Helping PRT students with the splits!

As I begin step back from my 8 years of taking PRT trainees through the London Diploma, I reflect on familiar issues that emerge with students year on year. One such issue is a student split that surfaces early on both within the group and within the trainees themselves.

This is the separation between those who usually – though not exclusively – arrive at the course with a psychotherapeutic training and those who may have a more medical background such as health advisors, doctors, and nurses. The latter find more affinity with the psychoeducational, tools & technique-based aspect of the work, whether that be demonstrating the use of dilators, teaching the stop-start technique or teaching partners the Couples Dialogue (H. Hendrix). For these students the psychotherapeutic aspects of the work may fill them with anxiety, they may get lost in the strange and often unfamiliar world of the use of self, countertransference, unconscious process and early defences for example, psychotherapy’s lifeforce. For the former the reverse is true. And whilst both are valid approaches it seems that never the twain shall meet. This can leave some students disheartened, questioning whether this specialism they looked forward to exploring is for them and now feel alienated by. Understandably they do not want to lose that part of their practice they had spent years developing, being replaced with something new and uncomfortable. Defences are raised as they deal with this internal dilemma and a split appears in the group.

At the London Diploma we support students deal with this schism, in that there is a way of integrating both and each has its value. One way is to see tools and techniques not just as treatments in themselves but as a portal to deeper psychotherapeutic material, be that family of origin, life scripts, trauma, power dynamics or more systemic material. This in turn informs the PST student of their formulation and what tools may be relevant in their therapeutic planning with clients including adjustments of these as more about their culture, background, sexuality, class etc. is revealed.

We need to support trainee therapists at their growing edge, those who may hide behind tools as they become anxious at leaning into the uncertainty of the work, or those who never consider behavioural homework as part of their therapeutic planning because it is not psychotherapy and so is intellectually light in some way. Just as we should be challenging clients who say they have done exercises perfectly like a box ticked, letting you know what good clients they are.

By seeing tools and techniques as diagnostic vis a vis just treatments we appreciate the richness of this work. This comes when communication tools become part of the power struggle in chronically stuck relationships. When clients do their best to avoid Sensate Focus when they purport to want change in their sex life. When unexpected and sometimes difficult emotions and thoughts arise before, during and after mindful masturbation, and when hearing about the practical difficulties that come up when you suggest use of dilators for vaginismus as part of particular cultures.

Such valuable material is grist for the therapeutic mill and allows student a way into working that may be less familiar and can consolidate their existing skill set. It allows a deeper and multi-dimensional understanding of clients struggle with change and growth, past present and future, and the systemic context which impacts their lives.

It is a joy to watch this process happen with students over time as they explore their own process, overcome their own anxieties, and gain an appreciation of a different way of working. It is a greater joy to see trainees realise and utilise the most important tool of all… themselves and the unique relationship they offer their clients, as splits are resolved skilled practitioners emerge.

David Piner – Associate Director – Reflective Group Leader LDPRT

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