Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Living Institute
Existential-Integrative Psychotherapy Diploma
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Table of Contents
1. Getting Started 2
2. Client Intakes and Interactions 4
3. Supervision 7
4. Referrals 10
5. Professional Ethics 10
6. Record Keeping 10
7. Student Clinic Responsibility 14
8. Graduation Requirements and Beyond 15
9. Appendix 1: Client Informed Consent Form 17
10. Appendix 2: Code of Ethics, Principles and
Practice Guidelines 20
11. Appendix 3: Electronic Practice 23
12. Appendix 4: Therapeutic Uses of Touch 25
13. Appendix 5: Intake Interview Guidelines 30
14. Appendix 6: Professional Journal Requirement 32
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We are happy to invite you to take the significant professional 1. Getting Started
step of joining the Living Institute Student Clinic. Through our (1.1) Students are generally eligible to enter the Student Clinic after
completing second year, subject to the conditions outlined below as
evolution since beginning this training program in 2007, we have
long as they have:
continued to refine the curriculum and develop clinical protocols to
a. Attended all required classes and completed assignments. Program
assure that your training will not only provide you with entry to Director consent is required. (Please note that for graduation, 90% of
practice competencies that will be recognized for licensure, but attendance of classes outside the strictly required list is needed for
will go beyond this to encourage your self actualization and graduation).
develop integrated professional expertise. We would like to b. Successfully completed the online TLI-207-O Clinical
express our appreciation to the committed students and faculty Psychopharmacology course.
who have contributed to our growing community. c. Have subscribed to a professional journal of their choice within the
field (see Appendix 6).
Psychotherapy training that prepares graduates for registration in d. Completed an intake and typology report on yourself according to
the College of Registered Psychotherapists of Ontario (CRPO) is PDM criteria plus class notes that demonstrate comprehension
e. Performed acceptably in the ‘therapist role’ and the ‘client role’ in at
recognized as being at a master’s level. The internationally-
least one Clinical Skills Integration class and made a written report.
accepted benchmark for a master’s-level education is determined
f. Have been assessed to have attained the necessary entry-level
by the “capacity of the graduate...to act competently, creatively personal and professional maturity and competency by their clinical,
and independently and ... [at] the forefront of a...profession... The academic and self development supervisors that would assure safety to
core objective is to ensure graduates will have the qualities clients.
needed...for employment in circumstances requiring sound g. Have had a Student Clinic entry orientation meeting with the Clinical
judgement, personal responsibility, autonomous practice, and Director’
initiative in complex and unpredictable professional h. Are in good standing with the Self Development Program as described
environments.” (Ontario Ministry of Training Colleges and below (see 1.2).
Universities) As an intern in the Student Clinic, you will be called on i. Have read the CRPO Jurisprudence, Misconduct Regulations and
to work closely with your practice supervisor to integrate your Professional Practice Standards documents and agree to abide by them
via signed consent. It is understood that there is a learning curve during
theoretical and experiential knowledge and skills as you work with
internship, and supervision will address questions that arise.
individual clients.
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j. Some students may be considered eligible for internship in the clinic able to meet the criteria for this important aspect of training. Please
when they are in the spring semester of year 2 of the program if they note that the CRPO Registration document recognizes that modality
have prior mental health or psychotherapist experience and meet the schools may define and are responsible for the ‘safe and effective use of
requirements outlined above. Both the Programs Director and Clinical self’ aspect of training programs, and that this is an essential aspect of
Director consents are required. psychotherapy training.
(k) All interns must engage in supervision with the Clinical Director when
they enter clinic until such time as the CD is satisfied with their capacity (1.4) As mentioned in the general program entry requirements, if
to perform professionally and in keeping with LI requirements. At that students on entry to the program have a pre-established
point, interns may choose to either continue with the CD or select psychotherapist and wish to continue with them instead of one of the
another supervisor from the LI list of program supervisors. Living Institute approved self development therapists or counsellors,
their chosen psychotherapist must submit a CV for approval to the
(1.2) Interns must be in good standing in their self development process Clinical Director. Approval is contingent on a reasonable match between
to be eligible for clinical work. This means fulfilling the requisites in the the therapist’s approach and the Existential-Integrative program. For
Self Development Program which includes regular appointments with example, strictly CBT therapy or training in one modality is not deemed
the approved faculty who are selected because of their integrative appropriate for this integrative training program. In addition the
background. (As outlined in the curriculum this means weekly or external self development supervisor must agree to the Living Institute
biweekly one hour sessions unless otherwise negotiated and approved Self Development assessment procedures. There will be a time limit for
by the Clinical Director.) This allows students to personally experience work with therapists or counsellors outside of the approved list. The
the therapeutic process they are being trained in. If elements emerge preferred mode of meeting personal growth requirements is to work
during the course of the self development program that may serious with the Institute therapists or counsellors as this is geared to
affect the safety of clients, the therapist or counsellor must discuss this complement and deepen the training.
with the student or intern and bring it to the attention of the Clinical
Director who will make recommendations. (1.5) Without liability insurance students will not be able to see clients,
including ones that they generate themselves. In order to be on the
(1.3) If interns find that circumstances make it impossible to maintain roster to take clients, or to begin to work with clients from other
regular appointments as described above, they must negotiate mutually sources, students need to pay an annual $250 insurance fee plus a $50
agreed upon changes with their therapist or counsellor. Significant per location fee to the Living Institute. Please notify the Institute of the
changes in the self development program involvement, such as landlord’s name and full location address and it will be added to the
psychotherapy or counselling frequency, (e.g. no sessions because of insurance file. Fees may change subject to costs increasing, such as a
extensive travelling or out of town work during the summer), must be premium increase. Interns who begin then drop out of the clinic will get
discussed with and approved by the Clinical Director. Excessive a pro-rated refund.
suspension of regular sessions during the training program, including
the internship period, is not acceptable. Interns may become ineligible (1.6) Interns must create an appropriately named professional email
for work in the Clinic and also ineligible for graduation if they are not account which is password protected so that only the intern has access.
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The email address must not identify the intern as ‘therapist’ or environment of the Clinic as well as guide the professional development
‘psychotherapist’ until registration with CRPO. The term ‘intern of the student.
therapist’ is appropriate on email, business cards or websites. Please
also review the Internet Security Policy document in Appendix 3. (2.1) Clients responding to the Student Clinic will have a 50 minute
face-to-face consultation with the Clinical Director or someone
(1.7) Interns who have completed the three year classroom curriculum designated by the CD. This is provided to the client at no charge.
of the program but have not yet completed their clinical hours will need The intern will pay $100 to the consultant for clients that come
to pay an extension fee of $450 per year until graduation in order to be to one or more therapy sessions. Payment is required
eligible to be an enrolled student and work in the Student Clinic. immediately after intern’s initial contact with client and
completion of at least one session. Please pay by cash, cheque
(1.8) After familiarizing yourself and discussing this manual, you will be or etransfer. If paying by etransfer, please put note that
asked to sign off on: (a) the Clinic Manual, (b) the Living Institute Code payment is for client transfer fee and put first name of client on
of Ethics, Principles and Practice Guidelines (Appendix 1), (c) the payment. If the client is not appropriate for the Student Clinic or
Therapeutic Uses of Touch (Appendix 2), (d) the Internet Security Policy does not make contact with the intern, the Clinical Director
(Appendix 3). Your signed consent to operate within these program absorbs the cost of the consultation. If interns are unable to pay
guidelines will be included in your supervision file. the consultation fee within a 30 day period, a carrying fee of
10% per annum will be added.
(1.9) Before beginning work in the Clinic, you must read the 3 CRPO
documents: Jurisprudence, Professional Practice Standards and (2.2) The intern then contacts the client in a timely manner, discusses
Misconduct Regulations. You will be asked for your signed consent to scheduling and office location and sets up a session time. This
operate within these guidelines. It is understood that there will be a first meeting is at no fee for the client because the pay-what-
learning curve which will be overseen by your supervisor. you-can fee has to be negotiated first. Pay-what-you-can is
Clinic policy and there are no exceptions. At this first meeting,
(1.10) Dependability and commitment to regular sessions with clients is the Informed Consent form must be signed, the intake
an important competency. The clinic gives you the opportunity to begin information is begun and/or psychotherapy commences.
your practice under supervision. You will be able to continue with these
clients after graduation, so they form the basis of your private practice. (2.3) Interns are responsible for contacting the Clinical Director
Please consider your readiness to engage with clients before entering promptly to report when contact is made with the client, when
clinic. therapy begins, when practice supervision starts, with whom, or
if the client does not enter therapy and why. Interns are also
2. Client Intakes and Interactions required to notify their supervisor once they have commenced
The Living Institute recognizes that people who seek psychotherapy are seeing a client. Interns must commit to providing regular
a vulnerable population, though still capable of agency and choice. This sessions for clients, in accordance with discussions in
manual is designed to provide safety to the public in the learning supervision.
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to validate client contact hours and must be kept strictly and understand that they cannot go back and forth between
ethically. psychotherapy and another form of treatment.
(2.12) The client contact log must include client session times (start & (2.18) The Student Clinic works on a pay-what-you-can basis with no
finish) as well as total (e.g. 50 minutes = 1 hour). Do not use this minimum fee. Interns are responsible for negotiating their
book for any other purpose. This is separate from your planning session fees with clients at their first appointment. The fee may
diary where you book sessions. Details are entered into the be re-negotiated, subject to changing circumstances and
clinic log at the completion of a session. reasonable notice. It is not acceptable to make individual
alterations to the Clinic payment policy.
(2.13) Interns are also responsible for tracking their supervision hours
in a supervision log, recording start and finish times and the (2.19) Students are financially responsible for reporting their income
name of the supervisor. The same ethical responsibilities apply from the Clinic to Canada Revenue Agency. See financial records
as for (2.8). in Record Keeping section. The Living Institute accepts no
financial responsibility for tracking student’s income or
(2.14) Please see Record Keeping for further details on records, logs providing receipts to Clinic clients.
and filing.
(2.20) Interns are responsible for arranging and paying for office space
(2.15) Confidentiality must be observed and clinical discussions in any rental at a location approved of by the Clinical Director.
training situation regarding confidential or potentially
identifying information must be discrete and avoid identifying (2.21) Payment for the client consultation fees ($100 per client intake)
details. and practice supervision fees must be paid at time of service
unless other arrangements are made. Practice supervision fees
(2.16) As consistent with CRPO requirements, no client hours prior to may vary between supervisors.
being accepted as an intern in the Student Clinic may be
counted towards the program requirement. This applies to (2.22) Since the Institute is based in Toronto, we now have a steady
interns who may have already been practising the profession stream of clients that come from the GTA. Interns who live
before entry. In addition, no parallel work with clients, e.g. life outside the GTA and wish to begin their practice base there are
coaching or other modalities, is transferable to clinical hours. responsible for distributing the Institute’s Clinic brochures and
working with their supervisor to bring in local clients. The
(2.17) If any clients associated with previous non-psychotherapy work internship must take place within Ontario.
(e.g. coaching or other modality) choose to transfer to
psychotherapy with the intern, they must have a consultation
with the Clinical Director at the regular fee. The intern must
explain the modality difference clearly and the client must
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Summary Chart for Internship Expenses: that the payment is for supervision and give the date of
Initial Clinical Director meeting $100 supervision on the e-transfer. Payment for client transfer fee
Insurance $250 annual + $50 per location must be made after the first meeting with the client an should
Practice Supervision Varies $100 - $150 per hour also be identified by client’s first name on e-transfer. Additional
Client consultation intake fee $100 per client charges may apply if interns fall behind in payments and extra
Office rent Varies ($15/hr average) accounting is required.
Self Development Program
therapist fee Varies $100 - $150 (3.5) The Student Clinic will operate with reference to the CRPO
Competency guidelines as listed on www.crpo.on.ca. All
Annual review $100
students are expected to familiarize themselves with it to help
Monthly Clinic fee $30 per month for GTA
them self-assess.
3. Supervision (3.6) The Living Institute will provide supervisors and interns with a
(3.1) On entering Clinic, all interns are required to do practice supervision guideline based on the CRPO competencies. There
supervision with the Clinical Director to assure that basic skills will be an annual review of these.
are in place and that the intern is able to master professional
requirements for safe and effective use of self, general (3.7) Interns must begin biweekly practice supervision of 1 hour as
professionalism, record keeping etc. soon as they begin to see a client. This may be individual or
(3.2) After this period (which will vary between individuals), interns dyadic. When interns begin to do four or more client hours per
may choose to change to a different supervisor, designated by week, they must undertake individual weekly supervision of 1
the school. It is not required to change supervisors, but if an hour duration as the dyadic format does not allow adequate
intern wishes to do they, they need to submit this request in time for responsible practice supervision. (Please note that this
writing to the Clinical Director who will discuss this with the is consistent with the CRPO proportion of 4 direct client hours
intern in supervision. to 1 hour supervision during training.)
(3.3) Please discuss the list of current Living Institute faculty for
practice supervision with the Clinical Director. They are selected (3.8) Interns are required to make notes during supervision sessions
based on their range of integrative training and years of clinical about what is discussed in a separate book for supervision
experience. Skype and phone sessions are acceptable. notes. Supervision notes do not go into the client file. Please
Supervision availability and fees are at the discretion of the note that clients may request and must be given a copy of their
supervisor but must conform with program requirements. therapy files, but the supervision notes are the private property
Interns may not engage supervisors who are not on this of the intern.
approved list.
(3.4) Payment for supervision is required at time of service, either by (3.9) Individual supervision must continue through the duration of
cash, cheque or e-transfer. If paying by e-transfer, please add internship until graduation, even if the number of supervision
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hours exceeds the total required. The ‘extra’ supervision hours issues. This would include issues such as potential harm to self
in the program can count towards completion of ‘Qualifying’ or or others including domestic abuse, harm to a minor, changes in
RPQ category to RP. psychiatric medication, refusal to take prescribed psychiatric
medication, change in psychiatric diagnosis, dangerous use of
(3.10) The CRPO has designated that only 20% of supervision hours non-prescription substances, new information on serious abuse
within training may be in the form of group supervision with a history, emerging symptoms of dissociative disorder, suicidality,
group size of 12 or less. This is covered in Clinical Discussion obsessive or delusional thinking that were withheld during the
groups where interns do case presentations under supervision. initial consultation or emerged during the course of therapy.
(3.11) Completion of DCC hours are self-paced by the intern. For (3.15) If the therapeutic crisis appears that it may have legal
example, if interns see 5 clients a week it would take them 90 implications, the intern must remind the client of the Informed
weeks to complete the required 450 DCC hours. If interns do 10 Consent Form which states that student records are not to be
DCC hours per week, it would take them 45 weeks to complete released for legal purposes (e.g. insurance disputes, child
the required 450 DCC hours. custody, domestic abuse, legal hearings etc.). All attempts will
be made by the Clinical Director to refer the client to an
(3.12) If an intern wants to change supervisors please email the appropriate mental health professional who is willing and able
Clinical Director that request in writing, explaining the reasons to create records for legal purposes. If a third party report based
for requesting this change. Supervisors must be approved by the on Student Clinic records is required, the Clinical Director, in
school, and the timing of supervision changes must be consultation with the intern, will provide this.
consistent with regular standards of professional practice.
(3.16) During any dyadic or group supervision sessions, clients will be
referred to by first name only or an alias if their first name is
(3.13) We try to make the best therapy matches possible, and this
highly identifiable. Any clients with personal links to the Living
includes location. Perhaps because of the school’s address, we
Institute (e.g. in the program, referred by someone in the
get more requests from the east end of town than the west end.
program, related to someone in the program, potential to enter
If you get a client who is a good match but the location is a
the program) may not be discussed in group or dyadic
problem, please talk to them about the option of skype or
supervision so as to preserve confidentiality.
Facetime or phone sessions which can work very well after a
few initial face to face meetings.
(3.17) The intern is expected to be self-reflective and transparent
about countertransference, matters related to providing safe
(3.14) If a Clinic client enters a therapeutic crisis or period of marked therapy and professionalism that affect work with clients in
destabilization, more frequent supervision may be required. Any practice supervision. The supervision session will process these
serious changes in client process must be reported to the aspects and make recommendations including for self
practice supervisor immediately by phone, and if necessary, development focus.
extra practice supervision session must be set to attend to these
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(3.19) Interns must be aware that their practice supervisor is legally (3.21) Intern discussion of Clinic clients may only occur at the following
responsible for the intern’s professional performance. If, after a times: with school-approved supervisors in individual or dyad
reasonable period of supervision, the intern is unable for any supervision, with the Clinical Director if a problem emerges, in
reason to perform competently (i.e. complete intakes, record the program’s clinical discussion groups, and with group leaders
keeping, client contact, completion of classroom assignments, during group observation regarding clients in the group. These
meeting self development criteria, etc.), they may be are the only times when interns may discuss their clients.
temporarily suspended from the Clinic until they can Interns may not discuss clients among themselves, either
demonstrate competency. The Institute recognizes that this is a informally or by setting up peer discussion forums, or
grave action with deep impact on the intern and also on clients communicate with professionals outside the clinic without
who would have their therapeutic relationship interrupted or specific permission from the Clinical Director. Please note that
terminated. For this reason, interns must consider entry to the Clinic clients give their consent for interns to discuss their case
clinic and the ensuing responsibilities of professionalism with a supervisor. The clients do not consent to interns
seriously before taking on clients. The Institute and supervisors discussing them with each other. Discussing clients with other
are committed to helping interns through difficulties, but must interns is a breach of confidentiality. In addition, interns are not
consider that protection of the public through requiring yet at a stage where they can give professional advice and
standard professional competency is primary. This is in keeping would not be recognized as capable of this until they have been
with professional misconduct regulations of the CRPO. an RP in the College for five years. As referred to in 3.14, the
supervisor and school are legally responsible for the actions of
(3.20) Interns must be aware that if they operate outside the interns and the impact on clients. Ad hoc ‘peer supervision’
guidelines and supervision of the Clinic and any claim or among interns may adversely impact client care and is therefore
occurrence were to arise, there would not be any insurance forbidden during internship.
coverage available to them under the policy as students of the
Institute Clinic. In addition, if they conduct services outside
supervision leading to a complaint, then any claim would quite
likely be brought against the Institute and their supervisor as
well as against them personally and any coverage would be
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4. Referrals
The Living Institute undertakes to feature the Student Clinic on its (5.1) Interns are requested to continually familiarize themselves with
the CRPO Professional Practice Standards, Professional Misconduct
website and through distribution of printed flyers. Because to our
Regulations and Jurisprudence for Registered Psychotherapists
location, most clients come from the GTA. Interns based in Ontario but
documents, all found at www.crpo.on.ca which they initially read before
outside the GTA are responsible for generating their own clients via entering Clinic.
distribution of flyers and connections with professional referral sources
in their area. (5.3) If your client is travelling briefly, electronic psychotherapy may be
continued as long as they have and maintain Canadian citizenship.
(4.1) The monthly clinic fee is reduced to $10 per month rather than Please notify the Clinical Director if this emerges.
$30 per month for interns outside the GTA to reflect this
difference in the school’s ability to provide clients. 6. Record Keeping
Record keeping is an important aspect of developing professionalism.
(4.2) The Student Clinic will attempt to distribute clients equitably to You will need to create separate log books for direct client contact
interns. However, some criteria such as requested gender of hours, one for supervision hours, one for supervision notes, and one
intern, marked compatibility, location, background or skill of for financial records. In addition, proper record keeping requires that
intern may alter distribution pattern, based on the needs of the you obtain a signed informed consent form, write an intake report,
client as the primary concern. session notes and supervision notes. You are required to file your client
records in the Institute Clinic files, but keep your logs in a secure place
(4.3) Sources of referral may specify which intern their referral is at your home or office.
intended for and be assigned accordingly.
(6.1) Until the intern has fulfilled all requirements for graduation, they
(4.4) Interns who refer clients from their networks may refer to are considered by the Institute to be in a developing professional stage,
themselves as long as this is ethically appropriate and and not yet ready to offer professional expert opinion. For this reason,
acceptable to the client. Any possibility for dual relationship or all intern client files are considered to be exercises in the gaining of
conflict of interest complication must be discussed with and competency, are the property of the Institute Clinic, and may not be
approved by the Clinical Director and supervisor. used in litigation or insurance cases.
5. Professional Ethics (6.2) Client files (intake and session notes), are stored at the Institute in
Please see: a locked filing cabinet. You will receive the key when you enter Clinic,
Appendix 1: Living Institute Student Clinic Code of Ethics, Principles and and return it when you graduate. Please keep files up to date.
Practice Guidelines Completion of filing is required for graduation. Please bring your own
Appendix 2: Therapeutic Uses of Touch file folders, put the first name and the last initial of the client on the
Appendix 3: Internet Security Policy
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front. Please put your name on the upper right corner of the fil folder. When in distress was there an adult they could turn to? School
All notes inside the file must have the full name of the client. (including educational experience, friends, bullying, activities and
incidents). Some people may have information on conception,
(6.3) Client records are the property of the Institute. At graduation, pregnancy and birth. If not these can be explored later in therapy when
interns may make photocopies of their own client records at their own relevant.
expense and return the originals to the Institute filing system, or make b) Teenage – Relationship with family at this stage. Rebellion or not,
photocopies throughout their internship as they file originals at the relationships and sexual exploration, puberty, significant events.
Institute. Identity exploration.
c) Young adulthood – after high school - university, travel, work?
(6.4) Intake Interview Guidelines Leaving parental home? Relationships and marriage? Children? Career
Bring your draft intake to supervision two weeks after the first client choice and changes? Other education.
session. After discussion with your supervisor, you will file the d) Adult life - Midlife and later life if relevant. Relocations, financial
completed intake two weeks after the draft has been reviewed. As you crises, deaths, friendships, romantic relationships, sex, traumatic
progress to weekly supervision, your supervisor may request a shorter incidents, violence. Also hobbies, interests, sport or martial arts
time frame for completed intakes. background, drug and alcohol use, what kind of books, movies, art or
music do they like. Any other relevant items that would give an idea of
Client profile: Client’s full name, address, email address, phone number, who the client is through details.
emergency contact name with relationship to client and phone number,
date of birth, age, GP’s name and phone number, referral source if Throughout the intake pursue details of problematic relationship with
relevant. family figures. Especially note early maternal relationship; any sexual or
Previous therapy: When, how long, was it effective or not? If no physical abuse; authority issues; family roles; nourishment issues;
previous therapy experience, briefly explain therapy process. attitudes to body, touch, sex; attitudes to work; general cultural or
1. Presenting Issues: What the client came for, in their own words, on ethnic orientation; attitudes to spirituality; drugs and alcohol.
their terms. Use quotes. Delineate into specific problems, symptoms, 4. Health - themes of illness, medical treatment, hospitalizations,
goals. Why seek therapy now? Identify specific precipitating factors. medications, family problems past and current.
2. History of Presenting Issues: When it started, what was going on, how it 5. Spirituality - spiritual openness; spiritual emergence potential and
progressed, qualifiers, timing, prior treatments, relationship to other life issues;
issues.
6. Family History - Get some idea of the clients extended family
3. Personal History: background, particularly grandparents, but also uncles and aunts, what
a) Childhood – Initial impressions (good, terrible etc.) Mother and kind of people they are or were, noting particularly people with any
father’s personality and client’s relationship to them. Client’s problems (such as mental health problems), unusual characteristics or
personality as a child. Siblings and other significant family members.
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particular strengths and gifts, such as psychic experiences, academic or Rolfing, chiropractic, massage, meditation, contact improv); other
business success and what the individuals meant to the client. health related modalities and issues (e.g. naturopathy, detox,
Traditional Chinese Medicine, homeopathy, good allopathic
7. Formulation: Not all the following are always applicable, but try to practitioner); prior treatment info; interfacing with other health care
discern the relevant ones. The formulation is the professional ‘snapshot’ providers and support system; consultations; supervision issues. Note
of the client that helps you to know how to proceed. changes to therapy plan or direction of therapy.
a. Typologies - PDM, bioenergetic, mythic or archetypal; borderline and/or
narcissistic tendency
b. Mapping of issues – developmental, archetypal, somatic, existential, (6.5) Clinical Records
phenomenological; life pattern tendencies; lifestyle/life quality picture; a. The signed Living Institute Student Clinic Informed
c. Psychological mindedness; relationship capability; regression capability, Consent Form should be discussed with and signed by
emotional openness; appropriateness for therapy, including results of the client at the beginning of therapy and placed at the
other therapies; prognosis; cautions; ego strengths and weaknesses; front of the client’s file.
d. Cognitive development, learning styles and disorders; b. Sessions notes Interns are encouraged but not
e. Body orientation themes; sexuality/eros themes, therapist gender restricted to the SOAP session note format which has
issues; become common in mental health client care. S -
f. Issues: transference/countertransference tendency; commitment; subjective (the client’s statements), O - objective (the
ambivalence; authority, discipline and containment issues; intern’s observations), A - assessment of therapeutic
dependency/autonomy issues; control issues; boundary issues; interventions, client responses, developments, P- plans,
dysfunctional tendency; addictive tendency; scapegoat tendency; progress, regression, client feedback. Some
depressive/anxiety tendency; suicidality; psychotic potential; experimenting with narrative note taking may be
dissociative potential; somatization problems; acting out tendency; suggested by your supervisor.
g. Sociopolitical orientation; c. Client contact outside of sessions via phone, emails,
h. Trauma severity, PTSD; letters, texts, skype should be noted.
i. Social network and supports (relationships, family, friends, finances, d. Incident report: when a major, unexpected difficult
social services, dependents); situation occurs, provide a clear record which may be
j. Health and medication issues. used to explain the event and the details surrounding it
e. Any information leading to a mandatory report (child
8. Therapeutic Plan: Type of therapeutic approach (e.g. urgent issues, abuse, sexual abuse etc.) should be noted and brought
relationship building, immediate depth work, ego building, to your supervisor’s and Clinical Director’s attention
psychodynamic focus, life focus, bodywork, emotional release, cognitive immediately.
focus, spiritual focus, expressive arts, support/challenge, couples, f. A record of the termination of therapy, reasons,
homework, reading/movies); individual, group, workshops; weekly/ summary of outcome, progress, referral or follow-up
biweekly; timing issues; other psychotherapy related modalities (e.g. recommendations. If the client was referred to another
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intern or practitioner, name of that person, contact 3. Identify different fees and note reasons why a fee
information and reason that intern referred them. may be reduced, increased or waived
g. Both electronic and hard copy client records must 4. Indicate if fees are charged to a third party
include client’s name, date of entry and signature of 5. Indicate any balance owing
intern on each page. 6. These records belong to you and must be retained
h. Records must be legible, appear in chronological order, for 5 years from the last psychotherapy interaction.
be dated and signed, any changes must be dated and 7. They may be kept separately from clinical records,
signed, showing the original. but should be stored securely and confidentially.
i. Note if you are keeping a file of additional notes on the 8. Interns are responsible for giving clients receipts for
client outside the clinical record. payment within one month of request. A more
j. Note the process of ongoing consent (e.g. for change of extended delay may be made in cases of illness etc.
modalities, new exercises). and should be explained to the client.
k. Risk assessment, initial and ongoing.
l. Note therapeutic results. Supervision Records
Interns will make notes during supervision sessions for their own
Client Contact Log education and reference. The notes should be stored securely. Use
i. Document the date, time and duration of each initials to identify clients for privacy reasons. Bring notes to supervision.
session. This is your client contact log. Do not
use this book for any other purpose and keep it Your supervision log records the dates and times of supervision. Add
securely to preserve confidentiality. This is the hours up at the bottom of each page. This will be your record to
reviewed by the practice supervisor occasionally track progress through the program requirements. It is an important
(see also 2.7 and 2.10). record.
ii. Document cancelled or missed appointments in
the log Supervisor provides an annual report based on the CRPO Competencies
iii. It is handy to write the total hours on each that comments on the intern’s progress.
page for easy referencing as you work through
the program requirements File Storage
Create a file folder with client’s first name and last initial, file according
Financial Records to last initial (e.g. Jane Smith is Jane S, filed under ‘S’). Put supervisor-
1. Indicate the client’s name and address, date approved intake and session notes into the file. Write full name of client
therapy was provided, brief description of service. on intake and session notes. Off site session notes should be kept in a
2. Indicate the cost of therapy, the date and method secure area (e.g. locked filing cabinet, lock box, safe) until transferred to
of payment received (cash, cheque etc.). Any Institute. Frequency of transfer is decided on the basis of practicality
balance owing.
14
and security but filing must be reasonably up to date. Supervisor may opinion will take priority if the matter cannot be resolved with
request review of session notes as needed. the supervisor.
As previously mentioned, each file must contain an Informed Consent
Form signed by the client after discussion at initial interview. Place this (7.4) Interns in the clinical level of training have to be aware that
at the front of the file, along with the intake. their activities outside the Institute may constitute a therapy
File client reports in the Institute locked filing cabinet. You will be shown activity, or therapy like activity, and this is a responsibility and
its location and given a key after you have entered the internship and potential liability for the Institute. Anything of this nature needs
paid your insurance fee. MAKE SURE TO LOCK IT AFTER USE. You must to be discussed with and approved by the supervisor prior to
return the key when you graduate or leave the clinic. the activity being undertaken. Ultimate responsibility rests with
the Clinical Director.
7. Student Clinic Responsibility (7.5) The question as to what constitutes ‘therapy’ or ‘therapy like’ is
(7.1) The Institute holds ultimate professional, ethical and legal
sometimes unclear. However, the Institute will be interpreting
responsibility for what students do clinically.
this conservatively in discussing what is appropriate for
students. In this case, after discussion, if there is a difference of
(7.2) The Institute, as an educational organization, is responsible for
opinion that of the Clinical Director has to take priority. If the
supervising the clinical development and day to day clinical
student wishes to consult with another faculty as to this
practice of the student. The Institute has to be able to say of a
question, they are free to do so, but then the question has to
graduate that they are ready to practice based on our
come back to the supervisor and Clinical Director for further
assessment of their theoretical knowledge, clinical skills and self
discussion. Ultimately, the Clinical Director has the final say in
development. The CRPO refers to this latter as ‘safe and
what constitutes therapy or therapy-like activity. Students may
effective use of self’ or SEUS.
follow the Complaints Procedure in the Program Handbook if
resolution requires.
(7.3) Interns entering the clinical level of training have had an
extensive education in the field. However, they are just
(7.6) Any student not acting in compliance with this policy may be
beginning their actual, real live client contact training and so are
subject to the complaints process of the Clinic and may be
not in a position to make and act on clinical judgements
subject to sanctions which shall include having student status
unsupervised. Students must not provide therapy to each other
revoked and being asked to leave the program and the Institute.
or to third parties unsupervised as long as they are students. In
this issue if there is a difference of opinion as to what is
(7.7) Students are not allowed to put into practice any of the clinical
clinically appropriate, after discussion, if a difference of opinion
material they have been taught, without the permission and
remains, that of the supervisor has to take priority. If there is
supervision of the faculty, until they are fully graduated and no
an extended disagreement or concern, the supervisor will
longer in the program. The current Registration Guidelines of
contact the Clinical Director. Ultimately the Clinical Director’s
CRPO state that even after graduation psychotherapists are not
15
authorized for autonomous practice until completion of a total hours from program elements not part of the Student Clinic – there is a
of 1,000 client contact hours and a total of 150 hours of Student Clinic exit review by Clinical Director
supervision. They are titled Qualifying Psychotherapist in (c) completion of the Self Development Program to an adequate stage
distinction from Registered Psychotherapist. with an approved therapist or counsellor with satisfactory Self
Development Program reports – there will be an SDP exit review by
(7.8) The Institute Student Clinic advises students that the CRPO has Clinical Director
said there will be a question in the application to the new (d) observation in approved group therapy or counselling, including
regulatory body as to whether the applicant has had any ethical supervision, with a satisfactory report from group leader
complaints in their professional organization or school. We have (e) one psychotherapy article written which is suitable for publishing in
a duty to report any serious complaints. a professional forum (does not have to be accepted for publication)
approved by Programs Director. Fee $100.
8. Graduation Requirements and Beyond (f) up to date practice records approved by supervisor
Although exiting from the Student Clinic is not graduating from the (g) completion of one public psychotherapy workshop (may be done as
program, when interns have successfully completed their clinical a team) approved by supervisor. See (8.3)
training, they are presumably ready to graduate from the program and (h) outstanding tuition, supervision and self development fees must be
receive the Living Institute Existential-Integrative Psychotherapy paid in full.
Diploma. This requires them to have successfully completed the (i) appropriate participation in a cultural activism activity as approved by
requirements of classroom curriculum and self development program, the Program’s Director.
as well as other requirements listed below. (j) subscription to a professional journal approved by the Program
Director and attendance at two journal classes for each year of
Please set up a CRPO account and complete their Jurisprudence e- internship.
learning module when you are about ¾ of the way through your (k) be in good standing with the Institute
requirements. Please apply to the CRPO via the Regular Route. This
allows them time to process your entry to the College. (8.2) The training program client contact, supervision and experiential
learning hours have received final approval from the Programs and
(8.1) Graduation with the Living Institute Psychotherapy Diploma Clinical Directors.
requires:
(a) completion of required classroom assignments together with (8.3) One public workshop is a requirement for graduation and is
attendance at required classes. In addition, as outlined in the Program recommended after completing third year. Students need to consult
Handbook, 90% attendance of classes outside the required list is needed with their supervisor and the Clinical Director before details of the
for graduation. There will be a classroom curriculum exit review by the workshop are made public. Any number of students may work together
Programs Director. to put on the workshop. The Living Institute provides a meetup account
(b) completion of a minimum of 450 hours of direct client contact with where student public workshops can be listed.
100+ hours of practice supervision with an approved supervisor and See http://www.meetup.com/The-Living-Institute/. Workshop
16
attendees must fill out a feedback form designed by the interns that (8.6) The CRPO Registration Requirement delineates a ‘Qualifying’
rates the workshop and interns. registration category as a separate stage after graduation from a
psychotherapy training program. Students who have graduated from
(8.4) The Living Institute will be initiating a time limitation of five years any program will have a limited time to complete the requirements for
to complete our training program. Extensions based on life licensure once entered in this category. The Living Institute undertakes
circumstances (health, pregnancy, family obligations etc.) may be to inform students of the regulation requirements with the
negotiated in dialogue with the Clinical Director. understanding that the profession is in a stage before final proclamation
at the time of the writing of this Manual. It is the student’s responsibility
(8.5) Once you have fulfilled all graduation requirements of our to make their own professional choices regarding admission to the new
program, you will no longer be a part of the Student Clinic. In the College.
interests of maintaining client/therapist relationship, notify your clients
in writing that you are no longer working under the auspices of the (8.7) Entry to the CRPO will require applicants to pay an application fee,
Clinic and are now in private practice. You will no longer be accountable complete an e-learning module for Jurisprudence and Professional
to the pay what you can Clinic fees, and may negotiate with clients at Practice (the content of which will be posted for educational purposes
your discretion (please discuss this with your supervisor as to various by the College) and write a Registration Exam which will assess the
ways of re-scheduling fees). Explain to clients that they have the option competencies. Please see www.crpo.on.ca for more details.
to continue with you as a Qualifying Psychotherapist (see 8.6) or ask for (8.8) The Living Institute values the formation of a robust community of
a referral to someone else in the Clinic. At this stage you will no longer professional colleagues. We look forward to including some graduates in
be covered by Student Clinic insurance and will have to obtain the recommended Self Development therapist list so that future
professional liability insurance via a professional organization (CHTA, students and interns will be given a choice that includes professionals
CAPT, OSP, OACCPP are options). If you choose to join CHTA, your with relevant training and experience. The Institute reserves the right to
membership can be processed immediately on graduation. The CRPO make this selection.
requires that you continue with practice supervision until 1,000 total
client hours and a total of 150 hrs supervision (i.e. including the (8.9) The CRPO is developing a set of criteria for supervisors. When
previously acquired hours), but you may choose any supervisor you graduates have fulfilled the CRPO requirements for the role of
wish, either associated or not associated with the Living Institute once supervisor, they may be invited, at the discretion of the Institute, to join
you have graduated. the list of recommended clinical supervisors to assist future interns in
the program.
17
Appendix 1
www.livinginstitute.org
info@livinginstitute.org
Client Informed Consent Form
208 Carlton Street Toronto, Ontario M5A 2L1 416 515 0404
INFORMED CONSENT
I have completed a consultation with the Clinical Director and have been referred to the intern whose signature appears below. I understand that
therapy sometimes involves discussing difficult aspects of life and I may experience feelings like sadness, guilt, anger, frustration, loneliness and
helplessness in the course of our work. It is also my understanding that the benefits of psychotherapy include but are not limited to: increased self
awareness, improved interpersonal relationships, a vitalized sense of self, discovery of meaning and purpose in life, solutions to problems, greater ability
to express thoughts and emotions, and reduction in feelings of distress. I understand that there are potential risks and benefits associated with any form
of psychotherapy and at some points in the process I may even feel worse. I can discuss my experiences in therapy with the intern and ask about
alternative courses of action. I understand that the consequences of not engaging in psychotherapy are varied and cannot be defined in a general way.
(2) The information disclosed by me during the course of my therapy is confidential. However, there are exceptions to confidentiality, including, but
not limited to: reporting child, elder, and dependent adult abuse; expressed threats of violence towards a victim; domestic abuse; legal
subpoena, suicidality. My intern has an ethical and legal duty to report these. As a part of the standard operation of the Student Clinic, my intern
will discuss confidential information from our sessions with a practice supervisor. Intern training requirements also include dyadic or group
supervision where details will be presented without identifying information such as my name.
(3) I understand that I have the right to access my file and copies of records on request, subject to reasonable notice.
(4) I have a right to a receipt for clinic services on request, subject to reasonable notice.
(5) If I have any questions or feel uncomfortable with the process of therapy, I understand that I have the right to bring them up in conversation
with my intern. I may ask for a referral to another practitioner if I choose or contact the Clinical Director to ask for referral to another intern or
to discuss any issues of concern regarding my therapy process.
(6) The full Code of Ethics for the Student Clinic is posted at www.livinginstitute.org for my information.
(5) I agree to share information regarding my mental and physical health as assessed by previous practitioners, including any disagreements I may
have with their opinions.
(6) As part of standard Clinic policy, the Living Institute Student Clinic does not release intern records for legal proceedings. If I anticipate a legal
proceeding (insurance claims, child custody cases etc.) I should tell my intern immediately so that alternative arrangements can be made.
(7) I understand that if my assigned intern believes, in consultation with their Practice Supervisor and Clinical Director, that my needs are beyond
the scope of their expertise, I will be provided with a referral to another practitioner. I have read and understand the information provided
above, which has also been explained to me verbally. I have discussed it with my intern, and my questions have been answered to my
satisfaction. I hereby consent to psychotherapy treatment in the Living Institute Student Clinic.
Date: ________________
Welcome to my practice.
I sincerely commit to working with you to the best of my ability
so that your psychotherapy experience will be deeply rewarding.
20
through professional practice or research. See Privacy and Living Institute Student Clinic interns and staff are committed to
Confidentiality policy below. an ongoing process of self reflection as part of ensuring their capacity to
Living Institute Student Clinic interns and staff do not practice, serve their clients fully and grow as clinicians.2,5
condone, facilitate or collude with any form of discrimination on the
basis of race, colour, gender, sexual orientation, age, religion, national
origin, marital status, political belief, mental or physical disability or any 4. Privacy and Confidentiality8, 9
other preference or personal characteristic, condition or status.1 All records in client files are confidential and are retained in secure files.
Living Institute Student Clinic recognizes the unique challenge Access to identifying information is limited to clinic staff, including the
involved in therapeutically mediated touch and trains interns practitioner responsible for the assessment, and supervisors. As part of
accordingly in the clinical and ethical issues involved. For more graduate training, case material may be discussed with other interns
information please see ”Therapeutic Uses of Touch” document4, under supervision. However, material will be presented without
Appendix 2. identifying information.8
Interns and clinic staff shall behave professionally and in public Information pertaining to counselling, psychotherapy or
in a manner that does not reflect disgracefully on the practice of assessments, including written reports, may only be released to other
psychotherapy, the Living Institute or the Student Clinic. 5,6 parties with the informed consent of legally authorized persons (usually
the persons who gave the initial permission for the assessment). There
3 Competence are exceptions to the confidentiality policy that are required by law.
Living Institute Student Clinic interns and staff recognise the boundaries Clinicians must report to the appropriate authorities when there is
and limitations of their techniques and their own personal expertise. suspicion of child abuse, when clients indicate that they may pose a
They only provide service and use techniques for which they are significant danger to themselves or others, when clients or other
qualified by training and experience. They take whatever precautions persons report sexual abuse by a health care professional, or when the
are necessary to protect the welfare of their clients and refer them on court issues a subpoena for record or testimony.8
to other professionals appropriately1. Security measures for internet communications are defined in
Living Institute Student Clinic interns and staff recognise that the Living Institute Student Clinic Internet Security Policy document.
they work in a developing and highly active field in which valuable new This recognizes the particular vulnerability of email communication to
ideas are constantly emerging. They continually monitor their own breach of privacy.10
knowledge and capabilities and have an ongoing commitment to As part of the supervision of interns, sessions may be
continue to develop their personal competence.1 audiotaped or videotaped with client consent. Tapes may be viewed
Living Institute Student Clinic interns and staff recognise that individually by the intern and supervisor, or by the students in class as
personal problems, temporary or enduring physical or mental part of group training and supervision for training with client consent.
incapacity, and other conflicts may on occasion interfere with their Strict confidentiality is maintained during class discussions as to any
professional effectiveness. In such circumstances they seek appropriate identifying information re client. All tapes are erased when supervision
professional assistance, supervision, support or advice.1 is complete, and no later than the termination of the assessment. Tapes
do not become a permanent part of the clinic record.8
22
elaborated into a tradition of sensitivity to primary needs through 2. Take a history of affection, control, punishment, sexuality re
themes such as Balint’s “primary object”, Winnicott’s “holding function” receiving, giving, witnessing touch;
and Kohut’s injunction to reflect the “gleam in the mother’s eye” 3. Pre-contract for touch as a possibility in therapy, explain that it does
through empathic mirroring. In psychoanalysis this translates into only not have to be a part of therapy, and that it may be stopped at any time
minimal body contact, while in Woodman’s Jungian approach it could at patient’s discretion. Poorly developed touch boundaries should be
mean more expressive, supportive touch and holding, and in primal addressed as an issue in itself before touch is utilized.
therapy has been developed into a reparenting model, where persistent 4. When in doubt don’t touch and bring the question up as a clinical
infant bodily needs are directly engaged. issue.
McNeely delineates several issues in body need gratification via 5. Examine your own motivations for touch regarding your attention
touch,vii including providing contact (which Whitmont describes as a focus to ensure that it is client centred and in response.
“channel of relatedness for contact starved adults”viii), affection (being 6. Pay attention to timing. Touching too soon may prevent an issue
careful to avoid sexualizing) and containment (e.g. giving support to emerging. Touching too late may reinforce old imprints of control or
release of terror or grief that would otherwise not be possible because deprivation.
of anxiety factors). She suggests the primary object of reparenting 7. Never touch a sexual area or an area the client considers private,
touch is healing of mind body splits created by early damage to the noting cultural differences in regard to privacy concerns.
body and psyche.ix She says that child analysts, such as Winnicott, 8. Trust your intuition but beware of projection, relying on training,
contend that a child of any age who needs to be held affectionately is experience and integrity to know the difference.
seeking a physical form of loving which is given naturally in the womb.x 9. Use touch generously and sparingly. Therapists can be sources of
She also says that in this model it is not enough to be conscious of the nourishment in patients’ lives while proactively and appropriately
early pain of deprivation, but is necessary that early wounding be challenging patients to find other sources for this.
repaired. She suggests “this may occur through reparenting physically Kepner addresses the issue of touch with these opening words.
and emotionally by touching and holding at a pre genital level, as one “Body oriented work in general, and work that uses touch as a tool for
would touch and hold a small child”.xi Greene says “we have all intervention in particular, places the client and therapist in a position of
experienced how insight into a complex and its archetypal images is unusual closeness and intimacy... The physical distance between the
often not sufficient to change the compulsive nature of an associated client and therapist is much less than the usual social distance and
behaviour that has its roots in the very structure of the body”.xii requires the client to let down some of his or her reserve to allow the
therapist in. The therapist is potentially in a position of greater power
ETHICAL AND CLINICAL CONSIDERATIONS and influence and the client is potentially in a position of greater
IN THE THERAPEUTIC USE OF TOUCH vulnerability and openness than the average therapeutic encounter”.xiv
The Somatics and Wellness Community of the Association for These issues increase the importance of a number of boundaries in
Humanistic Psychology gives the following ethical guidelines for the use body and touch oriented psychotherapy, including the importance of
of touch in body oriented psychotherapy.xiii therapists being aware of their own needs. In this sense, it may be
1. Get touch training; suggested that until a potential body oriented psychotherapist has
worked through any sexual dysfunction or confusion and deep, unmet
27
psychological needs they should not be doing bodywork. It should be (amongst other things) “good enough” reparenting. This requires
possible to develop a set of criteria that would guide this judgement. significant verbal, ego oriented psychotherapy work concurrent with the
The importance of a working contract, which includes a clear channel body work. The handling of possible malignant regressive tendency
for the client to communicate limits, and attention to then becomes a part of the therapeutic task i.e. the tendency to regress
transference/counter transference issues, especially in regard to to an infantile need gratification posture and want to stay there is the
sexualization of the therapeutic situation, are also vital in regard to actual subject of therapy, and not just an impediment or absolute
proper boundary maintenance. contraindication, depending on other factors such as ego strength,
Respect for client boundaries is an inherent part of any psychological mindedness and therapeutic relationship.
psychotherapeutic situation. For some clients, touch based According to McNeely, one of the arguments raised against touch in
psychotherapy may never be appropriate. For example, according to psychotherapy is that it complicates and overstimulates the
Kepner in paranoid disorders, schizophrenia and severe forms of transference.xviii She herself does not believe this to be true, and quotes
personality disorders, such as borderline and dissociative, the fragile Whitmont as saying “contrary to the usual expectation, the inclusion of
ego structure may not be able to discriminate between therapeutic non verbal enactment does not complicate the transference problems,
intent and retraumatization.xv This is also true of any clients with severe but tends to help in working them out. It does so by clarifying, through
abuse histories, especially sexual abuse. According to Jacoby, the direct experience, the qualities of transference and counter
possibility of a delusional transference is a contraindication because the transference. Mutual resistance and their unconscious motives are
analyst is not experienced “as if” he or she were father, mother, etc., brought into focus”.xix Kepner echoes this with his suggestion that
but is seen literally as one of these figures i.e. the projection is unconscious resistance may be brought into aware, owned and full
concretized.xvi Jacoby also cautions against feeding the addictive expression, thus bringing the client into more contactful engagement
potential in need gratification, for example through overly supportive with the environment, promoting a capacity for separation, power and
reparenting body work. This addictive tendency itself, however, may be aggression.xx
a significant part of what needs to be worked through, and thus body Primal therapy supports this view of the facilitative value of touch in
work may be simply what calls the issue into focus. In this, Balint psychotherapy, suggesting that the uncovering of unconscious infantile
distinguishes between benign and malignant regression.xvii In malignant preoccupations and needs is particularly facilitated by body oriented
regression the client aims at perpetual “gratification of instinctual psychotherapy. It further suggests that it is not possible to fully address
cravings” whereas the benign form serves basically to seek “the infantile preoccupations and needs by verbal techniques alone. While it
recognition of the existence... of the (client’s) own unique individuality”. recognizes the need for verbal interactions oriented toward insight,
Primal therapy is particularly aware of this problem as part of the understanding, ego development, boundary negotiations and timing, it
reparenting element of touch-based body work. In this context, holds that, in order for there to be full conscious explication of the
regression to awareness and expression of instinctual infant needs is tangled web of deep unmet infant need, need denial, self deception,
seen often and expected. In fact, in primal therapy, body oriented projection and acting out, a body orientation is essential.
techniques are specifically used to evoke this material for As in all psychotherapy, the quality of the therapeutic relationship is
psychodynamic work. The reparenting theme focuses on completing paramount in the use of touch. This brings into focus issues such as
the natural, developmental movement toward maturity by receiving empathy, trust and appropriate timing. The quality of a client’s social
28
support system is also an important criterion. Similarly, the therapist’s the anorexic tendency to control, the body may, in themselves, be the
confidence in the client’s ability to not misinterpret therapeutic body subject of therapy. Similarly, cultural background may encode typical
contact and to respect therapeutic boundaries must play a part in rigidified attitudes to the body which may become the subject of
determining readiness for body work techniques. This suggests that a therapy for the individual. Body oriented techniques may be introduced
bodily intervention that may not be appropriate early in the therapeutic to these clients when timing is appropriate, noting boundary issues,
relationship may become so once trust and familiarity have been built therapeutic bond and ego skills as significant qualifiers of this timing.
between client and therapist. In this sense, awareness of the In regard to the issue of sexualizing in body oriented psychotherapy.
psychodynamic and social readiness of a client to handle material that The first and last statement must be that, as in any form of
touch may evoke is vital. To evoke a suicidally depressed infant state in psychotherapy, indeed as in any form of relationship in the helping
a client with insufficient social support or therapeutic bond, for profession, sexual acting out is absolutely contraindicated, being
example, is obviously inappropriate. Similarly, to attempt to address harmful to the therapeutic relationship, the patient and the therapist. It
sexually charged issues using body oriented techniques in a client with is imperative that this be clearly understood as a principle and that
histrionic personality typology who is actively seductive is not therapists, through their own psychotherapeutic work, clear any sexual
appropriate. dysfunction, confusion and unmet need. Ongoing supervision and peer
According to Kepner, “Touch is not always a necessary, or even a contact is an important element in managing any potential problems.
desirable, part of working with the body in therapy. Much can be done Proper training in understanding both empirical and psychodynamic
of a physical nature in therapy without the use of touch: verbally aspects of sexuality is vital - for example, recognition of sexualizing of
directing the client’s attention to his or her body process (e.g. breathing defences, seductive gambits and the confusion of sexual and infant
posture and subtle movements); instructing the client in various maternal bonding needs are just some points at issue here.
exercises, movements or postures; asking the client to touch his or her McNeely, however, also points out that “While working with the
own body as a means of focusing attention and supporting body body one is usually confronted, at some point, with the sexual aspects
experience. With persons who cannot tolerate the physical proximity of of the patient”.xxiii This is also true of any long term, deep change
the therapist or for whom tactile contact is an exceedingly foreign and oriented psychotherapy, and of course for any client in whom sexual
frightening modality, much body oriented work can still be done using function is a psychological issue. McNeely goes on to point out
the above methods”.xxi He goes on to say “Work with touch can, like “Awareness of sexuality becomes a very natural part of the process of
body oriented work in general, be thought of on a continuum. Just as I becoming conscious of the body; the therapist who is managing his or
can use attention to body process or breathing without doing any major her own sexual energy well can observe the emergence of sexuality in
experiment such as movement or vigorous exercise, so too I can use the patient without getting compulsively caught up in his or her own
touch in a brief and unobtrusive way that does not involve extensive sexual complexes, just as a healthy parent can encourage a child’s
hands on application... and of course there are many clients with whom sexual development without participation”.xxiv
I may never do any form of touching because the goals and issues with The issue of potential sexual acting out, as would be the case for
which they are dealing do not require it.”xxii any health professional, needs to be addressed by the therapist’s
We must also remember that attitudes to the body are personal therapy to ensure personal maturity, training to ensure
characterological. So, for example, the schizoid tendency to deny, and
29
13
understanding of principles and integrity, and supervision to maintain Caldwell, Christine, PhD, ADTR, LPC, Founder, Somatic Psychology
vigilance. Dept., Naropa Institute, Boulder, CO. AHP Somatics Wellness and
1 Kepner, J. Body Process – Working with the Body in Psychotherapy. Community Newsletter. August, 1996. PO Box 2123, San Anselmo, CA
San Francisco: Jossey-Bass, 1993, pg. 72. 94979-2123.
14 Kepner, pg. 81.
2 Kepner, pg. 76.
15 Kepner, pg. 84.
3 Kepner, pg. 77.
16 Swartz-Salant, N. Narcissism and Character: The Psychology of
4 Kepner, pg. 77.
Narcissistic Character Disorders. Toronto: Inner City Books, 1982, pg.
McNeely, D.A. Touching: Body Therapy and Depth Psychology. 123.
Toronto: Inner City Books, 1987, pg. 67. 17 M. Balint. The Basic Fault, Second Edition. New York:
6 Jacoby, M. “Getting in Touch and Touching”. Body in Analysis. Ed. Brunner/Mazel, pg. 144.
Schwartz-Salant and M. Steen. Wilmette: Chiron Clinical Series: 1986, 18
pg. 114. McNeely, pg. 76.
19 McNeely, pg. 76
7 McNeely, pg. 74.
20 Kepner, pg. 76.
8 E. Whitmont “Recent Influences in the Practice of Jungian Analysis”.
21 Kepner, pg. 71.
Jungian Analysis. Ed. M. Stein. Boulder: Shambhala Publication, 1982.
9 McNeely, pg. 70.
10 22 Kepner, pg. 85
D. Winnicott. The Child and the Outside World. London: Tavistock
Publishers, 1957. 23 McNeely, pg. 75.
11 McNeely, pg. 71.
12 A. Greene. “Giving the Body its Due”. Quadrant, 17/2 pp. 9-24, pg. 1
30
Appendix 5
Intake Interview Guidelines
3. Personal History:
a) Childhood – Initial impressions (good, terrible etc.)
Mother and father’s personality and client’s relationship to
them. Client’s personality as a child. Siblings and other
significant family members. When in distress was there an
31
Appendix 6
Professional Journal Requirement
To fulfill CRPO Competency requirements regarding professional
literature and applied research (5.1 and 5.2), interns must
subscribe to a professional journal of their choice on entering
internship. The journal must be in relationship to some aspect of
the LIEIPD training e.g. Journal of Humanistic Psychology; Spring
Journal: Studies in Archetypal Psychology; Somatic Psychotherapy
Today; International Journal of Existential Psychology and
Psychotherapy; Voices Journal – American Academy of
Psychotherapists; Journal of Transpersonal Psychology. Choices
are not limited to this list and interns are encouraged to develop
their own professional expertise by finding professional journals
which help them develop their individual capabilities.