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Counsellors' use of poetry : what helps and hinders the therapeutic process Jalali Mazlouman, Shahla 2013

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COUNSELLORS? USE OF POETRY WITH CLIENTS: WHAT HELPS AND HINDERS THE THERAPEUTIC PROCESS by  Shahla Jalali Mazlouman  M.A. University of British Columbia, 2010    A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF   MASTER OF ARTS   in     The Faculty of Graduate and Postdoctoral Studies  (Counselling Psychology)      THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)     October 2013    ? Shahla Jalali Mazlouman, 2013 ii   Abstract  This study used the Enhanced Critical Incident Technique (ECIT) to explore what helps or hinders the use of poetry in counselling psychology. Interview with nine participants produced a total of 174 critical incidents and wish list items. The study resulted in a total of 23 categories, with 10 categories of helping incidents, seven categories of hindering incidents, and six categories of wish list items. The following helping categories had the highest participation rates: poetry elements, the poetry content, activity, and experience and knowledge. The following hindering categories had the highest participant rates: clients, personal factors, and professional development. The top wish list categories based on participation rate were the following: resources, connecting with other colleagues, time, and supportive work environment. Nine credibility checks were performed to ensure validity of the data. The purpose of this study was to provide counselling psychologists with knowledge about the helping and hindering factors in the use of poetry in counselling.             iii   Preface  This research study was approved by the University of British Columbia Behavioural Research Ethics Board on March 8, 2013 (H13-00361).                      iv  Table of Contents Abstract???????????????????????????????????ii Preface??????????????????????????????????....iii Table of Contents???????????????????????...???????.iv List of Tables????????????????????????????????..vi Acknowledgments???????????????????????????......?...vii Dedication????????????????????????????????.......ix Chapter 1: Introduction ................................................................................................................... 1 1.1 Definition of Terms ............................................................................................................... 4 1.2 Statement of Research Problem ............................................................................................ 7 1.3 Purpose of the Study ............................................................................................................. 9 Chapter 2: Literature Review ........................................................................................................ 10 2.1 The Role of Creativity in Counselling and Poetry .............................................................. 10 2.2 Application of Poetry in Counselling and Psychotherapy .................................................. 12 2.3 Clinical Implications of Poetry in Counselling and Psychotherapy .................................... 18 Chapter 3: Methodology ............................................................................................................... 22 3.1. Research Design ................................................................................................................. 22 3.2. Participants ......................................................................................................................... 25 3.3. Data Collection ................................................................................................................... 28 3.4. Data Analysis ..................................................................................................................... 30 3.5. Accuracy of the Data .......................................................................................................... 31 3.6 Ethics ................................................................................................................................... 34 Chapter 4: Findings ....................................................................................................................... 35  v  4.1. Helping Critical Incident Categories .................................................................................. 36 4.2. Hindering Critical Incidents Categories ............................................................................. 53 4.3. Wish List Items Categories ................................................................................................ 59 4.4 Contextual Findings ............................................................................................................ 64 Chapter 5: Discussion ................................................................................................................... 72 5.1. Correspondence to the Review of Literature ...................................................................... 72 5.2 Unique Findings .................................................................................................................. 75 5.3. Practical Implications ......................................................................................................... 79 5.4. Limitations ......................................................................................................................... 80 5.5 Future Research ................................................................................................................... 82 Chapter 6: Conclusion................................................................................................................... 83 References ..................................................................................................................................... 84 Appendices .................................................................................................................................... 90 Appendix A: Interview Protocol ............................................................................................... 91 Appendix B: Informed Consent ................................................................................................ 95 Appendix C: Recruitment Poster............................................................................................... 98               vi  List of Tables  Table 1. Demographic Table......................................................................................................... 28 Table 2.Helping Categories .......................................................................................................... 36 Table 3. Hindering Critical Incidents............................................................................................ 53 Table 4. Wish List Categories ....................................................................................................... 59                                      vii  Acknowledgment    There are many great people who were the standing pillars of this study, and to whom I would like to extend my deepest gratitude and appreciation.  First and foremost, I would like to thank my research and academic supervisor, Prof. Norman Amundson for providing me with the opportunity to work on this research under his supervision. I would like to express my deepest appreciation and gratitude for his endless and continual support, his guidance, and patience.  I would also like to thank the members of my committee Prof. Susan James and Prof. Carl Leggo for reviewing my thesis and providing me with support and invaluable feedback. Also, I would like to express my gratitude for the support of my clinical supervisor Dr. Pam Hirakata, and Lauri Mills, PhD Candidate, who greatly encouraged and supervised my use of poetry with clients and provided me with valuable feedback.  I would like to sincerely thank my parents who inspired me to do this research; and my dear brother, Shahriar who supported with love and patience overseas throughout this project. I would like to express my gratitude to my loving sister and brother in law, Shahrzad and Nima. With every visit from Seattle, they filled my heart with love, energy and motivation throughout this program and specifically during this research. Thank you for supporting me during this journey.  My utmost appreciation goes to my fianc?, Alexander; without whose love, support, and patience, my contribution to this project would not be possible. Thank you for lovingly standing by my side in times of elation and frustration.  I would like to thank the support of my caring friends Louise Young and Carolynn Turner for their unconditional and genuine care and support throughout this research and beyond.   viii  Last but the most, this thesis would not have been possible without the 9 participants who were willing to devote their time and valuable experience to me and this research. Thank you for your devotion, motivation, and support.                       ix  Dedication   To My Loving Parents:  Nayyereh Nouyan, my ultimate inspiration in pursuing Counselling Psychology, and the one who never ceases to encourage me to become whoever I ever wanted to be,  &  Dr. Rahim Jalali Mazlouman, my ultimate inspiration in Literature and Poetry, who never stops to fill our house with books, poetry, and love.   1  Chapter 1: Introduction  ?There was a Door to which I found no Key: There was a Veil past which I could not see: Some little Talk awhile of ME and THEE There seemed--and then no more of THEE and ME? (Quatrain 32, Rubaiyat of Omar Khayyam, Translated by Fitzgerald) Khayyam, in his quatrain, visualizes the dualistic perception of ?ME and THEE?, the struggle of being caught between the Self and the True Self which are separated by a barrier. Poetry is the key to unlocking emotion, passion, feeling, and, in other words, the invisible part of self. It removes the veil separating emotions from cognition and behavior. It allows individuals to experience feelings that may be foreign to them, or that they may need to re-experience (e.g. trauma). According to Gladding (2005): ?Poetry can play an important role in mending the broken spirits and the restoration of hope and wholeness? (p.114).   Poetry has been proven to be a useful tool which can lead to creative and effective communication. Poetry writing has been discussed as having significant implications in enhancing the clients? creativity. Kinloch (2005) discusses the importance of poetry writing for voicing the individual?s feelings, enhancing their creativity, and exchanging their emotions. In the United Kingdom, a group of writers outline the use of poetry therapy in creativity and empowerment (as cited in Hunger & Sanderson, 2007; McArdle & Byrt, 2001). Therefore, poetry has been recognized in the literature as a powerful tool in challenging client?s creativity and enhancing the therapeutic process.   2   Poetry has also been proven effective through facilitating the achievement of insight (Berger, 1969), and catharsis (Luber, 1973). There is significant connection between health, healing, and literature (Gladding, 2005). Indeed, not only physicians but ?dramatists, poets, novelists, and diarists throughout the centuries have also made the link between emotion, disclosure, and health? (Wright, 2002, p. 286). R. Furman (2004) argues that not only is poetry effective at conveying strong emotions, but it also creates an evocative and vivid image which can linger longer than conventional conversation in the mind of the client. This creative use of language motivates the client to move beyond passivity to actually engaging in the process of meaning creation. Poetry can therefore, empower clients to recognize their invisible feelings, and to verbalize them. It acts as a tool that entangles individuals with their emotions, gives voice to the ?shells of silence?, reinforces the weight of their actions, and that of their ?existence?:  ?Behind our backs, the memory of waves throws cold shells of silence on the coast. let us go to the edge of the sea, cast nets in the water and catch freshness from the water. Let us pick a pebble up from the ground and feel the weight of existence.?  (Sohrab Sepehri, In the Footsteps of Water)              Despite the richness of literature combined with the effectiveness of poetry in counselling and mental health (Gladding, 2005; Furman, et al., 2006; Stepakoff, 2007; Shafi, 2010; Norma D, 2012; Hunger & Sanderson, 2007; McArdle & Byrt, 2001), there is no clear map for the use of poetry as an intervention with clients within the counselling process. There is no specific structure for the appropriate use of poetry (when), the methods to bring poetry in the counselling  3  session (how), and whether it is specific to clients who have strong cognitive abilities or most suitable for use with any client experiencing angst (who). Moreover, poetry has been recognized as a useful tool in cross-cultural group counselling settings due to its universal element while also enhancing each individual?s unique interpretation (Kimberly, et al. 2002). However, no studies have extended the concept of universality in poetry to individual counselling. Adding this knowledge to the existing literature on poetry and counselling could be very helpful in the creation of poetry as an organized and clear intervention in the therapeutic process.    I have a long term interest and background in literature and poetry. Earning my Master?s degree in English literature, I gained specialized skills in understanding and analyzing poetry, metaphor, and creativity within language. During my clinical experience with the UBC Counselling Psychology program, I had the opportunity to work with a supervisor whose specialization is in arts and expressive modalities in counselling. She encouraged me to be creative with my clients. Her supervision was in fact a key factor that facilitated my personal experience of using poetry with clients. I noticed that it empowered my clients in identifying their feelings. From these experiences, I was encouraged to find results in the literature about the use of poetry in counselling, as well as the cases where it has proved successful in the healing process. I studied the techniques of using poetry in counselling, and the power of imagery, creativity, visualization, and externalization of inner feelings to an image. Through this study, I gained a better realization of my research goal which includes identifying the helpful aspects that facilitate the use of poetry in a counselling session, as well as the challenges. My goal also involves understanding the suitability of the use of poetry, and contributing to the recent data on the use of poetry in counselling as an intervention.  My long term objective is to develop a clear  4  and organized reference from the data on the current use of poetry in counselling, that would help practitioners and counselling professionals when using poetry as an intervention.  1.1 Definition of Terms  Creativity not only underpins poetry but is also enhanced by it. Poetry can be the creative use of words by assigning unconventional meanings to them. According to Luck Wright: ?If you're a creative person, then poetry is a great format because it's short" (BBC NEWS, 2011). This British poet who regularly interviews with BBC on poets and poetry, describes this literary use of language as the shortest creative style of communication. Poetry acts as a puzzle in the mind of the audience, and depending on the unique creativity of the client, various interpretations can merge. Due to the fact that creativity and poetry are intertwined, it is, therefore, important to define this term as a base for the therapeutic use of poetry. This section will define poetry both literally and within the counselling context.  Creativity   Creativity has been widely used in the literature of counselling psychology and has received numerous definitions. Gladding defines the central feature of creativity as divergent thinking (2005). Even though it may sound as if creativity is a gifted trait only endowed upon a talented few, Carson and Becker (2004) argue strongly that creativity is more of a skill than a gift; it is a style of thinking that can be learned by the counsellor and the client, and therefore it has the potential to develop over time. Kottler and Hecker (2002) also emphasize that, quite opposite to a gifted talent, creativity is an activity that can be learned and incorporated frequently in counselling sessions. Amundsen (1997) proposes practical activities which enhance counsellors? engagement in a creative activity. He highlights the use of metaphors in enhancing  5  the use of creativity in clients, and emphasizes the important role of creativity in reframing situations, and therefore facilitating the problem solving process. Hennessy (2010) describes two types of creativity depending on their impact on clients. There is the ?Big C? creativity, that majorly affects others and is very similar to experiencing an epiphany, and the ?Small C? creativity which refers to the day-to-day problem solving or adaption to change. Poetry and creativity are intertwined. The use of poetry in counselling will enhance the clients? creativity ability to reframe their situation and externalize their inner feelings to words described in a poem. It can act as a catalyst in surfacing emotions, angst, and pain. This creative externalization can facilitate the problem solving process through shedding new light into the abyss of the problem.  By challenging the client?s cognitive frames of thought, this process can lead to the creation of a new path of thinking, while each client creatively makes a unique interpretation and meaning out of a poem. Through the use of poetry, the clients creatively sweep away the dust from buried emotions within their heart and mind. This process can empower clients into discovering what lies behind the dust, and boost their self-esteem through creating, representing, reframing, and resolving.  Poetry  ?Poetry does not need a meaning or definition. Poetry is how the reader reads it,  Poetry is how the poet writes it. Poetry is real,  Poetry is fake,  Poetry is everything,  Poetry is fate.  6  Poetry is rythm. Poetry can ryme. Poetry is anything, I make it mine.?   (Eric Graham, Definition of Poetry by a 15 Year Old).  Eric J Jackson in his book Poetically Correct defines poetry as ?an imaginative awareness of experience expressed through meaning, sound, and rhythmic language choices so as to evoke an emotional response. Poetry has been known to employ meter and rhyme, but this is by no means necessary; the very nature of poetry as an authentic and individual mode of expression makes it nearly impossible to define? (2010, p.1).  Therefore, poetry could be any creative form of language used to externalize a feeling and is subjective to interpretation by the reader. Poetry has also been defined as ?a powerful non literal communication that potentially transforms the cognitive state of the individual? (Shafi, 2010, P.87). It is the means through which the layers of meanings, constructed by a particular society, can be recognized: ?It is a way in which we can understand each other and ourselves; a way in which we can delve into the depths of our souls and contact parts of ourselves we barely thought existed. Poetry can be subversive in the way it can use language as a rallying point around which we can gather to express our inner feelings. Poetry is a language that can talk about madness in a challenging and unique way. Poetry can give meaning where meaning cannot be found. It can reveal aspects of life that often remain obscured? (Jeffs & Pepper, 2005, p. 91).  Poetic practices in counselling focus on the use of poetry within the therapeutic process. Both registered counsellors by the National Association of Poetry Therapy (NAPT), and non-NAPT registered practitioners use poetry within the counselling process. The poetry therapist is committed to the appropriate use of poetry in counselling and the proper expression of emotions  7  of the past, present, and future (Gladding, 2005). According to Lessner (1974), poems that are most open for discussion within the counselling process have the greatest universal appearance (as referenced in Gladding, 2005), and therefore can be appropriate for discussion by clients from different cultural background. They are very productive in generating discussion and the exploration of cultural concepts in a multicultural group setting within a safe space (Anser-Self & Feyissa, 2002).   For the purpose of this study, poetry is defined very closely to Jackson?s definition of poetry as an imaginative awareness of experience through sound and image. It is a representation of an internal feeling by the client, facilitated by the counsellor. Poetry is enhanced by creativity, and is what the client and counsellor make it to be.    1.2 Statement of Research Problem  Over the past 10 years, many practitioners have turned to arts and humanities as a valuable source for insight about the human condition (Donohoe & Danielson, 2004; Frank, 1998; Genova, 2003). One of such resources is Poetry (Furman, et al. 2006). Information that is derived from humanities can be a valuable resource for helping to capture and understand complex psychological phenomena and mental illness (Furman, et al 2006). Furman, et al. (2006), discuss the importance of the complex poetic structure in its effectiveness on patients suffering from mental illness: ?Poetry, with its ability to capture complex, dialectical, and ostensibly contradictory dynamics, may be a valuable aid to exploring the processes of mental illness, as well as the experiences of those providing care for those suffering from mental illness? (p.332).  Using poetry in counselling empowers individuals to access significant discoveries about themselves as persons. The counsellor and client can personalize aspects of poetry into their own  8  lives: ?Poetic literature ranging from John Donne to Gladys Willington emphasizes the many roads to actual client change and the difficulty and trill of getting to and through life stages? (Gladding, 2005,p.115).  Reviewing articles on poetry therapy published in the past decade has indicated that poetry is an effective tool in the process of counselling (Gladding, 2005; Furman, et al., 2006; Stepakoff, 2007; Shafi, 2010; Norma D, 2012; Hunger & Sanderson, 2007; McArdle & Byrt, 2001). These articles have discussed poetry as a counselling tool that empowers clients in the creation of their own meaning out of the complex structures of language, and recognizing the hidden feelings that have risen to surface.  However, a void in the literature exists about using poetry as a technique and intervention skill in counselling. There is little known about the factors that have facilitated the effective use of poetry by counsellors. It is unclear whether factors such as the setting, the client, the counsellor, the type of poem, the method of bringing poetry in the session (e.g. expressive writing, bibliotherapy, poetry therapy, to name a few), should have specific qualities in order to make the use of poetry effective in the therapeutic process. Are there any other aspects that have facilitated the use of poetry in counselling and have contributed to the healing process? On the other hand, have there been incidents for counsellors in which certain aspects have challenged the use of poetry in the counselling session? What have these challenging aspects (barriers) been? And how can future methods of using poetry in counselling focus on reducing the occurrence of these barriers?   This study aims at taking a step forward in filling this void in the literature by finding what these helping factors in using poetry in counselling can be, while highlighting those aspects that are identified as hindering the therapeutic process while using poetry. Any incident that involves the various ways in which poetry has been used to benefit users of mental health  9  services whether through the expressive poetic writing or reading, will be valuable to this study. Identified helping and hindering aspects will be helpful in the creation of a systematic, research based, and structured road map that highlights how counsellors can overcome the barriers in using poetry and increase the occurrence of the useful and successful aspects. This contribution can be beneficial to all practicing counsellors as well as individual clients. 1.3 Purpose of the Study  This study aims at discovering what aspects help and challenge counselling psychologists in using poetry with their clients.   Research Question The main question in this research is: what aspects facilitate counsellor?s use of poetry in the counselling sessions while working with the clients, and what aspects challenge them?              10  Chapter 2: Literature Review   Creativity plays an important role in the creation of poetry and the incorporation of poetry into counselling. This chapter focuses on providing a review of the published articles on the role of creativity in counselling and poetry. Such discussion will then build into providing a summary of the published books and articles on how poetry has been applied so far in counselling and psychotherapy. It will then be followed by a brief discussion on the clinical implications of poetry in mental health, counselling and psychotherapy.  2.1 The Role of Creativity in Counselling and Poetry  Creativity is the central skill in the therapeutic process (Hecker and Kottler  2002; Gladding 2005). Hecker and Kottler (2002) consider ?divergent thinking? as the ?hallmark of creativity? (p. 8). Divergent thinking encourages the creation of different and novel ideas which can be helpful in the decision making process, problem solving, or fostering change. Divergent thinking also involves considering new possibilities and horizons rather than encouraging a focus on data and conclusion (Deacon, 2000). Creativity ?is a process typically born from frustration or the need for a solution? (Hecker & Kottler, 2002, p.2 ). In a counselling session, creativity has the power to break down the barrier wall that builds around the client and counsellor as they feel stuck in exploring options or expressing themselves (Hecker & Kottler, 2002). Amundson (2009) echoes the concept of restless clients in his term ?the crisis of imagination?, a situation in which clients feel stuck in the session, and cannot visualize other possibilities that would facilitate the problem solving process. If counsellors wish to help the client creatively in problem solving, it is important that they are well trained to take account of the client?s needs and unique problems. Creative problem solving in counselling consists of four steps: preparation (the process in which  11  the problem is thought over consciously), incubation (short or long period of time during which no conscious thinking is done), inspiration (the time the counsellor suddenly finds the direction of help: ?when the lightening hits? (Hecker & Kottler, 2002, p. 17), and verification (happens to test inspiration, confirming the process of change). To conclude, creativity does not happen automatically in the counselling process, nor are most counsellors particularly trained to use creativity in their work. It is a process that the counsellor and client engage in every day, a skill which can be learned and ameliorated over time (Hecker & Kottler, 2002). Central to the therapeutic process is discovering new and innovative alternatives to look at an issue and problem solve. Creativity is important in the counselling process and largely contributes to the flow of therapy: ?Flow is that which happens when client and counselor are completely enveloped in the moment? (Carson & Becker, 2004, p.113). Therefore, as a result of using creativity in counselling, flow can happen when counsellors help clients stay in a feeling, or when clinicians are able to help their clients move from their chair and act (Carson & Becker, 2004).  Creativity in counselling involves moving beyond one?s conventional skills in problem solving, and decision making. It involves hope, imagination, and inspiration. It opens the window to other perspectives while shifting our old and conventional thoughts, while helping clients to experience feelings, and considering new options.  This section fertilized the ground by discussing the history of the use of creativity in counselling, and its effectiveness in counselling. Poetry is a creative tool that can be effective in identifying invisible emotions while using as well as enhancing the clients? creative abilities.  It can help the client move beyond ?the crisis of imagination? by using poetry as an anchor for expressing emotions, re-framing thoughts, and changing behaviour. Collins et al (2006) discuss  12  the important of poetry in activating clients? creativity during the counselling process. Such effect can empower clients in the process of decision making, problem solving, and can elevate their sense of self esteem and confidence.   The following section sows the seeds of poetry in the fertilized land of creativity. It will further focus on how poetry is applied in poetry therapy. 2.2 Application of Poetry in Counselling and Psychotherapy  The roots of using poetry in therapy can be traced back to Aristotle who deemed poetry a cathartic experience which leads to ?emotional cure? (Hynes & Hynes-Bery, 1994, Mazza 1999). The healing aspect of poetry and the view of poetry as a tool have been discussed in different theories in counselling psychology such as Psychoanalysis, Adlerain, Gestalt, and cognitive therapy (Olson-McBird, 2012; Mazza, 1999, Collins et al, 2006). In psychoanalysis, Freud considered poetry as a means to bring about insight into unconscious and subconscious, which can consequently empower clients with the tool of recognizing previously unknown thoughts (Gladding, 2005; Mazza 1999). The potential uses of poetry therapy for practitioners in cognitive therapy are based on some of the shared goals of poetry therapy and cognitive therapy, as discussed by Collins et al (2006):  a) Encouraging problem solving and realistic thinking b) Nourishing creativity, and developing self-esteem and self-expression c) Strengthening communication skills d) forming new ideas, frames of thoughts, and insights  Combining poetry therapy and cognitive therapy, they recognized some of the goals in cognitive therapy that can be related to, and accomplished by poetry (Collins et al, 2006). Collins  13  et al (2006) further discuss how they have used poetry to reach some of the goals of cognitive therapy: One of the goals of cognitive therapy is to challenge the powerful frames of thought that control most of the human?s emotions, thoughts, and behaviors. Most of these thoughts are unconscious, and therefore it is the therapist?s job to bring them into the awareness of the client (Collins et al, 2006). Poetry has the potential to do the same; and through introducing poetry into the counselling session, the therapist finds the opportunity to discuss with the clients how the words in the poem have an impact on their feelings and thoughts. Once the thoughts have been awakened in the clients? consciousness, the therapist finds the opportunity to consider the extent to which these frames of thoughts impact the world of the client. (Collins et al, 2006). Collins et al (2006) further discuss the importance of metaphors found in poetry helping in clients? distancing the selves and engaging in a dialogue with the self that creates the potential to ?demonstrate the irrational nature of the belief and the potential for change? (p. 183). In cognitive therapy, the therapist helps the clients understand that they do not have to react to the irrational schemas that have been spontaneously formed since their childhood. By applying poetry, the therapists can give a tool to clients that empower them to recreate their lives. Clients find the power to part from the disabling thoughts that they may have owned for many years. They further find the chance to challenge or even replace these thoughts with constructive and helpful frames of thoughts and words through poetry. The words, images, and phrases found in poetry may help clients feel differently, and, as a result, act and behave differently (Collins et al, 2006). Such an effect is echoed in Sohrab Sepehri?s poem ?In the Footsteps of Water?:  ?Wherever I am, let me be,  The sky is mine. The window, the thought, the air, the love, the Earth are mine  14  What importance does it have then Sometimes if they grow, mushrooms of nostalgia?  I, don?t know That why some say: horses are noble animals, pigeons are beautiful. And why there is no vulture in any person's birdcage. What do clovers lack have that red tulips have. Eyes should be washed, afresh should we see . Words should be washed. A word in itself should be the wind, a word in itself should be the rain?.  In addition to the application of poetry to cognitive therapy, poetry has been promoted and used in different disciplines including nursing, social work (Houlding & Holland, 1988; Mazza, 1996), and psychology (McLoughlin, 2000). The aforementioned articles recognized the therapeutic and healing power of poetry in its rhythm, sound effect, imagery, and concern with human nature and consciousness. Several authors have discussed the healing power of poetry in their work and have emphasized its power in facilitating the clients? search for their inner voice. Reading poetry to clients facilitates gaining access to wisdom inside that humans can hardly recognize through ordinary conversation (Stuckey, & Nobel, 2010; Caroll, 2005; Jeffs & Peppers, 2005). Carroll (2005) highlights such powerful aspect of poetry in vocalizing the inner real self within us:  ?Our voices are saturated with who we are, embodied in the rhythms, tonal variations, associations, images and other somato-sensory metaphors in addition to the content meaning of  15  the words. Our voices are embodiments of ourselves, whether written or spoken. It is in times of extremity that we long to find words or hear another human voice letting us know we are not alone.? (p.164) Having discussed the use of poetry in achieving the goals of Cognitive therapy (Collins et al 2006) as well as its application in various health care areas such as nursing, psychology, and social work, it is important to provide an overview of how poetry has been applied in therapy.   Mazza (1999) discusses the basic domain of poetry therapy in ?perhaps the clearest domain of poetry therapy? (Collins et al 2006, p. 183): a. The receptive/prescriptive component: introducing poetry in therapy  b. The expressive/creative component: having clients writing poetry in therapy  c. The symbolic/ceremonial component: using metaphors, rituals, and story telling These three methodologies have been discussed by Collins et al (2006) in general sense as Stepakoff (2009) specifically applies them for working with suicide grief.   Poetry therapists? opinion about what constitutes a poem differs, as some consider literary qualities such as image, rhythm, sound, and economy of expression, while others simply rely on the client?s expressions (Collins et al, 2006). Poems are not the only tool of the poetry therapist; journal writing, personal metaphors, myth, and fables can encompass other methods of applying poetry to therapy.  Underlying the application of poetry in counselling is the poems? themes and contents. The therapists? concern is with the appropriate use of poetry to help clients in counselling rather than the process of poetry creation; therefore the content of poetry, poetic form, and style become of great importance in the counselling process (Gladding, 2009). Several guidelines have been published on the selection of appropriate poetry to be used in the counselling session by  16  various poetry therapists and authors (Olson-McBride, 2009; Mazza, 1999; Hynes & Hynes-Berry, 1994; Leedy, 1985; Luner, 1976). Leedy (1985) explains the concept of isoprinciple as the idea that the most effective poems are the ones that are ?close in feeling to the mood of the patient? (p. 82). He also has a list of poetry that the therapist should avoid in a session: ? Hopeless poems that have a chance of increasing depressive modes ? Defying the power of God or the father and mother figures in being reliable and helpful  ? Glorifying suicide  ? Guilt increasing  ? Confusing and homicidal themes ? Silence provoking and decreasing the chance of verbalization of feelings  ? Pessimistic and self destructive  Relying on these themes and picking poetry to be used in counselling based on the isoprinciple idea is common way of picking poetry in therapy, some of the clients or counsellors may find themselves arguing with these themes, because they would not represent their authentic feeling. Moreover, clients may find positive poetry is an insensitive move from the counsellors? side, and a representation of their lack of empathy and understanding. As a result clients feel invalidated, frustrated and the poetry use has had a counterproductive effect (Mazza, 1999).  There have been some alternatives to the isoprinciple idea for the selection of poetry. Hynes and Hynes-Berry (1994) examined the thematic and stylistic dimensions of poetry before its use in a therapeutic setting. The appropriate themes of poetry include but are not limited to positive, comprehensible, powerful ones, and also poems that contain universal experience and emotions. On the other hand, themes that are negative, powerless, personalized, and obscure, should not be encouraged for use in the therapeutic session. They also identified suitable styles  17  of poetry such as concrete images, rhythms, simplicity, precision, clarity of ideas and language. They also discouraged counsellors from using poems that promote styles such as abstract, hackneyed, difficult imagery, and length that are long and rambling.  The two other perspectives that have been proposed on the selection of poetry for the therapeutic setting include interpersonal poetry dialogue model, and the psychodramatic model (Schloss, 1976). The interpersonal poetry dialogue model occurs in a group setting. Either the group facilitator or one of the members of the group brings a poem into the session to be read out loud. If the facilitator brings a poem into the group, the theme of it may be related to the topic of the group, or the particular emotion or feeling they are examining. The members of the group will then comment, and respond to the poetry read by the facilitator. If one of the clients brings  poetry into the session, then it relates to their current state and feeling, and that is how they expect other members of the group to respond to them. The group members continually communicate with each other via poems (Schloss, 1976). In the psychodramatic model, similar to the interpersonal poetry dialogue model, the poetry is used in a group setting. Poems are used as the engaging tool at the beginning of the session, and they evoke emotions for the group members. The clients are encouraged to ?move from a description of a dialogue between himself and another to a dramatic enactment of the interaction with someone else standing in as the missing other? (Schloss, 1976, p.16).  This section discussed the application and efficacy of poetry in Cognitive therapy, and other health care areas such as nursing, social work and psychology. It further explained the three main methods of incorporating poetry in therapy, as well as the process of choosing the appropriate poem to be used effectively in therapy. The next section will cover literature on the  18  areas in mental health that have used poetry and discussed its effectiveness and importance in the healing process.  2.3 Clinical Implications of Poetry in Counselling and Psychotherapy  Therapists have used poetry in various settings of mental health. The healing power of poetry in counselling and psychotherapy has been discussed both in individual and group counselling, working on various issues such as immigration and anti-discrimination, (Ansar-Self et al, 2002; Wesley, 2007; Stepakoff, 1997; Thomas & Leon, 2012; Norma, 2012), in the treatment of schizophrenia (as cited in Shafi, 2010), depression (Furman, 2002) and suicide ideation (Stepakoff, 2009), counselling battered women (Hynes, 1987), recovery from grief and loss (Mazza, 2001), family counselling (Chavis, 1986), and in general recovery from mental health illness (Carroll, 2005; McArdle & Byrt, 2001; Macduff, 2002; Jeffs, & Pepper, 2005).  Poetry has been used as catalyst in resurfacing buried feelings, and unspoken pain of multicultural people with language barrier. People from diverse populations experience a lack of connection and alienation in the host country. Such alienation often results from the barriers that exist between these people and the host culture. Many diversity workshops aim at facilitating the taking down of the walls of language and cultural difference. In a divergent and changing world, the differences between people become more highlighted. Shelly Wesley (2007), discusses the importance of each individual in forming their own meaning through language and becoming expressive individuals: ?In this complex, interrelated, and changing world, we are challenged to explore ways of coming to know difference...Arts participation gives adults experiences, contexts, and tools through which to learn about difference.? (p. 13). The use of poetry in therapy is important in shaping the meaning that is generated from the differences between the  19  individuals. Poems help individuals recover from their buried memories, and allow them to recognize submerged aspects of their lives while they verbally embody their experience (Stepakoff, 1997).  ?I am! yet what I am none cares or knows, My friends forsake me like a memory lost; I am the self-consumer of my woes, They rise and vanish in oblivious host, Like shades in love and death's oblivion lost; And yet I am! and live with shadows tost Into the nothingness of scorn and noise, Into the living sea of waking dreams, Where there is neither sense of life nor joys...? (John Clare, I AM) After a number of years of conducting diversity workshops, the facilitators began using non-judgmental language through the use of poetry and the inclusion of personal artifacts to encourage workshop participants to communicate with one another without getting defensive or feeling shame. Poetry enabled workshop participants to become their real self, and express their emotions (Thomas & Leon, 2012).  Susan Stepakoff, in her experience of conducting workshops on anti-racism, discusses the different themes that emerge in the session: overt racism, covert racism, childhood socialization in racist society, psychological damage, and strategies to end racism. Each of these themes is represented by a poem, or series of thematically related poems, that engages the group into discussion about their experiences (Stepakoff, 1997).   Poetry therapy has been used as a powerful tool to connect clients with their own feelings. Clients find their emotions represented by the poet through the words and metaphors  20  chosen by the poet. Bowman, Sauers and Judice, (1996), discuss poetry therapy to have the power to bring insight into context, both physically and metaphorically. Clients find their emotions recognized and validated non-judgmentally. Therefore, empathy and normalization of emotions, two of the most effective tools in counselling, are facilitated through poetry (Hunter & Sanderson, 2007). In addition to recognizing and validating emotions, poetry provides clients with the tool to organize and structure thoughts and feelings, which are scattered and disorganized (Hunter & Sanderson, 2007; Schwietert, 2004). Klein and Longo (2006) illustrate the therapeutic elements of poetry such as compassion, and empathic connection through a poetic dialogue workshop.  Citing Nicholas Mazza (1999) on ??The use of a pre-existing poem?? which allows members ??to talk about feelings in a nonthreatening manner?? (p. 49), in their workshop, Klien and Longo (2006) encourage each member to read the poem of the other and comment on the correctness of information related in the poem, and if the feelings behind the words had any significance. In each group, it became clear how much each partner appreciated being understood in a way not experienced before. Klein and Longo (2006) further describe the feelings of the members of their therapeutic poetry workshop: ?They became mirrors for each other, each reflecting light held in the darkness within. When seen so clearly, each participant might even feel empowered for having succeeded in clearly communicating a secret. This could be, perhaps, a feeling of shame. Having this or another difficult feeling so openly received and turned into a productive and beautiful form as a poem, each feels validated and valued? (p.125). Conclusion  This chapter provided a description of the interrelated nature of poetry and creativity. It further explored the three general methods discussed so far in the literature for applying poetry in counselling (Mazza, 1999; Stepakoff 2009; Collins et al, 2006). While discussing the methods of incorporating poetry in counselling, this chapter also presented information on the recommended  21  themes and contents of poems as discussed in the literature. The last section of the chapter highlighted evidence in which poetry has been used for clinical purposes. Counsellors with different theoretical orientations, working with clients dealing with a vast range of issues from diversity, acculturation, mental health, to grief and loss, have provided testimonies on using poetry, and witnessing its positive effect on clients. Despite papers published on what poetry can do, and why it can be effective, there is a scarcity of research on incorporation of poetry in counselling. The literature appears to present very limited and outdated research on how counsellors use poetry in their practice. There is no information of the factors that can facilitate the use of poetry in counselling, nor is there any information on hindering factors. In the light of this scarcity of recent research, this study aims at understanding contemporary use of poetry in counselling by therapists; using the enhanced critical incident technique (ECIT) to explore the helping and hindering aspects of using poetry in counselling and psychotherapy.               22  Chapter 3: Methodology  This chapter focuses on the research methodology I used to conduct this study. In the first section, I will give an overview of my research paradigm and then the methodology which is Enhanced Critical Incident Technique (ECIT). This research has underlying roots in Critical Incident Technique (CIT), but adds context, wish-list items, and credibility checks. I will initially discuss CIT and then discuss those aspects that ECIT adds to this methodology. I will then discuss its appropriateness in answering my research question of ?what aspects facilitate counsellor?s use of poetry in the counselling sessions while working with the clients, and what aspects challenge them?? In the second section, I will discuss the participants? recruitment, the inclusion and exclusion criteria, demographics and selection. In the third and fourth section, I will discuss the process of data collection and data analysis from an ECIT point of view. I will then discuss the accuracy of the data, and expand on the nine credibility checks important to my research in the fifth section. Ethical considerations and limitations of this study will be discussed in the last section.  3.1. Research Design Research Paradigm  This qualitative research is constructed with the idea that all types of knowledge are formed in a cognitive framework and theoretical concepts of an individual; therefore an understanding and a perspective towards the world is constructed through each individual?s subjective interpretation of it. It is idiosyncratic for each individual, and is based on their creativity and cognitive abilities. Based on these beliefs, the basis of my qualitative research is in social constructivism (Schwandt, 2000).    23  Enhanced Critical Incident Technique  The Enhanced Critical Incident Technique (ECIT) builds on the traditional roots of CIT developed by John Flanagan (1954). This section begins with an overview of CIT, discusses the five steps of conducting a CIT study, and then discusses the nine credibility checks and wish list items which build into ECIT.   CIT stemmed from research focused on the Aviation Psychology Program in the United States Air Forces during World War II (Butterfield, Borgen, Amundson, & Maglio, 2005). This theory was used originally for highlighting the functioning aspects of an activity, and to determine the important aspects for a job success. Flanagan?s (1954) crucial paper on this theory focused on the origin and initial uses of this theory. He highlighted other uses of this technique such as measuring performance, training, selecting and classifying personnel, determining motivational attitudes, and its application in counselling and psychotherapy.  Woolsey (1986) published an article on CIT which focused on the application of this method in counselling and psychotherapy. Woolsey discussed CIT?s use as a unique research method in counselling, highlighting its consistency with the skills and values of counselling psychologists. She highlighted this technique?s ability to encompass the qualities of an incident, explored differences and turning points. Since then, this technique has been widely used for studying psychological constructs and experiences (Butterfield, Borgen, Amundson & Maglio, 2005).  Even though CIT is very similar to other qualitative methodologies, there are four features of Critical Incident Technique which distinguish this method from other types of qualitative methodologies according to Butterfield et al (2005):  a) the focus on critical incidents that are important in facilitating or hindering an activity or the experience of an activity; b)  24  industrial and organizational psychology are the origins of this methodology; c) after using interviews for collecting data, the data analysis is done through identifying incidents and forming categories; d) its narrative is the categories with operational definitions and self-descriptive titles.  According to Flanagan (1954), CIT is a thorough and precise observation of an activity in such a way that predications and inferences can be made from it. The cognitive, affective and behavioral elements, such as how the events are managed as well as their perceived effects, are taken into consideration (Butterfield et al, 2005). There are five major steps in the Critical Incident Technique: 1) recognizing the goals and aims of the activity that is to be studied; 2) identifying plans and specifications; 3) data collection 4) data analysis; 5) data interpretation and reports (Butterfield et al, 2005).  Butterfield et al (2005), discuss CIT as an appropriate and useful tool in the early stages of the research when there is still not as much known about the factors or particular incidents to be studied. It is a flexible method which uncovers facts, experiences, and crucial points and qualities of an incident. The technique helps researchers in discovering and exploring the ?effective and ineffective ways of doing something, looking at helping and hindering factors, collecting functional or behavioral descriptions of events or problems, examining success and failure, and determining characteristics that are critical to important aspects of an activity or event? (Butterfield et al., 2005, p.476).  This research used Enhanced CIT (ECIT) which adds context, wish-list (WL) items, and credibility checks to CIT. ECIT was used for this study due to its complementary qualities of WL, nine credibility checks, and the background data. Adding context at the beginning of the interview can be helpful in providing background knowledge for the CIT data (Butterfield, et al., 2009). Adding WL items in the interview will describe ?people, supports, information, programs,  25  and so on, that were not present at the time of the participant?s experience, but that those involved believed would have been helpful in the situation being studied? (Butterfield, et al., 2009, p. 267). Finally, the nine credibility checks will be helpful in proving the accuracy of the data during the interview and the data collection process. These credibility steps will be discussed in the section specific to the accuracy of the data.  Appropriateness  ECIT uncovers the turning points and qualities of a specific activity, and explores the helping and hindering factors of it (Butterfield, et al, 2009). This technique adheres to Critical incident technique, and is appropriate for the early stage of research in which there is little known about a particular incident (Butterfield, et al, 2009). Its flexible and exploratory nature (Butterfield, et al, 2005) makes it very appropriate for the research on poetry. Since the study of poetry in counselling as a research topic is still at the exploratory stage, very little is known of the factors that help and hinder counsellors in using poetry with their clients. There is little known of what factors are helping counsellors recognize when/how to use poetry in counselling, what aspects hinders them from using poetry with a specific population, and what methodologies facilitate the incorporation of poetry in counselling in order to be most effective. In order to create a clear and organized map for using poetry in counselling, I will need to a) identify the effective ways of incorporating poetry into counselling, and b) identify the helping and hindering factors in using poetry. 3.2. Participants  The sample size in CIT according to Flanagan (1954) depends not on the number of participants in the study, but on the number of incidents that each participant provides  26  (Butterfield et al, 2005). These incidents are created out of the interviews with the participants. The interviews and data collection through incidents should only stop when there are no more new categories, or new wish-lists that would emerge from the data analysis (Butterfield et al, 2009).  There were nine participants in this study, who provided enough critical incidents as well as wish list items to reach data exhaustion.   Participant Recruitment and Selection The participants for this study were selected through counsellors who responded to the recruitment poster (Appendix A) as well as snowball sampling. The study was open to all practicing counselling psychologists within Canada and United States. To be eligible to participate in this study, the participants needed to be practicing registered counselling psychologists, with at least 1 year of professional clinical practice experience, and self identify themselves as poetic counsellors, or have the experience of using poetry in their practice. The participants in this study did not need to use poems in their practice in any specific manner or frequency. The study, therefore, was open to any of the methodologies of incorporating poetry into counselling including but not limited to counsellor?s bringing other famous poets? work into the session, encouraging the client to write poetry as homework, or reading the poetry that the client has written before. It is important to mention that the focus of this study is on the aspects of poetry that work towards producing a stronger and more effective therapeutic process, and the aspects that hinder such achievement. Therefore, this study was open to any counselling psychologist who has used poetry in any format, and could refer to their experience as an incident which can highlight the helping and hindering aspects of incorporating poetry in their therapeutic session. In order to eliminate any language barriers, all participants had to be able to talk about their experience in English.   27  The recruitment poster for this research was circulated in multiple counselling centres throughout BC, at the department of counselling psychology at UBC, the NAPT in the States, the BCACC newsletter, and on LinkedIn. Eleven responses were received for this research, and all the potential candidates were screened via email. Two volunteers were excluded from participating in this study as one was not actively working with clients, and the other could not fully speak about their experience in English.   Participant Demographics  Nine participants were interviewed for this study. Five males and four females, participated. All these participants were from Canada, and spoke English as their first language. Five participants had a PhD degree in counselling psychology, and four had Masters Degree in counselling psychology. The age range of participants was from 43 to 80 years old, with the average age of 56. The participants had one to 40 years of experience in practicing counselling as well as the use of poetry in their therapeutic work. All the participants held multiple positions and responsibilities. For example, five of the participants were employed by universities (4), and school (1) in addition to their supervisory roles. Seven participants have worked in private practice, while three participants were founders or co-founders of counselling services with particular focus on poetry in their therapeutic work. Four of the participants worked for counselling services that highly supported or demanded the use of poetry in their counselling services. Table 1 demonstrates the demographic data collected from participants.       28  Table 1. Demographic Table     3.3 Data Collection  Five of the participants initially contacted the researcher through email in reply to the recruitment poster. One participant responded in person to the researcher, however, further contact with the participant occurred through email. These six participants passed on the researcher?s contact information and recruitment poster amongst potential colleagues. Through such connection, three other participants contacted the researcher through email.  Each of the participants was emailed the informed consent (Appendix B) for their review prior to setting up an interview. All the participants received, reviewed, and signed in the informed consent before participating in the research to ensure that the purpose of the study, confidentiality, and their rights as research participants are understood.  Data was collected through semi structured open ended interviews (see Appendix C for interview protocol). The interview protocol followed the examples set out by Butterfield et al (2009) in using Enhanced Critical Incident Technique. Each interview lasted approximately sixty to ninety minutes. At the beginning of each interview, the researcher reviewed the consent form with the participants and discussed any questions they may have. Each interview began with a Participant # Age Gender Level of education 1 66 M PhD 2 52 F PhD 3 80 F PhD 4 63 F Masters 5 46 M Masters 6 45 M Masters 7 43 F Masters  8 59 M PhD 9 46 M PhD  29  review of the purpose of the study. The participants were informed about the three main sections of the study to be covered: the helping, hindering, and wish list items. The addition of wish list items is recommended by Butterfield et al (2009) and is a relatively new area covered in ECIT. Participants were informed that demographic data would be collected at the end of the interview. Each interview started then with the researcher asking participants to provide some information about themselves and their work experience in the counselling practice. The participants were asked to define poetry, and rate themselves on a scale of zero to ten based on the frequency of the use of poetry in their practice. They were also asked to explain how they typically use poetry in their practice. These initial questions helped provide a contextual component for the research interview. This experience was corresponding to the ECIT formulated by Butterfield et al (2009). Once the contextual component was covered, each participant was asked to talk about the helping, hindering, and wish list items in their experience of using poetry in their practice. At the end of each interview, the participants answered the demographic questions.  All interviews were audio recorded and transcribed in full. In addition, some hand written notes were taken by the researcher during the interview. Three interviews happened via SKYPE, two over phone, two in coffee shops, and two in private offices, all at the request of the participants. As the participants were invited to describe their experience of poetry in counselling, I used basic counselling skills such as active listening, paraphrasing, and empathy to help participants explore their experience. It was crucial for me to encourage participants to describe their experience of the use of poetry in counselling in their style and pattern. Maintaining as much objectivity to participants? experience as possible was a priority; and therefore I was continually conscious of the effect I might have in the construction of the participants? stories. I carefully asked questions about the participants? experience in such way  30  that their answers would not be representative of my personal ideas or experience. In order to reach such goal, the researcher paraphrased the participants? comments and checked if her understanding was accurate.  All the initial interviews were followed by a second contact via email. This contact served to ask participants to check and validate the data collected from the initial interview with the participants. Details of data validity are described in the accuracy of the data section.  3.4. Data Analysis  According to the analysis of ECIT, formulating categories and analyzing thematic contents are part of the data analysis. In this research, all the recorded interviews were transcribed. Following this step, the transcriptions were carefully read through, and organized. Thematic contents with critical incident techniques were sorted into larger categories. Wish list items, and critical incidents (CI), were selected from the data in batches of three randomly selected interviews (Butterfield et al, 2009). For the first interview, the helping, hindering, wish list (WL), and critical incidents (CL) were identified. Larger categories were then formulated based on common themes and patterns among the CIs and WL items (Butterfield, 2009). The subsequent interviews, followed the same procedures with the identification of CI and WL items, and were placed in similar categories. For those CIs that did not match the existing categories, new categories were created.  Throughout the data analysis, the identified categories were merged into larger categories, or broken into smaller categories to create a more accurate and precise understanding of the data, and to avoid under representation or any over laps. I was also considerate of the rate of participants identifying incidents that fit into categories. These categories were given self  31  explanatory titles. The minimum participation rate standard was set and discussed by Amundson and Borgen in 1984 (as cited by Butterfield et al, 2009). All but three categories met the participation standard rate. Of these three categories, one of was 22%, and was considered relatively close to the standard rate participation. The other two categories fell below the minimum participation rate, however, in order to maintain the accuracy and true representation of data, these categories were kept.  The data analysis continued through the nine steps of data accuracy checklist as discussed in Butterfield et al (2009) for ECIT, some of which include recording the audio of the interviews, extraction of critical incidents independently, exhaustiveness, using an independent judge in placing critical incidents into categories, and using expert opinion. These checklists are explained in detail in the following section. 3.5. Accuracy of the Data  Butterfield et al (2009) discuss nine steps of accuracy check in data analysis. These nine steps, discussed at length below, were used to ensure the credibility and accuracy of the data analysis for this study. Recording  The interviews were audio taped to keep an accurate account of the interview (Butterfield et al, 2009). These interviews were transcribed by the researcher, and were used to analyze the data for the research.      32  Interview Fidelity       In order to ensure consistency and to uphold the rigour of the research design, a graduate student familiar with the ECIT research method, was asked to listen to a sample of interview tapes (Butterfield et al, 2009). Independent Extraction of Critical Incidents  An independent coder, familiar with the ECIT independently extracted a number of critical incidents from the one of the recorded interviews, or transcription. This number will most likely represent 25% of the total CIs gathered for the study. The logic behind this check is to calculate the level of agreement between the researcher?s understandings of a critical incident in the study and that of an independent coder?s. The higher this rate of agreement, the more accurate is the recognition of CIs (Butterfield et al, 2009).  In this study, a fellow graduate student, who is familiar with ECIT, was asked to be the independent coder. The researcher and the independent coder each provided the rational for identifying the critical incidents. The result of the discussion demonstrated a 100% agreement the researcher?s idea of CI and the independent coder?s.  Participants? Cross Checking A second contact was made with the participants in the study after the initial data analysis of the interviews. The participants received a summary of the analyzed data, including the identified CIs in the three sections of helping, hindering and wish list items, as well as the corresponding categories. The participants were asked to review the analyzed data and inform the researcher of any errors, or misrepresentations of their intentions. The participants provided feedback on the submitted analyzed data. Eight responded through email, one responded in hard copy. All the nine participants agreed that overall, the categories and critical incidents represent  33  their experience. Four of the participants recommended some grammatical changes, and replaced some of vocabulary with more accurate words to best represent their intentions, in the identified categories.  Placing CIs into Categories by Independent Judge 25% of the incidents was randomly chosen and given to an independent judge who placed these incidents into existing categories (Butterfield et al, 2009). The agreement rate was 100% after the independent judge and the researcher had a discussion about the rationales of placing CIs into the identified categories.   Exhaustiveness  A sign that would demonstrate that the domain of poetry (the activity being studied in this search) has been adequately covered is tracking the point at which no new categories will emerge from the data (Butterfield et al, 2009). In this study, the exhaustiveness was achieved by the eighth interview.  Experts? Opinion  In this section, two experts in the related field provide feedback on the categories formed out of the data. These feedbacks include information on whether the categories are comprehensive and make sense (Butterfield et al, 2009). If the experts agree with the categories, the credibility of the data is increased.  For this validation check, the categories with the descriptions were submitted to a counsellor with over 30 years of experience in using poetry in their counselling practice. The counsellor confirmed that the categories were clear, and inclusive. Only slight modifications were made to four of the categories.    34  Rates of Participants   Participation rate was calculated by the number of participants who cited a particular incident and then dividing this number by the total number of the participants (Butterfield et al, 2009).  For this research, the results of these calculations are demonstrated in tables 2-4.  Theoretical Agreement         The theoretical agreement was examined by comparing the categories that have emerged from the data to the literature to find support for them (Butterfield et al, 2009). The results of these discussions are demonstrated in the Discussion chapter.  3.6 Ethics The researcher has strong responsibility towards protecting the participants from any harm, and strives for the improvement of their welfare (Haverkamp, 2005). With this aspect in mind, there were several ethical issues to be mindful of in this study. A thorough informed consent form was created, in which the purpose of the study was mentioned clearly, to ensure that all the participants of this study fully understand my goals and intentions.  I was also mindful of the potential confidentiality harm that could befall the participants and their clients. During each interview the participants comfortably shared the private and confidential incidents of their clients. Some of the participants even expressed that they appreciated sharing their experience on poetry in this interview, and that expressing their opinions for this research have opened up a new perspective on their view of the use of poetry in their work.        35  Chapter 4: Findings  Nine participants were interviewed for this study. A total of 174 critical incidents (CIs), and wish list (WL) items were created out of the interviews. Participants found 91 incidents helpful and 47 incidents hindering in their use of poetry in their practice. There were 36 wish list items that the participants recognized as helpful, had they been accessible and present at the time of their use of poetry. The study resulted in a total of 23 categories, with 10 categories of helping incidents, seven categories of hindering incidents, and six categories of wish list items. Two of the helping categories were broken into sub categories to ensure the accurate representation of the data. This chapter will be discussing critical incidents in the helping, hindering, and wish list categories in three sections. There will be an overall demonstration of the results in a table at the beginning of each section. The categories and their critical incidents will be discussed in the order they appear on the tables. The final part of this chapter will focus on the contextual findings of this study, including the definition of poetry, how poetry is used by the participants in the study, the overall experience of the interview by the participants, as well as their ratings on the use of poetry.         36  4.1. Helping Critical Incident Categories  Table 2.Helping Categories   Helping Categories      Number of Incidents    % of  Helping Incidents    Number of Participants    % of Total Participants  1.Poetry Elements  c. Language   b. Validation  d. Catharsis 23 10 8 5 25% 7 7 4 2  88% 2.Poetry Content  a. Lucid Themes   b. Image- Focused c. Sensory d. Quietening  e. Autobiographical  11 3 3 2 2 1 12% 7 3 3 2 1 1  77% 3. Activity   12 13% 6 66% 4.Experience and knowledge   9 10% 6 66% 5.Clients   8 9% 6 66% 6.Presentation  8 9% 6 66% 7.Counsellors   7 7% 5 55% 8.Resources  6 6% 5 55% 9.Work Environment   5 5% 5 55% 10.Witness  2 2% 2 22% Total  # of Incidents:  78      37  1. Poetry Elements   The elements of poetry were the largest helping category, with 88% of participants describing 23 helping critical incidents. In order to ensure that such a large number of critical incidents are represented as accurately as possible, this large category has been divided into three subcategories.  These three elements of poetry -language, validation, catharsis- appeared advantageous to seven participants? use of poetry.  The feature of language in poetry was mentioned by multiple counsellors as conducive to their experience of using poetry in their practice. One participant described the ?symmetrical and impactful? language of poetry: ?the images contained in a line of poetry have the power to reflect an entire sea of change, and crystallize our understanding instantly, in a way that lots of talking can never do?. Such creative, yet impactful use of language encouraged this participant to frequently refer back to poetry in her practice with her clients.   Another participant named the power of language in poetry accountable in the sense that it could ?provide description of the indescribable and make visible some of the emotions and thoughts and feelings that are invisible and marginalized?. This participant further mentioned that such an effect is accessible through language in poetry since it can be used creatively. The participant discussed the flexibility of the ways that language can be incorporated in poetry, and therefore can easily be used by any type of client. Another participant described how the creative use of language in poetry is effective in making the commonplace appear ?exotic?: ?What appears common and everyday can be seen to be enchanting and magical; as well, ideas and ways of being that have hitherto been taken for granted can be challenged and explored, unravelled?.   In this way, the flexible and creative role of language was identified as a helpful incident in using poetry by these participants.   38  Two of the participants shared their positive experience of using the ?poetic language?. These participants discussed how multiple ways of communication can be evoked through the language in poetry:  When I then share poems with clients what I am imagining is that there?s a three way communication. Perhaps more than three...There?s the poet, poem, self and client...and there?s a ... a charged use of poetic language, it creates a possibility of an opening or deepening an experience in a client.  Such poetic use of language was identified as helpful for these participants because it encouraged their clients to engage in their emotions more fully, while opening up new possibilities and perspectives for them to consider. Such positive effects on clients, facilitated by the poetic use of language, encouraged these participants to use poetry more often in their practice.  Four participants discussed the powerful quality of poetry in validating the clients? feelings, while equally normalizing them. One of the participants mentioned that her clients feel validated because they find their emotions and thoughts are verbalized by someone they have never met or known: Poetry is validating ... it?s an ?aha? moment, and I feel like...that is what I mean and I feel understood by it... there?s a sense that you can be understood.  A pain, or whatever, that you feel like you?re alone with it and then you hear someone mention it and you feel not alone and heard and understood. The participant further described that witnessing such a power effect on clients encouraged her to use poetry more often in her work. The validating and normalizing feature of poetry was equally echoed by other participants in the study. One participant described the power of poetry in  39  ?mitigating shame?, while another mentioned that poetry was helpful in ?anchoring clients? feelings?.  Several participants attributed their incorporation of poetry in therapy to its cathartic features. One of the participants shared this feature of poetry positively encouraged his clients to stay with their emotions and to ?experience the experience?. Another participant identified such an emotional experience as releasing and ?healing? for clients. One participant describes witnessing this process:  Mary Oliver?s Wild Geese which reads as You do not have to be good...You only have to let the soft animal of your body Love what it loves..Can put people into tears because they simply realize that they?ve held themselves down, that they?ve kept themselves small their entire lives. And never allowed themselves to love and be loved...just a simple line like that...  has the power to unhinge, it?s a home coming...it?s permission to come home, to be who we are, and who we?ve always been.  2. Poetry Content  Seventy seven percent of participants found the contents of some poems more helpful than others in their use of poetry in their practice. 11 critical incidents were identified in which the content of the poem facilitated the participants? experience of using poetry. To be more precise and best represent the participants? account of these incidents, sub categories have been created out of the common helpful themes. These categories include: 1) Lucid themes, 2) Image-Focused, 3) Quietening, 4) Sensory, and 5) Autobiographical. As a result of the positive effect of these specific types of poems, participants felt more willing to use poetry in their practice.   40  Several participants identified poems with lucid and dominant themes as more convenient for use in therapy. They noted that poems with dominant themes could more easily tap into clients? issues. They claimed that as a result the clients could understand and connect with these poems in relation to their problem. One participant referred to these poems as the ones that ?get to the heart of that issue?, and therefore facilitated the therapeutic process, and invited the counsellor into using this type of poetry more often in their practice.  A number of participants described poems that are filled with images as a helping factor in their use of poetry as such poems can better focus and engage their clients into the poem, and often awaken foreign emotions in them. . One participant describes such an experience as ?We take weeks, we take months to understand what has been transported into one simple image?; while another participant describes the ?image? as a ?deeply moving? experience. For example, one of the participants shared the short poem ?Erosion? by E.J.Pratt, to describe how, by creating an image of the sea, the poet metaphorically engages the reader in the experience of death, along with the emotions associated with it:  It took the sea a thousand years, A thousand years to trace The granite features of this cliff, In crag and scarp and base.   It took the sea an hour one night, An hour of storm to place The sculpture of these granite seams Upon a woman's face.  41  This participant further explained how using poems with such content have been helpful in her use of poetry in practice than longer poems that require more attention, and devotion from the client?s side.  Two participants credited poems with relaxing and soothing effects as helpful in their therapeutic use of poetry. One participant mentioned that certain poems such as Walter de la Mare?s ?Nod? have a powerful relaxing tone and can quieten the mind of the audience:  Softly along the road of evening,  In a twilight dim with rose, Wrinkled with age and drenched with dew,  Old Nod, the shepherd, goes.        Another participant credited poems that emphasize the nature and the human?s five senses as very helpful in facilitating mindfulness, and therefore helpful in their experience of poetry. She described that certain poems like the works of poets such as Mary Oliver or Rumi, have the power to bring clients? attention to the present, and to the senses, and help promote relaxation and mindfulness: ?A lot of poetry I respond to is nature poetry; in mindfulness the senses and nature are very important, so we would chose those particular poems that would help the reader or listener to identify those senses?. Another participant found autobiographical poems that represent the poet?s experience of life as very powerful.  The participant noted that such poetry is ?normalizing, inspirational, and thought provoking?, and therefore she felt more inclined to use autobiographical poems in her practice. One participant gave the concrete example of such poetry by referring to the work of the Canadian poet, Shane Koyczan "To This Day"; a poem on bullying. The participant  42  particularly emphasized the normalizing aspect of such poems, saying that once clients recognize that their experience has been mirrored by another human being in the past, they can be so powerful in alleviating shame: ?poems mitigate shame, to know that there?s someone else who has had that experience [can be very powerful] ?.  3. Activity  12 helping incidents were identified in which certain activities facilitated participants? successful use of poetry in their practice. The central theme of this category included the personal activities that participants had explored to effectively use poetry with their clients. These activities were helpful in facilitating successful use of poetry in their counselling sessions. One participant described how aligning the lines of poetry with what is seen and experienced in nature can be a very powerful experience for clients. He found nature to be a helpful factor in grounding clients? attention to lines of poetry, and further explained that this way he can visually and tactfully engage the clients in the experience of poetry.  Simultaneously, concrete examples in nature invoked and invited clients to contemplate the words in poetry:  There?s a poem by David Wagner that is called Lost, and the poem speaks to us on a theme of stillness, on the importance of just finding your satire and really just being still when you are lost, and it?s a particular poem that is very powerful in a quiet place in a forest. I take people to places that are dens and quiet and ask them ...what if it was truly dark, and you didn?t know what to do...what would you do, would you stay?  Another activity that was identified as helpful for participants to successfully use poetry in their practice was inviting clients to write poems. Participants mentioned that writing poetry can be very empowering and validating for clients: ?It?s powerful?; and can turn the clients? own words into ?statements?. Participants credited this activity as helpful in using poetry with more  43  diverse clients, coming from varying educational backgrounds and life stages. One participant shared that some clients can be intimidated by the idea of writing a poem. In order to overcome such a barrier, this participant encouraged clients to create their own poetic style in unstructured way. For those struggling clients, the participant invited them to create their own poems in the following way:  I ask them questions and they answer and then those answers could be used for poetry... so the parameters of what poetry are, become very loose. It can be loose poetry, rap poetry, or concrete poetry.., they can just pick 5 words out of a page that stands out to them, and use that as their poem.  Another participant credited encouraging clients to record their own words as a very helpful factor in facilitating clients? poetry writing experience. The participant mentioned that ?I just ask [them] to write it [words] down, hear the sound of it, what does it do to your body?. This participant mentioned that this activity ?allows clients, with any level of literacy, to be creative and use their own words. Allow these words to become a Statement?.    A few participants highlighted the importance of inviting silence and respect for processing poetry. Several participants identified silence as crucial for their use of poetry in their practice as it provided space to process and contemplate on the lines of poetry. One participant describes how inviting silence encourages the ?slow alchemy? of poetry to do its own work:  Some people are really moved by a line and they don?t want to respond and just sit with it or walk with it for a few moments, and try not to interfere with the slow alchemy that is going on, ? but the right line of poetry at the right time triggers an alchemy and what is key is being respectful of that and using silence is important, as important as words.   44               One participant mentioned that poetry can only be helpful in their practice if it is used selectively and carefully: ?I Would say...it?s like ..a homeopathic and naturopathic medicine, you only need a tiny little drop, you have to be exquisitely careful...to use just a tiny little poem..if you use too much you might get the opposite effect?. 4. Experience and knowledge  Sixty six percent of the participants reported previous personal experience of poetry and previous training as a helping factor in their use of poetry in counselling. In this category 6 counsellors described 9 helping critical incidents.  Some counsellors described their professional training in counselling and personal counselling orientation as influential to their openness to using poetry in their practice. Counsellors with narrative, constructivist, or post modern backgrounds expressed higher tendencies in trying poetry with their clients. One participant felt that due to his narrative approach to counselling, he viewed language in ?a specific or possibly different way than therapists informed by most modernist positivists such as cognitive, and CBT?. This participant expressed that he attends to language ?with a poetic ear?. The participant further explained that personal training in a narrative approach to counselling has been very influential in his view of language and his use of language in a poetic way. He mentioned that through such perspective, he encourages his clients to write poems about themselves that challenge some of the old schemas, such as being selfish, or worthless. He further mentioned that this way, participants have a chance to be the authors of their own lives or ?re-author? their lives in a poetic way.  Another participant indicated that a post modern, narrative approach to counselling was instrumental in his use of poetry in counselling. He indicated that personal knowledge of French  45  philosophers such as Michel Foucault and Gaston Bachelard was influential to his counselling orientation and his use of poetry in his practice:  Bachelard was a French philosopher, he?s dead but ideas are alive, he wrote a book called the poetics of reverie and another book called the poetics of space and he wrote several other books and one of his quotes that I really like is ?the psychologists do not know everything, poets have other insights into men? so poetry for me is always been about...as a source of inspiration and what?s enchanting. Having such experience and knowledge of theories of language affected this participant?s approach towards language, and elevated the frequency of the use of poetry in his practice.  Participants also cited their personal experiences of the power of poetry in therapy, or in workshop training as strong influences in their own therapeutic use of it. One participant indicated that her training in mindfulness based stress reduction (MBSR) was powerfully affected by the poetry component that Kabat-zinn employed. The participant described the following personal experience: I just remember feeling so excited and emotional; it brought a lot of emotions for me as I was listening to poems...it felt so personal and intimate, and so...I decided to use it with my clients hoping that they would also be as emotionally touched and moved. Another participant credits their personal experience of poetry at a younger age as a helpful factor in their use of poetry with adolescences in their practice:  I heard poetry speaking into what was real or authentic; a kind of emotional and imaginable breaking through what otherwise was boring, tedious, and somewhat  46  oppressive in high school context. It was broken through, that oh there?s a viable vibe outside this institution and context. Several participants described the positive and direct effect of culture and family on the use of poetry in therapy. Many described how in their parental family or culture, poetry has been considered a value. One counsellor described her fluency in using poetry with her clients as a result of the culture she is coming from: ?we use a lot of poems from our culture, so I can use poetry effectively just by saying it?. Another participant referred to his household as a helping factor in his therapeutic use of poetry: ?I was raised on Irish literature...I?ve got rows of books authored by James Joyce , Samuel Beckett, and Oscar Wilde, all have had a huge influence on me?.   Other participants referred to their personal encounter with poets as a helpful factor in their use of poetry today in their practice. One participant expressed that they never considered using poetry with clients until their encounter with: ?David Whyte? whom the participant described as ?a very powerful poet and photographer?. This experience has been very powerful and influential in the participant?s tendency to use poetry.    5. Clients   Six participants reported 8 incidents in which their clients were a helping factor in using poetry. The participants had a stronger tendency to use poetry with clients that were open to trying new therapeutic approaches, were willing to take risks, and had a strong connection with their counsellors.  Several participants reported that before using poetry in their work, they assessed their clients? interest in poetry and art. They reported looking for specific artistic qualities or hints in  47  their clients before proposing poetry. One participant described that clients with interests in nature, colour, or art were more open to using and connecting with poetry. Another participant mentioned that clients with stronger interest in arts and social sciences or ?right brained clients? are open to poetry.  One participant confirmed that artistic qualities in clients acted as an invitation for them to use poetry in session with them. This client further added that it was important to look for a ?sense of affinity? with clients before using poetry in session with them. He further explained that a strong rapport and trust between the counsellor and client can be a strong helping factor in positive use of poetry in counselling: ?I think poetry is not for everybody and then they belong to something else...I need to have a sense of affinity with that person before I use poetry with them? One of the participants mentioned that in his experience of using poetry, he has found younger and adolescent clients more open and receptive to poetry than adult clients. He further explained that the younger the clients are, the less rigid and firm their expectations of a ?typical? counselling session were. This openness encourages the counsellor to use poetry in their practice: ?I think, generally speaking in my experience, the younger the people, the more receptive they are to the so called non traditional encounter of poetry?.  Two participants reported that they find it easier to use poetry with clients in a group counselling as opposed to individual counselling.  These participants reported clients in a group setting have a chance to discuss poetry, give each other feedback based on the poem, and experience non judgmental listening to one another. One participant mentioned that they have been able to use poetry in any group counselling session, however in individual counselling, they have to wait for the right client with interest in poetry.    48  While these participants emphasized the important role that clients play in the use of poetry in counselling, some other participants argued that poetry is a tool that can be used with any client. They highlighted other helpful factors in their therapeutic use of poetry. The categories below explain the helping factors that were listed by them.  6. Presentation  66% percent of participants reported eight critical incidents of the engaging styles that helped them use poetry in their work with their clients. The central theme of this category is the ways that participants could find a way to positively engage clients in poetry. For example, one participant found reciting a poem as inspirational and evocative for clients. Another participant found reciting poetry from memory, as genuine, authentic, moving, and engaging for clients. One participant mentioned that introducing poetry spontaneously into counselling practice can facilitate the authenticity and natural flow of mingling poetry and counselling practice: It [incorporating poetry in session] fits with my general approach to counselling, I don?t have a clear sense when I sit down with a client... I don?t have plans laid out in advance; I follow plans very spontaneously as they arise from moment to moment  Introducing poetry as an option to clients in an inviting manner, as opposed to a directive, and authoritative way was a common theme expressed by a few participants. One participant emphasized the importance of opening poetry to clients as an invitation to exploration and experimentation:  If you know best, they don?t need another mother or father to tell them what to do. They come to counselling with all the stress and I don?t want to push them. ..I don?t want to be an authority figure, I?m a partner in growth, I grow they grow...we learn together...so I ask them to read [poetry] later  49   Another participant highlighted the importance of providing the appropriate space for clients before using poetry with them. This participant further described that in order for poetry to work effectively in their practice, they bring clients? attention to the present, and encourage them to have ample time to process poetry:    What one needs to do is to get people in a position of readiness, in body...Completely present..Because some of Rumi?s poetry, Hafez..it?s so rich, that you?ll miss it...if you?re not sitting with it a 100%. For that reason, it?s all about that sense of energy in the room, how settled they are Another participant mentioned that encouraging clients to become more and more the author of their own narrative or story is a helping factor in engaging clients in poetry.  Such a process invites the use of narrative imagination.  This perspective accentuates each client?s individual source of knowledge and encourages them to tap into their own resources:  Clients find what is described by Michel Foucault as ?subjugated knowledge?. it?s very powerful in terms of rituals coming up with what I would call indigenous knowledge; we all have some wisdom, in terms of therapy, my practice is to bring forth the individuals? knowledge and wisdom and highlight that and accentuate that in a beneficial way, as opposed to them thinking that they are not worthy, or not honorable, or less than others and so on. Overall, the participants mentioned that activities such as reciting, reading poetry from the heart, introducing poetry in session spontaneously, preparing the space and the clients, and encouraging clients to be the writers of their own poems, were conducive in their experience of using poetry.   50  7. Counsellors   The participants of this study expressed that counsellors? beliefs; open mindedness and curiosity facilitate their use of poetry in counselling. Seven helping critical incidents were formed out of the experiences that these counsellors shared.  Several participants expressed how being open to tuning into new things and trying their intuition before using poetry has been very helpful for them. They shared their experience of  feeling uncertain on their initial incorporation of poetry in their practice. They mentioned that most of these feelings were probably based on previous beliefs and schemas about poetry (such as believing in myth that ?men are not open to poetry?, or ?poems are difficult to understand? ). They further reported that leaving these beliefs behind, opening themselves to taking risks, and trusting their inner feelings has been very helpful in their use of poetry in their practice: ?And you know try it to see what the effect would be...yeh and when I read poetry [in my treatment group] I couldn?t hear a pin drop?. Taking risks and believing in their practice and approach in counselling by counsellors was echoed by another participant?s thoughts on the position of counsellors:  I think it?s a risk you have to take, a lot of people have very specific traditional ideas of what therapeutic process is, and there exist many, many alternative perspectives and associated practices that have yet to be explored, and certainly using poetry and poetic way is a very way of ?experiencing experience?;...we need to find other mediums for experiencing experience.  This participant further emphasized approaching poetry from genuine curiosity and a position of ?not knowing?:   51  By not knowing it doesn?t mean that we don?t know anything, it means we remain curious and open, mindful,  about clients and don?t try to impose  our own agendas on others, we keep our agendas in abeyance. 8. Resources  More than half of the participants (55%) reported six critical incidents in which having access to materials, personalized poetry collections, books, references, professional developments, and contact with other counsellors have helped them to use poetry with their clients. One participant mentioned that attending poetry meetings and gatherings, networking with other poets or people who read poetry a lot, or reading poetry on their own as a hobby, is a helpful factor in becoming more fluent in their therapeutic use of poetry. Two of the participants reported the importance of continuously developing a personalized collection of poetry from any resources:  When I was standing on transit bus, I read a poem, and I thought to that poem is all about career, and I could use it, so I was writing it down, and that would be a great poem to use in counselling... to read it out loud and I thought that would be really nice, to help clients in career decision, or the pressure of parental pressure on career choice.  9. Work Environment   Five participants described five helpful incidents in which a supportive work environment has facilitated their experience of using poetry in their practice.  One participant reported that her use of poetry in her practice is strongly supported by her colleagues, and therefore she feels more inclined and free to use poetry in her practice: ?I do work in a supportive environment and what I?m doing is supported, so I think supportive colleagues that validate what you?re doing is helpful for the use of poetry in counselling?.   52  Several participants reported working for counselling services that have included the use of poetry as part of their curriculum and practice. These participants reported feeling more secure and confident in their choice to utilize poetry in their work environment.   10. Witness  The smallest of the helping categories, this section describes incidents in which counsellors have invited other people to witness, or actively provide feedback on the poems that have been written or shared by clients. These poems have sometimes been published by local newspapers for the sake of ?expanding the audience?. For example, one participant mentioned that the presence of these witnesses increased the efficacy of poetry in their practice:  Expanding the audience and witnesses who listen silently or provide feedback to the poems written by clients is a huge helping factor in using poetry in counselling. Clients get to see their changed story published to a wider audience...so the more witness to a new story the better.... for validation, and pride in the achievement of having it written.          53  4.2 Hindering Critical Incidents Categories Table 3. Hindering Critical Incidents Hindering Categories  Number of Incidents   % of Hindering Incidents  Number of Participants   % of Total number of Participants  1.Clients   12 26% 7 78% 2.Personal Factors   9 20% 6 67% 3.Professional Development  7 15% 6 67% 4. Lack of Research on Poetry  5  11% 4 45% 5.Lack of Time  5 11% 4 45% 6.Work Environment   5 11% 4 45% 7. Authority    4 9% 2 22% Total # of Incidents 47     1. Clients  This is the largest hindering category, with 78% of the participants describing 12 hindering critical incidents. These participants reported that some clients, or certain dynamics present in the therapeutic relationship, can be hindering in the use of poetry in counselling.  Several participants reported that a number of clients come into counselling with preset expectations of therapy. Such expectations become a constraint in the possibility of using poetry in normative counselling. Two of the participant referred specifically to well functioning clients  54  in the EAP (employee assistant program), who come to counselling with an idea of what their problem is, and look for advice or a solution to that problem. One participant further explained it is difficult ?to break through expectations of getting advice of those who have formed and informed their sense of identity as opposed to understanding themselves within the nexus of their inter-relationships, over time and space? Several participants referred to clients? beliefs about poetry as a hindering aspect in their use of poetry in their practice. Participants mentioned that some of these beliefs started from school years which demonstrated poetry as something to be studied rather than felt:   They[clients] have school memories, like Ulysses, like major major poetry, but if it?s long, and they can?t understand it, they may have become discouraged. I say let?s explore something small....I never lend poetry books out, or push poetry, it?s an important pillar of strength but it?s not the only tool.  Another participant mentioned that some clients hold strong negative belief about poetry:?People?s beliefs [about poetry often is that it], is flowery, snooty, and not about daily experiences, but that?s not actually too difficult to deal with...if you start exploring some poems that are very powerful?. Therefore it becomes challenging for counsellors to introduce poetry in session and break through such patterns. Another participant mentioned that the older the clients become, the more rigid are their beliefs about themselves and their expectations, and therefore using post modernist interventions with such clientele becomes more challenging: ?with a lot of ?older people? and I?m 60, so I?m old, a lot of rigidity of ideas and ideology gets embedded and its more difficult to use poetry as a therapeutic means to en end?  55  Two participants referred to the types of clients who are more ?concrete and left brain? people. They referred to such clients as very ?matter of fact?, and ?science based?. One participant mentioned that such concrete thinkers come to counselling usually demanding CBT (cognitive behavioral therapy) for the ?treatment of their depression?. These participants mentioned that using poetry with such clients can be very challenging if not impossible.  2. Personal Factors   This is the second largest of the hindering categories. Six participants described nine personal incidents which prevented them from using poetry in their practice. One of the participants reported her personal experience of poetry in her previous job prevents her today from using poetry with her clients. This participant described that being an English teacher prior to being a counsellor; she experienced a lot of her students? resistance to poetry in class. This participant shared that she often finds herself ?double thinking? if it is a wise choice to use poetry with her adolescent clients: ?I was an English teacher, and poetry is the part of English that most students despised ...and that?s probably my issue.?  A few participants expressed doubt about using poetry in their practice. One participant explained that such uncertainty may stem from the lack of research on the use of poetry in counselling, or personal ambivalence: [sometimes I] start questioning myself that maybe I am not grounded in what I?m doing, you know if I have my own insecurities...you know all the talk about whether  it [poetry] is evidence based or is it legitimate way of therapy  One participant mentioned using poetry was challenging for him because he was uncertain about how poetry would be received by his client. This participant further explained that sometimes what he thinks is a powerful and moving poem, may not be received in the same  56  way by his client. Such apprehension was identified as disruptive to this counsellor?s use of poetry:  The image that?s there, doesn?t necessarily strike, I have an idea that this image would be an effective image for a group or a person...sometimes it?s not on target, you think it?s going to be effective, and it isn?t. You?re always surprised, there?s not a direct correlation between one might think it will do it, and what it actually does...not always.  Another participant advised that assuming the clients? problems and ?prescribing poetry to amend a client?s problem is not the right approach to use poetry in counselling?. He further explained that such approach is a hindrance to his use of poetry because clients may view a poem as invalidating, insensitive, and judgmental.   3. Professional Development  67% of the participants discussed that the lack of professional development has been a hindrance in their therapeutic use of poetry. Six participants discussed seven critical incidents in which a lack of networking with other colleagues and professional development, have been a hindrance for their use of poetry. One of the participants expressed the need to fill in the void of networking with other colleagues: ?if there was a group of colleagues that could meet and share their experiences and talk about what would have helped and what they have used...that would be very helpful?.  4. Lack of Research on Poetry  Four participants referred to five critical incidents in which the lack of research and information on poetry has been a hindering aspect in their use of poetry in their practice. Some participants expressed that the lack of research on how to incorporate poetry in counselling, and  57  published articles on the benefits of the use of poetry in counselling often refrains them from using poetry with their clients. One participant mentioned that it is hard to educate her clients on the benefits of poetry when there is not much contemporary research on the efficacy of poetry in counselling: ?if I could show [the client] research on how poetry is being used in research and effective...or...if there?s been an evidence that this is a good counselling intervention maybe it would have worked?.  5. Lack of Time 45% of participants described five incidents in which lack of time has been a hindrance in the use of poetry in their practice. Some expressed that within the 50 minute individual counselling session, there may not be enough time to process the poem, and some of the participants have been forced to give poems as handouts to clients to read at their own time: ?We don?t have much opportunity in individual sessions, so I sometimes read it to them, or give them a copy to read... I usually don?t have much opportunity to discuss it further?. Participants expressed difficulty in discussing these poems later in session with clients. One other participant referred to the lack of time in group therapy sessions. She expressed that sometimes she has to refrain from discussing the impact of poems on the members of the group due to lack of time.  Another participant described that certain types of poetry with more abstract and layered metaphors such as works of Rumi and Hafez require more time to be processed. This participant mentioned that such poems are very helpful in their practice, but often this participant does not share them because there is not enough time for the clients to process, and respond in one sitting.     58  6. Work Environment  Four of the participants described five critical incidents in which work environment has been a hindrance to their use of poetry in their practice. Some of the issues associated with work environment have been the lack of supportive colleagues, fixed expectations of supervisors, and the lack of the supervisors? support. The participants described counselling services which have a very definite outline of how to provide counselling to their clients, and leave no room for the counsellors to use poetry.    7. Authority   With only five percent of the total number of participants, this is the smallest group in the hindrance categories. This category consists of four critical incidents, in which two participants described that their apprehension of changing the counselling process from client centered to counsellor centered, has stopped them from using poetry in their practice.  The fear of ?authority? and ?taking over the session? by the counsellor when using poetry was identified as a hindrance in these participants? use of poetry. For example, one participant mentioned that they always fear by using poetry, they are taking charge of the counselling session, and limiting the clients to speak about their experience. This participant further explained that due to such a feeling, she never ?requests? or ?introduces? poetry in her sessions, and always leaves it open to the client to bring it in.        59  4.3. Wish List Items Categories Table 4. Wish List Categories Wish List Items Number of Items  % of Wish List Items Number of Participants % of Total Participants  1.Resource   9 25% 7 78% 2.Connection with Colleagues   7 20% 6 67% 3.Time   5 14% 5 56% 4.Supportive Work  Environment   5 14% 5 56% 5.Professional  Development   6 17% 4 45% 6.Witness  4 12% 2 22% Total  36     1. Resource  The largest category in the wish list items is resources. Seven participants described nine incidents in which more resources would have been very helpful. Participants in this category expressed a desire for having access to indexed list of poems, interviews with therapists who have successfully incorporated poetry in their practice, and more research on how the brain processes poetry.   As one of the participants was describing the challenges of working with concrete thinking clients, he expressed that if he had access to more published articles on the creative ways of incorporating the use of poetry, he would not have given up on the use of poetry with his client.   60  Three participants referred to the importance of having an indexed based list of poems on the common topics in counselling such as depression, grief and loss, anxiety, etc:  It would be helpful to have a list of poems for other types of clients, like client?s that aren?t spiritual or religious, or even topics, a list of poems on career implication, or decision making, or relationship issues, so that would be helpful...so that content based, topic based.  Another participant credits a similar resource as helpful in the use of poetry in counselling:  One resource would be an index book on poetry, index by subject...on addiction, abandonment, poetry... grief, loss, ...there are short pieces and long pieces... maybe it could be done as a project...or  a thesis project that a graduate student puts together; a reference that can be used by counsellors, that would be a wonderful resources Another participant mentioned the same item as his wish list, and suggested that having a Wikipedia page would be helpful for counsellors, since everyone can distribute, edit, and change the poems they find helpful in counselling.  One of the participants mentioned that many professionals frequently use poetry in their practice such as Jon Kabat Zinn in his practice of Mindfulness Based Stress Reduction (MBSR). This participant mentioned that an interview with him on his experience of poetry, and how he thinks poetry is important and useful for his practice, would be very helpful: ?I have done research on MBSR, there?s nothing written about why poetry is used in there, it would be interesting to interview Kabat-zinn and ask him why he chose poetry?.   61  Several participants wished for more researched articles on the efficacy of the use of poetry in counselling. One participant, while describing the importance of educating clients on the function of the left and right side of brain and why creativity and poetry can be helpful in counselling, expressed a wish for more research on the dynamics of how our brain processes poetry:  It would be helpful to know based on research to know if, how and why poetry is healing. It is obviously healing to me, it?s obvious that it?s healing, but the scientific feeling would be to know why and how. Like what happens to our brain, when we read and listen to poetry, and know what parts of our brain are involved... 2. Connection with Colleagues  This category is the second largest category in the wish list items. 67% of the participants expressed seven wish list items. These participants expressed that connecting with other colleagues and counsellors who use poetry in their practice often would be very helpful for them. These participants all wish that they could either meet in person with local counsellors in one place on monthly or yearly basis, or in a confidentially safe cyber space. One participant expressed that the advantages of the meeting online is that there is a higher chance of participants attending and contributing beyond just counsellors in British Columbia. As one participant described:  I?m hoping that, myself or others who are using poetry...can talk about how effective it can be...so some network or community I would say...than can meet somewhere... we can?t do on skype...it?s not safe...so...some sort of connection of therapist who can talk about the techniques they have developed to use poetry in their work.   62  3. Time  In this category, six participants wished for more time to devote to reading, and creating a personalized resource of poetry. Some of these participants would like to have more time to devote to poetry in their practice. One participant mentioned that having more time for discussing the poems with clients and getting a verbal feedback from them would be very helpful for them.  4. Supportive Work Environment  56% of the participants in this category indicated that they appreciate a more supportive work environment. The participants listed five items in which supportive work environment can positively affect their experience of using poetry. For these participants, in a supportive work environment, there would be validation and encouragement for counsellors who are practicing and using poetry with their clients. One participant, reflecting on her own experience of working mentions that: ?I do work in a supportive environment and what I?m doing is validated. So I believe that supportive colleagues and supportive work environment that validate what you?re doing, is great for other counsellors? Other participants reflected on their experience of working in counselling centres where poetry is not only supported, but also demanded as part of the curriculum. Reflecting on their positive experience, these participants wished for more similar supportive counselling centres.  5. Professional Development  Five participants contributed four wish list items to this category. These participants would like to have regular access to professional development, get to know if and where they  63  happen, join, and network with other counsellors in this field. They further expressed that such a connection would be very helpful in promoting poetry, and would provide opportunities for these counsellors to meet one another.   One of the participants expressed the importance of these workshops in promoting and publicizing the post modernist, poststructuralist, and poetical practices to counselling. They believe that through such means traditional approaches to counselling can be challenged.  For one of the participant, it was important to have more opportunities to arrange workshops, and conference wherein he ?can talk about how effective it can be, just letting other participants know how powerful it is...it?s a distilled  ...it?s an adjunct to therapy, it?s not therapy...but talk about how powerful it is...what a gift it is...it?s a lasting gift that a therapist can give to clients?  6. Witness  This is the smallest of the six wish list categories. Two participants provided wish list items involving access to a wider audience of some kind to the poems written by clients. These participants mentioned that part of the reason that they use poetry is to encourage clients to find their voice. As part of this process, it is helpful for them to have audience to the written poems, so the clients can feel their voice is being heard and understood:  Sometimes [the] poems get published in the newsletter article in downtown east side, and so they (clients) get to see their [poems] published to a wider audience...so the more witness to a new story the better.... for validation, and pride in the achievement of having it written.  64  These participants therefore, wished for more witnesses to the poems written by clients. They wished for more local or international newspapers to publish their work, or encourage clients to share the poems with their peers through a letter, or to an open audience.  4.4 Contextual Findings    In addition to the information about the helping, hindering, and wish list items, all the nine participants of this study contributed contextual information as well. The participants provided information on how they define poetry, how they rate themselves on the use of poetry, how they incorporate poetry in their practice, and whether they view themselves as poetic people.  Definition ?Poetry? ?What are you?? They asked.   I hummed, I paused. So I answered:  ?Purposeful, and Meaningful I evoke, I create, I rupture The Unspeakable, The Indiscernible.? ?How?? They asked.  ?I shivered, I felt, Yet...I answered: Magical and mystical  I express, I encrust, I validate The emotive, the somatic, the non rational  65  Am I your voice? Your emotion? Your unheard words? I maybe  your medicine Or just a home coming Whatever I am, let me be, Just open your heart to me. At the beginning of the interview, participants were asked to give their definitions of poetry. Participants described poetry as evocative, purposeful, and expressive. One participant described poetry as ?the idea of evoking something that creates and gives meaning...Poetry often captures the ineffable; what can not be said, or, what is waiting to be said?. A number of participants concentrated on the role of language in poetry as ?that which opens pathways; it ruptures the normal and the taken for granted, it can fully express aspects of experience that clients haven?t fully symbolized into words yet?. Or ?Poetry is the use of language to go beyond language?.  A number of participants placed greater emphasis on the dynamics of words and emotions in poetry. One participant described poetry as the voice to what is otherwise difficult to share: ? It?s an expression with words, feelings of situations, and with teens it is one of the ways they are able to express themselves. Poetry are words to express emotion?, while another participant defined poetry as ?the use of words to express ideas and beauty, and in therapeutic context: the use of words to promote change and idea and beauty?.  One participant defined poetry simply as ?emotions encrusted in a few words?.  While one participant described poetry as ? a permission to come home, to be who we are, and who we have always been...it has a power to unhinge?, another participant described the  66  power of poetry in validating emotions ?Written words that speak to the heart, create an ?Aha? moment, and is therefore validating. Makes you feel heard and understood?  Incorporation of Poetry in Counselling  ?What the questions are for?? I enquired. ?To know you, to draw on you, to promote you To recite you, by eye or heart To experience you, by nature and landscape To discuss you, in groups of four or two To preach you, mindful and open. After providing definitions to poetry, participants were asked to describe the ways in which they incorporate poetry in their practice. Every participant was asked to describe their poetic intervention specifically. Many participants responded that they give poetry as handouts to their clients. These handouts include a wide range of poetry from lyrics, to popular poetry with dominant themes that the clients may relate to. Some participants mentioned that they read the poem out loud to clients, and by reciting the poem, they evoke emotions in the clients.   One of the participants described his use of poetry in nature. This participant described his intervention in which he combines poetry with outdoor experiences such as hiking: I match the theme of the poem with the concrete experience of nature, asking clients to reflect on their experience or further discuss the poem: (e.g. David Wagner?s poem: Lost: I like taking people to places that are dens and dark and asking them you know what if it was truly dark, and you didn?t know what to do...what would you do, would you stay? Would you run?)  67  I read the poem twice, ask a question, draw the clients? attention to a particular line and engage them in the process of poem discussion and meaning making: ? I invite comment and discussions, and silence.  A number of participants mentioned that they encourage and invite their clients to be the creators of their own poems. Participants mentioned that they open such invitation to clients by providing hints about how to create their poems. One participant described asking her clients to record their own words as they speak throughout the counselling sessions, and then turning these words into a poem. This participant further explained that these poems could be used later as a hallmark of the client?s progress in? both language use and emotional processing?. Another participant mentioned that he encourages his clients who have difficulty in writing poems to write poetry within a specific structure: e.g. ?I used to..?/ ? but now..? or ? I couldn?t...?/ ?If I couldn?t / didn?t / wasn?t......? followed by ?Then how could I have..?, and closing with the two lines, ?Now that I know I can (am) / I?m gonna...?.   Two of the participants described how they incorporate poetry in their practice from a post-structrualist, postmodernist, and narrative point of view. One of these participants described how he incorporates poetry in his group setting by adding authentic voices to challenge the dominant story of client:   Each member was asked to pick a dominant story that a parent or a teacher or other authority type figures have installed in them. [for example one person picks the theme of selfishness]. So we wrote these [themes] on the white board, and invited other members to think of other times when this person hadn?t acted...[selfish], so this person who was  68  going to write a poem, was getting examples from members of the group, and was gathering material for the poem.  Other participants described how they open therapy groups with a line of poem that promotes the theme of that group. Another participant described that they use poems with a theme of nature and five senses in their mindfulness based groups. This participant discussed that she further invited the members of the group to contemplate on the poems in silence or by sharing their experience with other members of the group. Another participant described reading poetry at the beginning of every session in her group:  In the morning when we gather together, it?s an opportunity for them to talk about positives that are happening what?s going on for them, and what their goal is...or what they notice about each other.. I really like the Slam poet Shane Koyczan...he has one poem in particular ?How we get wrinkles?:  I want to ask about your day before your day begins not ?How was it?? but rather ?How will it  be? What will you do? What will you want or need? How can I help?? I want your day to unfold like origami in reverse un-creasing itself losing its shape and flattening back into beautiful possibilities  69  one day you will be what you become in the meantime your life will bend and fold as you see fit each choice is a part of the becoming we all of us bend fold and crease we create ourselves over and over until we become what we are and that ends up becoming who we are I want to ask about your day because I want to know who you will be I want to ask before your day begins so that you will know I already revere who you are. ...yeah so it?s just so poignant and so beautiful and so appropriate for starting your day...    70  Rating  Participants were asked to rate themselves on their use of poetry in their practice on a scale from 0 to 10. On this scale 0 was no use of poetry, 5 was medium use, and 10 showed a very frequent use of poetry. Participants rated themselves twice throughout the interview. Once before talking about the helping, hindering, and wish list items, and one afterwards. All the participants mentioned that they would rate themselves the same as they did at the beginning of the interview except one participant. This participant rated herself higher in the second round of rating. This participant indicated that the interview gave her the opportunity to discuss and revisit her definition of poetry. Such discussion expanded her sense of poetry, and she realized that she actually uses poetry a lot more than she thought she does: I just realized talking with you that I've never really sat and spoken about it before and explored my feelings and thought processes around it.  You have with your questions broadened my sense of poetry and use. I use a lot of quotes and poems with clients, but I don?t write I recently had an article accepted by BCACC for the Insight journal and it is using metaphor to speak about addiction.  I considered it prose when I wrote it but it's actually also quite poetic in nature and I hadn't thought of it that way before.  Poetic person  At the end of the interview, the participants were asked if they have always considered themselves to be poetic people. All participants expressed that they have always been interested, and appreciated poetry. Most of these participants expressed how the culture they come from, or the family they were brought up in had a major effect on their interest and belief in poetry:   71  I grew up in a household where there were hundreds of books and journals; because my father was an English professor....my father?s dead now, however, in terms of the legacy he?s left me, he?s very alive...in terms of literature. One participant shared how he was affected in school by a teacher?s performance of a poem at a very young age, while another participant self disclosed publishing books on poetry since a much younger age. One participant expressed that their inspiration and commitment to poetry started after they experienced it with the famous British poet, David Whyte:  ?[my interest in poetry did not start] until the summer of 2011, I went on a walking tour in northern England, with David Whyte, and he?s a very powerful poet and photographer, and I went on a walking tour with him, and seeing how poetry can be combined with landscapes and...that?s only 2 years ago, a new thing for me?.          72  Chapter 5: Discussion  It is important to consider the critical incidents and the contextual findings of this study, and further discuss their clinical significance and implications. In this chapter, the findings of the study will be examined with regards to their correspondence to the literature review on poetry. In the latter part of this chapter, unique findings of the study, clinical implications, limitations, and future research will be discussed.  5.1. Correspondence to the Review of Literature  Definition of poetry  The findings of this study show that participants? definition of poetry is in alliance with the definition of poetry discussed in the literature as well as the definition of poetry used for this study. Poetry is defined as an honest communication that has the potential of ?transforming the cognitive state of an individual? (Shafi, 2010). Poetry is defined as a means to express our inner feelings in a unique way, and ?give meaning where meaning cannot be found? (Jeffs & Pepper,2005, p.91). Such a perspective towards poetry was echoed by the participants of this study as they referred to poetry as expressive, emotive, tangible, challenging, and as ?fruit for thought?.  The findings of this study on the meaning of poetry are reflective of the way poetry is defined in this study. Poetry in this study is defined using Eric Jackson?s definition of poetry as representing underlying feelings of clients through an ?imaginative awareness of experience through sound and image?(Jackson, 2010,p1).  Many participants echoed and highlighted the role of image in poetry, and its power in bringing to the surface clients? feelings that are difficult to vocalize.    73  The interrelation of poetry and creativity  It was discussed in the literature that creativity is the core of the creation of poetry. Poetry was reflected by many articles as the creative use of words, and language. Due to such an important role of creativity in the creation of poems, this section was covered in the literature review. According to Gladding (2005), creativity includes divergent thinking. Hecker and Kottler (2002) consider ?divergent thinking? as the ?hallmark of creativity? (p. 8). Divergent thinking encourages the creation of different and novel ideas which can be helpful in the decision making process, problem solving, or fostering change. Divergent thinking also involves considering new possibilities and horizons rather than encouraging a focus on data and conclusion (Deacon, 2000). The participants of this study represented the role of creativity and divergent thinking as they discussed the characteristics of poetry in its creative use of language, and creation of perspectives and ?voices?.  Amundson (2009) echoes the concept of restless clients in his term ?the crisis of imagination?, a situation in which clients feel stuck in the session, and cannot visualize other possibilities that would facilitate the problem solving process. Participants of this study described poetry as a creative tool can help the client move beyond ?the crisis of imagination? by anchoring emotions, providing alternative perspectives.  The selection of poetry  Many articles in the literature discuss the appropriate kinds of poems to be used in poetry. The process of selecting the appropriate theme or content in poems to be used in counselling is reflected and debated in most of these articles. Hynes and Hynes-Berry (1994) examined the thematic and stylistic dimensions of poetry before its use in a therapeutic setting. The appropriate themes of poetry include but are not limited to positive, comprehensible, powerful, and also poems that contain universal experience and emotions. They also identified suitable styles of  74  poetry such as concrete images, rhythms, simplicity, precision, clarity of ideas and language. In this study, participants discussed the specific kinds of poetry that they have found helpful in their experience of using poetry in counselling. The participants identified poems with lucid themes as helpful in their practice. Due to their clear and dominant themes, these poems are easier to be grasped by clients, and represent client?s experience more accurately and clearly.  Another concept proposed in the literature for the selection of poetry in counselling included the isoproincile model which is the idea that the most effective poems are the ones that are ?close in feeling to the mood of the patient? (Leedy,1985, p. 82). This idea seems validating, and empowering, as well as normalizing as clients may experience their stories reflected in poems. However, the downfall of such a style of selecting poetry for counselling is the chance that it may not match the client?s sincere feelings, and may result in them feeling invalidated and frustrated. This may cause poetry to have a counterproductive effect on clients (Mazza, 1999).  Most participants in this study emphasized the importance of enabling clients in ?Experiencing the experience? in therapy through poetry, and verbalizing their unspoken statements and words. However, there were also participants who mentioned that some poems may misrepresent the clients? feelings, and result in them feeling invalidated and frustrated.   The use of poetry in counselling  The use of poetry in counselling has been discussed in the literature in several articles. Chavis (1986) and Stepakoff (2009) described three different methods of incorporating poetry in counselling. These methodologies include the receptive/prescriptive component: introducing poetry in therapy; the expressive/creative component: having clients writing poetry in therapy; and the symbolic/ceremonial component: using metaphors, rituals, and storytelling. In this study, participants? description of how they use poetry in their practice with their clients pertain mostly  75  to using interventions that validate client?s feelings (receptive/symbolic component) by reading poetry out loud to them in individual or group counselling and then inviting discussions on their experience of poetry. Some participants discussed their experience of empowering their clients? expressions by valuing and recording clients? own words and feelings to create poems (expressive component).  5.2 Unique Findings  The underlying motive for this research was discovering the helping and hindering aspect in counsellors? use of poetry. As discussed in the first chapter, there are no publications in the literature on the factors that have facilitated and hindered the effective use of poetry by counsellors. Some of areas that had not been discussed in the literature included understanding the role of factors such as the setting, the client, the counsellor, the type of poem, and methods to introduce poetry in counselling. The findings of this study aim at filling in such void, and therefore, most of the findings of this study are unique in the existing literature.  One of the first categories of findings that stood out in this study was the impact that the content of a poem had on the participants? use of poetry with their clients. Seven out of the nine participants listed 11 helpful critical incidents in which the content of the poem had facilitated their use of poetry with their clients.  The interesting finding in this data is that participants found themselves more drawn to the type of poetry content that related to their area of work or personal counselling orientation. For example, if mindfulness was one of areas of expertise of a participant, they were interested in the type of poetry that represented or facilitated the experience of mindfulness. The participants expressed that they find using poetry helpful when they can connect with the poem personally and emotionally experience the poem.   76  Another significant finding lies on the impact of the personal knowledge and private experience on the participants? use of poetry in counselling. Six out of the nine participants described personal training and experience of poetry as positively affecting their use of poetry in counselling. One of the participants described their exposure to literature and poetry since a very young age, and that literature has always been considered a value in their family. Another participant reflected on their experience at a very young age in school, where a teacher?s recital of a poem had left a significant impact on him. Other participants reflected on their private experiences of poetry viscerally and emotionally. Feeling its power and deep impact on them significantly facilitated their use of poetry in their practice with their clients. One interesting finding is how these participants emphasized the importance of having workshops on poetry in counselling, because they believed that if other counsellors have the opportunity to experience poetry the way they have experienced it, they will be more drawn and open to using it in their practice. These workshops can focus on exploring new methodologies in counselling by shaking the traditional approaches to psychotherapy, and opening doors to postmodernist and poststructuralist approaches.  Another unique finding in this research was the impact that clients have on counsellors? use of poetry in counselling. Participants expressed that the clients who tend to be more intuitive, thoughtful, and subjective, are more open to trying poetry. Some participants described this type of clients as ?the right brain clients?.  They further explained that using poetry with the ?left brain?, logical clients who mostly come to counselling with certain expectations of therapy (such as asking for advice, or demanding therapies such as Cognitive Behavioral Therapy) is more challenging.  One of the participants expressed that one way of inviting such clients to poetry has been by explaining scientifically how the brain processes poetry and meaning making. This way  77  they have been able to engage some of the clients with poetry and have had successful outcomes. For example, one participant showed me the chart of the brain she always kept on the door of her office to concretely explain the benefits of using the right side of the brain for the clients.  Another participant expressed that in his experience, it has been easier to use poetry with the younger and adolescent population as opposed to the adult population. He further explained that adult clients may have more rigid and fixed beliefs about themselves as well as their expectations of the therapeutic process. This is while he found his adolescent clients are more open and receptive to writing, listening, and responding to poetry.  Most participants highlighted the significant impact of the counsellors? beliefs on their openness to use poetry. Such finding was figured from the critical incidents in which five out of nine participants reported how their personal views and beliefs about poetry has significantly impacted their tendency to use it. The participants mentioned that having an open mind and more modern outlook to counselling, have been conductive in their use of poetry in their practice. Some of these participants listed poetry as a postmodernist and creative approach in counselling. They mentioned that through such an approach, the clients have the chance to write their own poetry, and become the authors of their lives and stories. Two of the participants described their positive experience of using poetry with their clients from a postmodernist approach. They enabled their clients to create their own beliefs and stories, challenge the old ones, and re-author new poems and stories.  These participants also mentioned that putting aside myths such as ?poetry works better with women? or ?poetry is only accessible to the educated?, they opened themselves to trying this approach, and viewed poetry as creative, empowering, and accessible for all type of clients.  78   Two participants described their experience of having ?witness to poetry?. These participants described incidents in which counsellors have invited other people to witness, or actively provide feedback for the poems that have been written or shared by the clients. Some even demonstrated poems that have been published by local magazines. The participants mentioned that the presence of wider audience significantly accentuated the efficacy of their therapeutic use of poetry.  Participants also recognized poems containing images and metaphors that can represent or relate to nature, as helpful in their practice. Each of these participants described their unique experiences of using such type of poetry. One participant mentioned that he used natural images and metaphors in poems to concretize the experience and facilitate clients? understanding of the poems. Another participant described how they can facilitate mindfulness and hypnosis through the calming and relaxing natural images in poems.    Several participants discussed that using poetry in session will alter the dynamics of the therapeutic relationship. While a number of participants shared their experience on how writing, discussing, and verbalizing experiences through poetry can be an empowering and validating process for clients, there were participants who discussed the flip side. These participants expressed their unwillingness in using poetry in their practice too often in apprehension of ?taking control? over the session, and over ruling the ?client centered? orientation in their therapeutic work.  These participants pointed out the lack of research on the use of poetry in counselling, and alternative ways of representing poetry to clients from a non authoritative point of view.   79  Finally, there were some unique findings about the overall impact of the interviews. These interviews inspired some of the counsellors to reflect on their experience of using poetry, contemplate, and modify their definitions of poetry. Providing definitions to poetry at the beginning of the interview enabled some of the participants to realize that they use poetry in their practice more often than they imagined. They reflected that such a finding for them resulted from the fact that poetry does not have fixed and rigid definition, and can be used and matched with each client?s unique potential.  5.3. Practical Implications   This study resulted in many helpful practical implications. A majority of the participants found it very helpful to reflect on their experience of using poetry in their practice. They mentioned that they had the chance to visit or even revisit their definition of poetry, and discuss the helpful and hindering aspects of their experience of using poetry in counselling. Therefore, it might be helpful to practitioners to engage in a similar experience through even an internal self check to consider and revisit their experience of using poetry. It would be helpful to not only consider the personal and professional aspects that are helpful in their use of poetry with clients, but also consider the hindering aspects, and viewing them as potential areas of growth. Participants in this study reflected on how having a supportive work environment can positively impact the use of poetry in their practice. They mentioned that it is validating and assuring for them to use poetry in an atmosphere where it is accepted and supported by colleagues and supervisors. It might be helpful for working professionals in the counselling services to promote new approaches in counselling and accept challenging some traditional  80  methodologies of counselling. It might also be helpful for them to consider the results of this study as proof to the benefits of practicing new approaches in counselling and psychotherapy.  Participants expressed a desire for networking more often with counsellors who use poetry in their practice. They shared that through such connection; there would be more opportunities for reflecting on their experiences. Therefore, it might be helpful for counselling professionals interested in poetry to meet on a regular basis to discuss their experiences of using poetry in their practice.  Since networking was another wish list item for the participants of this study;  it might be helpful to organize more workshops on how poetry is used in counselling.   Finally, findings of this study demonstrated the usefulness of promoting the use of poetry for practicing professionals, or professionals in training. It might be helpful to consider offering a course on the benefits of using poetry in counselling in academic settings, and discuss the helpful and hindering factors of poetry in counselling.  5.4. Limitations  This study is limited by its focus on counsellors who self identify with the use of poetry in their practice. This could have affected the counsellors who decided to participate in this study. For example, there may be counsellors who use poetry in their work, but do not completely identify themselves as poetic counsellors. There might also be participants who use modern poetry, lyrics, or rap in their work, but due to their traditional definitions of what constitutes a poem, they did not volunteer for this study.   81  Even though most participants reflected on the impact of culture and value on their familiarity and interest in poetry, there were no specific questions in this interview on cultural impact. Such questions could have more specifically and accurately measure the cultural impacts on the participants.  Although data saturation was achieved and many incidents were created by the eighth interview, further participants and interviews may increase the participation rates of currently low participatory categories. It is important to emphasize that in ECIT, the number of incidents, and not the number of participants, determines adequate coverage of data. Nevertheless, further interviews could lead into creating more critical incidents, and theoretically change the structure of the existing categories.  The lack of generalization of results by using ECIT for this study is considered a limitation by some researchers. The goal of this study was not generalization. The goal was to explore and describe the helping and hindering factors of using poetry in counselling through the experiences of counsellors who have used poetry before. The participants were meant to represent a sample of counsellors who use poetry in their practice. The participants in this research shared their unique experiences of using poetry. Since there is such a diversity of experiences for counsellors, these results are not meant to be generalized to cover all counselling psychologists? experience of poetry. Even amongst this small sample of 9 participants, there were considerable differences in experiences. If other counsellors who self identify with poetry were interviewed, it is believed that many similarities and differences would emerge corresponding to the current researched study. Although the study is seen to be beneficial in adding to the research base regarding the use of poetry in counselling psychology, much like  82  other studies, it cannot capture the full scope of counsellors? experience of the use of poetry in counselling.  5.5 Future Research  This study illuminated valuable findings to the research of the use of poetry in counselling psychology. This study mainly focused on interviewing participants who self identify with the use of poetry in counselling. It concentrated on the helping and hindering aspects of using poetry in counselling. Since the study did not cover the perspective of counsellors who do not use poetry in their practice, it would be helpful in future research to highlight that aspect. The challenges identified by these counsellors, could be potential areas of growth for the use of poetry in counselling.  Also this study represents the counsellors? point of view about poetry and its positive effect in counselling. There is no information on the clients? experience of poetry, and what the helping and hindering aspects of it has been for them. Such information can be helpful in bringing about a clearer sense for using poetry in counselling.  Finally, it would be important to further investigate a correlation between clients? experience of poetry and the counsellors? use of poetry. It would be helpful to investigate how clients? reaction and experience of poetry could affect the counsellors? use of poetry with their clients. It would also be helpful to explore other factors that might impact the counsellors? use of poetry with their clients, such as the impact of the therapeutic relationship.    83  Chapter 6: Conclusion  This focus of this research was to investigate the use of poetry in the counselling practice. This study aimed at filling in the gap in the literature on the helping and hindering aspects of using poetry in counselling. Along with identifying the aspects that could have (wish list items) been helpful, this study represents a comprehensive list of the blessings, and hurdles of the current use of poetry in counselling. The overall results of this study invite current counsellors to approach poetry from an open point view, and encourage them to explore modern and novel approaches to counselling and psychotherapy. 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Psychopoetry. New York: Grosset and Dunlap. Schwandt, T. A. (2000). Three epistemological stances for qualitative inquiry: Interpretivism, hermeneutics and social constructivism. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 189-214). Thousand Oaks, CA: Sage. Schwietert, J. A. (2004). The use of poetry therapy in crisis intervention and short-term treatment: Two case studies. Journal of Poetry Therapy 17, 189_198. Shafi, N. (2010). Poetry therapy and schizophrenia: Clinical and neurological perspectives. Journal of Poetry Therapy 23, 8_99. Stuckey, H., & Nobel, J. (2010). The connection between art, healing, and public health: a review of current literature. American Journal of Public Health, 100(2), 254-263. Stepakoff, S. (2002). Poetry therapy for bearing, and being with, tragedy. Paper presented            at the 22nd Annual Meeting of the National Association for Poetry            Therapy Denver, CO, April. Stepakoff, S. (2003). 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New Directions for Adult and Continuing Education 116, 13_23. Woolsey, L. (1986). The Critical Incident Technique: An innovative method of research. Canadian Journal of Counselling, 20, 242-254.                             90   Appendices                                            91  Appendix A: Interview Protocol  ECIT Interview Guide:  Poetry in Counselling Psychology    Participant #:   ________________ Date:   __________________   Interview Start Time:   ___________   1. Contextual Component   Preamble: As you know, I am exploring the ways in which counselling psychologists use poetry in their practice. The purpose of this interview is to collect information about your experience of using poetry when working with your clients.   a. As a way of getting started, perhaps you could tell me a little bit about your experience as a counsellor.  b. You volunteered to participate in this study because you identified yourself as using poetry in your counselling process. What does ?poetry? mean to you?   c. Given your definition, I would like to get a sense of how you typically use poetry with your clients. Could you describe how you incorporate poetry into your practice?   d. On a scale of 0 ? 10, where 0 is a low use of poetry, 5 is moderate, and 10 is a high use of poetry, where would you place yourself?                       ________________________________________________    0 1 2 3 4 5 6 7 8 9 10 Low Use    Moderate    High Use   92  2. Critical Incident Component   Transition to Critical Incident questions: You rated yourself as a 5-6 (or whatever the participant rated him- or herself in question 1 (c) above).   a. What has helped you in using poetry in your work? (Probes: What was the incident/factor? How did it impact you? Can you give me a specific example How did the incident/factor help you?)   Helpful Factor & What it Importance (How did it help? Example (What led up to Means to Participant (What Tell me what it was about .. it?  Incident.  Outcome of do you mean by ..?) that you find so helpful.) incident.)      b. Are there things that have made it more challenging for you to use poetry? (Alternate question: What kinds of things have happened that made it more challenging for you to use poetry?)   Hindering Factor & What it Importance (How did it Hinders? Example (What led up to Means to Participant (What Tell me what it was about .. it?  Incident.  Outcome of do you mean by ..?) that you find so Hindering.) incident.)      c. Summarize what has been discussed up to this point with the participant as a transition to the next question:    We?ve talked about what?s helped you use poetry (name them), and some things that have made it more challenging for you to use poetry (name them). Are there other things that would have helped you? (Alternate question: I wonder what else might have been or might be helpful to you that you haven?t had access to?)     93  Wish List Items & What it Importance (How Would it help? Example (What led up to Means to Participant (What Tell me what it was about .. it?  Incident.  Outcome of do you mean by ..?) that you find so helpful.) incident.)     e. Now that you?ve had a chance to reflect back on what?s helped and hindered, where would you place yourself on the same scale we discussed earlier? The scale is from 0 ? 10, where 0 is a low use of poetry, 5 is moderate, and 10 is a high use of poetry,  where would you place yourself?                         ________________________________________________  0 1 2 3 4 5 6 7 8 9 10 Low Use    Moderate    High Use   f. What?s made the difference? (To be asked only if there is a difference in the first and second scaling question ratings.)    g. Do you consider yourself to be a poetic person?   (Circle one) Yes No  h. Have you always considered yourself to be a poetic person? (Circle one) Yes No  i. If not, when did this change for you?   j. What happened that changed this for you?    k. Demographics Component   i. Occupation   ii. Number of years in this occupation   iii. Length of time in current job/employer   iv. Industry in which the person works   94   v. Number of years in this industry   vi. Age   vii. Sex   viii. Income level (household)   ix. Country of birth   If not Canada/US, (a) length of time in Canada/US; and (b) 1st language   x. Marital status   xi. Family status/parental status   xii. Education level    Interview End Time:  _______________      Length of interview:  ______________  Interviewer?s Name:  _______________________                       95  Appendix B: Informed Consent  CONSENT FORM  ?The Counsellor?s Use of Poetry with Clients: What Helps & Hinders the Therapeutic Process?  Principal Dr. Norman Amundson, Professor Investigator: University of British Columbia Department of Educational & Counselling Psychology, and Special Education   Co-Investigator:    Shahla Jalali-Mazlouman, Graduate Student University of British Columbia  Department of Educational & Counselling Psychology, and Special Education   This research is being conducted as part of Shahla Jalali-Mazlouman?s graduate thesis project in the Counselling Psychology Master?s Program at the University of British Columbia. The results of this research will be included in a masters thesis that will become a public document in the University library once completed. The results of this research may also be published in appropriate professional and academic journals.  Purpose  The purpose of this research project is to develop systematic, research based, and structured technique for using poetry in counselling. This will be helpful to Counsellors and Practitioners as well as Individuals(clients).   Procedures  This study will require one interview and a follow-up contact. The interview will be approximately 90 minutes long. During this interview, you will be introduced to the purpose of the study and upon giving your signed consent for participation, you will be asked to describe your experience of using poetry in an open-ended question format. You will be invited to discuss events and experiences that made it easier or more challenging for you to use poetry with clients.    During the final part of this first interview, you will be asked to provide demographic information about yourself. This interview will be tape recorded, transcribed and given a code number to ensure confidentiality. Upon completion of the study these tapes will be erased.  The follow-up contact will be a brief discussion on the initial findings and will take  96  approximately 20 ? 30 minutes. Specifically, you will be emailed a 1-2 page summary of the categories and themes that emerged from your initial interview. This will provide you the opportunity to review the summary, so that you can give input, feedback, and comments on the content, meaning, and relevance of these categories and themes to your experience. Your feedback can be discussed via email or telephone, whichever is the most convenient for you.  Your total time will be approximately two hours within a two month period.  Confidentiality  Any information identifying individuals participating in this study will be kept confidential. Only the principal investigator and co-investigator will have access to the data. Upon signing the informed consent you will be given a code number to ensure the maintenance of confidentiality. Participants will not be identified by the use of names or initials in any reports of the completed study. All research documents will be kept in a locked filing cabinet in a locked office at the University of British Columbia. Computer data files will be password protected.  Compensation  There will be no monetary compensation to participants.  Contact for Information About the Study  If you have any questions or would like more information about this study, you may contact Dr. Norman Amundson (Principal Investigator) or Shahla Jalali-Mazlouman (Co-investigator).   Contact for Concerns About the Rights of Research Subjects  If you have any concerns about your treatment or rights as a research subject, you may contact the Research Subject Information Line in the UBC Office of Research Services.   Consent  Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time without prejudice of any kind.  Your signature below indicates that you have received a copy of this consent form for your own records.  Your signature indicates that you consent to participate in this study.  __________________________________ ______________________  Participant Signature Date   97   ________________________________________________________ Printed Name of the Participant signing above  I agree to be contacted in the future for research participation in similar studies by the same researcher.  Initials:_____Date: _______________   Thank you for your willingness to participate in this study.                                    98  Appendix C: Recruitment Poster   A Study Of How Poetry Is Used In Counselling Psychology:  What Helps & Hinders The Use of Poetry in Counselling?  The purpose of this research project is to give Counselling Psychologists who have experienced using poetry in their work with clients an opportunity to describe their experiences. It also provides individuals with an opportunity to discuss what has helped or hindered them in using poetry.   The investigators for this study are Dr. Norm Amundson, Professor in Counselling Psychology at the University of British Columbia; and Shahla Jalali-Mazlouman, graduate student in Counselling Psychology at the University of British Columbia.    We would be interested in hearing your experience of using poetry IF:  1. You are a Registered Counsellor 2. You have used poetry in your work with clients  3. You are willing to talk about your experience of using poetry in a confidential 90-minute interview  If you would like to participate, or would like further information about this study, please contact Shahla Jalali-Mazlouman by email   

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