The Tissue lesson

Written By: Hans Appel

I was fortunate to attend one of the best counselor prep programs in the northwest.  Central Washington University (CWU) in Ellensburg Washington is highly distinguished for 3 specific programs: Accounting, Teaching, and Counseling.  Indeed, their counseling program is second to none, in my part of the country! Perhaps, the biggest distinction between CWU and other universities’ counseling programs is the experiential practicum that students receive in a real world clinic. While some programs are grounded in role playing, scenarios, and fake setups, CWU required me to complete nearly 2 years of individual and group counseling with actual clients.  It was insanely rigourous and inordinately challenging. All 50 minute sessions were videotaped for us, our supervisor, and our student teams to review, annalyze, and critic. We spent hours transcribing words, interpreting non-verbals, and examining feelings or thoughts. If you’ve ever recorded yourself doing anything, you recognize that the camera catches everything. Frequent questions arose during viewing sessions that would make the most confident individual re-examine their future counseling path:
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**Why did you cross your legs there?

**How come you leaned forward there?

**What message are you sending to the client with this greeting?

**How might you more accurately capture this person’s story?

**What transference or countertransference was observable in that clip?

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As you might imagine every little component was picked over.  In fact, I believe the saying ”leave no stone unturned” could have come from CWU’s clinical counseling program.  It was a challenging and awesome experience and I loved everything about it! Frankly, we all knew that if we survived this program (and not everyone did) we’d be ready to flourish in the helping profession.  Of all the memories, learnings, and take-aways from my time in the program, the one I continue to come back to is something I call The Tissue Lesson.  

​During one unforgettable review session, my supervisor (Dr. Collins) took a close look at a session I was confused by.  During the session, the client and I seemed to be connecting well. We were building rapport and the she was slowly opening up.  At one point, she began to cry and started to share some intense feelings. Suddenly, she stopped emoting and put up an invisible wall. It was clear that she no longer felt comfortable to explore her feelings in that moment.  On video tape it became clear that she quickly clammed up and returned into her own head before moving the conversation into a different direction. As our team zeroed in on this piece of the tape, we tried to determine what might have gone wrong.  Dr. Collins, an expert in human behavior and a passion for teaching future counselors made me replay a 20 second clip probably half a dozen times. ​
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