Therapy Today October 2014
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10. Jung CG. Mysterium coniunctionis: an inquiry into the separation and synthesis of psychic opposites in alchemy. London: Routledge; 1963. 11. Jiménez JP. Between the confusion of tongues and the gift of tongues or working as a psychoanalyst in a foreign language. International Journal of Psychoanalysis 2004; 85: 1365–1377. 12. Stern D, Bruschweiler-Stern N, Harrison A, Lyons-Ruth K, Morgan A, Nahum J et al. The process of therapeutic change involving implicit knowledge: some implications of developmental observations for adult psychotherapy. Infant Mental Health Journal 1998; 19(3): 300–308. 13. Mearns D, Thorne B. Person-centered counselling in action. London: Sage; 2007. +++
Talking point We need courageous conversations Jackee Holder urges coaches and counsellors to face up to the reality of racism My first real experience of coaching was in 1987. I was fresh out of university and working as a youth and community worker in the London borough of Hackney. As part of our professional development all full-time youth and community workers in the borough were allocated a non-managerial supervisor. My supervisor, Rose, was a manager in another organisation and was African-Caribbean, just like me. We met monthly and from the start our shared racial identities meant that I felt able to talk openly about my personal experiences of race and diversity, which were key issues in our multi-cultural team. I found my voice in those sessions: a voice I rarely vocalised in our team meetings and in the borough-wide monthly youth worker forums. I allowed myself to be vulnerable and in that space my potential was realised; within 18 months I confidently moved into a new role and began a part-time postgraduate course so I could gain my professional qualification in youth and community work. Rose may well have been the catalyst for my journey into the world of coaching. That was some 27 years ago and the coaching profession has gone through a rapid acceleration process in that time. There has been an increase in the number of professional coaches from black and minority ethnic (BME) backgrounds, yet we are still hugely under-represented among leadership and executive coaches in the corporate and private sectors, both here in the UK and worldwide. In a recent tele-class on diversity presented by a global coaching professional association, I sat through the call wanting to share and name specifically some of my experiences in the coaching profession that I felt were racially and culturally motivated. However the general ethos of the event appeared to homogenise experiences of difference under the diversity umbrella; the message was, ‘We are all diverse.’ I marvel at how often, when meeting coaches for the first time in these kinds of professional contexts, I feel I have to justify my presence in the room. I am sensitive to and aware of the fact that thoughts and feelings triggered in these moments can be located in my own personal wounding and past experiences. I have worked on much of this over the years, both in personal therapy and coaching supervision, and this work continues. Yet not all of it is mine. Outside, in the wide world, I face racism and discrimination, just like any other black person. I cannot fully erase that possibility, and we need to remember and connect with the fact that, for many people, discrimination is a regular occurrence in the very organisations with which we coaches work. If we fail to embrace ethnic diversity in our training, CPD and peer events, how can we be sure we are noticing and highlighting it when it appears in the culture of the organisations and leaders with whom we working? These moments, when the reality hits home of how different our experiences, connections and understanding can be around race, diversity and inclusion, are what motivated me to write about the invisibility and lack of real conversation in the coaching industry around these issues. Consultant and diversity and inclusion specialist Paul Anderson-Walsh writes: ‘Inclusion helps you to make a difference with your difference.’1 I believe that the coaching profession cannot afford to be silent on these issues. We do the profession a disservice when we believe that we are so beyond the everyday experiences of different groups that we can see and treat everyone as the same. People are not the same and nor are their experiences. The clients and organisations we serve, the people at all levels within them, are having different experiences that require a safe space where they can be brought out into the open and made sense of. Executive coaches Carol Campayne, Caroline Harper Jantuah and Lori Shook (see http://diversitypractice.co.uk/authentic-leadership-coaching/) say one first step is to engage in ‘courageous conversations’. They write: ‘We stunt our client’s growth by failing to put fierce courage into action, challenging the messy stuff of race, culture, religion, sexual orientation that gets in the way.’ We need to take the blinkers off and recognise that colour and race are real and current issues of diversity that deserve to be at the forefront of our professional conversations and training. I look forward to exploring ways to take this important issue forward, individually, collectively and as a profession. Jackee Holder is a trainer, facilitator and an executive and business coach. Her full article is published in the October issue of Coaching Today. Visit www.bacpcoaching.co.uk/coachingtoday.php Reference
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Dilemmas The dangers of dual relationships This month’s dilemma Jim has a mixture of paid work roles and enjoys the variety this brings. He has a private counselling practice two days a week and works for a local school on a third day. The school has recently offered Jim another day’s work each week, as an assistant on a new project. Jim is very excited at the prospect, not least because the extra money will make a big difference to him. However Jim has a client, Indy, whom he has been seeing for a couple of months. Jim is aware that Indy has been job-hunting as this has been discussed in sessions. In their next session, it transpires that Indy has been offered the job as manager of the project that Jim has been appointed to. What should Jim do? Opinions expressed in these responses are those of the writers alone and not necessarily those of the column editor or of BACP. Brian T Jones (psychoanalytic psychotherapist) In this case, it is Jim’s responsibility to decline the job offer. By accepting it, Jim and Indy will enter into a dual relationship. The dual relationship, according to the BACP Ethical Framework, involves two or more concurrent relationships with the same person. Dual relationship behaviours occur when the therapist engages in a relationship external to the client/therapist field. In the case of Jim and Indy, even a time-limited interaction such as the job constitutes a violation of the framework. The question then becomes why are dual relationships problematic for therapists? Many professions maintain dual relationships. While others may have varying opinions about whether dual relationships are ethical, therapists ought to be vigilant in avoiding them. The therapist/client dyad involves a developed relationship that permits the discussion of personal feelings, thoughts and the revelation of one’s private and internal world. Given Jim’s professional demeanour, he may not be likely to expose Indy’s thoughts and experiences. However, Indy’s continued thoughts and interactions may produce an undue influence on their professional or therapeutic life. The undue influence involves an undeserved or unwarranted pressure to behave in a certain manner. Jim’s presence may place such a pressure on Indy vis-à-vis preferential treatment or discomfort in the workplace. Second, Jim is at risk of jeopardising the therapeutic transference. The work relationship may constitute a form of reciprocity that differs from the therapeutic relationship. In the work relationship, Indy maintains a position of power over Jim that does not transfer to the therapeutic situation. Such a power dynamic has the potential to disrupt or intrude on the current therapeutic work. For example, what if Jim disagrees with a decision made by Indy that was not addressed at work? Jim’s repressed feelings concerning the disagreement may reveal themselves as a negative countertransference reaction. Therefore Jim begins to lose his objectivity within the relationship. The case is complex and difficult. However, I would suggest that the potential problems outweigh the monetary benefits. As stated above, the risk to the therapeutic relationship and the undue pressure placed on Indy pose significant risks to Indy’s wellbeing and treatment process. William Johnston (person-centred counsellor in private practice) Dual relationships in therapy are always problematic. What this throws into stark relief for me is that the core issue is one of authority. I think that Jim has only two choices: he either accepts the job and ends his therapeutic relationship with this client, or he keeps his client and declines the job. I noticed the strength of reactive fear that I experienced at the thought of finding myself in a similar situation. I like to think that I do not behave in an authoritarian way towards my clients; that there is even a level of equality between us. I had to acknowledge that, however much I might strive for that sort of equality, it is a fantasy. Even if the only power that I operate is to manage the space in terms of time boundaries and making sure that we are not interrupted, I remain the authority in that respect, just as Indy will be the authority in cases of dispute at Jim’s workplace. How could either party operate within that hierarchy with so many confidences held between them? Given also that so much that arises in therapy has to do with child energies that the counsellor often has to hold as though playing the role of parent, how might any parent feel if they suddenly found themselves being managed by some precocious offspring? When questions of authority arise between counsellor and client, they can be held within the safety of the sessions and Jim can allow the tension of their relationship as a means to explore what it means to be one up or one down. If Indy has an alternative space where he can explore that balance – where he can, if we take matters to extremes, take revenge on Jim without Jim being in any position to challenge or hold that desire – Jim’s position must become increasingly perilous. In fact, there would be similar problems if Jim were to find himself managing Indy outside of their counselling relationship. The nature of this particular set-up just makes it more obvious that power is the issue here. I do hold authority over my client, and I would hope that I have the experience and awareness to use that authority creatively and to understand its limits and potential dangers, as well as its creative possibilities. My client is not bound by those structures, and I should be in no position to bring what happens at work into the sessions without my client’s permission. Most important of all, without the boundary of my authority within sessions I should become incapable of serving my client. If I put myself in a position where my client can abuse me then, in effect, through the loss of boundaries, I abuse my client. Rachael Wright (school therapist) It would not be fair to Indy or Jim to be both manager and client or counsellor and colleague. Jim has a number of obligations to himself and others: to work in the best interests of his clients, to earn money to sustain himself (and possibly others) and to work towards a fulfilling career. But he has to decide which to prioritise as, in this case, there is a potential conflict of interests. Jim cannot work in the best interests of his client while also fulfilling his own needs. So whose needs are greatest? And should there be a discussion about it? To raise it with the client for discussion puts Indy in a very difficult position and is likely to sabotage the therapeutic relationship, so I would suggest Jim needs to take independent action. Jim’s priorities should be with his existing commitments and, unfortunately, this new offer of work would directly threaten his commitment to Indy and could, at worst, damage his reputation. I felt for Jim and imagined his deep disappointment in having to turn down the job. It made me reflect on the nature of our roles – particularly when we work in the community (I work in schools), and how often our roles may be pulled in all sorts of other directions and how hard we have to work to protect our role as counsellor, with its necessary boundaries. I have just had to turn down a free trip to a theme park with my kids on the basis that it was with families with whom I have worked and will potentially work. Unfortunately I could not be both counsellor and helper/mother/colleague. Sad but necessary. Judy Stafford (Registered Member MBACP) Jim’s dilemma is the result of his enjoyment of diversity in his professional practice. While this makes his life exciting and dynamic, it can also produce difficulties, as this dilemma indicates. He clearly needs to now make an ethical decision, which primarily safeguards his client. This is complex since not only does Jim have two roles but Indy, his client, does too, and their dual roles both overlap with each other. As I see it, Jim needs to be transparent with Indy, since the counselling relationship cannot exist or continue without that. He then needs to decide what’s best for Indy and, if he turns down the extra day’s work and continues as Indy’s therapist, he will need to be careful that his other, existing work at the school doesn’t involve any interaction with Indy. If Jim decides he really does need the extra day’s work, then he will need to end the counselling contract with Indy. This must be done sensitively, with a satisfactory ending, and Indy will need to be referred on to another counsellor. The decision is Jim’s but he needs to act in a way that doesn’t undermine Indy’s autonomy. It sounds as if Indy is finding his feet, and receiving this job offer will certainly increase his self-confidence and his sense of his own value. We are not told what issues have brought him to counselling, nor what stage the counselling has reached and it may be that after two months the relationship is nearing a conclusion anyway. Jim certainly needs to give all these aspects careful consideration and discuss them in supervision, bearing in mind that hard decisions often have to be made. To avoid complexity in future, he may decide it might be easier to simplify his own way of life. November’s dilemma Sherifa completed her counselling qualifications three years ago. However she has been unable to find paid employment as a counsellor. Although she has continued to work in a voluntary capacity in order to maintain her practice, she has become increasingly frustrated and has decided to set herself up in private practice. As a first step, she enrolled on and completed a business start-up course, where she was advised to set up a website and to include testimonials from her current clients at her placement. However, Sherifa has just seen a conversation on a social networking site where some members have suggested that this is not wise. What are the ethical issues involved and what should Sherifa do? Email your responses (500 words maximum) to Heather Dale at hjdale@gmail.com by 27 October 2014. Readers are welcome to send in suggestions for dilemmas to be considered for publication, but these will not be answered personally. +++
The interview The quality of connection Mick Cooper talks to Colin Feltham about his kaleidoscopic interests and fundamental belief in the healing power of the therapeutic relationship You’re significant in the counselling and psychotherapy world for many reasons, and I’m wondering where to begin. Can you first fill us in on your path from childhood to academic psychology? As a child I loved maths. After that it was physics and chemistry. But when I thought about university, I wanted to do something more about people. I considered philosophy, but psychology seemed more concrete. In my late teens I also started getting interested in hypnosis. I was on a summer camp when someone did a guided relaxation with some hypnotic suggestion. I tried it out myself and was both awed and scared by the power that it seemed to have. I learned a guided visualisation where you ask someone to imagine a journey through a forest, and then you ‘analyse’ their personality by the kind of things they describe. It seemed to go down very well at parties! More than anything though, I wanted to do something that would make the world a ‘better place’, and studying psychology seemed a way into that. I’ve done a lot of different things, but the desire to help create a fairer, happier world is still the ‘red thread’ that runs throughout all my work. At what stage did your interest in existentialism emerge, and was it a natural progression for you into existential therapy? I read Jean-Paul Sartre’s Roads to Freedom trilogy in my early 20s, and loved the pathos and realism of his writing. I remember one summer on a Greek island, sleeping in a cave by night and swimming in the sea and reading Sartre by day. I got so absorbed in that phenomenological, detailed way of seeing the world that I wrote a short ‘Sartre-esque’ story about meeting my girlfriend at Athens airport, and her telling me she had met someone else. The story was lousy but, as it turned out, prophetic: she had been seeing someone while I was away. Just as I was starting my PhD in my mid-20s, I saw an advert in the local paper for a counselling certificate course. I wanted to do something practical along with my academic work. The course, at City University, was a 60-student-strong unstructured group encounter based on person-centred principles: exhilarating and bruising in equal measures. I learnt an enormous amount about myself, but found the interminable negotiations over when to have a coffee break too much. After that, I was keen to train as a Gestalt therapist as I liked the dynamism of the approach. However the course I applied for wouldn’t let me join in the second year. Around the same time I’d also been interviewed for a place on the existential counselling diploma at Regents College and in the end decided to take it. I wasn’t particularly drawn towards existential therapy: I just wanted to do something humanistic-ish. Can you clarify your position on the relationship between this and the person-centred approach, both of which you’ve written on extensively? Not everyone agrees on their compatibility. Both existential and person-centred approaches are very broad spectra, so there’s no really right answer on whether they are compatible or not; it depends on which versions you are looking at. In general, though, both tend to emphasise the development of a caring, empathic therapeutic relationship, and both explore clients’ experiences in a phenomenological way. After that, the existential approaches bring in more assumptions about freedom, death, meaning etc, and the person-centred approaches bring in more assumptions around growth, actualisation and emotional processing. I tend to find both sets of assumptions fairly helpful in developing a deeper understanding – and acceptance – of clients’ experiences. You’ve also had a long involvement with counselling in schools and I believe your current role as National Advisor for Counselling for the Children and Young People’s IAPT Programme extends this involvement? Yes, and for the past two years I’ve been working on Counselling MindEd, where we’ve been developing free e-learning sessions for counsellors working with children, young people and young adults (www.minded.org.uk). The counselling in schools work is incredibly important to me because it’s a way of extending therapeutic practices and values out into the wider community. It means that tens of thousands of kids can access emotional support in their own school. It’s also really important, though, that young people can access counselling outside of schools, and I’m currently working with Youth Access to develop the evidence base for counselling in the voluntary and community sector. Through the counselling in schools research, I’ve had an opportunity to work alongside some great people at BACP, like Nancy Rowland, Karen Cromarty and Jo Pybis. I’m sure that’s been a large part of why I’ve stayed so involved for so many years. Another theme for which you’re well known is the development of research, including (often unpopular among counsellors) randomised control trials (RCTs). Are you still actively trying to get this message across? For me, the most important thing is that relational therapies are freely available to large numbers of people, and if that means compromising some of my methodological principles, I think it is worth it. Having conducted a few small scale RCTs, I’m also much more positive about them. For the participants, it’s a chance to get therapy that they wouldn’t otherwise have, and I’ve yet to hear a participant say that they felt de-humanised or manipulated. Katie McArthur wrote an excellent article about this in Therapy Today (‘RCTs: a personal experience’, Therapy Today, September 2011). I believe you’ve also trained in emotion-focused therapy (EFT). Can you tell us what attracts you to this? I’ve done a couple of introductory courses in EFT and love the way that it helps to develop the person-centred approach. I think the person-centred field owes a great debt of gratitude to EFT practitioners and researchers like Les Greenberg, Robert Elliott and Jeanne Watson. They’ve been enormously important in establishing the evidence base for person-centred and experiential practices and giving this approach a foothold in the NHS. You’ve led doctoral programmes in counselling psychology. What divisions do you see between counselling psychology (BPS/HCPC) and counselling and psychotherapy without the psychology affiliation (BACP)? Both approaches are rooted in a relational model of practice: engaging with clients in deeply valuing and respectful ways. If I had to identify some divisions, I’d say that counselling psychologists tend to draw on a wider range of methods, particularly from CBT and third wave CBT, while counsellors tend to be a bit more single orientation. Counselling psychologists also tend to draw more from the psychological. Having said that, for me, the commonalities are much more important than the differences. I just wish there was more collaboration between the two professions: for instance, on developing the evidence base for relational practices. Relational depth is another of the themes with which you’re associated. What new research and clinical threads are emerging within this theme? We published a new edited book in 2013 entitled Relational depth: new perspectives and developments (Palgrave). It’s got some really interesting new research in there. Sue Wiggins, for instance, developed a measure of relational depth, and went on to show that it was correlated with positive therapeutic outcomes. And Rosanne Knox looked at clients’ experiences of relational depth, and what they think helps to bring it about. A major theme that comes out is the importance for clients of feeling genuinely cared for by the therapist. This is more than just non-judgmental acceptance; it’s about clients feeling that they really matter to their therapists. And pluralism and pluralistic therapy, which you and John McLeod have pioneered – where is that development heading now? I’d like to think there was something really important in what John and I were trying to say, even if our first attempts to express it were clunky at times. It’s not about working in an integrative way, per se, or the structure of ‘goals’, ‘tasks’ and ‘methods’. The really critical point for me was about developing shared decision making with clients and, more than that, creating a framework that helps us to think openly, non-defensively and creatively about what’s most helpful in therapy. In the last few years, we’ve had some great new people come on board with this pluralistic project. We’ve just finished a multi-site study of pluralistic therapy for depression with Tony Ward (University of the West of England) and Biljana van Rijn (Metanoia Institute), and Windy Dryden and I are editing a handbook of pluralistic therapy for Sage. I’ve also really valued it when people challenge the way John and I formulated things and suggest new and better ways of articulating a pluralistic approach. I believe you’ve had an interest in the political aspects of therapy but perhaps you’re not so well known for this? Yes, I grew up in a communist household and was interested in anarchist politics in my late teens. So issues of social justice and change were with me from the very start. One thing I feel particularly passionate about is extending our learning about human wellbeing and relating into the wider political field. As therapists, we’ve learnt about what people need to thrive and to relate to each other in empathic and cooperative ways, and that knowledge could be so helpful in creating a better and fairer society. For instance, I think we could make a massive difference to society if there was more emotional literacy training in schools. I’ve tried to write about this, and really hope I can do more in the near future. You recently moved from Strathclyde to Roehampton University. What was behind your move, and where will it take you? I’m a born-and-bred north Londoner, and always had a yearning to go back down south. Our older kids also often talked about going back to Brighton where they were born, though when it came to it they were distraught at leaving friends. I was also really excited about going to the University of Roehampton, where there’s so much going on in the counselling and psychotherapy field. We have courses, for instance, on play therapy, art therapy and integrative therapy, as well as the doctorate in counselling psychology, and there are some great new colleagues. A lot of my role will be to lead on research, and we’ve recently set up CREST: the Centre for Research in Social and psychological Transformation. So I’m hoping we can conduct studies that will help to establish and extend relational practices, as well as developing the interface between social and psychological models of change. I understand you have a large family – how well do your busy professional life and family commitments co-exist? My wife, Helen, and I have four kids: Zac (7), Shula (9), Ruby (12) and Maya (14). Helen is fantastic – not just at multi-tasking but at omni-tasking – and without her there would be no way of doing this much. But I am away or working quite a lot of the time, and the irony of being apart from my kids because I’m presenting a paper on child mental wellbeing isn’t lost on me! I guess one thing I do is try and find something specific to connect with each of our kids on. With my daughter Shula, for instance, who has been diagnosed with Asperger’s (which she asked me to say), we have chats at bedtime about things like disabilities and what it would be like to be a conjoined twin (her favourite topic). So I guess I try and make up for quantity with as much quality of connection as possible. +++
How I became a therapist Jeremy Christey Jeremy Christey is the new Chair of BACP Universities & Colleges I come from a Manchester background. My father is down on my birth certificate as a ribbon and tape weaver, having worked in the mills of Lancashire. My mother was a cleaner. They came to London to give me a different start to life. There’s a wonderful black and white photograph of my mother, pregnant, at a mainline London station, starting a new life. Undiagnosed dyslexia in childhood meant that when I left school at 16 I was only really any good at woodwork. I had another bash getting into a traditional education, but both the college and I failed at that too. I ended up on the dole at my parents’ house, now out of town, with sinking mood and sinking prospects. With no qualifications I had approximately zero chance of finding work in the recession of the early 1980s. So I blagged my way into some voluntary work and moved back to central London. Someone suggested that I was a good listener and pointed out social work to me, and I developed a portfolio of experience so I could apply to university as a mature student. I volunteered at a hospital for the elderly, used that as an opportunity to move into residential social work and live-in posts in an adolescent therapeutic community, a unit for homeless men and a (unique and somewhat chaotic) drug rehab centre for people still using opiates. Keyworker interactions with individual residents, the more intimate and influential conversations, were the areas of the work that I most enjoyed and I started accumulating as much training as I could. Over the years I accumulated thousands of hours of topic-based short courses, hung around more substantive counselling trainings, starting with personal construct psychology in 1986, then an integrative (principally humanistic) postgraduate diploma in the early 1990s and a counselling psychology masters as a mature student, focusing on the psychodynamic traditions. I was stunned that there was theory behind these therapeutic conversations and soaked up as much of it as I could. With HIV taking a foothold in the drug-using community, I started that as a specialism and worked at an HIV service launched by the first wave of gay men affected by the disease in Brighton. I then specialised as an HIV counsellor working in the NHS, and started private practice in the early 1990s in primary care. Primary care was where I cut my teeth on pragmatic methods in shorter-term, focused work. Despite being a good student, I experienced a limit to what I could bring to the humanistic approaches. I changed to a psychodynamic gear, did the three-times-a-week analysis, applied a good blank screen to the work and tried my best to work with the emerging relational issues – to begin with at least. This proved too much of a withholding approach, and obviously more activity was required for shorter-term work. The theories of the shorter dynamic ways of working opened up a less evangelistic approach – a strategic pragmatism of acknowledging early experience but working more with the effect of that in current relationships. I have settled with this approach now, toggling between the past and present, but mostly with a present, change-focused approach. Discovering the relational and dynamic foundations of CBT drew me into training in that approach, and I use that as well as the psychodynamic traditions, very much as Beck had in mind. I have trained with Tim and Judith Beck in recent years as a CBT therapist and have passed on some of this in training cohorts of UK CBT therapists, with that balance of sensitivity to the relational but within the well-evidenced world of CBT formulation and interventions. I am now balancing my clinical and directing work. I am a counsellor/psychotherapist with the University of Sussex Counselling Service and Project Director for Students Against Depression, a very well used website of resources and interventions for depression in young people. Harnessing the talents of the pool of motivated young people who shape the website has taken me back to my HIV campaigning work nearly 30 years ago. I have thrived on the challenge and versatility of working with differing modalities and I hope I can apply some of this in my new role as Chair of BACP Universities & Counsellors. +++
Letters If not us, who will help them? The letter from Carol Jones in the September issue of Therapy Today resonated totally with my own experiences and perspective. I too have funded my own training and expended years of blood, sweat and more than a few tears to become the practitioner I am today, with a holistic approach to each unique and individual client who appears before me in the counselling room. I too hoped for better things when GPs were charged with heading up and being responsible for the Clinical Commissioning Groups (CCGs), but this has once again ended in disappointment. I see those prepared to jump on the Government’s CBT bandwagon being regarded as the ‘right stuff’, while much more experienced counsellors are sidelined or, as Carol states, deemed ‘unsafe’ by NICE. Why? Well one reason is that, as ethical practitioners, we are unable to blow our own trumpets to any great degree when it comes to positive outcomes, and this really doesn’t fit in with the tick box culture of evidence criteria and the practice of recording positive clinical outcomes. How indeed do you capture someone’s life changing on a spreadsheet? Which box do you tick? If we could shout about our success stories from the rooftops, maybe we might gain some recognition for the valuable but largely unsung work we do, week in week out, away from the limelight (and the funding). My hopes were raised dramatically recently when I received an answerphone message from a man claiming to represent the CCG for GP surgeries in my area, asking if I would be interested in taking referrals from surgeries in the city. Would I call him back, please? Would I?? My spirits soared, but after several unsuccessful attempts to call him back (and an excited call to my supervisor), I contacted the CCG and was informed that they had never heard of this individual. I had to conclude that this had been a prank call. An odd thing to make a joke of something so important – I failed to see the funny side. In my mind, I had imagined the scenario: a grateful client returning to their GP who, astonished at the improved wellbeing of the client, contacts the CCG etc, etc. Maybe I should have been less naive, but I live in the hope that one day the powers that be will wake up and see the incredible resource for mental health that is just going to waste in this country. Like Carol, I feel being deemed ‘unsafe’ by NICE is insulting to those of us who work tirelessly and largely unrewarded in the voluntary sector, as very few opportunities exist for us to obtain paid work. I have a small private practice as a lone practitioner, and I mean small (typically two to three clients at any one time) and work with survivors of rape and child sexual abuse at a rape centre one to two days a week in a predominantly unpaid capacity. My only other income comes from casual waitressing to make ends meet! In what other profession would you be expected to work unpaid after a long and arduous training, having gained years of valuable experience in trauma and alleviating distress? You only have to look in the Therapy Today recruitment section to see how few paid posts are available for experienced counsellors, but there are chances aplenty to work for nothing. Some might say that I am foolish in the extreme to continue, but it’s hard to walk away from clients like ours. If not me, then who will help? And Ora Dresner from the Camden Psychotherapy Unit is right (‘A slice of the cake’, July Therapy Today): eight sessions of CBT is not the answer for those with more complex issues, and it never was. We are badly letting down people in need in this country, and why, when people like Carol and I just want the opportunity to practise without having to abandon our effectiveness, professional ethics and principles to ‘fit in’ to a failing system? For me and many others working in a similar way, counselling is not just a nice little hobby meriting a pat on the head (which was all my patronising MP had to offer). Counsellors like me all over the country are offering professional, effective and credible long-term solutions for those in great distress, and there are many such people out there without access to any sort of appropriate service at all. It’s high time this wasted valuable resource was recognised and used. Time indeed to wake up to reality. Jill Davies Member MBACP Suicide and mental disorder
Doctoral research student at University of Gloucestershire; counsellor with Listening Post. Email soper@mindwealth.uk Reference: 1. Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E. Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. Journal of Traumatic Stress 1998; 11(1): 103–112. Hit by reality of an unviable career Following several articles in Therapy Today concerning the lack of paid opportunities for newly qualified counsellors, I am writing to give my experiences as a trainee who has considered giving up the idea of counselling as a career, due to financial constraints. It is well documented that there is a dearth of paid work for the newly qualified. The reality of the situation hit me when, a year into the course, I attended a placement open day at a low-cost service and learned that most of their counsellors had continued to work on a voluntary basis after qualifying. When I asked one of the counsellors what the situation was regarding pay, she said dismissively, ‘Oh you don’t go into counselling to get rich.’ Students on placement were required to pay £32 every four weeks for supervision. Another agency I approached charges students £12 per week for placements and a one-off fee of £50. Clearly it would take me years to accrue the minimum of 450 client hours required for most jobs (including those in the NHS) and I would have to commit to working unpaid while doing so. My household income is low and this would make life very difficult. The main cost of training for me would be lost earnings rather than course fees or therapy. I would be in my early 50s when qualified and feel that I am unlikely to recoup this financial outlay through paid counselling work (either in private practice or agency work). Let’s face it, the idea that counselling is a profession of middle-class helpers is entirely accurate. I believe it is akin to the situation with internships in the arts and media; certain career paths are now open only to the affluent. The training I have received has been wonderful and I cannot fault the guidance I have received from my tutors. But I have become entirely disillusioned with the idea of counselling as a viable means of making a living (even a very modest one). Name withheld Same old anti-CBT arguments Reading Catherine Jackson’s review of Thrive, Layard and Clarke’s book about CBT (Reviews, Therapy Today, September 2014), I was surprised that she said it was mainly about CBT. Similar things could be said about the person-centred and Gestalt books reviewed in the same issue of the journal. I would assume a book review would contain both elements of good and bad in equal parts, finding the middle ground for others to make their mind up on purchasing the book. However, what I found was that it became an opportunity for Catherine to vent her feelings on the two authors, politics, NICE and CBT in IAPT services. After two paragraphs it was almost like Catherine couldn’t wait to get the book review out of the way and get on her soap box about the ‘same old, same old’ arguments that have been raised since IAPT was implemented in England. Her first sentence sets the tone with the word ‘self-congratulatory’. Leaving orientation out of this for one moment, Layard and Clarke do deserve to congratulate themselves because, thanks to them, £173 million was invested in the mental health of England. Let’s acknowledge that 15 per cent of the population are receiving more therapy now than ever before. In time we will get it right and we will be able to offer people the right therapy at the right time. Let’s at least become a little optimistic in achieving this. I do agree with Catherine that services still have not got this quite right. I would invite Catherine to find a way to move forward with these same arguments. Those arguments, like IAPT services, have moved on. Government, commissioners and services are willing to move on, learn some lessons and embrace other modalities. Isn’t this one of the reasons why Counselling for Depression is now a commonly accepted treatment in IAPT services? We are also moving forward in research to find ways of evidencing other modalities. What really interests me is that this reviewer is Deputy Editor of Therapy Today, a journal from an organisation that embraces all modalities. I wonder what some of the members are thinking and feeling when they continually read, or have to listen to, the slating of IAPT services or CBT? How many training courses accredited by BACP use CBT as part of their integration model? How many of the readers reading that book review are in IAPT services themselves, or trainers of CBT or integrative counsellors using CBT in their practice? So what is Catherine saying about her fellow colleagues? The review reads as judgmental, cynical, condescending and rude. Her last sentence captures this when it says that only advocates of CBT will enjoy this book and others of a critical stance will be further enraged. There is a separation and divide here of the different orientations and I am definitely not comfortable with that. This is how I’d describe the book if I were to review it. ‘Thrive is a decent, easy to read, jargon-free book giving an understanding of mental health. It would suit student, seasoned practitioner, commissioner and service manager with its two parts discussing the problem with mental health and what can be done. Within those parts there are useful chapters on how many people suffer with mental illness, how it affects people’s lives and what is the economic and social cost. There are also good chapters on what works for whom where modalities like EMDR, short-term psychodynamic therapy and interpersonal therapy are offered. There is also a great chapter on young people and a further chapter on how we could all work together to create a better culture on mental health. This book of course is part of the CBT family and might not suit everyone but nevertheless, with simple short chapters and plenty of graphs and illustrations, it is a book to keep on the shelf to remind ourselves why we do the work we do for those who suffer from distress.’ In order to thrive in life we have to continually move forward. In the talking therapies what is going to help is a united front, supporting one another and the modalities we choose to practise from. Let’s in future keep the reviews (as the journal’s guidelines suggest) as an overview of the book, its strengths and weaknesses, usefulness and to which audience it is best suited. Elaine Davies Out-dated mode of education In response to the letters in the September issue entitled ‘Positive experiences of boarding’ (Caroline Elliott) and ‘School is only one influence on children’ (David Gladwell), I would suggest reading Nick Duffell’s first book The Making of Them, where he does not discount other influences on children’s lives, and nor does he discount the possibility of boarding school for children at 16 when they can make an informed choice. His concerns are for younger children and the many children who have been sexually, physically and emotionally abused at boarding schools, and his assertions are evidence-based from his therapy practice. Currently 130 private schools in this country have recently been or are currently under investigation after allegations of abuse.1 I am extremely glad that someone like Nick Duffell is focusing on these less publicised child protection issues. As Caroline Elliott points out in her letter, there may be children who benefit from boarding who come from homes where there is serious disruption or parents unable to provide a loving environment. However, this makes boarding schools seem rather more like social service children’s homes than establishments of excellence in education, their success depending on parents who, for whatever reason, feel unable to provide a suitable home environment. As a parent of two children, now adults, I cannot imagine ever having wanted to send them to boarding school. Both my children thrived well at inner-city comprehensives. I loved picking them up from school or being at home for them when they arrived back from school, helping them with their homework, hearing about their day, meeting their friends, cooking their dinner and everything else. If they, or I, were away for a weekend, I missed them and looked forward to seeing them. Being unnecessarily separated from my children for two-thirds of the year was unimaginable. In fact I would have been heart-broken. Most boarding schools today recommend a complete severance of contact with home for the first three weeks of boarding. What is it like to endure that as a parent of an eight-, nine- or 10-year-old? And how does that make a child feel? It is generally accepted that children suffer from homesickness when they first go to boarding school and I am surprised that David Gladwell did not feel a ‘wrench’ at first, even if he went on later to find positive experiences. He does, however, mention the ‘considerable emotional (and financial) cost’ for his parents. For the past 10 years I have worked in Sure Start Children’s Centres, working with postnatal depression and facilitating Solihull attachment-based parenting groups. I hope I have not misunderstood attachment theory, but to my mind there are very few circumstances, if any, that justify the existence of boarding schools. Even if you think there may be positives, I would say there are certainly better ways than this to bring up your children and help them become responsible, sociable and emotionally intelligent adults, and better ways as well to cope with difficult home circumstances. Boarding schools were set up in the days when Britain was a colonial power, to provide education ‘back home’ for children of colonial administrators. Surely it is time that this out-dated mode of education was abandoned? Val Harding Dip Couns; MSc intercultural therapy Reference: 1. See http://boardingconcern.org.uk David Smail (1938–2014): an appreciation It was David Smail’s singular achievement to have set out an understanding of emotional suffering based firmly in reality. In a series of books, starting with The Treatment of Mental Illness (1969), co-written with TM Caine, to his last, Power, Interest and Psychology (2005), he argued that people’s problems were invariably and inevitably to do with our vulnerabilities as embodied beings or with our exposure to ‘noxious social influences’ that have their origins, most often, ‘far beyond the orbit of our personal lives’. Reflecting on his first encounters, as a young clinical psychologist, with those diagnosed ‘mentally ill’ in the large asylums, David said: ‘Even the most severely disturbed didn’t appear ill so much as confused and despairing, beside themselves sometimes with frustration, grief or rage; the less disturbed... were at least profoundly unhappy.’ There was, he went on, ‘if you bothered to talk to them, not one whose life story did not abound with good reasons for their distress’. He was being in no way ironic when he said it was Margaret Thatcher who taught him to see in all its awfulness what the social environment did in producing human unhappiness and misery. The ‘utter soulless, callous indifference’ of those years towards ordinary people made it obvious to him that what matters in psychological wellbeing is not ‘responsibility’ or ‘self reliance’ or ‘initiative’, however these are presented, but ‘the provision within society of material resources’. Denied them, what is the result? The damaged and derived seek help ‘in droves, mostly bemused and blaming themselves for what they saw as their own inadequacies’. A courageous writer, taking on many deeply held assumptions, David was also an original one. He was well read, far beyond the confines of psychology, but re-reading him is to be struck by how much thinking he was doing for himself. It’s like he kept asking the simple questions: why are people suffering and in these ways? What causes this? Why do we believe what we believe? It is because we feel things to be inside us that we look inside, as it were, for the solution to our difficulties, and we are too easily encouraged to do this by many professionals. But this way of thinking is itself a product of culture; culture defines the meaning of experience and all the evaluations we make of ourselves and each other are shaped by culture. We have come, he said, to regard emotional pain and suffering as not just abnormal but unnatural. We believe we have a right to have it removed, and so we turn to supposed experts. We never think that what we feel is normal – almost by definition it’s not – and the result is anxiety and shame. For instance, post-traumatic stress, he said, has become a disorder rather than a completely understandable response to a traumatic situation. In this context psychotherapy is, at best, a form of solidarity, of comfort and encouragement and demystification; at worst, it is itself a form of mystification, blaming people for their own difficulties. David could be excoriating in his criticism of therapy: psychoanalysis, ‘a quite extraordinary moralistic approach’ to ‘neurotics suffering’; humanistic approaches that could ‘drip with uplifting precepts and blueprints’. Psychotherapy, especially as it became more respectable, literally could not afford to see that people may well be willing to change but simply lack the power and resources to do so. It was part of David’s project to re-empower individuals who were suffering; ‘how to survive without psychotherapy’ is, after all, the understandably provocative title he chose for one of his books. But he also challenged what he called, ‘the tyranny of normality’. He wanted people to trust their own experience: ‘Nobody has been where you have been at the same time you’ve been there and with the same people,’ he wrote. ‘Only you know what your life has been like.’ David wrote lucidly, with not one word of what he called ‘mumbo-jumbo’, and everything he said was underpinned by a lifetime working as a clinical psychologist in the health service and, after retirement, as a student counsellor. Who can argue with this statement, which could be seen to summarise a great deal of what he was arguing: ‘As things are, the hugely unequal distribution of power works against the vast majority of people being able to live a life in which insecurity, anxiety, confusion, ignorance and pain are kept to a minimum. For things to improve for the majority, power would have to be redistributed.’ These are some of David’s key writings: Illusion and Reality: the meaning of anxiety (1984); Taking Care: an alternative to therapy (1986); How to Survive Without Psychotherapy (1996), and Power, Interest and Psychology: elements of a social materialist understanding of distress, published in 2005. Paul Gordon Contact us We welcome your letters. Letters that are not published in the journal may be published online on the Therapy Today website – TherapyToday.net – subject to editorial discretion. Please email the editor at therapytoday@bacp.co.uk +++
Reviews From fixity to fluidity Person-centred communication: theory, skills and practice Renate Motschnig and Ladislav Nykl Open University Press, 2014 256pp, £28.99 ISBN 978-0335247288 Reviewed by Mike Gallant This inspiring work is not primarily about counselling practice; it is a book that encapsulates the nature of the person-centred approach (PCA) as a ‘way of being’ rather than a school of therapy. Rogers’ later writings and practice were very much to do with the application of a solidly grounded theory of human personality development to diplomacy and international relations, so it is not too surprising to see a book that applies his philosophy to personal, systemic and organisational settings, as well as to counselling psychology. Emanating from Vienna, the book has a contemporary continental flavour, both in its relational post-humanistic approach and in the writing itself. Having said this, the book constantly refers back to basic tenets of the original Rogerian approach, freely quoting him alongside succinct case studies and useful text box invitations to the reader to reflect on potential learning points. The first half of the book sets out the theory and the skills required in applying the PCA across a wide range of settings. This is not a book dominated by psychotherapeutic practice, although I found myself disappointed that the majority of examples are taken from this area of application. In the second half the authors examine the approach in practice, including useful observations about online and other written communication, its use in learning and teaching and the nature of dialogue and encounter. So, apart from person-centred course tutors, who is this book aimed at? The authors make a credible case for the global applicability of the PCA, despite its mid-20th century, Western, privileged, male origins. In my opinion this book should be read by every potential power-wielding human being likely to make any impact on the world! It certainly gave me a warm sense of validation, and I would especially recommend it to practitioners of other modalities who wish to gain a broad understanding of what is sometimes, unreasonably, viewed as a simplistic and possibly utopian vision of how individuals, groups, organisations and societies can grow from fixity to a fluidity that embraces difference and equality. Mike Gallant is Senior Teaching Fellow (Counselling & Psychotherapy) at Warwick University For further information about the book, please visit http://www.mheducation.co.uk/html/0335247288.html The mind–body split Touching the relational edge: body psychotherapy Asaf Rolef Ben-Shahar Karnac, 2014 416pp, £39.99 ISBN 978-1782200949
Directory: docs -> doc doc -> Ap english Language and Composition doc -> 2 Pre Columbian-1775 Land bridge- american Revolution doc -> Achievements (2013-14) 2013-14 Another year of coveted credentials at dps vindhyanagar doc -> International Journal of Enhanced Research Publications, issn: 2319-7471 doc -> Review on Wireless Sensor Network Techniques for Security in Railways doc -> Service provider access in mobile networks doc -> Design and Implementation of Home Energy Management System Based on gsm network doc -> Annual Meeting Press Policy asa’s 105th Annual Meeting: Toward a Sociology of Citizenship doc -> Explanatory memorandum introduction Download 465.67 Kb. Share with your friends:
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