# 20220124 Systemic Group Supervision 24 Jan 2022 Previous [20211004 Systemic Group Supervision](evernote:///view/463671/s5/71d50d12-d26a-ff0c-f816-f628ea82b87b/e17c6692-39b3-4ab3-b727-dd25f2b3e898/) - #countertransference #Transference - [[Systemic Thinking]][[Systemic group supervision]] - [[🏠 Trauma]] --- PS presented PTK JJ A ## Formulating the case ![[Pasted image 20220130110120.png]] ![[Pasted image 20220130110127.png]] ![[Pasted image 20220130110133.png]] ![[Pasted image 20220130110138.png]] - Attachment pattern - Development ![[Pasted image 20220130110154.png]] - Birth order - Social Graces - blame? Grief/Loss **Triangulation** - Double Bind - Fusion. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666286/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666286/) - Close to father, critical voice of mother - close of mother, critical voice of father. Juliana : Trauma history J's went through. - "[L202003051338: Trauma disrupts the person worldview, and their sense of control of what happens in their life.](evernote:///view/463671/s5/e63a3883-4331-48aa-827d-b46100e7b6f1/e4d9289e-90fe-0f31-de29-1fe2324165a6/) - _Trauma is related to sense of control. When a person experience trauma, they experience a lost of control._ - [Book Notes - The Body Keeps the score](evernote:///view/463671/s5/f98a7d14-fd7c-1ee2-798d-566b2dc6a688/57ba5125-cfd0-4795-9c56-4f9115b91ae9/) - Victims of trauma feel emotionally numb, unable to connect with people. - Trauma causes one to lost trust in self and others. Become closed up. Parent-ification - Cognitive is older - Emotion is arrested (related to Trauma) ### Worker reflection - Similar, feeling that she is not good enough. Taking on rescuer role. Making sure there is harmony at home. - Blaming younger one, resentment, for not having to take care of family problem. - Parallel - it's always someone wrong.. it's ME or the patient's wrong. Then what is right? Triangle when we become rescuer role -- we also persecutor and victim.  How to get out of this triangle. What are we enforcement/enabling when we always rescue. ^77a77f ### Self- In relation to Patient - What is your role AS A CM ### What is the greatest fear if you understand the patient and family. What is it about this family that is holding you back? Our work is reparenting patients. - On one hand, you want to move forward to trust, but there is also the need to feel safe. All creatures have only these two needs: For closeness/ Connection, and protection of self in face of threat. - Anger bring distance. Sadness, pain draws people in. That's why there is a ding-dong. **Parent's critical Voice** - Even if father already passed on, still need to engage father's voice through patient. To help patient integrate, and make peace with those critical voice. **Helping patient to trust herself. First step of establish trust. Autonomy goes back to her. And we encourage the patient by supporting her.** **Restoring the sense of control, and trust in herself.** "Safety is in the presence of connection of self and others. Not in the absence of threat" She is rejecting herself. ## Questions - Middle child? What's the gain? - Brother - Seeing drinking as coping, what cause him to drink? - Sudden grief and loss of father, precipitated patient's illness - Loss of stablising figure for the family. How did pt's father react to the loss of his supportive person. - Father abusive towards wife. Son abusive towards patient - Mother felt cheated about husband mental health history? - Spirituality Mother and patient attend Church - how come? who brought them? - Why now? What's the gain? What's the gain when patient became unwell - Grandfather passing in 2019 --- - What Changed after patient started treatment? Client not regular with follow up and treatment - - on and off - How is J like when younger? before onset of illness? ## P.A.D.I - What is the client's problem and goals now? ![[Pasted image 20220130110219.png]] - Why did the mother go to FSC? - PS shared about the FSC counsellor interactions with patient in FSC... i wonder what was the purpose.. she said suspect of attachment injury. ![[Pasted image 20220130110225.png]] ![[Pasted image 20220130110230.png]] - Why family want to believe it's schizophrenia? Pathologise? Easier to accept? ?When she postpone, how is she? what will she do? ?How is the youngest child doing? - **Transference and Counter Transference issues?* - It is draining for us to give the attention.  - **Context is different, feelings are the same.** - In trauma, feelings get confused with the context. Patient confused that right now is still dangerous because they feel the same trauma **What's the feeling towards worker that's uncomfortable? (patient blame her)** - Anger Puzzling - Fear that if patient feeling suicidal, she would encroach on her boundaries and space. - Nervous / anxiety ## Presenter Requests 1. How to work with patient attachment to helper? How to protect self, from patient "personality" **?How to hold and contain the patient dsyregulation?** 2. Patient overly thankful and appreciative, made her uncomfortable. _Countertransference  [What Is Counter-Transference?](evernote:///view/463671/s5/9d87e568-d646-4208-942a-8a2a9d4cceab/c24bc1f0-1ab8-482a-b3ed-5d0ab50ef081/)_ - _Psychological transference by a psychotherapist in reaction to the emotions, experiences, or problems of a patient undergoing treatment._ - _The [transference](https://www.wordnik.com/words/transference) of a therapist's own [unconscious](https://www.wordnik.com/words/unconscious) feelings to his or her [patient](https://www.wordnik.com/words/patient); unconscious or instinctive emotion felt towards the patient._ - _the psychoanalyst's displacement of emotion onto the patient or more generally the psychoanalyst's emotional involvement in the therapeutic interaction_ [L202003051547: Feeling towards clients](evernote:///view/463671/s5/419c2c4c-5391-4183-bae3-c16321ee0b17/e4d9289e-90fe-0f31-de29-1fe2324165a6/) ## Suggestions - Worker have more information than she need, and confuses her. patient have more responsibilities than she need. Attunement,  Affirmation, Acknowledgment of patient struggle. They may not believe it.  because of their habit. Keep driving it. ![[Pasted image 20220130110243.png]] [Attunement,  Affirmation, Acknowledgment](evernote:///view/463671/s5/057f21a7-764a-0650-16f6-a09619a199db/c24bc1f0-1ab8-482a-b3ed-5d0ab50ef081/) - "When patient use cognitive, they are actually very protective. Protecting the emotions." _Reminder, sharing alot of intention, of why we are doing that.. so patient know why are doing that._ - Talk about it, how to collaborate together - **Using the here and now** - process what's happening here, how are we working together? - **Question: How to help patient be ready to process "deeper" processing** --- # **Taking away** - **Helping patient to trust herself. First step of establish trust. Autonomy goes back to her. And we encourage the patient by supporting her.** **Restoring the sense of control, and trust in herself.** "Safety is in the presence of connection of self and others. Not in the absence of threat" - Sharing lot of intentions of why i am doing what i am doing