good title to have Bob I like that one and I know you're very relational in your developmental work I am I do I do like you know to me looking at things relationally and one of the things that one of the relational needs that always sticks with me is the need for the other to initiate yes that's so interesting and I don't know whether that's because I need that that that's the one that I kind of hone in on a lot of the time but I think it is really important even in the therapy room for me to initiate contact with the clients and another relational need that you hone in a lot in so I just want to say that I'm sitting on these podcasts is the relational need for safety and security yes yeah and you're right they represent our history no it's all interesting stuff this isn't it Bob yes and unfortunately I know we've got to stop that's a hint of pops going over time but such a wonderful podcast this I think yeah from a wonderful title we've covered all sorts of stuff we've been all the way there and back again so what we're going to be looking at next time which again is another wonderful title is five things I wish I'd known before I became a psychotherapist when I came to this title Jackie I thought my first title was 10 things I'm sure we'll come up with 20 things but I thought we have 10 we'll be here it'll go away over time in in the podcast so I've cut it back to five and now I'm thinking to talk to you perhaps I wish I kept it to 10 but I'm looking forward to that me too we'll see how many we come up with I'll keep counting until next time Bob thank you very much bye bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and 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