Publications

I am pleased to present a number of my contributions and publications that have appeared in respected journals and online blogs specialising in psychotherapy.

I hope you enjoy reading them and if you have any comments or questions, I would love to hear from you.

International Psychoanalytical Association

June 2023: Mind In The Line Of Fire

“Invited by the International Psychoanalytic Association (IPA) to participate in a worldwide short essay contest, in this book the winners, 120 authors from 34 countries, share their thoughts about the challenges and complexities of our times. They show how wars, migration, climate change, racial prejudice, gun violence, and child abuse affect us; they explore, dream, muse, reason, mourn, and remember; they grapple with loss, alienation, anxiety, fear, and despair; and they find love, hope, comfort, patience, new answers, and creative ways to think about the conflicts and difficulties we are facing. The IPA in the Community and the World committees on Climate, Culture, Education, Health, Humanitarian Fields & United Nations, Law, Migrants & Refugees, Violence, and Prejudice, Discrimination & Racism have selected these texts to inspire a dialogue with all who want to develop a deeper understanding of the world we’re living in.”

(Mind in the Line of Fire / Mente en la Línea de Fuego: Psychoanalytic voices to the challenges of our times / Voces psicoanalíticas ante los retos de nuestro tiempo: Amazon.co.uk: (IPA), International Psychoanalytical Association, Schmidt-Hellerau, Cordelia, Erlich-Ginor, Mira: 9798395910424: Books)

BACP

March 2023: No Such Thing As A Baby

The following link will download this article in which Florence applies a psychodynamic lens to the ways that family dynamics can get re-enacted in professional systems.

No Such Thing As A Baby PDF File

Further details of the training course linked to this article can be found here.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

©This article was first published in BACP Children, Young People & Families, the journal of the British Association for Counselling and Psychotherapy for counsellors and psychotherapists working with young people (BACP)

September 2022: Cushions And Creativity

I much enjoyed reading Lawrence Capon’s adaptation of a Gestalt exercise (‘My practice’, Therapy Today, June 2022). It beautifully reflects how one can grow as a therapist by finding our own ways of using the modality we were trained in. It is important for a theoretical framework to be seen as a starting point rather than the end product. By this, I mean that flexibility and creativity must always be key ingredients in a qualified therapist’s work. This is like an artist being presented with a blank canvas. They will be using the skills developed within their specialised art modality to gather their resources and possibly imagine an artwork in their mind. But the process from then to the completed product will engage their own individuality. They may play with colours, shades and shapes. They might plan ahead or follow the spontaneity of their imagination. The possibilities become endless. Lawrence Capon’s examples tell me that his adaptations have allowed him to shape his work to suit the needs of individual clients. A therapist’s creativity must always have the clients’ best interests at heart as it fully engages our commitment to meet their needs in a way that they find tolerable and accessible. Another important point is that Lawrence clearly based his ideas on a modality he was knowledgeable about. Such creative practice cannot be celebrated without emphasising the importance of basing adaptations on solid grounds. An architect’s creative ideas become a sturdy and safe building when placed on foundations built by an experienced and trained specialist. The ideas themselves can only develop if based on a sound understanding of structures. The term ‘flexibility’ I used above must therefore be taken with great care. It does not mean coming up with fancy twists and turns to randomly selected therapeutic concepts. It means spending a fair amount of time training in a modality and humbly sticking to its boundaries while learning. For years, I worked with the original psychoanalytic box, and spent time exploring its meaning, effectiveness and purpose before developing my own adaption of it.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published in Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

May 2022: Is It OK To End Work With A Client Because You Don't Like Them?

I am struggling to like one of my clients. They are frequently late for their appointments, with no apology or explanation, and they seem quite distracted in sessions. What’s worse is that I find myself questioning their integrity. Sometimes I refer back to something they have said in a previous session and they deny ever having said it, and this throws me completely. I really don’t want to work with them any more, yet I fear it could be damaging to them to bring the work to an end. Also, I’m mindful of our commitment to ‘make clients our primary concern’, so does this mean I have no choice but to stick with them?

Reader Response:

Perhaps the client’s attendance could be celebrated despite the lateness?

It sounds as if the therapist in this example is experiencing a very powerful countertransference. This can help them understand their client better if they can tolerate it. It is a hard but necessary catalyst for change.

In such a situation, I would be curious about the purpose served by the behaviours described. It seems that, by attending, albeit late, the client is communicating a wish to engage. But has the client learned to keep themselves safe by behaving in ways that prevent closeness? Could the lateness indicate a wariness of a therapeutic alliance? It would be helpful if the therapist could find a way to wonder about the lateness with the client without it coming across as a reprimand, to open a door to thinking together. Perhaps the client’s attendance could be celebrated despite the lateness?

Referring back to something a client has said in a previous session can be risky as it puts the therapist in charge of the narrative. Perhaps the client denies it as they are emotionally not in that same place in this session?

Before even considering ending the work, I would strongly recommend that the therapist engages in several in-depth discussions with their one-to-one supervisor and their peer group supervision, if relevant, and consider using the BACP’s Ethics Service for further advice. To successfully navigate this case, the therapist will need to feel contained and supported within their own professional network.

An ending to the work without the above thinking could act as an affirmation that the client should indeed keep others at bay, or that they are not worthy of care and attention, or even that being disliked potentially keeps them safe from further emotional pain. An ending should also ensure a good transition to another service or professional.

Equally, continuing the work if the therapist cannot tolerate the countertransference and its consequent reflective thinking could place the client’s emotional wellbeing at risk of harm. Ultimately, a decision to either end or continue the work must be made as part of joint thinking between the therapist, their professional network and, importantly, the client themselves.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published in Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

Cover of Therapy Today June 2022 from BACP
February 2022: Embracing Challenge In Therapy

‘Embracing challenge in therapy’ (Therapy Today, November 2021) offers a good starting point for anyone wishing to reflect on their own practice. I related closely to the dilemma of challenging a client whose sessions bring bread to our tables. I was recently placed in a position where parents were urging the young person to end the work, while both I and my client knew we had more to explore together. Discussing this with the parents, I was very conscious of this underlying anxiety many of us in private practice experience, where we somehow feel that we have to work harder to convey our professional argument so it is perceived for what it is (a reflective, evidence-based clinical decision) rather than a financial venture.

When it comes to clients themselves, the article reminded me of the many discussions I had in supervision during my training. As a trainee, negative transference was possibly the most challenging learning curve. At first glance, it emotionally contradicts the very reason we chose to become therapists – our wish to help. However, this, if one is not reflective and open to constructive criticism, can quickly turn into a wish to be the ‘good object’, as Klein would put it, with none of the ambivalence that is crucial to an integrated emotional development. If anything, working solely in positive transference (without dismissing its central place in therapy) places us at risk of reinforcing unhealthy, unconscious splits.

From a psychodynamic perspective, I see what the authors call ‘challenge’ as accepting to be the recipient of negative projections. Only through this can we truly become what Bion termed the ‘container’ for our clients’ most painful thoughts and feelings. Unless we welcome such projections, we cannot digest them on their behalf and return them in a manageable enough form to allow for their reintegration as part of the client’s inner self.

Despite how strongly I share the authors’ belief in the need to challenge clients, I am very cautious of doing so too early in the work. I was rather viscerally taken by the authors’ reference to Kerner’s work. Such an approach may be valid and efficient where clients require low-level, cognitive behavioural interventions, but I see it as important to highlight how counter-effective this would be in a psychodynamic framework, where challenges are presented in the form of interpretations. These should remain minimal during the assessment and should only be shared in a timely and sensitive manner throughout an intervention. Safety and containment in the therapeutic alliance must be the precursors of any type of challenge when offering more intensive, in-depth therapy. This is also key to any trauma recovery work.

While psychodynamic thinking is very cautious of self-disclosures, I really liked the reference to Lewis Aron’s work where the therapist found a healthy compromise, inviting mentalisation and promoting therapeutic alliance.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published in Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

Cover of Therapy Today May 2022 from BACP
December 2021: Celebrating Wildness

The interview with Nick Totton (Therapy Today, November 2021) on working outdoors and celebrating wildness in both the outer world and our inner psyche spoke to me on many levels. As I consider embarking on a post-qualification course in eco-psychotherapy with children and adolescents, doubts regularly creep into my mind about how this will affect therapeutic boundaries. I found Nick’s idea of boundlessness useful in framing my existing commitment to approach each therapeutic alliance with open-minded flexibility. Some children prefer me to remain in my therapist’s chair, while others want me by the sand tray with them, or standing to play catch, and other quite active interactions. As Nick says, one might choose to hold strict boundaries because the client needs them, rather than because they are of ‘universal validity’; ‘Another client might find [such boundaries] oppressive and unhelpful.’ While all this comes naturally to me in the therapy room, I am conscious that taking it outdoors reaches a new level.

I am aware that taking sessions outside has become something of a trend since the pandemic. I was struck by the absence of reference to any in-depth training sought by professionals prior to taking that step. To work ethically, we owe it to our clients not to take this shift lightly. Working outdoors has very profound ramifications and overlooking the deep meanings (for both therapist and client) of such a shift could be detrimental to any therapeutic process. As Nick rightly states, it requires a ‘surrender of control’ – something that cannot be trivialised if one is to continue providing the containment that is so crucial to therapy.

Nick’s idea of unpredictability made me realise how much traditional psychotherapeutic boundaries render us so predictable that they inevitably contradict the very nature of the world we live in. While predictable boundaries are essential for some clients and to specific stages of any therapeutic relationship, surrendering to a perhaps more realistic practice may increase relatedness and connectedness, thereby promoting deeper and more sustainable changes in one’s inner self.

While having been trained to see the therapy room as an essential boundary, I am, in my personal life, more of an outdoors individual. Safely and ethically bringing therapy outdoors would beautifully merge my professional and personal values.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published in Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

Cover of Therapy Today November 2021 from the BACP
October 2021: Adolescent Dropouts

I was interested in reflecting on Frances Bernstein’s article (‘Understanding why clients drop out’, Therapy Today, September 2021) in the context of my work with children and adolescents.

I follow a clear assessment process, after which, if the formulation is to enter therapy, I find it helpful to think with both the child and their parents about those challenging times where negative transference may be experienced in the course of therapy. This corresponds to Frances’s idea of ‘anticipating difficult areas of therapy where drop-out might occur’. It is crucial to engage parents in thinking about those areas, how their child may react and ways in which they can help the young person navigate them. Child therapy is more likely to be successful when their environment is conducive to and supportive of the process.

The added dimension here is the parental experience of sending their child to therapy. It can at times trigger or reinforce internal feelings of failure or rejection. When a child explores a particularly difficult area in their therapy, they may want to avoid the next session, or voice their dislike of the therapist.

Failing to acknowledge parental experience from the outset increases the risk of parents unconsciously colluding with their child acting out negative transference. A parent who feels rejected by the young person building a therapeutic alliance may be driven to project their feelings onto the therapist by supporting the child’s request to end the work. Meeting with parents on their own during the assessment process allows us to create a thinking space where they feel heard and their fears, assumptions or worries can be named and acknowledged. Drop-out rates are, in my experience, much lower when parents feel actively involved and held in mind by the therapist as they work with their child.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published in Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

Cover of Therapy Today September 2021 from the BACP
Underwater image featuring a green and pink tined sea anemone

Psychotherapy Networker

August 2021: Trust The Process

August Quandary: I often take notes during therapy. It helps me better digest what my clients are saying and helps me recall detailed information. However, I sense that some clients are bothered by it. Sometimes they get distracted when I start writing. Recently, in the middle of a note, one client asked whether I’d just heard what he said. Another asked what I was writing and was bold enough to ask if he could see my notes! I’d hate to give up this valuable tool, but worry that it sometimes impedes therapy. What should I do?

Trust the Process
Whether you should or shouldn’t take notes largely depends on your theoretical framework. There was a time in my work where I used a laptop during assessments, taking notes to make sure I was ticking all the necessary boxes. But I never felt comfortable with this model. It felt as if, while busily typing, I was missing all sorts of client cues. My therapeutic focus felt restricted by the administrative demands of my employer.
When I transitioned to working as a psychodynamic psychotherapist, I felt enormous relief since I was taught to be present in the here and now in sessions, and to learn to recall conversations without relying on notes. My focus became the client, the unconscious dynamics at play, and my bodily responses. I could finally work in the transference without being pulled out of it to take notes.
Many therapists who follow different models often ask me how I can recall session details without notes. The truth is it’s taken years of training to master. I find it helps to try to write up an approximate transcript of the session after it’s ended. Doing so has helped me realize just how much information we can recall without the aid of in-session notes. Now, I rely solely on the transference and countertransference that comes up in sessions as my guide to complete a write-up.
In sessions, instead of using silence or breaks in the conversations to take notes, I sit with the silence. I listen to my body and feel the unspoken narrative, all of which I missed when I used to have a laptop or notepad with me. Since clients now have my undivided attention, they feel at ease, like the room is their safe space. It’s made the whole process of therapy much more efficient.
To this clinician wondering whether he or she should take notes, I’d simply suggest that they follow their instinct. It seems like taking notes is a key part of their practice and they wish to retain it. Perhaps it’s a matter of having an open conversation about notes and their rationale for taking them. I’d advise that this therapist communicate that note-taking is a caring gesture, a way of keeping track of the important points the client makes so that they can deliver the best support possible.
However, it also sounds as if this clinician might be ready to explore a different way of working, one that doesn’t include notes. It doesn’t necessarily mean abandoning their therapeutic model, but perhaps adapting it to fit their needs and those of his or her clients. This could lead to a beautiful journey where the clinician discovers their own unique style and methods.

Florence Nadaud MBACP, children, adolescents and families psychodynamic psychotherapist in private practice

© This article was first published on Psychotheraphy Networker in August 2021

Pink flower growing by the seaside

PESI UK

October 2022: Perinatal History 1 and 2

The following links will take you to 2 articles published on the PESI UK website about the importance of a client’s perinatal history for therapy.

Perinatal History 1/2: The Missing Piece In Adolescent Assessments

Perinatal History 2/2: Exploring Earliest Life, Making Meaning

Pretty white flowers growing by rocky cliffs on a shoreline

Explore Your Own Mosaic Of Life With Us

Contact Us