User:5X7 Matrix

5x7 Integrative Therapeutic Matrix – As Utilized with a client experiencing Low Self-esteem and Rejection

Tania G. Blom, Samuel Ochieng & Artemis S. Antoniou

This article comprises a brief description of the 5x7 Integrative Therapeutic Matrix as a Theoretical and Clinical Model for Psychotherapy Integration, and as a tool utilized with a client experiencing Low Self-esteem and Rejection. The case study is a real case study and that the client is now not recognisable and that I have informed consent from the client. Rooted in research evidence Clarkson (1995, 2003) declared that it is not any particular psychological counselling paradigm itself that is the essence of therapeutic effectiveness, but the actual therapeutic relationship between therapist and client (Antoniou & Blom, 2006). Clarkson (1995, 2003) stated that there are five types of relationships, (a) the working alliance, (b) the transference/countertransference relationship, (c) the developmentally needed relationship, (d) the person-to-person relationship, (e) the transpersonal relationship. In addition, she suggested that there are seven domains, these are: (1) the physiological, (2) the emotional, (3) the nominative, (4) the normative, (5) the rational, (6) the theoretical, (7) the transpersonal (or the currently inexplicable).

'''1. THEORETICAL AND RESEARCH BASIS '''

The therapeutic approach is based on the Clarkson’s 5x7 Matrix. This matrix is composed by the Five Relationships framework for psychotherapy integration (Clarkson 2003; Antoniou & Blom 2006) and the Clarkson’s Seven Level model. O’Leary, E. (2006) describes integration as being theoretical, convergent, idealistic and unifying, constructing something new, by blending the parts creating therapy which is greater than the sum of the parts integrated. More research findings indicate that more than any other factor, it is the actual relationship between the therapist and the client that establishes the value of the therapy (Bergin & Lambert 1978; O’Malley, Suh & Strupp 1983; Hill 1989; Roth & Parry 1997). For Goldfried (1980) relationship is the foundation of all psychotherapy. Frank (1979), Hynan (1981), Norcross & Goldfield (1992), (Kahn 1996:13), Hubble, Duncan, & Miller (1999), Padeskey (2000), Paley & Shapiro (2001)

2. CASE PRESENTATION

The present case study describes the therapeutic process of a client within the context of the Clarkson’s 5x7 Matrix.

3. PRESENTING COMPLAINTS

Christine (pseudonym) came to see me as a result of a referral from her family physician, whose referral reported that ‘she was having signals of mild depression’ and he was recommending that ‘a course of psychological therapy would be beneficial for her’.

4. HISTORY

Christine is a 32 years old Caucasian single female in full time employment. She is the eldest of two sisters. The first born daughter in the family died at six months by cystic fibrosis. Both of her parents are still alive. She lives alone in her own house, and says that she was constantly bullied both at school and at home. She experiences her mother as both controlling and demanding and expresses exclusively negative emotions towards her, describing her as a tough woman. She sees her father as being totally dominated by her mother, but she does have positive feelings towards him even though she feels disappointed and deserted by him.

5. ASSESSMENT

During the initial assessment Christine reported suffering from “low self-esteem” and “always feeling rejected by everyone.” She claimed that she now rejects people as “It’s better to reject than to be rejected” and that she “sometimes feels guilty for rejecting, but that’s not bad as it feels to be rejected.” Therefore, she sets herself up for a vicious cycle of rejection It is this vicious cycle and its consequences that she wanted to ‘break.

'''7. COURSE OF TREATMENT AND ASSESSMENT OF PROGRESS '''

The 5x7 Matrix as utilized with client-Christine…

The Five Relationships

The working alliance between Christine and I, was well shaped from the first session. Thus, early in therapy it provided a secure and trusting space for Christine where she could safely and non-judgmentally express her feelings. Through the working alliance I communicated with the client (verbally and non-verbally) messages such as ‘I will not reject you’, ‘I am listening to you and your feelings’, ‘We can learn from each other’, ‘We can agree about our co-operation as adults’. This provided face validity or ‘communicator credibility’ (Dryden, 1984:249) for the particular client, a very important element in effective therapy, which concerns the tendency of some clients to associate certain attitudes and characteristics with an effective and reliable psychotherapist (Clarkson, 2003). Additionally, the working alliance was used as a corrective experience/relationship, since Christine had not experienced in the past a positive, safe and reliable alliance with her mother and other significant ones (e.g. sister, grandmother).

In transference/countertransference relationship Christine mirrored her fears and anticipations in our relationship. Christine was very interested in details of my personal life indicating to me that she was possibly projecting her own needs for engagement and intimacy. In such moments  I chose very carefully to answer those that I thought would facilitate the therapeutic relationship and mostly by gently reminding her that this hour was hers. Her questions about me could be transformed into precious material for her own exploration. On the other hand, Christine seemed to be much more reluctant than other clients to disclose material that she perceived as potentially threatening for her ‘psychological security’, indicating her profound fear of trust and possible rejection. Christine’s trust and sense of security in the therapeutic context seemed to be empowered by the therapist’s socio-economic status/image and academic qualifications. The latter transferential aspect contributed in a facilitative way in the therapeutic relationship, as the image she perceived of me seemed to be indicative to her that I was evidently a reliable and worth-trusting person. I conceived this as a positive therapeutic element, since I could function for her as a positive authority figure she could now trust, in contrast with her primary authority figures, her parents. This would enable me to work more effectively into the developmentally needed facet of our relationship, since there were no significant transferential disruptions. The developmentally needed relationship that was intentionally provided to Christine, enabled her in a fundamental way, to construct a ‘new reality’ regarding the effects of her early relationships, to her present psychological and existential state. This happened by providing Christine a ‘new experience’ of relating, as well as new knowledge and information. Fairbairn (1958: 377) suggested that the patient’s disabilities arose ‘from the effect of unsatisfactory and unsatisfying object-relationships experienced in early life and perpetuated in an exaggerated form in inner reality’ (in Clarkson, 2003). Using interventions from TA and CBT spectrums I enabled de-cathexis and promoted the ‘adoption’ of a new internal Parent. My facilitating and nurturing relationship with Christine profoundly helped her to unblock and relieve her strain, and this contributed to her growth and self-acceptance, significantly contributing to strengthening Christine’s Adult.

A person-to-person relationship could be potentially established between Christine and I during therapy. Christine‘s ego state had gradually developed and she seemed to be taking the initiative of beginning the end of her therapy. Clarkson states that ‘like a healthy organism, if they have had enough they will go’ (Clarkson, 2003). In Christine’s case developmentally needed, transpersonal and person -to- person moments in the relationship seemed to permeate each other. The therapy with Christine is still ongoing so the person-to-person level might keep on developing to a more prevalent form of ‘between-ness’ towards actual termination.

As far as the transpersonal relationship is concerned, it is a complex and challenging task to accurately define and describe the transpersonal dimension that takes place during the therapeutic process. Yet it seems that the transpersonal dimension had a significant role in Christine’s therapy. I shared with Christine her wonder and the search for existential (or higher) meaning she had or wanted to have in her life. Christine seemed to seek the answers and/or to feel fulfilled and supported through her spiritual beliefs and her faith in God, as she perceives it. Was faith an invisible means of support in Christine’s therapeutic journey? I believe that this was also an essential element in the therapeutic process with Christine. Both as therapist and as person, I chose to allow and include this dimension in the therapeutic process, value it, and respect it. I became aware of it, I shared it and worked with it, aiming always to facilitate Christine’s journey towards self-fulfilment, self-actualisation and healing.

The Seven Levels

Tracking some of the client’s movement as reflected within each level:- Level 1: Physiological. Christine moved from a quite negative body image towards positive body awareness. She was now happy to engage to volitional body exercise, nurture and take care of her body with greater gentleness and sensitivity to her physiological needs. She could now experience her body with much less negative transferential disruption. Level 2: Emotional. The positive changes on the physiological level contributed to Christine’s emotional uplifting and her self-esteem was increased. She was feeling OK and was comfortable with the idea of just ‘Being’. This positive and more realistic emotional state she was now experiencing created the necessary space for Christine to move from developmental/traumatic arrest towards re-decision, e.g. relinquishing her ‘old insecurities’. Christine was now seriously thinking of registering to complete training as a nurse.

Level 3: Nominative. Christine moved from disownment and victim-like attitudes towards responsibility and adjustment in her family’s reality through an adult mode. For instance, she does not call herself a ‘replacement child’ anymore. She now perceives herself as an ‘independent woman’ and among the other roles that she has as an adult individual, she is also the ‘eldest daughter in her biological family’.

Level 4: Normative. Christine was now able to commit more fully with another family system being more accepting and flexible to the fact that this family was not biologically related to her. Level 5: Rational. Christine moved from identity-disturbance (which was as a result of the sequence of her birth in combination with the label ‘replacement child’) towards clarification of the facts and recognition of her existential uniqueness. For instance, she now recognizes and acknowledges her mother’s realistic difficulties regarding the fact that her first daughter died

Level 6: Narrative level. Christine moved from a damaging and limiting life script towards re-storying and rewriting her life script. For example, Christine recognized that she had been reading too much into not being included and this was inhibiting her relationships to flourish, since she was constantly interacting with others through the colours of this fear. She could now realize that she owns her unique life script yet there is not only one way to approach it or live it, the potentials are many.

Level 7: Transpersonal. Christine seemed to have already a developed sense of the transpersonal level. This had an important facilitative role in therapy and in establishing an effective relationship with me. Therefore, Christine will ‘carry’ these effects in her ‘new’ life, which is OK. Christine’s genuine faith in God coupled with her positive experience from therapy potentially constitutes a powerful Love-based antidote for coping more constructively with difficulties in the future. Taking into account all the positive changes through her therapy a greater ‘soul-space’ was revealed to her calling her to explore, experience and grow with new awareness.

The 5x7 Integrative Therapeutic Matrix

The use of the 5x7 Matrix provided the opportunity and ‘informed’ flexibility to navigate all my therapeutic skills and repertoire in an integrative, containing, and creative way. Working with the 5x7 Matrix I had the opportunity to use all the information I had, systematically and effectively. This facilitated to develop the efficiency of the therapeutic relationship with Christine to maximum. An effective therapeutic relationship was established between Christine and I, which is evident from her progress during therapy regarding the issues that brought her to therapy, i.e. low self-esteem and rejection. Recommendations

The 5x7 relational Matrix as a Theoretical and Clinical Framework for Psychotherapy and Integration offers flexibility to integrate several methods and techniques (e.g. TA, CBT), yet under the umbrella of the whole therapeutic relationship with the client. Instead of fitting the client into a pre-decided theoretical framework, the 5x7 model is a self-evolving tool, which enables the therapist to use and navigate all the information that s/he receives from his/her relationship with the client and using/integrating a variety of theoretical frameworks- to act accordingly in order to meet the unique needs/issues of a unique client.

The 5x7 Matrix can be applied not only into the psychotherapeutic context, but also to any scale of relational context and to all relationships. It is a useful tool for understanding yourself, a situation or a subject and it can provide the most complete description of human experience. It can facilitate any professional, practitioner, student, person or group to decide what to do with the vast amount of information they have and choose inclusively and consciously a cost-effective and beneficial action.

Authors’ Note to the Readers: Since a truly integrative orientation involves developments that can be subjected to research, the authors would welcome any thoughts, views and experiences around this innovative therapeutic tool.

References

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