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Therapy Today July 2014 Volume 25 Issue 6

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+++ Contents

Features

A slice of the cake Catherine Jackson explores the challenges facing the third sector as NHS counselling services are put out to tender.

Wounded leaders Nick Duffell argues that our political leadership is fatally flawed by the emotional scars of a boarding school education.

A hand across cyberspace Jane Fahy describes an international online counselling service for people with gambling addiction.

Congruence or criticism? Nicola Davies highlights the ease with which ‘congruence’ can turn into bullying in the context of counsellor training.

Tenuous contact Peter Pearce and Ros Sewell discuss their new concept that seeks to capture the fragility of the counselling relationship with young clients.

Regulars

Editorial

Columns Jeanine Connor Chris Rosie Dansey Barry McInnes

Talking point Claire Thomas

Dilemmas Working with two therapists The interview William West

How I became a therapist Nash Popovic

Letters

Reviews

From the Chair

BACP News

Public affairs

Professional conduct

BACP Research

Professional standards

TherapyToday.net

In ‘From the archive’ Nick Duffell describes the emotional damage to children of a boarding school education; Christine Rösch writes about the inspirations behind her pictures. Plus the latest online news, reviews and noticeboard. +++ Editorial

You may have read the recent, very powerful Observer article by Alex Renton detailing his personal account of abuse and neglect in boarding school in the 1960s and 70s. He concludes his article with some words about parents today who have chosen to send their children to boarding school: ‘For convenience, or notions of status, or just because they did not love them enough, [they are] taking a mad gamble with their children’s emotional health, with their lives.’

In response, a letter calling for an end to early boarding and signed by a number of senior psychotherapists was sent to the Observer. ‘Attachment theory,’ they write, ‘plus the work of clinicians over the last two decades and now the findings of neuroscience leave no doubt about the psycho-emotional consequences of depriving children of touch, warmth and a “secure base”.’ Of course children who live at home can be equally deprived of touch, warmth and a secure base, but we do understand enough about attachment theory and emotional development to know that sending a young child away to school can risk lifelong emotional damage.

In this issue one of the signatories of the Observer letter, Nick Duffell, examines the effects of a boarding school education on our political leaders. He argues that it is our unique boarding system that maintains our class structure, resulting in a divided, top-down society rather than a true social democracy, and producing leaders with ‘unacknowledged psychodynamics’.

Nick argues that children sent away to board at a young age, like our current Prime Minister, must learn to survive rather than to relate, which he sees reflected in David Cameron’s political style, and particularly in his attitude towards Europe. And, having no truck with vulnerability from a young age, ex-boarder politicians cannot understand the vulnerable but can only create a culture for winners.

Sarah Browne Editor +++ News

‘Devastating’ cuts to CAMHS

Cuts in children’s mental health service budgets have devastated children’s mental health services and created a national crisis, YoungMinds has warned.

Based on Freedom of Information requests to every NHS clinical commissioning group (CCG) and ‘upper tier’ local authority in England, YoungMinds says 77 per cent of NHS CCGs (74 out of 96) have frozen or cut their CAMHS budgets between 2013/2014 and 2014/2015; 60 per cent (59 out of 98) of local authorities in England have cut or frozen their CAMHS budgets since 2010/2011, and 55 per cent (56 out of the 101 local authorities in England that supplied data) have cut, frozen or increased their budgets below the rate of inflation between 2013/2014 and 2014/2015.

YoungMinds says NHS England should instruct CCGs to immediately prioritise the resourcing of children and young people’s mental health, with particular regard to early intervention and prevention.

‘While the Government has prioritised children and young people’s mental health, spending in local areas, where lives are directly affected, does not reflect this – so now we are seeing services in crisis,’ Sarah Brennan, YoungMinds Chief Executive said. ‘Clinicians tell us that their services are at breaking point. As a result they are forced to increase thresholds, which means only the children with the most severe illness receive care.’

Responding to the survey, Care and Support Minister Norman Lamb said: ‘We’ve set out plans to improve care for young people and I would urge everyone to put pressure on local commissioners to make sure children’s mental health gets its fair share.’

Six sessions are ‘too short’ says Layard

IAPT treatment should not be limited to just six sessions, Professor Richard Layard says in a new book, Thrive, co-authored with psychologist Professor David Clark and published by Allen Lane.

In the book they call for the capacity of IAPT to be doubled. They propose that an ‘adequate’ therapy service would be able to treat at least four per cent of the adult population in a year.

They say the therapy ‘would be evidence based but it would not be the cheapest possible variant that commissioners could get away with – like “six sessions maximum”. We would never propose half a course of treatment for a physical condition, nor should we for a mental illness.’

Parents want more PSHE

Nine out of 10 parents want schools to provide more teaching about mental health and emotional wellbeing, alongside academic subjects, a YouGov survey for the PSHE Association has found. But the Association says PSHE education is getting pushed off the curriculum in many schools. In a survey of 400 of its members, representing some 4,500 schools, 59 per cent said current PSHE teaching was inadequate, getting worse or at risk; 71 per cent said it had been reduced, and just 40 per cent said teachers in their school were adequately trained to deliver it. The majority (79 per cent) wanted statutory PSHE education.

The Association has published an evidence briefing on the benefits of PSHE for children’s personal, social and academic skills. www.pshe-association.org.uk/evidence

Commission urges ‘pursuit of happiness’

The Government must do much more to promote ‘happiness’ and reduce the human and economic burden of mental illness in England, a report from the independent CentreForum Mental Health Commission has said.

The Commission is chaired by former Minister for Health Paul Burstow. Its 12-month inquiry into mental wellbeing in England concludes that the ‘pursuit of happiness’ must be made an ‘explicit and measurable goal of government’. It calls for a National Wellbeing Programme to promote ‘mutual support, self-care and recovery’, and reduce stigma; more investment in the mental health of children and young people, including increased access to psychological and other therapies in schools or in the community for children with mild to moderate mental health problems, and action to make workplaces mental health friendly.

It says the Government should require the NHS to provide a ‘full range of evidence- based psychological therapies in primary care to everyone who needs them’, including children and young people, together with GP social prescribing.

It also calls for parity of funding for mental health, which it says currently receives 13 per cent of NHS spending in England but accounts for 23 per cent of demand. http://www.centreforum.org/assets/pubs/the-pursuit-of-happiness.pdf

More people seek counselling

Increasing numbers of people in the UK have consulted a counsellor or psychotherapist, amid growing public awareness of the need to take care of our emotional health, a national survey commissioned by BACP suggests.

The 2014 public attitudes survey was conducted by Ipsos MORI in March. A total of 2,084 adults aged 16–75 from across the UK took part.

Some 28 per cent of people said they had sought help from a counsellor or psychotherapist, seven per cent more than in 2010 when BACP last surveyed public attitudes to counselling.

Overall, 54 per cent had seen a counsellor or psychotherapist or knew a family member, friend or work colleague who had. Nearly a third (32 per cent) of women had consulted a counsellor/psychotherapist, compared with 23 per cent of men. At 38 per cent, people aged 35–44 were most likely to have had counselling or psychotherapy.

The survey also revealed a growing acceptance of counselling in the general public. In a 2004 BACP survey, 60 per cent of people agreed that ‘people today spend too much time dwelling on their emotional difficulties’; in 2014 this had dropped to 39 per cent, with least agreement among 16–24 year olds (36 per cent) and most among people over 55 (46 per cent). In 2010, 39 per cent of people agreed that ‘It is self- indulgent to seek counselling or psychotherapy if you do not have a serious health problem’; in 2014 this had dropped to 30 per cent. Two thirds (64 per cent) of respondents said that counselling should be available to all school children in schools, and 69 per cent felt that the world would be a better place if people talked about their feelings more.

However, only five per cent said they would go first to a counsellor if they had emotional or mental health problems; most (38 per cent) said they would consult their GP, and 15 per cent would talk to a family member first.

The majority (76 per cent) said they’d prefer to speak to a counsellor face-to-face; nine per cent said they’d prefer to speak online, although this rose to 16 per cent among the 16–24 age group.

See http://tinyurl.com/lura8lt

Emotional overeating overlooked, survey shows

Emotional overeating is a major psychological problem that is often misunderstood by health professionals, a survey by the eating disorders charity Beat has found.

Of the 857 respondents, 88 per cent said they overate for emotional reasons, such as feeling low, anxious, lonely or because they couldn’t cope with difficult feelings. Of the 48 per cent who sought medical help, 73 per cent said their GP did not investigate their emotional health. Other health professionals were only slightly more helpful, respondents said, and most focused on diet (reported by 73 per cent) or exercise (19 per cent); only 7.6 per cent said the health professional showed interest in their mental/emotional health.

The survey also reveals the social pressures on people with emotional overeating problems: 85 per cent had a negative body image, 79 per cent felt under pressure to lose weight, and 76 per cent had low self-esteem. One respondent said: ‘Instead of being supportive, people assume that you are just greedy and lazy.’

Beat has launched a campaign to eradicate the stigma and misunderstanding attached to the problem.

Wilful neglect to be a crime

Health and social care workers and professionals could risk a criminal sentence if found guilty of deliberately neglecting or mistreating their patients.

The Government has tabled an amendment to the Criminal Justice and Courts Bill that would make ‘wilful or reckless neglect or mistreatment’ of adults in any statutory, independent or voluntary sector health and social care service punishable by up to five years in prison and a maximum £5,000 fine. Individuals and organisations would be liable to prosecution.

Currently there is only legislation to protect children and adults who lack mental capacity or who are sectioned under the Mental Health Act; no legal protection exists for adults.

COSCA wins PSA approval

COSCA, the national counselling association in Scotland, has become the latest professional body to have its voluntary register accredited by the Professional Standards Agency.

This brings to 12 the total number of voluntary registers of therapy practitioners in the UK accredited by the Authority, of which seven are for professions working in mental/emotional health and five in physical health. +++ In practice

Seeds of hope and potential

Jeanine Connor

This year, 6 June marked the 70th anniversary of the D-Day landings – the beginning of the end of World War II. On 4 August we mark the centenary of the outbreak of World War I. Summer 2014 has a distinctly commemorative feel. Until a few years ago, my knowledge about World War I consisted of sketchy memories of war poetry I’d reluctantly read at school. So it was with some ambivalence that I took the opportunity to visit the Somme area of France. During my stay I became immersed in its history, desperate to improve my meagre understanding of the atrocities of World War I. I visited countless cemeteries and gazed with awe at immaculate row upon immaculate row of war graves. What I found most striking about the Somme was its vastness and its immense beauty. It is truly breathtaking how vile and bloody battlefields have been transformed into the serenely exquisite memorials that stand in their place today. The experience of bearing witness to this was the epitome of poignancy.

And of course there are poppies. Papaver rhoeas (field poppy) has an innate capacity for survival. Every flower head contains over 1,000 seeds, each with the potential to become a new plant. Those seeds, once dispersed, lie dormant in the earth until they are disturbed and exposed to light. Perhaps this is why the poppy has long literary associations with sleep, torpor and homoeroticism. One hundred years ago the Western Front was reduced to mud and trenches. But when the fighting ceased, hidden seeds germinated in the fields and craters, creating miraculous swathes of red poppies. Their colour reflected the bloodshed and the Royal British Legion adopted the flower as its ubiquitous emblem.

There is much symbolism in the imagery of war that feels pertinent to my therapeutic work. Often when I meet families they tell me about the battles at home: the fighting, futility and hopelessness. They express despair and despondency. They describe separations without hope of reconciliation. I hear about verbal attacks and abuse, as well as physical assault, rape and violence. Some clients describe the internal war raging within them, and their tireless fight against psychological demons that are an omnipresent enemy. It is human instinct to turn away, not to want to listen or learn about other people’s bitter experiences, just as some people turn away from images of conflict.

But therapists in practice have a different instinct that encompasses a desire to hear our clients’ stories and visualise their awful realities. We are curious and empathic. We can hear the unspeakable and we do ponder the unthinkable. And we are rewarded with the opportunity to facilitate change, to awaken the latent hope that we know must be hidden somewhere beneath the hopeless devastation that our clients share with us.

The poppy would make a fitting emblem for therapy – or, rather, for clients in therapy. Not because of its connotations with bloodshed and oblivion but for its extraordinary robustness and its potential to endure suffering and regenerate and survive even the most ferocious experiences. In each of our clients there are minute seeds of hope and potential. There is also an innate instinct to survive, emotionally and psychologically as well as physically. When our clients come to us, the seeds of hope are often dormant and buried deep within. Our role is to unearth them (sometimes by shaking things up a little!). We shed light by illuminating our client’s realities: their strengths and difficulties, what can change and what is unchangeable. We fertilise their potential with care and attention. We bear witness as the seeds flourish and our clients emerge psychologically and emotionally more robust, ready to survive and shape the future.

So, as we commemorate the two World Wars this summer, let us also be reminded, in the symbolism of the poppy, of our clients’ battles and of the journeys on which we accompany them, through devastation, depression and dormancy to something alive and hopeful. This summer, and always, let us remember them all.

Jeanine Connor MBACP works as a Specialist Child and Adolescent Psychodynamic Psychotherapist in private practice and in Specialist Tier 3 CAMHS and is also a writer. Visit www.seapsychotherapy.co.uk +++ In the client’s chair

Amazing to be myself

We’d gone to Relate. Jan, my wife, organised it and I went along for the sake of peace. I loved it. For the first time I could say how I truly felt. Our counsellor asked me to say what I wanted. I came out with two things: time for me and my own bank account and credit card. And, critically, no questions asked. Jan wanted to be desired.

I did desire her at first but five years of infertility treatment killed sex for us. By the time we had two beautiful daughters, sex had become a chore. I started to ache after gay guys. When we finally went to Relate, I nearly asked to see the counsellor on my own to tell her why I no longer desired Jan, but I was too scared.

Relate was the start of my self-discovery. I was 47. To start with, I didn’t do a lot with my new resources. I saw them as keys to explore things I had always wanted. I went to night classes to study psychology and philosophy. I did an Alpha course and re- awakened my faith and spirituality, becoming a Quaker.

I was out walking one day with my friend Neil, who had recently walked out on his wife and was suffering from depression. Neil told me that he was struggling with his sexuality. We walked on in silence. Finally I told him I was struggling with the same issues.

Over a few weeks I shared with Neil that my first sexual experience was with two older boys at boarding school when I was 11. It went on for most of my first year. Neil asked if it had ever occurred to me that what the older boys had done with me at school was abuse. It was as though a steamroller came crashing through the wall.

I got on the internet and searched for resources to help victims of abuse. I found a book, Victims No Longer, and bought it. It had a list of contacts. One was for Survivors UK, an organisation offering support and therapy for survivors of sexual abuse and rape. I rang and Neil and I went together to meet the guy, and that’s how we joined the weekly therapy group.

The first session was hell. There were about eight guys present. I sat on an armchair curled up in a foetal position and left the session halfway through to sit on the stairs.

The next session felt better. The format was for us to tell the group briefly about what was going on in our lives under the headings ‘Trauma, trivia, joy’, and then fall into discussion about a topic that emerged. There was no structure to the remainder of the session.

It was hard to talk so openly but I learned that once something had been dragged out of me it always fell into a better place. But it also always shattered me. I learned that the more shattered I was, the bigger the mental event had been and the better a place I then got to with it.

The great thing about the group was that they hacked into areas where I was afraid to go and then they were there to support me. I loved the weekly trek over there and the exhausted trip back. From there I decided to work individually with a therapist. He was never happy with the group as he felt it seemed to be uncontrolled. I was kicked out not long after I started with him, which hurt, but not for long. I realised that I was outgrowing it and that this was causing a problem for the group leader.

After Relate, my wife and I had started to drift apart. A few weeks after I began therapy with the group, she and I poured out to each other how we felt. We agreed to separate, not to wait until the girls had left home.

Sex with guys was tainted for me by my experience of it being ‘wrong’ at boarding school. I still felt that sex with a guy was sordid and wrong. I managed to talk this through with my therapist and realised I had to focus on finding a kind guy who would let me relax and start to enjoy sex, and I met Dan. It felt so right, like I had come home. Dan gave me my ticket to freedom as an openly gay male. We split up after seven months but I will always be indebted to him.

Now I’m happy being me for the first time in my life: an openly gay man – along with many other possible descriptors. And I’m better friends with my wife than I have been for years. I love her to bits. To other guys in my position, I’d say, find someone to hold your hand (like my friend Neil); take the leap; get a good therapist, and know that it is unbelievably amazing to find yourself, to be yourself.

Chris’ story is an extract from the book The Marrying Kind? Lives of gay and bi men who marry women by Charles Neal (2014; ISBN 978-1496146830). +++ In the supervisor’s chair

Images of supervision

Rosie Dansey

I wonder whether the current emphasis on clinical supervision can lose a therapist’s creativity? At times my supervision has been an energising space where the expression of client issues has been through diagrams, colours, objects and metaphors. The safety net of supervision gives me space to laugh and cry; to have fun and get angry; to celebrate and despair; to bring frustrations, desires, shame and success; to acknowledge spirituality and what it means to be human; to go from despair to hope. Without reaching extremes, I might not find the way forward.

I believe that relational depth,1 ‘not just a specific moment of encounter, but an enduring sense of contact and interconnection between two people’, has its place in the supervision room too. Have I been fortunate in my supervisory relationships that I have usually left supervision challenged in my work and re-energised? I would be concerned if I am not passing on this energy to my supervisees too.

Supervision is an opportunity to learn, to replenish energy, to be challenged and to raise awareness of ethical issues in the work. However, of most importance is the protection to my clients offered by supervision. My work is more focused after supervision; pitfalls have been brought into awareness and a possible way forward has been identified. More importantly, when I have been working with the darker side of client material I have been offered space to separate myself from the client’s world so I can offer the person-centred core conditions unconditionally. Battye and Gilchrist’s description is so apt:2 ‘Supervision is for the benefit of the client, but the underlying principle is that the client is best served by supervision that enables the supervisee to become the best counsellor they can be.’

I visualise supervision as a spider’s web: it can be sticky but through the stickiness I find my way out. I looked for images of supervision in counselling literature and discovered it described variously as a container, a torch, a mirror, a playpen, a dance, a journey, a sculpture and a thermometer.3 Ryde4 sees it ‘like Dr Who’s Tardis, very small outside and timeless and huge inside’, whereas Hewson4 imagines an animal ‘that can range across prairies, climb mountains, swim into the depths and fly close to the sun’. Gibson5 portrays a fruit loaf: ‘I arrive for supervision carrying a melted jelly, runny sticky. I try my best to hold it together. When I leave my supervisor’s house, I have a warm, moist fruit loaf, rich, weighty and solid’. What image describes your supervision?

These are positive images; it is more difficult to find negative impressions of supervision, both in the literature and in research findings. I wonder whether the reluctance to disclose this comes from shame or blaming self, or even the desire to protect a supervisor? Colleagues or readers of this column who have disclosed unhappy experiences to me have expressed the wish for anonymity. West6 argues: ‘The culture of supervision can be characterised by significant levels of secrecy, an absence of a ready ability to engage in collaborative working and avoidance of ethical dilemmas.’ Among therapists, the supervision experience ranges from excellent to poor, or prone to imbalances of power and a bullying environment. I see the revision of the BACP Ethical Framework as a challenge to ensure the safety of clients while working towards this vision of supervision: ‘“En-courage-ment”, with courage at its heart, develops the person’s inner resources and courage and enables the building and maintenance of a constructive working relationship.’7

I valued being invited to participate in the live audience of the second webinar where the role of supervision was discussed. As a profession, we have something special to celebrate and, through the review, an opportunity to be involved in open consultation, so do take part by contributing your thoughts to [email protected].

As I write my last column for this journal, it seems fitting that the wheel has turned full circle. My first comment was that supervision has received scant attention; now it is in the spotlight. Goodbye and thank you for all the feedback I have received.

References

1. Mearns D, Cooper M. Working at relational depth in counselling and psychotherapy. London: Sage; 2005. 2. Battye R, Gilchrist A. Person-centred supervision across theoretical orientations. In: Henderson P. (ed). Supervisor training: issues and approaches. London: Karnac; 2009 (pp197–207). 3. Carroll M, Gilbert MC. On being a supervisee: creative learning partnerships. London: Vukani; 2005. 4. Cited in Wilmot J. The supervisory relationship: a lifelong calling. In: Shohet R (ed). Passionate supervision. London: Jessica Kingsley; 2008 (pp88–110). 5. Tudor K, Worrall M (eds). Freedom to practise: person-centred approaches to supervision. Ross-on-Wye: PCCS Books; 2004. 6. West W. The culture of psychotherapy supervision. Counselling and Psychotherapy Research 2003; 3(2): 123–127. 7. Millar A, Holloway J, Henderson P. Becoming an encouraging supervisor: the encouraging supervisory relationship. Private Practice 2014; Spring: 27–29. +++ The researcher

Data don’t make the difference

Barry McInnes

A recent article in the Guardian Society section reported on the AdEPT (Adverse Effects of Psychological Therapy) programme. Titled ‘Misjudged counselling and therapy can be harmful, study reveals’,1 the article profiles a study, funded by the National Institute for Health Research for Patient Benefit (RfPB) programme, that aims to better understand and help prevent the adverse effects of therapy.2

The study has three principal strands – a review of the literature on the extent and nature of the problem; analysis of existing datasets to discover what kinds of people in what types of therapy with what kinds of therapists are most likely to experience adverse effects, and in-depth interviews with clients and therapists where therapy has gone wrong, to understand the process of failing or harmful therapy. A main aim of the project is to develop and test practical support tools for clients, therapists and service managers with the aim to reduce adverse effects and prevent harm in psychological therapy.

The programme is drawing to a close and has yet to report its findings, but the article serves to highlight some of the major themes emerging. The chief investigator, Professor Glenys Parry of Sheffield University’s School of Health and Related Research, pointed out that most people are helped by therapy, but that, like any intervention with the power to truly transform lives, it can also be misapplied, to the detriment of the client. The results are likely to be laced with caveats. For example, while some therapists had many more clients who deteriorated than others, Parry pointed out that this may be because they had more difficult cases. Additionally, some clients might have got worse whether they had therapy or not.

How useful the study will be in terms of new learning remains to be seen, for the themes seem hardly new. We know, for example, that bona fide therapies are broadly equivalent in their outcomes for common mental health problems – accepting, of course, that some therapies may be contra-indicated for certain conditions. Wampold and colleagues concluded that the effect size for therapies was 0.2 (ie a small effect), which would account for no more than one per cent of the variance in therapy outcomes.3 The therapist him or herself is also an important factor in outcomes variance. Wampold4 concluded that the contribution of therapist effects is between six and nine times greater to therapy outcomes than that of the therapeutic model.

The idea of developing tools to support the therapeutic endeavour is intriguing, although also not new. Lambert and colleagues5 summarised the effects of four different ways of providing therapists with feedback about client improvement. Clients whose therapists were given feedback that they were not on track, along with the option of using a range of clinical support tools, achieved a rate of 49.1 per cent clinical and/or reliable improvement, against a rate of 21 per cent for clients whose therapists received no feedback.

It should also be noted that the same study found that, when both therapists and clients were provided with feedback warning that the client was not on track, the recorded rates of improvement rose to 56 per cent, the highest for any of the feedback conditions.

It will be interesting to see whether the AdEPT study reveals any new ways of supporting therapists, or indeed clients, to achieve better outcomes or avoid adverse ones. I wonder if a more major concern is whether therapists and service providers can find both the will and the means to use such tools meaningfully?

We know that using measures of outcome in every session to gain feedback on client progress can significantly improve outcomes and reduce dropout,5 but how many of us use measures at all, unless we are mandated to do so? And even if we do, how many of us have the training, supervision and technical support to be able to apply that feedback to our practice in a way that makes a difference?

The AdEPT interviews with therapists and clients may yield useful new learning. For our own sake as therapists, and for the sake of our clients, I hope it is learning we can use while we still have the client in the room, not when it is too late to apply it.

To get in touch with Barry, email [email protected]

References

1. http://www.theguardian.com/society/2014/may/26/misjudged-counselling- psychological-therapy-harmful-study-reveals 2. https://www.shef.ac.uk/scharr/sections/hsr/mh/mhresearch/adeptproject 3. Wampold BE et al. A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, ‘all must have prizes’. Psychological Bulletin 1997; 122: 203–215. 4. Wampold BE. The great psychotherapy debate: models, methods, and findings. Hillsdale, NJ: Lawrence Erlbaum; 2001. 5. Lambert MJ et al. Providing feedback to psychotherapists on their patients’ progress: clinical results and practice suggestions. Journal of Clinical Psychology 2005; 61(2): 165–174. +++ News feature

A slice of the cake

Catherine Jackson reports on the challenges facing voluntary sector counselling organisations as they engage with clinical commissioning in an increasingly competitive NHS marketplace

Clinical commissioning groups (CCGs) have been formally in place since April 2013. They’ve had time to get to grips with their local health economy and decide which model of commissioning works best for them; they are now setting out their commissioning plans for 2015/16, and are likely to be putting most of the health services for which they are responsible out to tender. Voluntary sector counselling organisations will be jostling with other providers in a crowded marketplace.

The voluntary sector has already been badly hit by the 2009 recession and the Government’s austerity programme. The latest NCVO UK Civil Society Almanac reports that the third sector’s total income from government sources fell by £1.3 billion in 2011/12 (the most recent figures available). The Almanac also records the shift among health and local authority commissioners away from the traditional grant funding. Contracts for delivering public services now comprise 81 per cent of voluntary sector income, up from 49 per cent in 2000/01. But, says NCVO: ‘Many [voluntary sector organisations] feel they have been locked out of contracts by commissioners’ focus on lowest price and biggest scale. This is a missed opportunity, because many organisations could play a transformative role in designing and delivering better public services.’

BACP shares this belief, and is concerned too that many voluntary sector organisations are not yet ‘tender ready’ and may not have the necessary infrastructure or the resources to bid for contracts to deliver NHS counselling and psychotherapy services. This concern has prompted the publication of a new report, Commissioning Third Sector Counselling. The report spells out the contribution of the voluntary sector to meeting local counselling needs and what both commissioners and third sector organisations can do that would help improve the commissioning relationship and the sustainability of the third sector as a key contributor to NHS provision.

‘The days when third sector organisations could expect a three- or even five-year grant from their local PCT, under relatively loose contractual arrangements, are over,’ says Louise Robinson, BACP Healthcare Development Manager.

The report has been produced with the Centre for Psychological Therapies in Primary Care (CPTPC), at the University of Chester, which has been tracking how commissioning is affecting the provision of counselling and psychotherapy. Across the whole healthcare economy, full competitive tendering is proving the most popular model (used in 63 per cent of contracts). Says Joan Foster, Honorary Senior Lecturer at CPTPC: ‘My concern is that the survival of the third sector is threatened because commissioners are returning to the traditional model of putting out tenders and nine times out of 10 a single, large provider is the winner.’ The major players – NHS trusts, and even large private healthcare companies – almost invariably win the contracts simply because they have the organisational capacity and financial viability to deliver the scale and breadth of services needed. But the effects on the local healthcare economy can be like those of a major supermarket, as Michael Lilley, Chief Executive of My Time, a community interest company specialising in multilingual counselling services, points out: ‘The smaller corner shops get squeezed out, even though local people want them and they are closer to their customers and better able to provide what they need.’

Diversity of provision

The BACP report cites the National Audit Office, which in its Successful Commissioning Guide toolkit lists the reasons why public service commissioners should foster third sector organisations: for their closeness to their communities and to client groups that statutory services may struggle to reach; for their contribution to public services’ ability to deliver on outcomes; for their ability to innovate, and their capacity to deliver what they promise.

‘We want to help preserve the third sector’s place in the patchwork of provision,’ Louise Robinson says. ‘Some third sector counselling organisations are telling us the tendering process is too difficult. The harsh reality is that we have got to find some way of stepping up to this challenge. We have to be engaging with and educating commissioners. The business-oriented language of commissioning may jar with us, but commissioners can find our language difficult to engage with too. It’s about being flexible and realising that, at the end of the day, we all want what is best for the local population.’

If the voluntary sector gets squeezed out, she says, vital specialist services such as multi-lingual counselling for BME communities, choice of therapies and early intervention and preventive work will suffer. ‘The voluntary sector offers interventions in different languages and uses culturally sensitive models at a level that is not being achieved by NHS services. It takes a more population-based approach and can be more flexible about the therapies it offers to suit the individual’s needs. It also offers groups and support services, such as bereavement support, that can prevent problems escalating into mental health problems that do cross the treatment threshold,’ she argues. Commissioners too stand to lose an important line of communication into the heart of the communities they serve. ‘Without that link, they are likely to have a poorer understanding of local service user needs and perspectives to inform their Joint Strategic Needs Assessments.’

Robinson says forward-thinking commissioners do ‘get it’. She was recently approached by a commissioner seeking advice on how to maintain a genuinely mixed local economy of counselling provision alongside the IAPT service. ‘They were very aware of the advantages to their population of having that diversity, but needed to be able to deliver outcome data in a form that could be used to evidence that they were meeting IAPT targets,’ Robinson says.

Facing the challenges

The challenges facing the third sector are fourfold, as the BACP report explains: time (commissioning and contracting are time-consuming and more complex than funding applications, and require a much higher level of knowledge and skills, as do the contractual requirements with regard to data collection and reporting); finance (for small organisations, zero value contracts can be disastrous, and they lack the financial capacity to offset low treatment tariffs against other, better paid sources of income); workforce (the voluntary sector can’t access IAPT training for its staff, unless the organisation is already delivering counselling under contract to the NHS, which makes it harder for them to compete against NHS bidders), and referrals (many third sector organisations say they are having to pick up more self-referrals – people who come to them having been turned away by their local IAPT service, or because they did not find what was offered helpful; in a consortium bid, the organisations in the partnership may struggle to cope with unpredictable client volume and flow).

Youth information, advice and counselling services (YIACS) are similarly affected, says Youth Access Director Barbara Rayment. ‘These huge tenders are of no use to our members. They simply don’t have the capacity to bid for them. And if they join forces with the local CAMHS, that brings other challenges. CAMHS have a different culture and a different way of working. Our organisations are much closer to the client. They will offer other forms of help and support as well – not just the therapeutic relationship but other, more informal support if that is what the young person wants and needs and can help with their problems.’

What particularly upsets her is that the sums of money are tiny. ‘The voluntary sector offers quick, easy hits, but you don’t save a lot of money by cutting them out. And if there’s nothing left on the table for voluntary organisations, young people will be the losers. We are already seeing a huge run of traffic back from CAMHS into YIACS because CAMHS have been raising their thresholds. Prevention, early intervention and in some respects even a good crisis response just isn’t on offer. Our members at least have an open door policy and can signpost young people on, if need be. That will be lost if there isn’t a funding mechanism tailored to ensure the sustainability of this sector.’

Joining forces

Voluntary sector counselling organisations are adapting to the new climate, and often successfully. CPTPC conducted a small-scale survey for the BACP report and found a range of strategic partnerships being formed to enable the third sector to get a slice of the counselling cake, but all bring their own problems. One model is to form a consortium with other similar organisations and pool resources; another is for a single provider or group of voluntary organisations to go into partnership with their main IAPT provider. But, says Foster, ‘there is no formal mechanism for that dialogue to take place;’ it is entirely dependent on whether the main provider is willing to share its contract. Some NHS IAPT services have sub-contracted elements of the overall service to specialist local voluntary sector providers. ‘But this too presents great challenges, particularly in terms of IT connection and clinical governance issues,’ Foster says.

My Time CIC has explored several of these routes. Birmingham-based (it has recently also extended to the Isle of Wight), it has an established expertise in providing multi-lingual counselling and culturally sensitive support to people from BME communities. But it has struggled to win enough contracts to maintain its viability. ‘Small voluntary sector organisations like us mostly do not have the financial strength to bid for a tender. We recently submitted a tender for a contract worth £250,000 a year. We had all the requisite experience and skills but our tender wasn’t assessed as we didn’t meet the stringent requirements of the initial financial evaluation,’ Michael Lilley says.

They tried working in partnership with the local mental health trust, delivering a specialist multilingual service within the overall psychological therapies contract, but the trust decided to bring the service in-house. ‘It was a real attempt to create a public sector/third sector model but the trust was under pressure from the commissioners to cut costs, and when it comes to cuts, the third sector will always lose out because it’s easier and cheaper to cut external contracts than to make your own staff redundant. We lost the discussion about whether they were actually able to provide the service,’ Lilley says. ‘It’s understandable, but it’s a very sad thing. GPs want more of these community-based services but, because of block contracts, there isn’t the money to pay for them. Commissioners and trusts tell us their funding is so restricted that they haven’t got the flexibility to move away from the IAPT model, even though they recognise that some elements of the community, like BME groups, have been failed by it.’

My Time recently went into partnership with the Richmond Fellowship and three other small provider organisations, to form what is now the largest voluntary sector mental health provider in the UK. ‘We have seen the writing on the wall. There is a view that you keep in there, getting the crumbs from the table, in the hope that things will pick up. But you are totally reliant on the commissioners and the good will of your local mental health trust. You can’t run a business on patronage,’ Lilley says. ‘By joining the Richmond Fellowship, we now have the backing of a £40 million business and we are working with organisations where we share a philosophy and core values. But it brings its own difficulties. Consulting with the other partners takes time, when the clock is already ticking and timescales are, by the very nature of tendering, short.’

Going it alone

The social enterprise Listening Ear has been providing its listening and counselling service for adults in Merseyside since 1992. Ten years ago it also introduced the Butterflies service for children from the age of six who have experienced loss – whether bereavement, divorce or family break-up – and a Friends after Bereavement group. Richard Brown joined the organisation as Chief Executive in 2012. He came from the Big Issue North, where he was Managing Director, and brought with him considerable expertise in running social enterprises. Since he has been there he has strengthened the organisation’s infrastructure and set up a central business unit that is solely dedicated to expanding its income sources. They recently diversified into occupational mental health and have won contracts with Moseley Council and Jaguar Land Rover, a major local employer.

‘We need to balance our income. The public sector is going through a period of severe austerity. We can’t keep growing the same thing if there’s no market for it. So we need to grow different things, and offer products that have more tangible outcomes,’ Brown says.

‘The voluntary sector needs to get business-minded – but without losing touch with why we are doing this work,’ he argues. ‘The challenge for us has been to go out and get contracts that demonstrate not just our expertise in delivering counselling but that we can manage the contractual, governance and quality standards required in any contract. Eighty per cent of our business now comes from contracts. But we’re not big enough yet to deliver an IAPT contract. I’m not saying we couldn’t do it; we have an annual turnover of a quarter of a million, but no commissioner would trust us with a £1 million IAPT contract, so we have to look at partnership arrangements with NHS trusts and other providers. It’s about moving to a critical size to demonstrate to commissioners that we can manage large contracts. You need to be big enough to wash your own face.’ He is upbeat about the future, not just that of his organisation but of counselling too. He argues that commissioners are increasingly recognising that the NHS needs to be able to offer more than IAPT. ‘Smart commissioners are realising that if they want a quality psychological therapies service that delivers their target outcomes, they need to do it differently. They’re looking to the IAPT-plus model. If the statistics aren’t good, they’re telling them they have to change, and let the professionals have some say on what the service delivers and which models might work better. Bean counting hasn’t worked; people need more than the restricted IAPT offer.’

He is also convinced that commissioners will be persuaded by the low management costs and the high focus on service delivery that the voluntary sector offers: ‘They need to be asking if the NHS is the best vehicle for delivering IAPT. The voluntary sector can be less management-heavy in comparison with the NHS, more flexible, more creative and with a higher focus on service delivery. I’ve seen a freeing up among commissioners and the more forward-thinking CCGs realise they need to be doing things differently.’

No compromise

Camden Psychotherapy Unit (CPU) is an independent charity, based in north London. Founded in 1976, it offers free and low-cost weekly individual and group psychoanalytic psychotherapy to adults (18+) for up to two years. It has more recently introduced 16-week Dynamic Interpersonal Therapy (DIT), which is one of the IAPT-approved treatments. It employs five part-time psychotherapists and two part-time administrators, and also uses 10–12 honorary (unpaid) psychotherapists. It accepts GP and self-referrals and treats around 100 people a year.

In 2011 Camden PCT decided not to renew its annual contract (its then £83,000 annual running costs were funded entirely by the NHS), and put out to tender the contract for running the entire psychological therapies services for the borough. CPU approached other larger local counselling and psychotherapy providers to take them on as a junior partner, with no success. ‘And I can understand why. The budgets were limited; we were all fighting for our lives,’ says Ora Dresner, CPU Chief Executive and Clinical Director. ‘We were prepared to change, to provide a brief therapy alongside the longer-term treatment, but our colleagues refused to include us. It has been very difficult. By forcing these conditions on clinicians, it’s like a war where we are all fighting over one piece of bread.’

Since 2011, CPU has been totally self-funded, drawing on its contacts in the media, arts and sports worlds, and on the psychoanalytic community through the British Psychoanalytic Council, to raise the funds to cover its running costs. Last year, it was awarded a grant from the Big Lottery to cover 40 per cent of its annual budget over five years, which it has to match-fund.

CPU is hampered both by its small size and its insistence on providing the longer- term treatment that it believes its clients need. ‘Longer-term psychotherapy is almost unavailable nowadays on the NHS,’ Ora Dresner says. ‘We believe it is wrong that people are being deprived of the treatment they need just because they can’t afford to access it privately. Our main allies have been the GPs, who continue to refer people to us because we offer time and space. This is not something the NHS can offer, and my impression is that commissioners nowadays may not believe that longer-term therapy is necessary. ‘They put out a tender for a service seeking as many patients as possible for the least number of sessions possible at the least intensive level possible. You have to ask, is it in our nation’s interest to invest in the mental health of our citizens and children or not?’

CPU is not expensive: with its very low overheads, its costs are less than £50 per hour, compared with around £200 for the same treatment provided within the NHS, Dresner says. And it works; clients rarely drop out once they enter treatment. ‘For the majority, their problems improve significantly and many of them turn their lives around. The tragedy is that we clinicians have to spend so much of our energy on fundraising and campaigning, which we are not trained for, and which takes us away from the clinical work. Our patients and colleagues are in constant uncertainty whether there will be enough money to keep going next year. But if we don’t do it, we will have to close down, which we believe would be a terrible loss to mental health services. There is a war here for the mental health and wellbeing of this nation and it is very sad that some people think they can win it with eight sessions of CBT.’

Commissioning Third Sector Counselling is available for free to download from www.bacp.co.uk/commissioning +++ Wounded leaders

Nick Duffell argues that the emotional damage caused by the British boarding school system can be clearly seen in the attitudes and decisions of its political elite

‘Are we going to be head of rugby?’ Two mothers self-consciously banter as they stand by their BMWs in the forecourt of a small stately home – the school where their young sons are boarding for the first time. Trunks have been carried in, housemasters have made brisk reassuring comments; the ‘settling in period’ has begun. There are no tears.

The scene comes from a 40 Minutes BBC documentary, made 20 years ago, called The Making of Them, in which young boarders were discreetly filmed over their first few weeks at prep school.1 It is available on YouTube, but be careful – it will make you weep, or angry, or both.

I borrowed the title for my first book,2 which described the effects of being sent away to school at a young age and my work as a psychotherapist with adult ex-boarders, whom I named ‘boarding school survivors’. For 25 years I have tracked how children adapt to institutionalisation by dissociating from their feelings and developing a defensively-organised character, the ‘strategic survival personality’, which I argue severely limits them emotionally and psychologically in later life.

An ex-boarder myself, and later a teacher in a boarding school, I remember how on my first day, 300 miles from home, my mother slipped away unnoticed to avoid her own difficulties with saying goodbye. Of course she, like so many other mothers, did not want to ‘upset me’, and she was doing her best. Crying was not done in those days – not by mother or child. Tears of loneliness were never permissible in front of the other children – you might get away with it in the two places where there was some privacy – under the sheets or in the toilets – only at my school the toilets were doorless, to guard against other equally prohibited activities.

I don’t think it ‘made’ me, but it has made me difficult to live with.

The assumption that social success will result from this privileged abandonment is rarely questioned. If their parents can afford it, children are sent away to follow a well-trodden path straight from boarding school through Oxbridge to high office in institutions like the judiciary, the Army, the City and, especially, government. David Cameron was only seven when he was sent away to board at Heatherdown preparatory school, set in 30 rolling Berkshire acres. The boarding school industry is worth billions and has a massive lobby behind it. In other countries the state contributes a sum for every child in private education. Not in Britain. Thus our uniquely exclusive boarding system props up the class structure, partly through the establishment’s unquestioned durability, but chiefly by its promise of upward social mobility, reframed as ‘parental choice’. Consequently, we remain a divided top-down society, not a social democracy.

There is, I believe, a direct link between the problems caused by the boarding school experience and our domination, at the highest levels in our society, by men who do not provide good leadership because of unacknowledged psychodynamics. In my latest book I call them ‘wounded leaders’.3 Boarding is so embedded in British life that we don’t really notice how odd it is. Even the therapy profession has been largely resistant to naming the problem, as I have argued previously in this journal.4 You have to look from outside the box, and then you can’t stop seeing it. Our European neighbours are generally appalled that we have children only to send them away for others to raise.

Without the right guidance, the wish to do the best for their children can confuse parents. As if the needs of eight year olds were still unknown, the Boarding Schools Association, at their 2014 conference, declared, ‘Boarding schools develop true grit!’ Our society wants to produce winners, but the message that such hothousing carries a high cost is unwelcome, and is confused still further by the challenge of drawing any distinction between abuse and neglect, and between damage and survival.

Here is where our Prime Minister is a prime example. Can he – a man at the top of the nation – be called damaged? He and his colleagues Boris Johnson, Jeremy Hunt, Andrew Mitchell, Oliver Letwin and others, certainly tick all the boxes for being survivors. As socially privileged children, they were forced into a deal they did not choose: trading an ordinary, home and family-based childhood for the hothousing of entitlement. All boarding children have to survive this.

Reinventing the self

‘Survival’s about keeping your head down,’ Solomon Northup is told in the film Twelve Years a Slave, a powerful portrayal of the rank dissociation and objectification that was the psychological engine of our colonial empire, staffed by young men straight out of public school. Outraged, Solomon replies: ‘Days ago I was with my family; now you tell me all is lost, to tell no one who I am, that’s the way to survive. Well I don’t want to survive, I want to live.’ But Solomon soon experiences the imperative to survive; he must create a new persona that involves betraying himself and his values.

This is precisely the boarder’s dilemma. Prematurely separated from home and family, boarding children must speedily reinvent themselves as self-reliant pseudo- adults. Hence the false self that is apparent when we develop the psychological eyes to notice it. The child survives boarding by attaching to this self instead of to a parent, but the ex-boarder often retains a permanent unconscious anxiety, reinforced by strong internal double binds, and rarely develops emotional intelligence. ‘They told you they were doing it because they loved you, but it left you bereft of love,’ one survivor told me.

Ex-boarder politicians have not had empathy on their school curriculum. Having forsworn all forms of vulnerability since they were seven or eight, they can’t imagine that humans might depend on one another. How can they then understand the vulnerable, or provide anything but government by and for the winners – a culture in which the losers end up despising themselves? Cameron’s behaviour (like that of Tony Blair before him) is typical of a boarding school complier survival type who successfully deceives himself (or herself) that everything is fine. This self-deception may include a seamless duplicity, an unshakeable faith in his ego, a tendency to bully when he feels threatened, a barely concealed contempt for women who try to tell him what is what, and ditto for foreigners.

Furthermore, he has to believe his own self-invention, which is the most dangerous, for it allows him to do anything without conscience. Thus Tony Blair was able to march our standing army (mostly staffed by those who can find no real place in society) off to the Iraq war and ignore the millions marching against it. He can ‘robustly’ maintain his position today, when his critics’ direst predictions are coming to fruition.

Boarding school survivors tend to operate strategically. Tied to rigid timetables in rule-bound institutions, they are ever alert to staying out of trouble. Crucially, they must not look unhappy, childish or foolish – in any way vulnerable – or they’ll be bullied by their peers. So they dissociate from all these qualities, project them out onto others, and develop duplicitous personalities that are constantly on the run. That is why ex-boarders make the best spies – a theme that novelist John Le Carré has developed to such brilliant effect. In adulthood they stick to the same tactics. Whenever they sense the threat of being made to look foolish, they strike. We see this in former Chief Whip Andrew Mitchell’s contentious bicycle ride down Downing Street, and in Cameron’s response to MP Angela Eagle, less than a year into his new job, in the now infamous session of Prime Minister’s Questions when he patronisingly told her to ‘Calm down, dear!’, as if she was upset and not him. The Opposition loved it, of course, howling ‘Flashman!’ (the bully from the archetypal boarding school book Tom Brown’s School Days). But they never take on the cause of these leadership defects.

The problem is that boarders, wrenched from their families into a peer group of other equally frightened and abandoned children, are forced to grow up so fast that they never really have a childhood, or come home again. In adulthood they can talk the talk confidently; they can get into Oxbridge and get top jobs. But the young boy inside them stays frozen in time. He is anxious and strategic, eternally on the lookout to stay out of trouble. He tries to manage by himself, surviving when relating would be more appropriate. He may bully his way out whenever there’s a risk of his vulnerability being exposed. This is why Cameron over-reacts when caught out (in the Angela Eagle incident, it was over hospital waiting time figures). He is ready to sacrifice anyone to avoid trouble. Many wives of ex-boarders will know this strategic move. If it is not addressed, boarding school survival creates huge difficulties with intimacy, and many trans-generational problems.

The outward character of ex-boarders may appear competent but it is brittle and run from the inside by the poorly attached little boy. The results of the 2010 election shocked me, because I knew we would have more of the kind of politics that sideline women and are dominated by the boys in the men who run things. Having learned to survive, not to relate, Cameron is incapable of making proper relationships in Europe, unlike John Major (Rutlish grammar school, now a comprehensive); he can talk of leading Europe, but not of belonging to it. It’s hardly surprising: wrenched away from home as a child, never having had enough belonging, the ex-boarder mistrusts it. It took me 20 years to join a tennis club.

Never admit to error

The problems consequent with boarding’s attachment-deficit institutionalisation are vehemently denied by its proponents and hidden by the social privilege it carries. This privilege is double-edged: it creates shame that prevents sufferers from acknowledging their problems; in return, they get an assumption of entitlement. The latter accounts for why Boris is so supremely confident: he needs neither surname nor adult haircut. He trusts his buffoonery to distract the public from what former Daily Telegraph proprietor Conrad Black called ‘a sly fox disguised as a teddy bear’.5 This sense of entitlement cannot easily be given up: it is compensation for all those years without love, touch and family, for the stress within the personality and the lack of emotional, relational and sexual maturity.

In Wounded Leaders I trace its history to what I call the ‘entitlement illusion’, a long tradition on these islands with roots in the days of slavery and the terror of the French Revolution. It reached its zenith in the late 1890s, the ‘Age of Privilege’, in which some of our current leaders would not seem out of place. Notable for its unparalleled gap between rich and poor, it culminated in folly. This year, we mark the century since the men at the top, cut off by their elite boarding school experience from the emotions needed to make good decisions and practise empathy, led us into the pointless carnage of World War I. Take, for example, Sir Douglas Haig (Clifton College, Brasenose Oxford and the Bullingdon Club), Commander in Chief of the British Expeditionary Force, who presided over the bloodbaths of both the Somme and Passchendaele. A devout cavalryman, he declared the machine gun and the tank ‘over-rated’.

Today, says commentator Toby Young, Eton and Oxford have transformed themselves into ‘chimaeratocracies’.6 Cameron’s electoral campaign image of the caring, ordinary bloke shows how ex-boarder politicians, trained in dissociation and duplicity, can magically turn privilege into meritocracy, and believe their own myth. We might have forgiven Blair had he admitted he was wrong on Iraq, but the politics of belief built on strategic survival cannot deconstruct the illusion or admit any form of vulnerability.

This elitist education is, in fact, not a good preparation for modern day leadership. My book presents evidence from several neuroscience experts that supports what attachment theory has already told us. Sue Gerhardt has convincingly summarised the evidence that, in the crucial early formative years, the brain thrives in the medium of secure attachments and empathic relationships, and its normal development is hindered without them.7 Antonio Damasio demonstrates that, without access to emotions, whether through brain lesion, dissociation or lack of emotional intelligence, good decision-making is impossible.8 Stephen Porges’ social engagement system shows how victims of long-term trauma and those exposed in childhood to extreme emotional neglect are unable to recognise vagus nerve facial signals. This means they can’t then distinguish whether an approach is intimate or hostile; to be on the safe side, they tend to interpret it as the latter.9 Ian McGilchrist’s work on the brain shows how excessive focus on rationality over-stimulates the left hemisphere, preventing access to the bigger picture and engendering blinkered views developed in isolation from their context and without empathy.10 The science seems to underpin political commentator Will Hutton’s view that the decisions of the Tory Party ‘have, over the centuries, been almost continuously wrong’.11

Psychotherapy and politics

Britain needs to change. A new parliament building would help. Exchanging the adversarial architecture of Victorian Gothic – so like a public school chapel – for a floor plan in the round might encourage constructive discussion and discourage polarisation and bullying. A real socio-political transformation, however, will require a wholesale review of our anachronistic education system. We cannot patch up boarding through Ofsted inspections. School-based counselling is damage limitation and an impossible job. Young children need to be at home, not to have better boarding. If boarding were restricted to the over-16s, the stock of buildings and staff could be redeployed to offer a more democratic and psychological healthy model. In Denmark, for example, mixed-gender Efterskole offer boarding for teenagers where they learn grown-up civic responsibility and are prepared for the greater independence of higher education.12

The world is entering a new phase of interdisciplinary collaboration; the neuroscience revolution and its mutual embrace with the psychotherapy professions has been a game-changer. I believe that psychology, history, literature, philosophy and politics might similarly combine to provide leverage against the pervasive forces of the banal, to help us get a bigger picture about the world and to learn from the mistakes of the past. Psychotherapy and politics have been kept apart for too long, which is one reason I wrote Wounded Leaders. Lynne Layton of the Massachusetts Institute for Psychoanalysis suggests: ‘There is a strong pull to collude… part of what is considered good practice is to separate the psychic from the social; those who broach these topics are often criticized for importing politics into the sacred realm of the clinic’.13

In 2011, when Therapy Today published my first boarding school article as the cover story, the references to named politicians were omitted.4 The British Journal of Psychiatry was even stricter in 2012, in the correspondence that followed Joy Schaverien’s paper on ex-boarder psychotherapy.14 That this article can name names suggests that new, creative attitudes are emerging.

As practitioners, we have a responsibility to understand the symptomatology of ex- boarders and to recognise the syndrome, even when it is not the presenting issue. This is why my colleagues and I continue to offer specialised training (a manual will be published by Routledge next year15). But we are also citizens, and should therefore speak out about the normalised harm caused by boarding and how it infects our national life. Several senior clinicians (Susie Orbach, Joy Schaverien and Andrew Samuels, to name three), along with writer AL Kennedy and ecologist and ex-boarder George Monbiot, were among the signatories to a letter to The Observer earlier this year that called for an end to early boarding.16 ‘Children may learn to function competently, but at the cost of dissociation from their feelings of abandonment, even if there is no outright abuse,’ they wrote. ‘Attachment theory plus the work of clinicians over the last two decades and now the findings of neuroscience leave no doubt about the psycho-emotional consequences of depriving children of touch, warmth and a “secure base”… If boarding once played a role in preparing men for the rigours and cruelties of an imperial age, our present interdependent world calls for a different, more complex and caring set of values.’

We continue to need this kind of pressure to assist our fellow citizens out of denial. Without it, we will remain the most class-ridden of the developed nations, unlikely to produce a world-class statesperson like Angela Merkel or Barack Obama, as the changing values of the global political scene leave us far behind, stuck in the late 19th century.

Nick Duffell is a psychotherapy trainer, psychohistorian and author of Wounded Leaders: British elitism and the entitlement illusion – a psychohistory (2014), and The Making of Them: the British attitude to children and the boarding school system (2000). He co-authored Sex, Love and the Dangers of Intimacy and co-founded the Centre for Gender Psychology in 1996. Trauma Abandonment and Privilege: a guide to therapeutic work with boarding school survivors, written with Thurstine Bassett, is to be published by Routledge next year. Email [email protected] References

1. http://youtu.be/2uRr77vju8U 2. Duffell N. The making of them: the British attitude to children and the boarding school system. London: Lone Arrow Press; 2000. 3. Duffell N. Wounded leaders. British elitism and the entitlement illusion: a psychohistory. London: Lone Arrow Press; 2014. 4. Duffell N. Old school ties. Therapy Today 2011; 22(3): 10–15. 5. BBC 2. Boris Johnson: the irresistible rise. First broadcast 25 March, 2013. 6. Goldfarb M. The British establishment: who for? BBC World Service, 2011. http://downloads.bbc.co.uk/podcasts/worldservice/docarchive/docarchive_20111025- 1000a.mp3 7. Gerhardt S. Why love matters: how affection shapes a baby’s brain. Hove: Brunner Routledge; 2004. 8. Damasio AR. Descartes’ error: emotion, reason, and the human brain. New York: Avon Books; 1994. 9. Porges SW. The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: Norton; 2011. 10. McGilchrist I. The master and his emissary: the divided brain and the making of the western world. New Haven & London: Yale University Press; 2010. 11. Hutton W. David Cameron’s act of crass stupidity on Europe. The Observer, 11 December, 2011. 12. http://www.efterskole.dk/ 13. Layton L. Who’s responsible? Our mutual implication in each other’s suffering. Psychoanalytic Dialogues 2009; 19: 105–120. 14. Schaverien J. Boarding school syndrome: broken attachments – a hidden trauma. British Journal of Psychiatry 2011; 27(2): 138–155. 15. Basset T, Duffell N. Trauma, abandonment and privilege: a guide to therapeutic work with boarding school survivors. Hove: Routledge (forthcoming). 16. de Zulueta F, Schaverien J, Orbach S et al. Boarding schools: pupils’ suffering has been ignored for too long. Letter to the editor. Observer, 11 May, 2014. http://www.theguardian.com/theobserver/2014/may/10/the-big-issue-boarding- schools-abuse +++ Talking point

Counselling brings its own rewards

Claire Thomas adds her voice to the debate about qualified counsellors working for free

In March I attended the live webcast of the fifth OCTIA (Online Counselling and Therapy in Action) annual conference. As well as some very interesting presentations, there was a lively debate in the chatroom about whether or not qualified counsellors should continue to work in a voluntary capacity. Feelings ran high on both sides.

There seem to me to be three main arguments. The first is that most other professionals, having trained, are not expected to work for nothing, so why should counsellors? And further, the more that counsellors work for free, the more the profession is devalued, making it less likely that providers such as IAPT or the prison service, for example, will fund counselling.

The second argument is that people enter counselling because they care about other people, so it makes sense to them to offer services to those who need them regardless of whether they’re paid to do so.

And the third is that there is a real need for counselling that is not being met at present by the statutory sector and, while counsellors wish to value themselves and the service they offer, they do not want people to go without help.

I consider myself to be part of the third argument. I dearly wish the statutory sector was prepared and able to invest more heavily in counselling. However, the situation in the prison where I volunteer is so stretched that management cannot even spare the time to interview voluntary counsellors who would like a placement. The idea that any time soon they might have sufficient funds to pay counsellors is a pipe dream.

My partner works for the NHS. The tale I hear is that services are being squeezed so that responsibility for patient care is passed like a hot potato until the increasingly stretched and struggling service at the end of the line has no choice but to offer something. The staff with patient contact are increasingly frustrated and worn down by the system in which they work and, while the demands rise, services are being cut – not because there is no demand but because cuts have to be made.

Another issue is the number of ‘honorary’ positions advertised. While the quality of support workers has never been higher, lack of funding and the long waiting lists that result have led health trusts to advertise voluntary positions in order to support struggling paid professionals.

At this point I should say that I have recently been accepted for a voluntary counselling role at a refugee and migrant centre. This is in addition to the other voluntary role I already have in the prison service and the paid work I do as a private practitioner. When the refugee and migrant centre interviewed me, I was told that referrals come directly from GPs because there is no adequate service in the NHS for this client group. When an individual has suffered potentially unimaginable trauma and may not speak any English, what is called for is long-term support that addresses his or her all-round needs. It is hard to imagine that anyone in this situation – potentially destitute, homeless, and facing language and cultural barriers to psychological support – would be helped by just a few sessions of CBT or, indeed, any time-limited service. Due to the political climate in the UK regarding refugees and migrants, funding is very hard to secure. In this situation – with individuals who need a long time to build a relationship and to heal – the only option is to rely on volunteer counsellors who work alongside volunteer lawyers and advice teams, as well as a core of paid staff, to provide the long-term therapy this client group needs.

I value my profession and the work we all do, and I am paid well by my private clients. I also believe that being paid well for this private work enables me to offer my services to those who need them but are unable to pay. Working in the prison service has been a truly remarkable experience, and my clients have amply rewarded me. Instead of money, I have been offered the gift of walking alongside them as they face both past and yet-to-come challenges and fears. I look forward to the new challenges I will face in the refugee and migrant centre – working with interpreters, for example, and with cultural diversity. Should I wait until the Government decides to provide funding? For me the answer is no. The need is now.

Claire Thomas is a person-centred psychotherapeutic counsellor working mainly in private practice with face-to-face and online clients. She lives on a narrowboat in Oxfordshire with her three children. www.clairethomas-counselling.co.uk

This article was first published in Private Practice, the quarterly journal of the BACP Private Practice division. Visit www.bacppp.org.uk +++ A hand across cyberspace

Jane Fahy describes what is unique about online support for problem gamblers, with its anonymity, worldwide reach and access to a supportive community of thousands of fellow addicts

This article is written in a style similar to that used in many forms of online communication, including blogging, emails and interacting with others using a synchronous chat function. This is to give readers who are not familiar with cyberculture a taste of what you can expect to encounter online. Stylistically it may be very different from other, more academic articles you have read. I use ‘rich text’, which typically involves a greater use of punctuation and emoticons to create a generally more ‘chatty’ feel.

Gambling Therapy is a website set up by the Gordon Moody Association, a UK- based charity that provides an intensive residential treatment programme from centres in the UK, as well as online and outreach services. In the UK, Gambling Therapy provides wrap-around support for people accessing the Association’s residential treatment programme. We also educate and support their friends and families. Outside the UK, Gambling Therapy offers a range of online services in different languages to supplement the face-to-face support provided by other agencies all over the world. We do this in our forums, in online groups, via email and through our helpline. We currently support roughly 16,000 people around the world who either have a gambling problem or are close to someone who does.

The number of problem gamblers worldwide is hard to pin down, for a variety of reasons that I won’t bore you with now… Generally speaking it’s accepted that between one and four per cent of people who gamble have a gambling problem.

Working with addictions is tough. Ask any addiction specialist! On the one hand your client wants to change; they’re desperate to. On the other hand they are driven by a white hot desire to continue doing what they have always done. After all, it keeps them safe, doesn’t it?

Some people struggle to understand how an addiction that doesn’t involve a chemically addictive substance can hold someone in its thrall in the same way as an addiction that does involve a substance. Why would you do something that costs every penny you have, has destroyed your family and has left you homeless, unless you were high? So I suppose this leads us on to a discussion about what we mean by the term ‘high’. An altered state maybe? Euphoria? Escape? These are all words I’ve heard when working with problem gamblers.

How then is it that problem gamblers are unable to stop even when they’re not actively gambling, because surely the effects wear off quickly, right? Wrong, the brain needs time to acclimatise to working within a more ‘normal’ range of stimulation, which can take a while. To put it in more simple terms, if you’ve spent hours on a roller coaster and adjusted to such a high level of stimulation, your head would spin for quite a while after you got off! So the cycle continues, the thoughts become more distorted and the gambler gambles, until one day the cost is too high. That’s when I ‘meet’ them. ☺

So how does it all work? Well, it’s kind of like a jigsaw puzzle. People come to us for help to put themselves together to form their own recovery picture. It’s a picture that changes, depending on where someone is in their recovery and what they need on any given day. Accessing online services like ours means people can take a dynamic approach to their support and tailor their recovery so it’s personal to them. In practice that means that, if the person accessing our site wants to talk to someone who’s ‘been there’, someone who’s bought the t-shirt, they can do that. If people want to talk to a counsellor who can help them to explore the ‘whys’ of their situation, they can do that too... it’s a kind of a pick and mix solution!

What online support offers

If we’re looking at the nuts and bolts of supporting problem gamblers online via an established website with a vibrant community, I guess we first need to look at online support in more general terms. What is it, and what are our clients are getting from it? I view it in terms of the following categories: accessibility community anonymity flexibility.

First, accessibility. A client using online support can access that support at any time of the day or night, irrespective of the time zone they’re in. Support can be accessed on a laptop, PC, Mac, on a tablet or even a phone. Effective and comforting assistance can be a coat pocket away!

Next, community. An online therapeutic community is a powerful entity. Many people who have accessed a support group talk about the feeling of acceptance that hit them like a wave when they walked into a room full of others in a similar situation. Now, imagine that room is a virtual room, containing thousands of people from all over the world, all understanding at least part of your story, all wishing you well and offering you a hand across cyberspace. Then that feeling of acceptance has the potential to turn into something altogether exceptional... maybe even overwhelming in its ability to wrap an individual up in a blanket of understanding.

Then, anonymity. As therapists, we often hear clients talk about shame – the shame of an addiction, an experience or even a relationship. Part of the work we do is to break through that shame and allow our clients to express themselves freely through their experience of our unconditional positive regard. Understandably, it can take our clients time to perceive that we aren’t judging them, that we have feelings of warmth towards them. These allow them to speak freely, but what happens if they don’t have to look us in the eye? Kate Anthony, CEO at the Online Therapy Institute and BACP Fellow, calls this the ‘disinhibition effect’ – a term initially coined by the psychologist John Suler.1 Anonymity can free clients to express themselves at a deeper level perhaps more quickly than they would face to face. If managed correctly by the therapist, this can lead to some very valuable work over a relatively short period.

And last, flexibility. We all respond differently to different kinds of support and different people but sometimes it can be hard for us to be specific about what we need and what works for us. Premises have to be maintained; they can only be open at certain times, and have to be staffed by at least two people, usually more, for the sake of safety. These all impose physical constraints on the capacity of the service. Online support is often more dynamic, lean and capable of rapid change than a land- based practice. The range of services can be adjusted relatively quickly to meet the needs of those accessing them and feedback about those needs is often frank and forthcoming, thanks to the disinhibition effect. This means people accessing this form of support can choose from a wide range of help that they can tailor to suit their personality and preference, some in real-time and some that offer a less immediate response (as with forums).

Benefits and pitfalls

So we know why this kind of support works, but what specifically are the benefits and pitfalls of supporting problem gamblers in this way?

Human beings are complex and problem gamblers are no exception, so when looking at how best to support them and deliver therapy we have to consider why they do what they do, what are they likely to respond to... most of all, WHO ARE THEY?

I’ve come into contact with problem gamblers from all over the world who gamble on everything from poker to scratch cards... online or in a casino or betting shop... games that are legal or illegal... alone or with others trapped in the same downward spiral. I guess the thing you need to know about problem gamblers is that no two are the same. But what remains the same with all of them is the pain behind their actions.

So, OK they’re all different but that doesn’t explain why supporting problem gamblers online works so well. Not to beat about the bush, with addictions to substances there will be many occasions when the people accessing support won’t be in a coherent state, particularly if they’re in their home environments and early on in their recovery. Being coherent is something that’s a basic requirement when it comes to getting help online and, where there is no substance addiction, it’s something that people I’ve supported don’t generally struggle with.

Something that helps problem gamblers in recovery is the use of practical barriers. These can include handing over financial control to someone they trust, excluding themselves from land-based gambling venues, or adding blocking software to a PC or mobile device. Many barriers involve the avoidance of triggers and one of the biggest triggers for many gambling addicts is walking past a bookie. Readers who live in the UK can, I’m sure, imagine just how hard it would be in many of our towns and cities to plot a route somewhere that didn’t take you past a bookie. I don’t object to seeing bookies on our high streets, as I’m aware many people can and do enjoy gambling responsibly and recreationally. But what about those who must feel they can’t escape from them? Online, you don’t have to walk past a bookie, a casino, an arcade or a shop selling scratch cards to access help, so when they’re feeling vulnerable the people we support relish the opportunity to connect and talk to us without having to take that risk.

Of course it’s not possible to avoid all triggers, emotionally charged situations or vulnerable moments over an entire lifetime. So, in order to regain a sense of living a ‘normal’ life in which avoiding triggers doesn’t play such a prominent part, problem gamblers may initially use online support as a safe and secure stepping stone back to the life they want. If we revisit the idea of the online therapeutic community that I mentioned earlier, the potential for the community as a whole to model recovery and a return to normality is vast, particularly for those who’ve completed residential treatment, because leaving that bubble can be extremely daunting! The community also performs the very valuable function of acting as an ongoing safety net, always there if needed, never judging the person in need. Diversity and difference

Our virtual doors are open to male and female problem gamblers but something that I found surprising when I first started delivering online support was the number of women accessing the support. You might be surprised to learn that, out of the 1,868 most recent contacts, women made up roughly 46 per cent of the people accessing the Gambling Therapy helpline or online groups. I had wrongly assumed that problem gambling was a predominantly male concern... I guess I had an image in my head of Del Trotter standing outside the bookie clutching a betting slip and proclaiming ‘This time next year...’ Needless to say, that’s not what I found, and shame on me for making assumptions. ☺

Perhaps because of this common assumption, women often hold off on accessing face-to-face counselling or group support but they seem more willing to engage with therapy online... Maybe because they can choose whether or not to even disclose their gender at first. Maybe because they don’t have to walk into a room full of men, which they could be imagining will be the case, or maybe because they feel less judged for being a woman who gambles, for the reasons I’ve already mentioned.

Styles of gambling vary so much from country to country, as do attitudes towards gambling and the help available for problem gamblers. In the US, for example, many people are used to getting support for a variety of reasons, and help is readily available.

However, in other countries help is more limited, and people in need may be actively discouraged from seeking it outside the family unit. Because we work in the way we do, with people from all over the world, we HAVE to work in a truly transcultural way. We can’t know everything of cultural significance relating to every corner of the globe so we HAVE to work with the person on the other end of the screen, without making any assumptions based on where they’re from. We find out from them everything we need to know about them, and put the individual at the centre of the process rather than being influenced, however subconsciously, by a cultural stereotype.

As with any personal development work, it can be rewarding for clients to reflect on their progress. Some people use our forums as a journal that, because it’s online, is open to people with similar experiences to read and contribute to. Others use them to ask questions and support their peers. What is ALWAYS useful is to look back during vulnerable moments to see how far we’ve come.

So, that’s all from me, I’m sure you’ll agree that there is value in online support and see its potential, particularly in terms of supporting problem gamblers. I hope you’ve enjoyed this small glimpse into our world. Thanks for reading. ☺ TTFN

Jane Fahy MBACP has been a counsellor for six years and now specialises in online therapeutic communities and the global online treatment of problem gamblers. She is Clinical Services Manager at Gambling Therapy. Email [email protected]

Reference

1. Suler J. The online disinhibition effect. CyberPsychology & Behavior 2004; 7(3): 3211–326. +++ Congruence or criticism?

Nicola Davies argues that congruence is often misunderstood by trainee counsellors and can end up as bullying

‘On a fortnightly basis, for nine months, I was told by the majority of my training group that I was intimidating, unapproachable, or something else that was negative. I heard the words “being congruent” banded about whilst this was happening – it seems that the other group members justified the systematic bullying because they felt they were being congruent. In one of the last process sessions I felt entirely alone and, even though I asked that the subject not be raised again, 10 or more of the group continued to verbally attack me, all in the name of congruence.’

These are the words of a counselling trainee, who went on to point out: ‘Attacking someone and labelling it congruence is a deep abuse of what can be a valuable tool for self-discovery.’ This crucial difference between congruence and the opportunity to go for the jugular is what this article is about.

The origins of congruence

Congruence is perhaps the most complex and least understood of the person- centred concepts offered by Carl Rogers. At its most basic, congruence can be divided into two components: 1) the ability to be aware of our own internal experience, and 2) transparency via the willingness to communicate to other people what is going on within us.1 So, when Rogers proposed that congruence had therapeutic value, he was referring not only to being aware of our own internal experience but also to the external demonstration of this experience. It is this external component of congruence – openness and honesty – that causes the most confusion.

Rogers explained that, for counselling to be effective, the relationship between client and counsellor needs to be ‘genuine’ or ‘congruent’ – a relationship characterised by transparent communication, where the client is able to ‘say it all’ to the counsellor. Such a relationship is only possible when the counsellor models a genuine way of being and offers the client unconditional positive regard. Indeed, it could be argued that a client can only find solutions to their problems if everything is put on the table, so to speak, through a shared congruence between counsellor and client. All the information required by the client to work towards self-actualisation can then emerge.2

Being congruent doesn’t come naturally, however; we are conditioned from birth to bow down to externally imposed conditions of worth. As a consequence, we develop an external locus of reference rather than an internal, authentic way of being. Being congruent can, therefore, require a conscious effort before it becomes a natural process. This is why learning to be congruent is a large part of counselling training – not only helping counsellors to become congruent themselves, but also helping them create a therapeutic atmosphere that allows their clients to be congruent too.

Counselling training As illustrated in the opening quote, a significant number of counselling trainees mistakenly view the process of establishing congruence as an opportunity to attack fellow trainees in skills practice or process groups.

In skills practice, when the counselling experience is simulated between two trainees, the challenge for the ‘counsellor’ is to be able to establish congruence – which is only possible through a transparent exchange of feelings between the two. There is also often an observer, who is required to be congruent with feedback on the performance of the counsellor. But not all observers adhere to the ‘feedback sandwich’ that I was taught in my own training. In the name of ‘congruence’, many go straight to the ‘filling’ – no soft bread on either side to cushion the impact. Maybe this is why one of my peers calls it ‘slap, kiss, slap’ instead of the feedback sandwich?

Clearly, the same honesty that is necessary for congruence can be mistaken for what Greenberg and Geller have referred to as ‘unbridled openness’, which can be more destructive than beneficial.1 It is often unbridled honesty from the counsellor that makes clients, or peers, feel they are being attacked. Consequently, what one person believes is congruence can be perceived by another as rudeness or bullying. One study, by Markakis and colleagues, even showed that some trainees consider their peers to be unprofessional if they feel they are being personally attacked by peers during counselling training.3 Aveline has similarly noted that mistaking congruence for rudeness or personal attack is a common problem among counselling trainees.4

So, why is this? Research appears to suggest that it could be down to communication skills, inconsistent use of the three core conditions, and ‘unbridled sharing’.

Communication skills

At the core of counselling is communication – both verbal and non-verbal. As highlighted by Dexter in her research on the impact of counselling training, counselling skills can be broken down into sets of micro-skills, of which communication skills are a fundamental aspect.5 In terms of congruence, counsellors are required to communicate with themselves (internal awareness) and with others (external display of internal awareness). Although, at its basic level, establishing congruence involves being honest and genuine, another element is how this honesty is communicated. Being congruent is, therefore, rife with potential for misunderstandings – on an internal and external level.

For therapeutic congruence at least, which is after all the skill that counsellors want to hone, honesty needs to be communicated in a manner that is not offensive or attacking. This is where assertiveness skills come in. Rather than being assertive or confident in their congruence, some counsellors can be so aggressive in communicating their views that clients or peers feel their own views are being disrespected.

When it comes to learning therapeutic congruence, the counsellor needs to be able to openly and sincerely communicate his or her views and feelings in a way that also expresses their genuine concern for others. This can be achieved through an assertive rather than aggressive approach.

The University of Illinois Urbana-Champaign Counseling Center recommends that we consider the following points when being congruent:6 1. Be as clear and specific as possible when expressing your thoughts and feelings – tentative or vague statements can lead to misunderstandings

2. Own your congruence, acknowledging and emphasising that all feedback, feelings and views you express are yours – eg ‘I’m feeling…’ instead of ‘You make me feel…’

3. Listen to others’ feedback to clarify whether they understand what was just said and, if they haven’t, take the time to explain further.

Use of the three core conditions

McLeod believes there is more to misunderstanding congruence than ineffective communication. In particular, some counsellors can forget to apply all of the three core conditions – congruence, unconditional positive regard and empathy – when establishing the appropriate atmosphere for the counsellor–client relationship, in practice and in triad work.7 This was confirmed by Lee, Rovers and MacLean, whose study explored the outcomes of counselling training among counsellors who use congruence couple therapy with clients addicted to gambling.8 They found that negative training outcomes, such as depression, anger and contempt, result when trainees lack the ability to simultaneously manifest all three core conditions.

For Rogers, congruence, unconditional positive regard and empathy are interrelated and strengthen each other, which means that they should be considered together and applied together during the counselling process. While the counsellor tries to relate transparently to the client by hiding nothing behind a professional façade, they ideally also need to show no disapproval towards the client. This comes across in a willingness to attentively listen to what the client has to say, without interruption and without judgment or giving advice. By doing this, the counsellor is able to help the client feel that they are accepted as their authentic self, so setting the stage for congruence.

To demonstrate empathy, the counsellor needs to communicate their desire to understand the client’s views or perspectives. Rogers explained in A Way of Being that the counsellor should work towards being so much within the private realm of the client that they are able to clarify meanings of which the client is even sometimes unconscious.9 In order to achieve this, the client needs to feel safe being congruent, so that the counsellor can accurately gauge their frame of reference and join them.

Unbridled sharing

Despite emphasising the importance of congruence, some believe that Rogers failed to elaborate on what he meant by ‘transparency’ – which is central to establishing congruence. Greenberg and Geller demonstrated that counsellors sometimes interpret transparency as informing others of all their views and feelings without following any communication rules.1 In other words, they interpret being honest as showing their emotions as they come, without really thinking of their implications.

According to psychodynamic counsellors, this unbridled sharing can lead to ‘negative countertransference’. Therapeutic congruence, however, requires the counsellor to pay attention to their internal experience, to intend no harm to clients and to facilitate the client’s personal development – the counsellor’s Hippocratic oath. Based on their research, Greenberg and Geller argue that counsellors should be able to develop appropriate attitudes, gain enough knowledge and become aware of how their beliefs affect their reasoning before they can truly offer therapeutic congruence. They state that, ‘to be clearly understood, congruence needs to be seen as being a process embedded in an appropriate network of beliefs and intentions… it is this tacit framework of intentions and beliefs that informs the therapist in how to be skilful in communicating congruently’ (p148).1

It is only through this process that counsellors can be effective and offer both clients and peers an environment productive of shared development or therapeutic value. This entails a disciplined communication: one that counsellors can achieve as they gain self-awareness through personal reflection. Such reflection can help us learn to separate our primary and secondary experiences. This is important as congruence is about sharing core emotions rather than secondary feelings. This is why congruence is not about blurting out feelings and experiences as soon as they develop, but also about organising our thoughts and feelings before we communicate them.

The organisation of thoughts and feelings facilitates comprehensiveness, which is a key aspect of effective congruence – not just knowing what to say but also why you are saying it. This is part of owning our congruence. Here is an example. We might inform a client that we feel irritated by their consistent lateness (the feeling) because we believe they would gain more from the sessions if they were to arrive on time (where the feeling comes from). Furthermore, we can let them know that we are telling them this so that they have the opportunity to consider whether they might benefit from arriving on time and, if so, how they could arrange their schedule to facilitate this (why we are telling them). In this way, the client is less likely to feel judged or attacked by the negative emotion being expressed. Instead, they have the opportunity to appreciate the contrary emotion felt by the counsellor and empowered to use (or not use) this information.

Conclusion

Rogers believed that being ‘real’ with each other facilitates trust and communication.10 However, trust is unlikely to come from a relationship based on honesty that does not also include concern for the other’s feelings. Congruence is more complex than just saying whatever emotions we have – in fact, I believe that if you hear the words ‘I say it as it is’ or ‘I’m just being congruent’, the speaker is probably making an excuse for not considering the feelings of others and how their comments might be received. Other conditions are needed to ‘hold’ congruence, including empathy and unconditional positive regard. Therefore, therapeutic congruence involves a complex set of interpersonal skills that can be enhanced through personal self-reflection, insight into internal experiences, a desire and willingness to share these internal experiences, and an understanding of intentions surrounding sharing these experiences.

Congruence isn’t just about being honest and speaking the truth; it also incorporates accurate and timely delivery of thoughts and feelings. In other words, congruence is about more than transparency. It is about ‘appropriate transparency’ – there is a time and a place for congruence and, indeed, a way of being congruent.

As counsellors we need first to do no harm and therefore it is necessary to know when it is appropriate to share our congruent feelings. When used under the appropriate conditions, congruence can be a powerful healing tool. However, it can also be abused by those who lack a clear understanding of what congruence is and its true purpose.

Nicola Davies is a person-centred counselling trainee at Bedford College, coming to the end of her first year of a level 4 diploma. She is also a professional writer. You can see more of her work on her blog at http://healthpsychologyconsultancy.wordpress.com or follow her on Twitter: @healthpsychuk

References

1. Greenberg LS, Geller SM. Congruence and therapeutic presence. In: Wyatt G (ed). Rogers’ therapeutic conditions: evolution, theory and practice. Vol I: Congruence. Ross-on-Wye: PCCS Books; 2002 (pp148–166). 2. Rogers C. Client-centered therapy. Massachusetts: The Riverside Press; 1950. 3. Markakis KM, Beckman HB, Suchman AL, Frankel RM. The path of professionalism: cultivating humanistic values and attitudes in residency training. Academic Medicine 2000; 75(2): 141–149. 4. Aveline M. The training and supervision of individual therapist. In: Dryden W. Dryden’s Handbook of Individual Therapy (fifth edition). London: Sage; 2007 (pp515–548). 5. Dexter LG. A critical review of the impact of counselling training: courses on trainees. Durham Theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/1569/1/1569.pdf?EThOS%20(BL) [accessed 1 November 2013]. 6. Counselling Center at University of Illinois Urbana-Champaign. Being assertive in a diverse world. Urbana-Champaign: University of Illinois; 2007. Available from: www.counselingcenter.illinois.edu/?page_id=187 [accessed 1 November 2013]. 7. McLeod SA. Person-centred therapy. SimplyPsychology; 2008. Available from: http://www.simplypsychology.org/client-centred-therapy.html [accessed 1 November 2013]. 8. Lee BK, Rovers M, MacLean L. Training problem gambling counsellors in congruence couple therapy: evaluation of training outcomes. International Gambling Studies 2008; 8(1): 95–111. 9. Rogers C. A way of being. Boston: Houghton Mifflin; 1980. 10. Rogers C. On becoming a person: a therapist’s view of psychotherapy. Boston: Houghton Mifflin; 1961. +++ Tenuous contact

Drawing on many years’ experience of counselling in secondary schools, Peter Pearce and Ros Sewell propose a new theory to capture the sometimes fleeting nature of the counsellor’s relationship with young people

This article is about the challenge of connecting adult counsellor to adolescent within the counselling relationship in a school environment. It charts the tentative development of a new concept, ‘tenuous contact’, to describe the sometimes fleeting and fragile nature of the counselling relationship with young people.

We are both person-centred in orientation and have developed the concept after more than 10 years’ counselling in secondary schools. It is a concept that we are told makes sense to many parents and teachers in explaining their relationships with young people too. Our aim here is to take a positive approach; rather than see the tenuousness of the contact as a negative, we believe the concept offers a way both to frame the experience between adult and adolescent and, very importantly, to reframe the adolescent’s relationship with their own experiencing. Our aim is to extend what we mean by ‘connecting’ in this environment and with these young people, as well as to invite a re-evaluation of what kind of contact may be ‘necessary and sufficient’.1

The following example illustrates how far apart the worlds of a young person and an adult counsellor can be. Here the counsellor is challenged both by the young person’s language and by the value references being expressed.

Student (speaking very quickly, almost without a pause for breath): I’m not ’av’n nuffin’ to do wiv ’er no more – she fuckin’ speak’n to me like tha’ – I don’t cotch wiv ’er no more – I saw ’er out she’s shit right – she fuck’n blanked me – this is me right don’t blank me – this is ’er right I weren’t – boy she’s a liar – I know if someone fuck’n blanks me – know what I mean? – I’m pissed man – and then in school today right – she says she’s bringing ’eads down – I’ll tell ya – she don’t get me shook – if she’s bringing ’eads down – I’m bringing ’eads down – I’m bringing bare ’eads down an’ we got borers right – d’you get me?

Establishing contact

Connection with a young person may have to be striven for and the level of the contact may vary from session to session and may fluctuate during the session itself.

Striving for contact with young people can at times feel like more than offering unconditional positive regard and trying to stay in their frame of reference. It can feel like sensing the threads, thoughts and feelings of their unspoken world and holding that sense very gently until they express their experience in sometimes unexpected ways and begin, if not always to make sense of it, then to put it in a place where they may hurt less.

Tenuous contact might, therefore, be thought of as akin to van Werde’s description of ‘grey zone functioning’ in the context of work in adult mental health settings.2 This might be thought of as rapidly changing functioning, both anchored in the shared reality and sometimes also ‘pre-expressive’, and sometimes the two realities blended together. In van Werde’s terms, then, tenuous contact might be situated in the upper half of this grey zone functioning, very close to everyday expressive functioning but partially remaining in a private world. For some this might predominantly be a ‘not choosing’ to connect with an adult, while for others it may be less of a choice – this ‘locked in’ feature may have become a way of being.

In either case, a counsellor working with young people often has to stand the frustration of not yet receiving full contact. Contact has to be ‘earned’ and may have to be tested; the relationship has to be safe enough for a young person to permit themselves to have contact with another.

We have noticed that contact has to be established anew at each session; contact gained in previous sessions cannot be taken for granted. For a young person, contact from session to session can feel new, difficult and tenuous. It may not be possible to re-ignite a previous link, which can often be taken for granted at the beginning of a session with an adult. There is no ‘relational capital’ – or at least none that is available in the moment – on which to build.

Young people can often be much more in the moment. This means that, in order to establish contact, a therapist needs to be attentive and sensitive to the mood and expression of the young person at the first encounter.

Developing the concept

The concept of ‘tenuous contact’ emerged during a substantial collaborative doctoral research project in which we were both involved. The project aimed to explore the type of school counselling service that might have most benefit for students and staff. In particular, we were interested in the impact of the counsellor ‘coming out’ of both the real and metaphoric counselling room3 and being more present in the culture of an inner-city secondary school.

We are both middle aged, white, and middle class by virtue of education. There is a very considerable divide in terms of age, class, race and culture between us and the young people coming to us for counselling. This has been an inescapable reality for us to work with and unpack in order to connect with them. We quickly realised that we were not going to get far if we stayed in our counsellor’s ‘cultural enclave’, expecting others to come to us to understand and trust what counselling was and what its benefits could be. To meet some of the challenges that this school setting posed, we found ourselves keeping detailed notes, trying to make sense of our experiencing.

These notes show that our early conversations and supervision sessions were dominated by our questioning whether what we were actually doing in our counselling sessions with young people was of any value. We noticed that the supervision sessions seemed to be highlighting that working with young people was very different from working with adults. We were keen to try to understand what was happening, how we were managing the counselling work in this setting, what was different, and to identify what exactly we were offering in this context, with what intended impact.

A repeating theme of ‘struggling for contact’ emerged and we went to the existing literature to try to find supportive theoretical maps for our experience. This included exploring the continuing plasticity of the adolescent brain, research into child development, and the evolving construction of the therapeutic relationship. We have been grateful for dialogue and support from Dion van Werde, Mick Cooper and Charles O’Leary. Their ideas have helped to shape and develop our own.

The therapeutic relationship

Recent years have seen increasing evidence to support the idea that the quality of therapeutic relationship is central to the effectiveness of therapy. It comes behind only ‘client variables’ and ‘extra-therapeutic events’ as a reliable predictor of therapeutic outcome.

We considered how concepts of this therapeutic relationship had evolved and developed, from the uproar that met Rogers’ research-derived assertion of the necessary and sufficient conditions,1 through exploration of the importance of the ‘working alliance’,4 ‘presence’,5,6 the shift to mutual intersubjectivity’,7 descriptions of phenomenological, ‘moments of meeting’8 and emphasis on ’relational depth’.9

There seemed to be a lack of ‘fit’ between this cutting edge person-centred theory and our experience with young people. We found constructs such as relational depth to be less relevant to our work with distressed children and young people; these occurred less frequently than anticipated, while ‘contact’ of a more fleeting nature, that continually seemed to need to be re-made, appeared more common. The term ‘tenuous contact’ emerged in conversations between us on our doctoral work. It seemed to us to most appropriately describe these therapeutic encounters that did not easily fit in with the accepted theoretical literature that had come out of working with adults. Some tentative aspects of this construct that emerged from our research are described below.

Adolescent relating (or at least adult–adolescent relating) seems less about relational depth and more about persistency and consistency over time in small pieces, based on the physical and emotional availability of the young person, not on that of the parents. Relationship for an adolescent in the throes of puberty seems more often to be about an adult being there somewhere, consistently and non- judgmentally. What’s important is the ‘contact’ rather than the ‘content’ in each encounter.

Student: It’s so fucking boring in here. I’d rather be in double maths! I mean what is this group?

Counsellor: Yeah I’ve got that. It’s so fucking boring that you would rather be in maths… and that would be OK.

Student: What would?

Counsellor: Maths. It would be OK if you wanted to go to maths.

Student: Well I dunno – a bit of me wants to go and a bit of me wants to stay here… find out if I like it.

Counsellor: You’re not sure, Donna. You want to go and you want to stay and find out if you like this group… You know… both parts [are] very welcome here, Donna.

Hypothesised causal factors for tenuous contact may include issues of power inequality, motivation for therapy and institutional system issues, to name a few. All this makes for a ‘tenuous context’ for the work. If motivation, understanding, power and context are all tenuous, it would be easy for the majority of potential clients to be experienced as ‘didn’t want’ or ‘inappropriate for’ counselling. To model good practice in this setting, we believe that a sensitive understanding of these ‘tenuous contact’ issues is needed and a willingness to work at a ‘pre-therapy’ level in order to build relationship. In this setting, the building of relationship ‘is the therapy’ and is often required afresh every session.

Implications for practice

It can seem sometimes as if all previous knowledge of connection and disconnection is lost, making it easier for the counsellor to take a position of power. The counsellor needs to be mindful of what has gone before and what the student might not be saying, as the student may rarely bring difficult issues back, and may act as if they have forgotten. It may therefore lie with the counsellor to initiate this discussion. The counsellor certainly needs to be aware of what has gone before and may need to take sensitive and informed risks so that the possibility of a deepening relationship increases.

Difficult moments of contact that have occurred in previous sessions can seem to dissolve, as well as moments of connection. It can be easier to connect after a difficult session. Seeing us in the corridor the day after a groupwork session where she had gained some painful insights through some challengingly congruent comments on our part, a student rushed over to speak, and it was easy to begin again. We were still in touch with our feelings from the session the day before when we had felt directive and controlling. She brought none of this, and at that moment we had a choice: to act as if nothing had happened or to acknowledge that there had been difficulties. When no sensitivity is shown to this, it can reinforce power inequalities and may collude with a young person’s perception of how unfair the relationship between adult and young person can be.

We have found tenuous contact, and the later addition of tenuous context, to be useful terms that have influenced how we have constructed our therapeutic work with this group to optimise the chances of success.

Striving to be phenomenological – that is, to see relationship as a phenomenon and without agenda – can be important. Without such a non-judgmental approach, something someone has just said within the session can sometimes result in lost contact. We have found that the ‘presence’ strived for in a person-centred approach can often be unique in the young person’s world, where some adults may either have been absent or may have related on their own terms and were therefore not able to step into and honour the young person’s world as they see it.

Tenuous contact may provide some help with understanding the nature of a therapeutic relationship with a young person, by describing and explaining some of the challenges of working with this client group. Consistency is often the key, so counsellors working with young people need to offer low level, invitational contact and consistency over time. They need to remain there somewhere, on the young person’s terms, non-judgmentally and often in the background.

The concept values young people and makes them central to the process. It requires specific skills from competent practitioners and moves the establishment of the relationship with the young person on their terms to the heart of the work. Young people are used to adults making relationships ‘about them’ rather than the relationship being offered for use ‘on their terms’. Feedback and comment

We have presented the concept at workshops and a number of conferences and have been interested and encouraged by the feedback. Therapists working with young people seem to recognise the ideas that we have tried to convey. They have told us that ‘tenuous contact’ feels like an accurate description of the difficulties they experience when trying to connect with a young person in a therapeutic relationship. Some therapists have reported that understanding the relationship in these terms has helped them to feel more positive about their work and stopped them feeling that they are not ‘good enough’ counsellors.

Workshop participants who are parents of teenagers as well as therapists have responded from a different perspective. They report that the concept makes sense to them and helps them to understand what is going on for their teenagers developmentally and why they sometimes feel they are connected and can speak to their children and sometimes feel unable to approach them.

We have explored our thoughts further in a chapter in a new book (see end of article) and plan to produce further publications in due course. Our hope in offering these ideas is that ‘tenuous contact’ may help others as it has helped us, both as counsellors for young people and as parents of teenagers, to hang in there with young people when we are unsure of what is going on; to stay with it when we feel deskilled and useless, and to continue to reach out when we are not sure if anything is being received.

This article is derived from a chapter in Person-Centred Practice at the Difficult Edge, edited by Peter Pearce and Lisbeth Sommerbeck, published by PCCS Books (ISBN: 978-1906254698). The book is available at www.pccs-books.co.uk

Peter Pearce is Head of the Person-Centred Department at Metanoia Institute and has provided person-centred counselling and psychotherapy with young people in NHS and education settings since 1989.

Ros Sewell is a Primary Tutor on the MSc in Contemporary Person-Centred Psychotherapy and Applications at Metanoia and has provided person-centred counselling and psychotherapy with young people in NHS and education settings since 1989. She has 40 years’ experience of working with children and young people.

Jointly Peter and Ros are completing collaborative doctoral research on more than a decade of counselling in schools, have written and presented widely on these issues and are currently joint lead researchers for an efficacy study of person-centred school-based counselling in collaboration with Professor Mick Cooper (University of Roehampton) and the BACP Research department.

References

1. Rogers CR. The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psycholology 1957; 21(2): 95–103. 2. Prouty G, van Werde D, Portner M. Pre-therapy: reaching contact-impaired clients. Ross-on-Wye: PCCS Books; 2002. 3. Pearce P, Sewell R. Applications of the person-centred approach ‘coming out’ of the counselling room: Holding a psychotherapeutic posture within an educational setting. Person-Centred Quarterly 2008; February. 4. Greenson RR. The technique and practice of psychoanalysis. Vol 1. London: Hogarth Press; 1967. 5. Bugental JFT. The search for existential identity. San Francisco/London: Jossey- Bass; 1976. 6. Rogers CR, Stevens B (eds). Person to person. London: Souvenir Press; 1973. 7. Jordan JV. Empathy, mutuality and therapeutic change: clinical implications of a relational model. In: Jordan JV, Kaplan AG, Miller JB, Stiver IP, Surrey JL (eds). Women’s growth in connection: writings from the Stone Centre. New York: Guilford Press:; 1991 (pp283–299). 8. Stern DN. The present moment in psychotherapy and everyday life. New York: WW Norton; 2004. 9. Mearns D, Cooper M. Working at relational depth in counselling and psychotherapy. London: Sage; 2005. +++ Dilemmas

Working with two therapists

This month’s dilemma

Abraham runs a small counselling charity specialising in PTSD work. A local GP has referred Dave, an ex-Marine, as there are real concerns about his wellbeing, including suicidal ideation. However, at the assessment stage Dave discloses that he is already in therapy to deal with issues of abuse. That therapist has been clear that she cannot deal with PTSD.

The organisation does not normally work with clients who are receiving counselling elsewhere but there is a genuine risk that Dave’s mental health will suffer considerably if he does not receive help for his immediate issues, and Abraham’s charity has the expertise to help.

Opinions expressed in these responses are those of the writers alone and not necessarily those of the column editor or of BACP.

Julia Segal (counsellor and author)

If it were simply a matter of Abraham’s organisation having expertise that most therapists do not, they could offer to act as consultants to Dave’s therapist, with Dave’s permission.

However, I am puzzled by a therapist who works with abuse but makes it ‘clear she cannot deal with PTSD’. Is this really the case, or has Dave misunderstood something his therapist has said? There is an obvious question about how committed Dave is to his current therapist: is he unhappy with her, perhaps because of her reaction to his PTSD, or some other reason?

It is also possible that Dave is working out some desire to undermine and attack his therapist, perhaps by complaining to the GP and Abraham’s organisation that she is refusing to help him. It is also possible that his current therapist finds Dave difficult or frightening and would not at all mind ‘losing’ him. With these considerations, it makes sense to suggest he talks to his therapist about whether therapy with her is helping him sufficiently or whether he needs more specialised help.

Suggesting that Dave sees both a counsellor from the PTSD service and his existing therapist concurrently is probably not a good idea. It would set up a potentially conflicting situation: each may work in very different ways; the counsellors could be set against each other and Dave could end up in a worse situation than he was before while his internal conflicts are worked out between his two therapists. There is the possibility that Dave might want to put his therapy on ‘hold’ while he works with Abraham’s counsellor, with the intention of returning later. If the PTSD service only offers a limited number of sessions, this might make sense.

However, Abraham’s situation is complicated by the nature of the speciality and the urgency of a client who has suicidal ideas. When there is a threat to life it is much harder to think carefully and to negotiate; the temptation is simply to act. The GP and the PTSD counsellor are likely to feel anxious; they may also be angry with Dave’s therapist for not being more help.

On the other hand, Dave may be trying to avoid distressing his therapist; he may not have let her know how disturbed he is feeling, and how important his PTSD symptoms are. He may need help from the PTSD counsellor to address these issues with her, and she may then be perfectly capable of working with whatever he brings. Discussing this with Abraham might help Dave to clarify what he has told her and whether she really can or cannot work with his suicidal ideas and his PTSD.

Ultimately, Dave has to decide whether he wants to continue with his current therapist or whether he thinks he will get more help from Abraham’s counsellor.

Justin Havens (psychological therapist in the NHS and private practice; MBACP (Accred))

The immediate issue is why Dave is seeing another therapist for abuse issues who ‘cannot deal with PTSD’. It sounds as if the current therapist is not addressing Dave’s immediate distress. We are not told much about the PTSD but might infer that it is linked to Dave’s military service. Adverse childhood events, such as the trauma of abuse, may also be linked to its onset. It is therefore impossible to treat one without the other, and I would be concerned for a client who was seeing a therapist for abuse issues who did not feel capable of working with PTSD.

To maintain the ethical standard of ‘least harm, most good’, I would recommend that Dave sees one therapist who is capable and competent to deal with the issues that he is experiencing, starting with stabilising his current situation, especially the suicidal ideation. When Dave is ready to move forward, the therapist should work with both traumas, using evidence-based approaches such as trauma focused CBT or EMDR (Eye Movement Desensitisation Reprocessing).

My recommendation is that Abraham speaks to Dave to explain the treatment of trauma, and allows him to make an informed decision about whether to leave the current therapist and begin working with him. Abraham should also seek Dave’s consent to speak to his current therapist, to explain the nature of the GP referral, Dave’s current symptoms and Abraham’s trauma expertise in a way that does not diminish the therapist. The result of this conversation may be that the current therapist decides that it is not appropriate to continue working with Dave. It would then be possible for them to have a proper ending and for Abraham to begin working with Dave as soon as possible.

At all times, Abraham needs to be sensitive to the previous relationship Dave has had with his therapist, and not undo any of the work that has been done. It is also possible that Dave does not want to leave his current therapist; that is, of course, his right, as long as Abraham has clearly stated his concerns about not addressing the PTSD issues.

It would be both unethical as well as very poor treatment for Abraham to offer to see Dave separately to ‘just work on the PTSD’ alongside his current therapist.

Mandy Pitts (BACP student member) The fact that Dave’s GP considers a new referral to be appropriate suggests that a different practitioner may be helpful. Although Dave’s current therapist is clear about not ‘dealing’ with PTSD, the abuse discussed in their sessions may be a contributing factor to the PTSD. If this is the case, it is possible that no amount of therapy with this practitioner will fully meet Dave’s needs.

I am assuming that the counsellors at Abraham’s charity, or some of them at least, have experience of working with survivors of abuse, so one possibility could be for Dave to stop seeing his current therapist altogether, at an appropriate ending point. If this is not a possibility, it could perhaps be arranged for Dave to have a break from his current therapist and see one of Abraham’s colleagues, or for Abraham’s organisation to make an exception and allow Dave to receive counselling from both. However, this could result in an increase in his distress and vulnerability and place him at risk.

I would not make a decision about this until I was able to speak to Dave in more detail, taking risk factors into account as well as the progress he is making in his other therapy. With Dave’s permission, I might also seek the opinion of his other therapist about her own regulations, if nothing else.

Andrew Saunders (humanistic counsellor)

It appears that Dave’s current counsellor has not assessed well. If there is an existing or newly presenting issue with which a counsellor feels they cannot work, the onus is on that counsellor to know their limitations and discuss this with their client and signpost them elsewhere.

It is suggested that Dave presents a suicide risk. This is something that counsellors are likely to encounter with some frequency. Dave’s GP is in the front line where risk is concerned. Signposting a person to another organisation is only part of a risk management scenario; so too are community mental health teams and medical solutions. Does Abraham’s assessment of Dave indicate these are not available to effectively manage risk? Of course Abraham may also contact the local adult at-risk service, which in my area runs a 24-hour hotline. Abraham will no doubt make his own assessment of how likely Dave is to translate his suicidal thoughts into a plan and action.

Abraham could consult his supervisor on this matter. He should also suggest that Dave speaks to his current counsellor at their next session about this situation, and the immediacy of the PTSD versus the abuse, if we assume these are separable issues. If there is a good working relationship in place, this could be useful in a holding sense. Stability in risk situations has a value.

Abraham must assess the risk. If there is a clear, imminent risk of suicide, he has no option but to break confidentiality and inform the adult at-risk service, Dave’s GP or the police, depending on the immediacy.

If the risk of suicide is not so urgent, Abraham may be able to draw on non- counselling approaches from within his organisation, such as support networks/groups. Abraham has much to consider. Would intervening actually cause more distress and confusion and disturb the work in progress? Would a clear boundary of how Abraham can help be useful? He has decided that the PTSD is the clear and present danger – but how is he so sure that the abuse or, for that matter, something else that Dave’s current counsellor might be working with, are not the drivers for Dave’s suicidal ideation?

Abraham needs to be open about the options and trust Dave to choose, while considering risk.

September’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?

Email your responses (500 words maximum) to Heather Dale at [email protected] by 29 August 2014. Readers are welcome to send in suggestions for dilemmas to be considered for publication, but these will not be answered personally. +++ The interview

What happens in the silence

William West talks to Colin Feltham about the shared energy generated by counselling and spiritual experience

Can you summarise for us the early events that brought you to your interest in therapy?

I always wondered about things, and still do. I felt I didn’t quite belong in my birth family, or in my small hometown, which I found restrictive. As a young man in the late 1960s, I left home and moved to the big city of Manchester to do my first degree, in computer science. This was a time of great discovery for me and I was drawn to radical ideas about mental health, politics and spirituality. I read RD Laing, David Cooper and Wilhelm Reich and had many conversations about the meaning of life and how to change society for the better. I also had my first life-changing spiritual experiences in nature at that time.

You were initially involved in Reichian therapy. How did that come about and how did it influence your development?

I left university and, after a brief spell as a computer programmer in the NHS, I ended up in Notting Hill Gate in 1973 working for a 24-hour information and help service called BIT. Through BIT I got involved with people having strange mental health states, sometimes drug induced, sometimes not. I gathered together a group of people with mental health experience and we set up a group called COPE, which ran a phone service and a crisis centre. As part of our training we attended encounter and other therapy groups and some of us entered our own individual therapy.

I had continued to read Wilhelm Reich and later, when I got the chance to experience the therapy in the late 1970s, it had a huge impact on me – even stronger than the encounter groups. So I trained up and started running groups and offering individual therapy. I spent the 1980s working this way and ran groups all over Britain, and in Ireland, Spain, Switzerland and Japan.

A key feature of Reichian therapy was the focus on the body – how we breathe, how we hold our bodies and the tensions in our muscles and how all this tells stories about us. Reich also talked about people as energy systems in a universe that is not empty but has energy. So I had a way to connect the energy I felt in spiritual experiences with the energy of Reichian therapy.

You did a PhD at Keele with John McLeod and around the same time I believe you moved into a person-centred affiliation. Can you explain these developments to us?

In 1990, aged 40, I was a bit bored with what I was doing as a therapist and did not want to work that way for the rest of my life. Many of my therapist friends were moving towards process orientated psychotherapy. I was still interested in spirituality and felt drawn to spiritual healing. I had always dreamed of doing a second degree but nothing quite came together. Doing an MA in counselling with John McLeod, Tony Bolger and Val Davies was a delight.

By accident, just after the first Gulf War started in January 1990, I had ended up at a Quaker meeting and felt at home. I sensed the same energies as those of my spiritual experiences. And, curiously, doing my MA had an implicit spiritual element to it for me. I realised that I wanted to do a PhD immediately after it – because it was there, like Everest, or cycling from Land’s End to John O’Groats (which I did a few years back).

My PhD explored therapy and spiritual healing. The MA was pretty person-centred and I loved Rogers’ late spiritual flowering, but I had done too much broader humanistic therapy to become purely person-centred. I feel the same way about Christianity. Curiously, I quite often get asked if I am person-centred, and on other occasions if I am Christian. It really depends on what my questioner means by these words. I am inspired by both Carl Rogers and Jesus Christ but I don’t think I quite belong; I can’t quite toe the line. The great thing about Quakers is that they don’t have a creed so words don’t get in the way and the focus is on what happens in the silence of a Quaker meeting. When I have a spiritual experience, time stands still; I feel I am in the depth of my being and feel connected to everything and everything makes sense. It is hard to construct a personal theology on that but it is all I have right now. I once read somewhere that Quakers are mystics and I thought, ‘Yes, that explains it.’ I know people react to this word ‘mystic’ but it works for me.

You’ve travelled quite a bit in relation to counselling, for instance to Kenya. What have your observations, your learning and personal enrichment been from these experiences?

How long have you got? I do not glamorise Aboriginal people but, given how sick our society is, I am very suspicious of exporting our ‘Western’ therapy to the ‘developing’ world. I delight in how mindfulness as a practice originally rooted in Buddhism has taken off in Britain and I do a bit of Ananda Marga type yoga every morning about 6am. Visiting Kenya was an eye opener for me in many ways – the poverty, the energy, the strangeness for me of being in a conference with 300 black Africans and about a dozen white people. Later on, visiting Bangalore in India was eye-opening in different ways. At a counselling conference there I felt more present as everyone was acknowledging spirituality and religious affiliation in a way that I have not experienced before or since. I felt freed up to talk simply and openly as a man of faith.

One of your contributions to the counselling world has been the promotion of qualitative research and you’re still supervising a number of doctoral students. What changes have you seen in attitudes to research over the years?

Studying at John McLeod’s feet (he was a secular guru for me), I found in myself a real passion for research, especially qualitative research, and this remains with me 20 years on. What is interesting is how narrow, and out of date, some people’s notion of research is, even now. My own stance is increasingly pragmatic. I still feel most drawn to the more deeply reflexive and creative research approaches like autoethnography and heuristics but I increasingly look for the best, indeed elegant, fit between topic, researcher and methodology. The same would be true for counselling practice. I think something in me draws me to the edges, not uncommon in those of us who end up as counsellors. So I am aware that many do not like either (postmodern) qualitative research or spirituality unless it is, say, mainstream Christianity or Islam.

Your publications have focused largely on spirituality in counselling and psychotherapy, and you’re a Quaker. Can you say why you think interest has grown in this area, and what your particular take on it has been?

I don’t think that interest has grown that much within our profession. I know that BACP Spirituality now has 1,000-plus members but that is still a small minority of the BACP membership and, if you look in the counselling journals, there are still very few papers on spirituality. However, there remains great interest in spirituality among the public at large. I keep coming back to the realisation that both counselling and religion deal with human suffering – what causes it; how can we help people in their suffering; how can we reduce or eliminate it?

You’ve worked quite a bit with Roy Moodley in Toronto on traditional healing methods and non-Western therapies. Do you think that work is having an impact on therapy in the UK?

I wish. At least by going into print on it we have put markers down and perhaps made a conversation more likely to happen. Most people on our planet believe in God, but most of them do not have access to modern ‘Western’ medicine. There just might be herbal remedies being used in some remote areas of the planet that could help us all and likewise there may be some – maybe shamanic – therapeutic practices we could all benefit from. It only takes a bit of humility and an open mind and soul. And these practices could also be happening in our inner cities and not just in the rainforests.

Just as counselling is unwilling to recognise that many of its practices are rooted in earlier forms of religious pastoral care, I feel a link to traditional healing has always been part, albeit in secret, of our Western culture that is likewise denied or denigrated. This tradition has at times been linked to women, witchcraft and paganism.

You’re approaching retirement from your post as Reader in Counselling at Manchester University, I think, but already extending your spirituality and research interests elsewhere?

Yes, I need to move on from Manchester where, it is true, I have had an extraordinary 19 years. I have recently discovered that other universities in the North have need of me! I am thus developing my work as a Visiting Professor at the University of Central Lancashire and the University of Chester. In both places I am pleased to be attracting new PhD students.

Are you pleased with the way therapy has developed in the UK, and what do you see as emerging positive and negative trends?

Again, how long have you got? I am happy that it is no longer seen as weird to access therapy. I am ambivalent about regulation but, again, I expect my GP and my physiotherapist to be regulated so why not my counsellor? We can as counsellors get a bit precious and not realise that other ‘emerging’ professions like social work, teaching and nursing have had similar struggles.

Likewise, when I see my GP and physiotherapist they don’t ask me to fill in a form, so why does my counsellor? And self-report forms are not that good as research instruments. I am all for us defending our practice with statistics but let us do it in an informed way and not too defensively.

Tell us about the novel you wrote, your health habits and other non-work interests.

Several times in my life I have written fiction, most recently about a mystic private eye living in Manchester. It has been fun to write about the places I know and to move sideways to become this character (more details are on my blog at www.billonbike.blogspot.com). I have been on the 5:2 diet to keep my cholesterol level down for six months now. This has changed how I feel about my body – I like the new thinner me but on the two days a week that I am eating very little I can get grumpy. So far this ‘fasting’ has not yet had a spiritual impact on me! I cycle to work and go out on my bike occasionally all day and enjoy it and that does feel spiritual. I sing in the Manchester Community Choir, which is a sheer delight, and I play the piano not well but with great enjoyment. I feel grateful for my comparative good health and for the people in my life. +++ How I became a therapist

Nash Popovic

Nash Popovic describes his winding evolution into senior academic and personal consultant, devising and teaching a new model of integrated coaching/counselling

When I was six somebody asked me what I wanted to be when I grew up and I answered without hesitation, ‘A fireman!’ I didn’t think much about it for the next 10 years or so, until I had to decide what to study. By that time being a fireman had lost its appeal, so what else could I possibly be but a film director? The competition in Belgrade, where I was born and grew up, was fierce: more than 100 candidates for each place at the Faculty of Film Art. I passed the first two stages of the entrance exam. The third was an interview, which was more or less a formality – and I overslept!

In hindsight, I am very glad as I now know that I would have been a lousy film director. I find it very difficult to make people do what I want them to do, which is essential if you want to direct a film – but an asset for a psychotherapist. My job is to help my clients help themselves – to be, so to speak, their own directors.

So, I failed my entrance exam and went on to study world literature, which I enjoyed so much that I took my time (studying was free in socialist Yugoslavia). Alas, all good things must come to an end, and I went straight from playing the clarinet at New Wave gigs and all night parties into the boots of compulsory military service. You’ve heard about soldiers having to clean toilets with a toothbrush? They are true (although it was not my toothbrush).

What I felt in the army was that we are often like leaves in the wind at the mercy of forces outside us, but even more inside us. This is when I decided what I wanted to do in life: to help people be more in charge of their own lives. This is not about happiness, wellbeing or even self-actualisation. It is about freedom and the responsibility of being at the helm of your own boat.

I remember buying my brother Carl Rogers’ book On Becoming a Person for his birthday. He never read it; I did. That other classic, Viktor Frankl’s Man’s Search for Meaning, clinched my decision to write a book that would address every important area of human life (which 10 years later became my book Personal Synthesis, published in 2005), and to train as a therapist.

Belgrade had (and still has) many nice bars and cafés, but no good therapy training, so when a close friend of mine suggested that I join her in London, and another friend, an air hostess, offered me a free seat on the plane, I took my chances – and fell in love. With London – still my longest love affair.

After waiting at many a table, I learned English sufficiently to finally be able to train in counselling and psychotherapy. In the meantime I witnessed what anxiety and uncertainty, as a result of the collapse of social structures, can lead to: vicious wars in my native country that nobody could have predicted or wanted.

Existential counselling was a natural choice for me, and a good one. It taught me how to just ‘be’ with the client, and the importance of it. Novices, as I was, are eager to help and impatient to do something. In our profession, though, being is doing. This is a basis for helping clients deal with their inner world to which we practitioners don’t have direct access.

However, in time, it became clear to me that clients want both – to explore their inner world, resolve their internal conflicts and make tangible behavioural changes and achieve their goals. I came to the conclusion that we need integration of ‘pure’ counselling/psychotherapy with more proactive approaches such as CBT, solution- focused therapy or coaching. I named this integrative approach ‘personal consultancy’.

The first attempt to make it public was not successful. The time was not right. But now more and more practitioners have recognised that integration is viable, especially since coaching has become a reputable player. Personal consultancy has attracted increasing interest: the LinkedIn group has hundreds of members; Personal Consultancy, the book I co-authored, was published recently by Routledge; there is a new organisation for integrative practitioners (AICTP), and I am running the first UK postgraduate programme in Integrative Counselling and Coaching at the University of East London. So has it all been worthwhile? Ask me in 30 years – the really interesting part has only just begun!

Dr Nash Popovic is a personal consultant in private practice, Senior Lecturer at the University of East London, and Director of the Personal Well-Being Centre. +++ Letters

We welcome your letters. Letters that are not published in the journal may be published on TherapyToday.net subject to editorial discretion. Please email your letter to the editor at [email protected]

Rights and privileges

I am becoming increasingly irritated by those who complain about not being able to find jobs as counsellors. I detect in many of these complaints an assumption that, having completed all the necessary training, they are now entitled to a job and cannot understand why this right has been denied them.

Where does this assumption come from? I have completed two diplomas, and don’t recall any of the tutors on either course, or anything in the course materials, telling me that I would get a job once I graduated.

I do note that BACP’s efforts to promote counselling as a profession may lend people an illusory sense of status, and therefore of right. Personally I do not believe that achieving such status is even desirable.

Granted, doctors, assuming they pass each year’s trials, are more or less guaranteed employment. On the other hand, they are obliged to sell themselves, body and soul, to their profession. I certainly am not prepared to go down that route.

I would say that counsellors are more in the position of graduates of music colleges and art or acting schools. They will have received thorough groundings in technique and more. They will also have made contacts that may help them on any future career. Beyond that, however, it is talent alone that will see them through where jobs are in short supply.

Nearly 40 years ago I completed a degree in modern languages. Despite the reasonably prestigious status of my degree, I still did not regard it as any sort of passport to a prestigious job, even if that had been my wish. That was not, in any case, why I did the degree. I did it because it was what I wanted to do, and it gave me a breadth of education that has benefitted me to this day, not least as a counsellor.

Over the next 20 years I went through a series of crises, and these drew me towards the desire to work as a counsellor. In order to finance my way through two counselling diplomas, I have worked as a road sweeper and a local government officer, and I have cleaned toilets. Cleaning the toilets in the organisation that provided my counsellor training enabled me to train for free, as the fees were waived for employees.

Most of those whom I respect as counsellors have trodden a similar route. They did not qualify as counsellors because they thought it would be a fun way to earn a living. They came to counselling as a result of a calling that grew out of their personal experiences. They, I am also reasonably sure, are not the ones complaining about not having jobs.

Working as a counsellor, in private practice, with a very small number of clients – most of whom pay me very little money – is one of the most satisfying things I have ever had the privilege to do. I do not work enough hours to support myself by this alone, but then I wonder whether working full time as a counsellor is even sane. I have a part-time clerical job, which I find enormously satisfying in a quite different way, and which enables me to take regular breaks from counselling and not to worry too much when I don’t have many clients.

I do think that BACP needs to think more about counsellors like me when it comes to requirements for maintaining registration. The required levels of supervision and CPD may not be appropriate under these circumstances, and are probably not affordable. But this would also mean letting go of the obsessive push towards professionalisation.

A good counsellor training is far more than a qualification towards an over- subscribed occupation. The trainings that I have done have been the means to find out things about myself that I would otherwise never have known. The opportunity to work with clients has been a remarkable bonus.

William Johnston Person-centred counsellor in private practice

Be honest about jobs

In the June edition of Therapy Today Michelle Sudbury writes: ‘Is our future a volunteer profession?’ As a senior lecturer in counselling and psychotherapy I found this letter very thought-provoking and refreshing in its honesty.

This morning I sat at my desk to provide a reference for one of my graduating students who, like Michelle, has completed three years of hard graft on a counselling BA (Hons) degree.

The student was really excited when she contacted me a couple of weeks ago asking if I would act as her referee. She asked me for tips on how to remain calm and succeed in what was to be a very rigorous group interview. The next day she contacted me by email, delighted that she had been successful. She thanked me for my three years input and said many nice things. Rather pompously, I thought her email would be excellent material for our open days, to support employability claims for our course.

This all fell apart this morning when the covering letter for the reference stated that this student had been successful at interview in gaining voluntary employment. I feel that most higher education counselling and psychotherapy courses attract students with prospects of future employability, and do so either directly or unwittingly. Only this morning on the drive to work I heard on the radio a well-known national course provider announcing the start of counselling and psychotherapy courses in my area with a promise of potentially making £45 per hour minimum on completion.

I do empathise with Michelle and her anger at how she experiences the situation. As for a solution, I would not dare offer one. A good number of my students would have made excellent therapists, and committed ones too, but they could not even get onto fee-paying postgraduate courses. The most common reasons given are their age – they are too young – or their lack of ‘hands-on’ experience, or a combination of both. As Michelle rightly states, the time has come to re-evaluate what our courses offer with regard to employability and for us to be honest with our students about how seemingly difficult and complex it can be to gain employment in the field of counselling and psychotherapy.

The article in the same issue by Lee Partis illustrates these struggles brilliantly when he states that he was ‘on the verge of applying for a job with Pizza Express’ (page 39). I sincerely hope that one day soon Michelle secures the dream job she has worked so hard for.

Dr Bill Naylor MBACP; Senior Lecturer, BA (Hons) Education, Psychology and Counselling

Don’t expect high returns

My sympathy to Michelle Sudbury (Letters, Therapy Today, June 2014) for her dilemma, one with which, as a trainer and supervisor, I am very familiar. The numbers of people being trained as counsellors these days is completely disproportionate to the requirements. The training culture itself, particularly in the further education setting, appears utterly disingenuous – the criteria for the latter being ‘bums on seats’.

It is a well-known fact, although one that is conveniently ignored even within these pages, that most people who train as counsellors do not go on to practise.

While Michelle and others equally disillusioned no doubt entered their training in good faith and with good intention, no one, it seems, had the honesty to inform them, prior to their commitment, that the prospect of earning a living from this ‘profession’ was severely limited indeed. In my view this is really quite outrageous and betrays the integrity that the practice of psychotherapy requires.

Having said that, the trainees in all cases will be adults and are responsible for ‘joining up’ in the first place. The idea that the mere existence of a training of any kind presumes a job is waiting in the world is naive in the extreme. I have met many therapists who are disillusioned and angry on leaving colleges etc with their diplomas to find there are no jobs.

As Michelle implies though, there is a larger picture. There are no economic advantages to anyone other than the (private) therapist; no corporation makes money on the back of our ‘help’ and expertise. Thus, no lobby groups have any financial or political muscle to influence the Government, and its present efforts to provide an effective psychological therapy service (IAPT) are in my opinion, laughable.

Sadly, if you train as a therapist, you should know that your investment will most likely not reap (financial) dividends. If you want to do this work, then you’ve really got to want to do this work.

Clive Oxford Therapist, trainer, supervisor; email [email protected]

Tips for jobseekers

As an employer of counsellors (and as a therapist who has enjoyed 20 years’ paid employment), I have compiled 14 suggestions for those who may be considering training as a counsellor, the newly qualified and those feeling aggrieved about working on a voluntary basis.

Four things to do before starting counsellor training

1. Carefully research the counselling job market before embarking on training. In which sectors and geographic areas are jobs most abundant? What sorts of salaries do they offer?

2. Then balance the cost and effort of training against the realistic likelihood of gaining post-qualification employment or career advancement.

3. Decide on the employment sector in which you aspire to work. Choose a training programme that offers the models and level of qualification that will prepare you appropriately with the clinical skills and competencies demanded by that market.

4. Also seek concurrent training in leadership, communication, marketing and business skills. Because you are going to need them.

Four tips for having the right attitude when you finish training

1. Don’t finish training with a sense of entitlement to paid work. Instead, be prepared to meet stiff competition for jobs.

2. Don’t expect the Government, the NHS or the charity sector to ‘fight your corner’ for paid work for counsellors. It is not in these bodies’ interests to do so. So you need to make a personal choice: whether to push to get a paid job, or take the easy route and work for free.

3. The counselling profession has only itself to blame for the vast numbers working for free. People who can afford to pay for their own training then willingly give away their time as volunteers. The more that is given, the more is taken by our ‘Big Society’.

4. If you do not want to give away your time for free, then don’t.

Six ideas for getting paid work

1. There’s a vibrant job market for good counsellors and supervisors at this time, especially in the independent sector, and especially in urban areas. Be prepared to travel or move for decent work.

2. Counselling job applications tend to be discarded by potential employers because the applicant does not meet the person specification, has failed to explain how they can perform the job, or has created a sloppy CV. Avoid these mistakes.

3. Counsellors do not have an automatic right to be paid for being a ‘worker’, if they have signed a volunteer agreement and are treated as volunteers by the organisation. Be careful what sort of agreement you undertake. Only work for a service that has clearly differentiated agreements for trainees, volunteers, self- employed workers and employees. Only take placements with organisations that pay some (if not all) of their workers.

4. If you have enjoyed your placement and want to stay on as a paid worker, say so. 5. Network! Many jobs are secured through personal and professional connections, and counselling is no exception.

6. Counselling services thrive when they have managers who work hard to secure and deliver the grants, contracts and service level agreements that pay their staff salaries. Don’t let the business of counselling be a blind spot. Learn what you can about small business management, social enterprise, grant- and bid-writing and commissioning, as this knowledge is a real asset should you decide to become your own boss or, better still, to create paid work for other counsellors.

Caroline Vermes MEd, MA, MBACP (Accred), MBPsS; Director, Oakwood House Psychological Services; email [email protected]

The value of self-belief

I have wanted to respond to the question ‘Are we paying to work?’ (Letters, Therapy Today, April 2014) for some time. I have decided that simply recounting my experience could be the most helpful contribution.

I began my training in 2003. My placement was in local drug and alcohol services and I loved the work, and was enormously grateful for the support I received; it felt to me like I was being paid for my work, just not in money. I got experience of one-to- one work with active clients, experience of one-to-one supervision and experience of group supervision. The icing on the cake was education, both from the organisation and the clients. When I qualified I was keen to get my accreditation, and so I continued to volunteer with a view to getting to 450 hours as soon as possible. It still felt like a two-way street.

Over the course of my five years volunteering, my own self-worth grew. When I got my accreditation I had a decision to make: do I go all out for making a career in private practice, or do I continue to hedge my bets by doing unrelated paid work a few days, volunteering a few days and hope that prospective clients will fit in with my limited time frame? I decided to go for it. I quit my unrelated paid work, quit my placement, constructed a counselling room in my garden, and put myself ‘out there’ via marketing and networking – and lo and behold, since 2008 I have been able to sustain myself through my private practice.

I don’t mean to imply that the process was easy – it wasn’t. Self-employment is inherently insecure. But what I do want to convey is that, as employed counselling work is hard to find, the only option for me was to go into private practice. A wise man once said to me, ‘Make a decision, choose what you want and go for it. Surround yourself with people who will support and believe in you and the “universe” will provide.’ That was my experience; I knew what I wanted, I went for it and I got it.

To the question, ‘Why is so much counselling provided free of charge?’, my answer is simple: because there are lots of people willing to do it. As long as governments do not have to pay for something, they will continue to draw on the willingness of others to provide it. So perhaps the solution lies with us, the therapists, rather than ‘out there’. Perhaps we should value what we provide; perhaps we should value ourselves. My experience was that, when I learned to value myself and value what I provide, clients began to call, and I am happy and, dare I say, proud to call myself counsellor, psychotherapist and clinical supervisor in private practice. Richard Church Registered member MBACP (Accred)

Questioning supervision

Supervision has been a ‘given’ for me for nearly 50 years. Rarely have I stopped to consider critically why. In the spirit of Colin Feltham’s article ‘Whatever happened to critical thinking?’ (Therapy Today, April 2014) I want to share some of my thoughts.

BACP’s accreditation gives the seal of approval and much influence to supervisors, and it has rarely occurred to me to question their importance. Like leaders in other fields, their knowledge and mystique can be preserved. Despite lively competition between different models, the importance of supervision in all of them remains unchallenged. In my experience, no one dared enlighten our supervisors to the elephant in the room! BAC (now BACP) Trainers and Supervisors conferences helped open up our work to one another. Francesca Inskipp showed us how to recapture the unspoken and unconscious interactions of client and counsellor, supervisee and supervisor by the use of video.

On the one hand supervision is central to counsellors’ learning and practice. On the other, the contribution it makes to a client’s wellbeing is assumed, not tested. I have found little evidence of how supervision actually benefits a supervisee’s clients. In the soon to be published Wiley International Handbook of Clinical Supervision,1 the editors admit ‘that the supervision–client outcome link has been only minimally studied’ (p7), and in none of the chapter headings does the word ‘client’ appear. I find this quite extraordinary. How can something as important as the effect supervision has on the client be so ‘minimally’ researched when the object and justification for supervision is the client’s wellbeing? Does our difficulty identifying how ‘good’ supervision benefits the client account for the priority given to the normative element in supervision, which at least protects clients from the worst we might do? Bailey speaks for many: ‘I am not at all sure we can ever prove conclusively that supervision works but a system that monitors everyone’s process in the service of others feels a good enough check and balance to me.’2

The history of supervision offers clues as to why it has such an unchallenged place in our profession. Are supervisors like priests or shamans, above and beyond scrutiny? Recent research reveals that humility, rather than good technique, most affects the quality of the therapy clients receive.3 Is the same true of supervision? As a client, I approach counselling humbly, rather than competently, because something is amiss in my life. I don’t need a counsellor whose technique is faultless. I want someone who knows the human struggle subjectively. As a counsellor, I want a supervisor who makes mistakes as well as has brilliant insights. As a client, counsellor and supervisor, I recognise the different contributions each makes to therapy. Counsellors empathise with their clients and their needs, bearing the weight of this with the support of their supervisor’s belief in and critique of their work. A supervisor’s distance from the pain in therapy enlarges the counsellor’s vision and understanding. The counsellor’s immanence and the supervisor’s transcendence contribute directly to the therapy. In my experience, supervision is not just about therapy but a major contributor to it. How then are we to measure the value of ‘mistakes’ and ‘humility’ to satisfy the evidence base now expected of therapy?

I learnt about the therapeutic power of supervision from family therapy. A colleague working with multiple families filmed his supervision sessions with their therapists, and played them back to the families and the therapists together. Most individual counselling depends on preserving the boundaries of the therapy, but his method broke open the ‘giveness’ of how supervision helps and/or harms therapy. I wonder, are there counsellors who have applied these methods to individual therapy, and with what results?

Currently supervision is required for counsellors’ and supervisors’ education and development, but not, I hope, at the expense of the client. As parents can forget about their children by focusing on their marriage’s enrichment, the supervisory relationship can be so absorbed with itself that the client is forgotten. It is timely and welcome that the BACP’s review of its Ethical Framework has prompted a proposal from Tim Bond ‘to remodel slightly our approach to supervision to make it more accountable to the client (rather than just the practitioner)’.4

John Foskett Retired counsellor and supervisor, fellow of BACP and President of APSCC. Email [email protected]

References:

1. Watkins CE Jr, Milne DL. The Wiley International Handbook of Clinical Supervision. Chichester: Wiley (in press). 2. Bailey C. Therapy Today 2012; 23(10): 30–31. 3. Humility trumps good technique. News. Therapy Today 2012; 23(10): 5. 4. Hawkins A. From the Chair. Therapy Today 2014; 25(5): 48.

Double wall of silence

I read with interest and applaud the article ‘The story goes on’ by Judy Sherwood (Therapy Today, June 2014) and her suggestion in ‘Lessons for now’ that therapists expand their awareness, ‘... allowing them to ask questions that might not otherwise be asked, and to put their clients’ lives into a context that might otherwise be missed’.

I agree and want to add that, for questions to be asked, there has to be awareness and knowledge on both sides. My interest in transgenerational trauma developed through my own personal history, being one of a ‘second generation’ and a therapist who had no knowledge but, like many, always ‘knew’.

I suggest that a broader view of this time in history is needed. Many groups suffered atrocities in the then occupied Eastern Europe, caught between two brutal regimes – Nazi Germany and the Soviet Union. A broader view would provide the much-needed recognition of groups that might be otherwise missed due to a lack of information. Knowledge allows for the ghosts of other historical trauma, genocides and atrocities, such as the Armenian genocide, to have a chance to step out of the shadows, find a voice and work through the painful process of integration and understanding of intergenerational transmission of trauma for the second and third generations.

For this to happen we also need to be open to and aware of the silence, emptiness, denial and shame that will be sitting in our consulting room (in the therapist’s chair as well as the client’s). This is the ‘conspiracy of silence’ described in Yael Danieli and Dan Bar-On’s ‘double wall’ of silence image, where survivors, unable to openly express and share their experiences, built a wall between them and their present life. Descendants, sensing this wall, built their own wall in response. If one side wanted to open a window in their wall, they would meet the wall of the other side. This resistance and blocking between parent and children (and society) may well happen between client and therapist.

Simone Kaptur BA (Hons) Dip Couns; Registered Member MBACP; integrative counsellor

Racism denial

I was saddened to read the Dilemma responses in June’s edition. Assad, a trainee counsellor feels that ‘a cohort of students on his course is implicitly racist’. None of the respondents are clear that this needs to be explored in the context of racism, rather than his inner process.

Assad’s pain sparks anxiety in us white people that we manage by denying his experience. We might say he’s ‘playing the race card’. My advice would be that he asks for a workshop on critical race theory so that his class, and your respondents, can increase their understanding of the shame and fear they feel when faced with their prejudice. This YouTube video is a great place to start https://www.youtube.com/watch?v=9urhrbVGIsI

Matthew Byng MBACP (Accred)

Personal therapy

I was very pleased to read Jennie Cumming-Knight’s letter printed in the May issue in which she says that she ‘believes that personal therapy should be a requirement for all trainees.’

For some years now I have been troubled by the fact that increasingly few training courses require their students to have therapy as part of their training, or if there is a requirement it is often for 10 sessions only. While 10 sessions may be considered adequate for a counsellor doing six session work, it is nowhere near enough in my view for counsellors working longer term with clients.

As a supervisor, I frequently despair at the low level of personal awareness that students have. Of course there are notable exceptions but the general level appears to be lower than it was in the days when 40 hours of therapy was a normal part of training. Consequently there is often a lack of understanding of what might be taking place in the counselling room during a session. I may be sticking my neck out if I say that the misuse of power, the blurring of boundaries and inappropriate counsellor input seem to be increasingly prevalent in supervision these days – I would value feedback on this.

It seems to me that, with increasing numbers of extremely vulnerable clients, we need to be more aware, rather than less, of how we relate to them. BACP, please bring back a requirement for counsellors seeking accreditation to have had a level of personal therapy and don’t leave it to training courses, which have such differing standards.

Kitty Willis +++ Reviews

True love conquers maleficence

Jude Fowler reviews Maleficent, Disney’s new take on Sleeping Beauty and the age- old theme of the triumph of unconditional love over the forces of evil

Fairy tales are like tendrils dipping into our deepest fears and fantasies. Freud used the symbolism of fairy tales to interpret the meaning of dreams, and Jung went beyond pathology into the universal symbols, or archetypes, of the collective unconscious.

The new Disney film Maleficent is a reworking of Sleeping Beauty that is dripping with symbolism – layer upon layer of potent metaphors in sometimes chaotic sequences that disturb, confuse but somehow make perfect sense. This is a movie about relationship with self and other, and is complex and messy. The characters in the film are played by live actors but there is a cartoon quality to them that renders them interesting, not always in themselves but for what they represent.

We are introduced to a land dominated by men where lust for power takes precedence over all else. Co-existing alongside this is a land in harmony with nature, where magic infuses everything: light and dark, yin and yang, anima and animus.

The viewer is introduced to the protagonist, Maleficent, in childhood. Orphaned at a young age, she presents as solitary and independent yet well adjusted, caring, compassionate and open. The film explores and explains her transformation into the evil queen and beyond; the shadow side is never far away.

What is unusual in this film is that no one is looking for someone else to rescue them; all is achieved by the courage, integrity, empathy and resilience of Maleficent. In the end, her ability to be flexible and take risks in a relationship results in profound personal and environmental changes. The ingredient that heals Maleficent and integrates her wickedness and her compassion is unconditional love; this is the movie’s message. As in the recently released and lightweight Disney animation Frozen, romantic love is contrasted with true love. Romantic love is demoted to the inconsequential while true love takes centre stage as the panacea for the world’s every ill.

From the perspective of a newly qualified therapist, I found the psychological depictions of trust, betrayal, disintegration, repair and hope utterly compelling. The narrative does falter in places but, if you are interested in working with metaphor and have a soft spot for the darker side of fairy tales, then this is a film worth seeing.

Jude Fowler is a counsellor working with children and young people

Maleficent is directed by Robert Stromberg. Walt Disney Pictures, 2014 (PG, 97 minutes)

Good guide for bewildered trainees What you really need to know about counselling and psychotherapy training Cathy McQuaid Routledge, 2014 212pp, £22.99 ISBN 978-0415813341

Reviewed by Abi Howarth

This guide takes a comprehensive and largely accessible look at counselling and psychotherapy training.

McQuaid starts with an exploration of different modalities, qualifications, course requirements and learning styles. These practical chapters are then followed by a look at the more personal considerations of counselling and psychotherapy training, such as individual therapy, the impact of training on relationships, workload and costs. The book also has a chapter dedicated to the outcomes of training, including an honest look at career prospects.

Each chapter contains excellent summaries at the start and end, with suggested questions to challenge the reader and prompt further self-reflection or research. There are handy website references at appropriate points, as well as comprehensive comparison tables and practical appendices. McQuaid has also talked to students, who offer useful and varied personal perspectives throughout.

I most enjoyed the chapters later in the book on the personal impacts of counselling and psychotherapy training. For me, the book is particularly successful in communicating what a life-changing experience training is. For trainers, I can see that the sections on learning theories and styles would be most useful and of most interest.

In terms of the different courses, modalities and qualifications available to a potential trainee, the book attempts to de-mystify this information as far as possible. However, I was still left feeling a little bewildered by the sheer volume of what is on offer. That said, I think this says more about the counselling profession than about how the information is presented here.

The book challenged some of my thinking about the profession by delving into current topical debates. For example, McQuaid outlines the conflicting opinions on the differences between counselling and psychotherapy; whether a training course should require that a trainee undertakes personal therapy, and the perceived pros and cons of regulation.

Overall, this guide strikes a good balance between the practical and personal considerations of counselling and psychotherapy training. It demonstrates that the questions of whether to train and, if so, which course to take deserve full and careful consideration. I believe it will be of ongoing value to potential learners, existing learners and trainers alike.

Abi Howarth is a second year student working towards her advanced diploma in integrative counselling

To read sample material from the book, please visit http://www.routledge.com/books/details/9780415813341/ Continuing work in progress

Personal and professional development for counsellors, psychotherapists and mental health practitioners John McLeod and Julia McLeod McGraw Hill, 2014 272pp, £22.99 ISBN 978-0335247332

Reviewed by Sharon Breen

This engaging and accessible book reminds us that, like our clients, counsellors are works in progress. Through its 10 lively chapters, John McLeod and Julia McLeod take us on a compelling journey of self-discovery. En route, they invite us to press the pause button and reflect on our lives in all their messy complexity.

The book is arranged in two parts. The first explores the meaning of personal and professional development and the practical ways in which it can be facilitated. It contains the latest research and theory and an overview on evaluating effectiveness.

In part two, the reader is invited to complete a series of richly textured learning tasks. Reflective writing and participation in a learning group are strongly recommended and there are frequent pointers to ways in which the tasks may help to deepen therapeutic engagement with clients.

Chapter six, ‘Reflecting on life experience’, is the section’s anchor, packed with more than 30 exercises, such as ‘How do you cope under pressure?’, ‘Becoming more emotionally available’, ‘What motivates you?’ and ‘Mapping your relationship patterns’.

Many of the tasks are writing-based. This may not suit everybody, but there are also opportunities for private and group reflection and the use of art materials and other means of creative expression.

As a counsellor-in-training, I especially enjoyed working through chapter eight on using theory to build a framework for understanding client work. The thought- provoking exercises allowed me to do something I had wanted to do for some time – reflect on and bring into focus my personal approach as a therapist. Chapter nine, on handling practical dilemmas, cemented this learning into place.

The authors are both highly experienced trainers who clearly understand and empathise with their readership. As they rightly point out, students have often been left to their own devices when it comes to fulfilling the personal development part of professional counselling training. This book more than amply fills that gap.

Although written primarily for trainee counsellors, there is much here for the experienced therapist, supervisor, group leader or counselling course trainer to admire and to learn from. Indeed, I believe its appeal extends more widely, and it would be a valuable addition to any mental health professional’s bookshelf.

Sharon Breen is a counsellor-in-training, coach and writer

For more details about the book, please visit http://mcgraw- hill.co.uk/html/0335247334.html Safe space to think about difference

Thinking space: promoting thinking about race, culture, and diversity in psychotherapy and beyond Frank Lowe (ed) Karnac Books, 2014 288pp, £26.99 ISBN 978-1782200598

Reviewed by Linda Watkinson

As the title suggests, this book explores difference and how we relate to it. It is thought-provoking and challenging, but its tone is compassionate and containing. It is the culmination of the work of Thinking Space, a discussion forum that has met monthly for the last 12 years at the Tavistock Clinic in London.

The book’s many contributors have been part of this forum and they write of their learning experiences, often painfully gained, with honesty and courage. They demonstrate the importance of and need for safe spaces in which to explore unconscious prejudice and question theoretical background and intellectual belief. In turn, this creates a safe place for the reader to consider afresh their own blind spots when working with difference.

A particular strength of this book is that it challenges the often tokenistic, brief, one-off training approaches to difference in both counselling and psychotherapy training courses and in equality training more generally. It provides a much-needed model for promoting greater understanding of race, culture and diversity – all complex, charged and often anxiety-provoking issues.

The chapters address ethnicity and race, class and sexual identity, and reference is also made to gender and faith in the context of wider cultural issues. I would have liked to see a chapter on the misunderstanding that often exists between people of faith and none and how this can affect the therapeutic encounter.

This is an important and groundbreaking book which dares to explore beyond the politically correct. It is essential reading for all counsellors and psychotherapists, and for a wider audience wishing to explore their own attitudes to difference.

Linda Watkinson is a counsellor

Living the life left to us before we die

Life to be lived: challenges and choices for patients and carers in life-threatening illnesses Catherine Proot and Michael Yorke Oxford University Press, 2014 176pp, £24.99 ISBN 978-0199685011

Reviewed by Frances Basset Written by a psychotherapist and a pastoral carer in bereavement counselling and palliative care, this book at first sight resembles a nursing textbook – its value for counsellors and therapists only emerges later.

Presented in five parts and 15 chapters, it is an attempt to explore what can bring a sense of healing to people facing terminal illness and death. Much of the book’s strength lies in its narrative style, which encompasses actual accounts from patients, therapists and chaplains. This will be of particular appeal to counsellors and therapists working in palliative care settings. Counsellors and therapists wishing to understand more about the impact of a life-threatening illness will also derive much from this useful repository of information.

The book sections are presented coherently, ranging from the patient experience to the impact on the family and professional roles. However the chapters range widely, which makes it hard for the reader to get a sense of the overall message. For example, from chapter 12 onwards, the authors cover areas such as professional and lay roles, blurred boundaries and self-disclosure, whether or not to attend a client’s funeral, mindfulness and support groups, the value of memory boxes and art therapy. These are all valuable areas of explanation but the way they are presented lacks a logical flow.

One central theme that does emerge is ‘Help me to live, not to stop dying’. This message is clearly articulated and touches on the possibilities for emotional, mental, and spiritual growth in the face of death. This I felt established a hopeful and positive core throughout the book.

While the authors point out that ‘Spirituality is the hand and religion is the glove which fits it’ (pxii), the book’s emphasis is on Christian chaplaincy and its role in spiritual care. This reflects the experience of the authors but I was left feeling that it would have been helpful to explore this important topic from a broader and more diverse perspective.

Frances Basset is a psychosynthesis psychotherapist working in private practice

To read a sample chapter, please visit http://fdslive.oup.com/www.oup.com/academic/pdf/13/9780199685011_chapter1.pdf

How to be competent and careful

Competence and self-care in counselling and psychotherapy Gerrie Hughes Routledge, 2014 184pp, £19.99 ISBN 978-0415828079

Reviewed by Jane Cooper

Hurrah for a book that normalises the experience of feelings of incompetence! As Gerrie Hughes concludes, ‘the nature of therapeutic work means that practitioners need to be able to withstand relationship ruptures, “mistakes” and uncertainty’ (p171). Indeed it seems that having the capacity for professional self-doubt has a positive effect on outcomes for clients. This is a well signposted and clearly structured book that presents a framework for competence around the elements of Practitioner, Client and Context. Hughes, an accomplished Gestalt psychotherapist, uses eight principles to elaborate these elements. It is relevant to any theoretical orientation and appropriate for practitioners at any stage. The second part of the book focuses on care of the self as an essential requirement for maintaining competence.

What brings this book alive are the case studies, activities and personal reflections at the end of each chapter. Hughes is generous with her personal reflections and a good role model for the reader in encouraging us to be honest with ourselves.

The book is designed to be used in three ways – for individual reflection, for study with one’s supervisor, and with a group or a work team – and Hughes offers creative suggestions for how we might do this in the ‘activities’ sections. I found her prompts for short bursts of uninhibited journal writing particularly helpful; salient points from the journaling can then be shared in groupwork.

The sections on the Client and the Context are short in comparison with the Practitioner. The ‘co-created field’ does get a brief mention, but I would have liked more of an emphasis on how the three elements work together, particularly in the current social and political context.

The chapter on supervision, however, is excellent and, alongside a succinct description of the function and benefits of different kinds of supervision, includes a discussion of Casement’s concept of the internal supervisor and Schon’s ideas on reflective practice.

A lot of work has gone into this concise little book. What we read is a distillation of a huge amount of material. Above all, it’s a practical manual on how to stay compassionate and robust in our dealings with others and ourselves.

Jane Cooper is a counsellor and supervisor

To read sample material from the book, please visit http://www.routledge.com/books/details/9780415828079/

Group analysis revisited

Listening with the fourth ear: unconscious dynamics in analytic group psychotherapy Leonard Horwitz Karnac Books, 2014 384pp, £29.99 ISBN 978-1782200178

Reviewed by Christopher Davies

This book seeks to survey the field of analytic group psychotherapy through the eyes of a highly experienced American practitioner, teacher and supervisor.

Its four main sections are variously headed Historical, Theoretical, Clinical and Training, demonstrating the breadth of its scope. Each comprises four or more chapters and together they chart the development of analytic group psychotherapy, mainly as it occurred in the US. Horwitz developed a programme of group psychotherapy and teaching in the Menninger Clinic in Kansas, with assistance from a British analyst from the Tavistock Clinic, John D Sutherland. This led to a long association with the Tavistock and the development of a particular theoretical model and model of clinical practice within American analytic group psychotherapy that continues to this day. This may explain Horwitz’s rather limited perspective on Foulkesian group analysis, the pre-eminent model in the UK and other parts of Europe.

Horwitz acknowledges that the context for group analysis has changed almost beyond recognition since he started to develop the programme at the Menninger Clinic. Long hospital admissions and extended treatment programmes have disappeared. What was introduced as pioneering short-term treatment is now seen as long-term when viewed through the lens of ‘managed care’ in a health insurance system that demands treatments that are encapsualted and branded like drugs. A casualty of this unstoppable development – which is now gaining ground in the NHS in the form of Payment by Results and mental health ‘clusters’ – the Menninger was merged with other institutions in 2002.

Chapters outlining clinical work and the thinking underpinning it will engage any student of group analysis, but I was particularly interested in Horwitz’s own ‘inductive group centered approach’. This is his attempt to find a way to draw together the sometimes opposing approaches of practitioners who focus on the group-as-a-whole and its relationship with the therapist and those interested primarily in the interaction between peers. There is a clinical vignette to illustrate this approach but I found myself wanting more than one example of its application.

Taken overall, the book is an accessible and readable overview of analytic group psychotherapy within the US but in many ways it is as much a professional memoir as it is a student textbook.

Christopher Davies is a group analyst and NHS adult psychotherapist

Have you seen a new film or been to a concert, an exhibition or other cultural event that you think has special resonance for counsellors/psychotherapists? If you’d like to write a short, lively review, please contact Chris Rose, Reviews Editor, at [email protected] TherapyToday.net reviews

Suzie Chick reviews Frank, a far from archetypal rock band movie that explores issues of identity, vulnerability and the interface between who we are and who we want other people to think we are

Frank tells the story of friendship, creative conflicts, mental instability and one (literally) big-headed lead singer. Jon (Domhnall Gleeson), a young wannabe musician, joins an alternative rock band fronted by the strangely charismatic Frank (Michael Fassbender), who permanently wears a large papier-mâché head.

Most of the film covers the lengthy recording of the band’s album in a remote lakeside retreat. During this time, Jon communicates to the outside world through social media, uploading videos of the band, and gaining significant popularity.

The atmosphere of the film changes when, inspired by the online following, Jon convinces the band to perform at a well-known music festival. Jon’s obsession with success and popularity results in a disastrous gig where they attempt to play ‘the most likable song ever’. The band self-destructs and Frank runs away without his fake head. Jon eventually finds Frank living back with his parents in suburbia, a far cry from the eccentric environment of the band.

Mental illness is a constant theme throughout the film; most of the characters have spent time in psychiatric hospitals, but the centrepiece and metaphor is Frank’s fake head. In every scene it presents itself as the unspoken ‘elephant in the room’. Like Jon, we want to know, ‘What goes on inside the head inside that head?’ Jon is convinced that you need to suffer for your art and that Frank must have experienced some past trauma to justify his musical talent as well as his fake head. The band’s manager even commits suicide wearing one of Frank’s spare heads, as if he wants to be Frank, or disguise himself behind Frank’s persona.

As a trainee therapist, the fake head screams at me that something is intensely amiss with Frank, and I feel a great deal of concern for him. Frank’s physical mask makes him clearly visible, but at the same time more susceptible to outside assaults. The unmasked Frank is vulnerable and painfully shy, in contrast to his masked self, who appears so charismatic and creative. Frank raises challenging questions about the vulnerabilities we hide behind our own everyday fake masks or ‘false selves’, and what can happen when these are challenged and exposed.

Suzie Chick is a trainee psychotherapist and blogger

Frank is directed by Lenny Abrahamson and written by Jon Ronson and Peter Straughan. Magnolia Pictures, US, 2014 (95 minutes)

Fading Gigolo

Danielle Lloyd-Edwards reviews Fading Gigolo, a sensitive exploration of emotional healing and how breeching the boundaries of care-giver and care-receiver can break the spell Fading Gigolo is an understated take on the ‘oldest profession’. Fioravante (John Turturro) is down on his luck: the bookshop where he works, owned by his friend Murray (Woody Allen), is closing down and he is behind on his rent. Rather implausibly, Murray has been asked by his dermatologist (Sharon Stone) if he knows anyone with whom she might be able to have a threesome. Murray thinks of Fioravante, and so launches his assistant on a career as a gigolo.

Murray takes to his role as pimp with gusto, the humorous realist often persuading the more scrupulous Fioravante that his role is one of service provider not predator. Murray persuades a lonely Hasidic widow Avigal (Vanessa Paradis) to see Fioravante, promoting his skills as a ‘healer’. There is a moving scene where, at the touch of Fiorevante's hand on her back, Avigal begins to cry. Later in the film she explains that she was ‘crying from loneliness’.

The themes of humour, compassion and desire run alongside grief, vulnerability and loneliness. From the outset Fioravante is tender yet aloof and so remains hard to read throughout the film. In his work, as in the therapeutic relationship, Fioravante becomes the container for his clients’ projections. His quiet, non-judgmental stance allows his clients to unburden themselves. His relationship with Avigal is profoundly poignant and healing, as he is able to hold her loneliness and grief. He does not turn away.

In a mirror of the therapeutic relationship, once the boundaries of the client relationship become blurred and Fioravante allows his own needs to be felt, the spell is broken. He is no longer the ideal object.

Ultimately, Fading Gigolo shows that the need for the boundaries in this type of relationship are not simply there for the client but are also intrinsic to the role of care- giver. In order to be able to receive and hold the client’s projections, we must first know where the boundaries of the relationship lie. The sense of intimacy created can confuse both parties; when acted on in life, as happens in the film, the client may still gain insight but the relationship is unsustainable and inevitably must end.

Danielle Lloyd-Edwards is a psychodynamic psychotherapist

Fading Gigolo is directed by John Turturro. Antidote Films, 2014 (90 minutes).

Starred Up

Patience O’Neill reviews a powerful exploration of the violent sub-culture within our prison system and the flickering flame of hope that therapy can offer its inmates

This film directs an unflinching gaze at a prison environment, and is gripping from start to finish. We learn, in a visceral way, about the sociological sub-culture of the institution for prisoners and for staff, and experience the feeling of being inside a locked cell.

The key character is Eric, 18, who is ‘starred up’ – transferred early from a young offender institution to an adult prison. The story follows his violent and poignant coming of age in a prison where his estranged father Neville is also a prisoner. One strand of the narrative is the depiction of a therapeutic group, run by Oliver, a voluntary therapist. We see therapeutic meetings he facilitates, in non- confrontational, affirmative way, connecting with the positivity of the prisoners. On one occasion an argument escalates between two group members and Oliver silently places himself between the two men as a non-violent boundary, to de- escalate the encounter.

We witness group members communicating with each other about feelings and relationships in group sessions. Eric joins, and the group support him to name and stay with his anger, for the first time in his life. They become his mentors and allies. Like a single candle flame in a cave, the therapy group is a potent and yet vulnerable presence within the violent sub-culture of the prison.

The group’s sanctuary is aggressively interrupted by the prison managers and by Eric’s father Neville, as if they cannot tolerate the positivity it represents. Neville tries to connect with Eric, and his clumsy bravado is painful to watch. As Eric says, ‘You weren’t there in my childhood, why bother now?’ In a surprising twist towards the end of the film, Neville saves Eric’s life; father and son finally connect and are able to show their need for each other.

However, the daily drills of prison life continue, with violence erupting between the competing sub-groups, and the darkness of the dystopian system prevails. The candle flame of the group is extinguished and Oliver gives way to the sabotage and brutality of the prison managers.

There is no spelled out ‘moral of the story’ in this film. Instead we are left to reflect on the nature of prisons. What are they for? What effect do they have on inmates and staff? Should they have a reparative or purely punitive function? There are questions too about therapy. The film shows its power and potential, but also how it can challenge and disturb institutions and be so easily snuffed out.

Patience O’Neill is a counsellor, supervisor and trainer

Starred Up is directed by David Mackenzie, written by Jonathan Asser. Film4, 2014 (106 minutes) +++ From the Chair

Don’t blame technology

Counsellors have to keep up with new technology if we are to be of use to our young clients, writes Amanda Hawkins

I started writing this column at the BACP CYP conference in London, on 21 June, surrounded by really great counsellors all committed to helping children talk about difficult feelings in an increasingly troubled and troubling world. The conference title was ‘Technology: friend or foe?’ and its aim was to challenge the common perception among us caring and concerned counsellors that new technology is some alien force threatening children’s mental and physical wellbeing.

New technology is part of their lives; they like it and use it. Even if we don’t like it, we need to be able to use it and to speak its language if we want to be able to communicate and work usefully with children and young people. That’s the message I took away with me.

The opening keynote speech was particularly challenging. Jim Gamble is a former police officer who was for many years head of CEOP, the Child Exploitation and Online Protection Centre, a specialist operation set up under the aegis of the National Protection Agency to target online abuse of children. The title of his talk was ‘It’s not about the technology’ and he challenged us to move away from blaming technological advances for the apparent explosion in the sexual abuse of children. Technology isn’t the problem; we need to look for the people who sit behind the screens and keyboards – people who have always abused children, online or not. The internet just means they can do so more easily and more profitably, he told us. It was a sobering presentation and Jim constantly reminded us of the flesh and blood children and young people who are being harmed and exploited.

Jim pointed out that if we want to communicate with children and hear their worries and troubles, it is our job to learn how to use the media they use to communicate, and make sure that it is safe for them to be doing so. Don’t just blame the tools – educate children and young people about the dangers of online grooming: make sure they know there are people out there who are ‘not nice’ and may try to hurt them; make sure they know how to protect themselves and that they feel they can come to us for help without shame or fear of judgment.

For me this topic connected to some of the stuff that Tim Bond was talking about in the Ethical Framework webinar on 24 May, about supervisors becoming more accountable for their practice. Jim soberly reminded us that, among our 42,000 members, there will be some practitioners who do want to harm children and might use the mask of a ‘helping, kind, professional counsellor’ to win their trust. It’s something I hear more and more: where has trust gone? For Jim, there’s no question: where there’s a question mark over whose version to believe, surely the right thing to do is to always give the benefit of the doubt to the child and work from this position? It was a tough presentation to hear but good to be challenged as a profession to stay ‘professionally curious’ – whether working with young clients or with supervisees.

The conference ended on a high, with a launch party for the Counselling MindEd e- learning website, which BACP has worked on with the Department of Health. All the material has been written by counsellors for counsellors. It is such a good showcase for the quality of what we do. Watching some of the film clips made for the training sessions, I felt incredibly proud and moved to be associated with counselling.

And now to the sad news, reported elsewhere in this issue, that Laurie Clarke has stepped down as CEO of BACP after 12 years at the helm. Laurie has led the Association through an amazing period of growth and success. It has been an honour to work alongside him as Chair. We are all sharing a sense of great loss.

And he is not the only one who has left us. I want also to acknowledge the fantastic work of Sally Aldridge, BACP Registrar and Director of BACP Registers, who retired at the end of June. Sally has worked for BACP for over 15 years, but was active within BACP for many years before that. She has given so much of herself in taking forward the regulation of our profession, as well as our professional standards and training.

I can’t imagine BACP without Laurie and Sally. I trust they will keep in touch and let us know how we are doing, even from afar.

Goodbyes are perhaps a little less hard when we are left with such a legacy. +++ BACP interns: ‘a breath of fresh air’

BACP’s internship scheme is offering real work opportunities to young people at the start of their careers, as Catherine Jackson reports

Launched in 2011, following a one-year pilot in 2010, BACP’s internship scheme offers full-time, paid work experience to three interns a year (or six for six months, as in 2013).

‘We wanted to be able to offer real work opportunities for interns and apprentices, as part of our corporate social responsibility,’ explains Beverley Brennan, BACP Director of Human Resources and Customer Relations. ‘The Board backed this all the way, starting with the pilot with just one intern in 2010, and they have committed to it every year since.’

BACP’s interns were initially paid the national minimum wage, and from this year are earning the Living Wage (slightly more, at £7.65 an hour). The BACP scheme is based on the Common Best Practice Code produced by the Gateways to the Professionals Collaborative Forum, which includes the Chartered Institute of Personnel and Development (CIPD), the General Medical Council and the Law Society.

BACP takes its commitment seriously. ‘Key to the success of the scheme is that there is a clear programme of work for the interns,’ says Beverley. ‘The directors put in their bids each year and we expect them to offer a thorough induction and training programme. Our interns need to be sure they will be learning real skills and taking on real responsibilities.’

Talking to interns past and present, it is clear that BACP is meeting its own very high standards. Alex Vostanis has just started as Policy and Public Affairs intern – he had been in post barely a week when we interviewed him for this article, coming straight from Birmingham University, where he studied International Relations with Economics. ‘For me, BACP really stood out because it was much more professional than other organisations offering similar positions,’ he says. ‘It offers a proper personal development scheme, and the chance to get involved in real work, and a living wage.’

John Hildreth joined BACP’s Customer Services department as an intern in October 2013, and was immediately given the task of taking forward BACP’s application for accreditation with the ICS (the Institute of Customer Services). He says: ‘I’d heard horror stories from other students, both of having to work ridiculous hours and only being paid travel costs, and also people not being given work experience that was going to improve their skills. BACP was really good at getting me involved in real projects from the outset.’

‘I felt valued for the graduate skills I brought, not devalued for not having work experience,’ says Anna Lewis, who completed a six-month internship with the Policy and Public Affairs Department last year. She had just graduated from York University with a degree in History and Politics. ‘My experience was completely different to many of my peers. I had the opportunity to experience the real work of the department from day one. I wasn’t just in an admin support role.’ She praises BACP’s commitment to paying its interns. ‘BACP recognises how unfair it is if only those who can afford to work for free are able to have these opportunities, especially in the context of higher tuition fees.’

Not all interns are graduates. Jenny Peake had already worked with BACP in 2002, with the Events team. She left to retrain in marketing and was looking for a job in the sector when she saw BACP’s advert for a social media internship on its website. ‘I wanted a role where I could gain some good, solid practical marketing experience. An internship wasn’t something I was looking for specifically, and the pay was a consideration for me, but it seemed an ideal route into a new career and I was more than happy to return to BACP,’ she says.

Former interns have spread their wings and flown away – and some have successfully applied for permanent posts with BACP. Jenny was recently appointed to the permanent, full-time post of Marketing Officer, which came up towards the end of her internship. ‘I’m thrilled. The internship has meant I was able establish myself fairly quickly in the job I wanted to be in and where I’m going to learn masses more,’ she says. John Hildreth successfully applied for a 12-month maternity cover post as CPD Officer with the CPD and Events team and Anna Lewis was appointed full-time Policy and Public Affairs Officer earlier this year. ‘It says a lot about what is expected of its interns that I didn’t feel there was a huge jump from the internship to my current role – although obviously I have much more responsibility now,’ she says.

Beverley Brennan sums up the benefits of interns for BACP: ‘They bring new ideas and perspectives. They roll up their sleeves and get on with the work. They’re like a breath of fresh air.’ +++ BACP News

Laurie Clarke stands down

Laurie Clarke has stepped down as Chief Executive of BACP after 12 years in the position. The positive impact that Laurie has made on our organisation is considerable, and it is with sadness that we announce his decision to leave in order to safeguard his health.

‘It is with a heavy heart that I leave BACP after 12 years in the role as Chief Executive,’ said Laurie. ‘I feel extremely privileged to have had the opportunity to lead the organisation during its many successes, and I’m very proud to leave BACP, and the profession, in the strong and respected position that they are in today.’

‘During his 12 years as Chief Executive, Laurie has overseen the development of BACP into the leading professional body in the sector,’ said BACP Chair Amanda Hawkins. ‘The extended period of growth and success that BACP has experienced over the last decade are due in no small part to Laurie’s skill, talent and enthusiasm. BACP membership has more than doubled, from just under 20,000 in 2002 to nearly 42,000 today. The passion he has brought to his role and the tireless work he has done during his tenure have been phenomenal.

‘On behalf of BACP’s Board of Governors, I extend my gratitude to Laurie for his exceptional contribution to our organisation, and wish him the very best of luck for the future.’

TT.net wins national award

TherapyToday.net has won the Online Media Award for Best Health/Education News Site – for the second year running.

Judge Liz Vercoe said: ‘The international accessibility and interest in the website is particularly impressive. It makes a valuable contribution to spreading good practice in highly topical and sometimes sensitive subject areas to both developed and developing countries.’

Sarah Browne, editor of Therapy Today, said: ‘This is a real boost to our continuing development of the website and a welcome accolade.’

Update on the BACP Register

BACP has made some changes to the BACP Register website to make it easier for members to join the Register and to renew their registration.

The improvements include changes to the information about how to join the Register and about the Certificate of Proficiency, which is the route onto the Register for current MBACP and Individual Members of BACP who haven’t completed a BACP accredited course. BACP is also reminding registered members that they need to renew their registration annually, at the same time as they renew their BACP membership and/or accreditation.

Go to www.bacpregister.co.uk for further information or to renew your current registration.

Hoxter Educational Bursaries

BACP is offering 60 bursaries to students to help them with the costs of their counselling course fees for this coming academic year.

The Hoxter Educational Bursaries are each worth £500 and are available now for the academic year 2014–15. They are open to any student enrolled on a BACP accredited course, although priority is usually given to those who are receiving benefits or grants or are on a low wage. Students who have received a bursary in a previous year can apply again for this academic year.

For further information and the application pack go to www.bacp.co.uk/crs/Training/bursary.php or please email [email protected] or call 01455 883382. The closing date is 31 July.

BACP Private Practice conference to focus on anxiety

This year’s BACP Private Practice conference is on Saturday 13 September 2014 in central London. Following last year’s conference on depression, the theme this year is ‘Anxiety: How can therapy help?’.

Keynote speaker Richard Hallam will present on how to create an individualised formulation and tailor goals and methods accordingly. Dr James Davies will close the conference with a keynote presentation on how practitioners can improve their confidence when working with clients diagnosed with anxiety.

The packed workshop programme includes OCD and hoarding anxiety, with Sally Ingram; mindfulness, with Kamila Hortynska; working with anxiety using Solution- Focused Brief Therapy, with Evan George; attachment and anxiety, with Julia Greer; brain development and anxiety, with Dr Richard Evans; stress in the workplace, with Andrew Kinder; and social anxiety, with Professor Robert Elliott. To register, visit www.bacp.co.uk/events/conferences.php or please call Customer Services on 01455 883300.

Farewell to Sally Aldridge

Sally Aldridge, Registrar and Director of BACP Registers, retired from BACP at the end of June.

Sally joined BACP as a student counsellor when it was still the British Association for Counselling and has been closely involved with the Association ever since. In the late 1980s she was a member of the Management Committee (now Board of Governors) and Chair of the Accreditation Sub-Committee. She joined BACP as Head of Accreditation in 1999 and subsequently became Director of Regulatory Policy, then Registrar and Director of BACP Registers in 2010, and in 2012 led the process to achieve accredited status for the BACP Register with the Professional Standards Authority.

Sally was one of the first members to be awarded a BACP Fellowship. During her time at BACP she has published two books – Counselling Skills in Context, written with Sally Rigby (Hodder & Stoughton, 2001) and A Short Introduction to Counselling (Sage, 2014)– and she is currently writing a history of counselling in the UK.

Dr Hadyn Williams, previously Deputy Director of BACP Registers, took up the post of Registrar and Director of BACP Registers from 1 July.

Making Connections in Bristol and Midlands

The next two BACP Making Connections events are in Bristol on 5 September and Birmingham on 10 October.

Making Connections is an opportunity for BACP members to meet senior executive and non-executive officers, to catch up on what’s new at BACP and in the wider world of counselling, and to network with other members.

Both events will feature a short presentation on the new Counselling MindEd online training resource, and Professor Tim Bond will also give a progress report on the review of the BACP Ethical Framework.

For details and to book, please visit www.bacp.co.uk/events/conferences.php or call 01455 883300.

Workplace counselling

BACP is seeking evidence from workplace counselling services to help make the case for their benefits to employers.

It is looking for hard data to demonstrate that investing in counselling support services for employees produces measurable economic and human benefits. The aim is to produce a dossier of evidence that services under threat from cuts or closures can use to bolster their position.

‘You may have data on reductions in absence rates, faster rehabilitation, reductions in stress, less disruptive workplace behaviour, greater productivity and so on,’ Rick Hughes, BACP Lead Advisor: Workplace, said. ‘If so, we’d love to hear from you.’

You can contact Rick at [email protected]

Board of Governor elections/AGM Business Sub-Committee

Ballot papers for the BACP Board of Governors elections are enclosed with this issue of Therapy Today.

Three nominations have been received. Ballot papers must be completed and returned to the independent scrutineer not later than 5pm on 12 August 2014. The names of the elected Governors will be announced at the BACP Annual General Meeting on 21 November 2014. Also included with this mailing is a nomination form for a vacancy on the 2014 AGM Business Sub-Committee, which is to be filled by co-option. The Business Sub- Committee is responsible for managing the AGM. The Sub-Committee is required to meet either face to face or electronically at the end of September and then at the AGM.

Completed nomination forms must reach the Chief Executive’s Secretariat, BACP House, Lutterworth by 5pm on Monday 11 August 2014.

If you have any queries about these, please contact Jan Watson, Assistant to the Chief Executive, on 01455 883383 or email [email protected]

Supervisor training framework

BACP has just launched the long-awaited BACP Counselling Supervision Training Curriculum, which offers training providers a framework for delivering training for counselling supervisors.

The curriculum is based on the Supervision Competences Framework (www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm), which identifies aspects of counselling supervision practice that are evidence based. It covers the range of topics needed for comprehensive supervision training, and includes a session-by-session guide that highlights best practice. It is not intended to be prescriptive and is designed to be flexible so it can be taught at different academic levels, including Postgraduate Certificate and Postgraduate Diploma. It is consistent with the QAA National Framework for Qualifications.

BACP members can download the curriculum free from the BACP website at www.bacp.co.uk/research/resources/index.php

For further information or to give feedback on the curriculum, please contact Helen Coles, Head of Professional Standards at [email protected]

Why I joined... BACP Healthcare

Shanaz Patel, like many BACP members, has several jobs. Based in Preston, for one day a week she is employed as an outreach counsellor with Lancashire Women’s Centres, working with parents attending local child centres. Another day a week she works at Sahara, a voluntary sector health and wellbeing organisation for BME women. Her third job is with the NHS, where she is a bank primary care counsellor for Lancashire Care NHS Foundation Trust’s IAPT service.

She’s been a member of BACP ever since she started her counselling training in January 2011. As a relatively recently qualified counsellor, she says she is always seeking learning opportunities, and that is one of the main reasons she joined BACP Healthcare. ‘I joined about the time when the NHS structures changed and commissioning was moved to GP consortia. BACP gave out a lot of information about it and there’s been more since to help us understand how commissioning works and what the implications of the changes are,’ she says. ‘I really enjoy working across so many different settings but I find, in the voluntary sector, your horizons tend to be a bit more limited to the organisation where you’re based. As a counsellor, you can be quite isolated from the wider world and, as I think about developing my career, I think it’s important to have this wider perspective.’

The quarterly journal, Healthcare Counselling and Psychotherapy Journal, is a mine of information. It keeps her informed about BACP conferences and events and she also gets a lot out of the articles on working with different client groups and describing how other counsellors have responded to particular dilemmas and challenges, she says. This is why she also joined BACP Spirituality. ‘A lot of my work is with people from BME communities so I have a big interest in spiritual issues too from a counselling perspective.’

Shanaz went to the Leeds BACP Practitioner’s Conference earlier this year. ‘It was brilliant. There was so much choice. I went for the pick ‘n’ mix – one workshop on Spirituality, one in the Healthcare strand, and one on Coaching because I’ve heard a lot about it and it was a good opportunity to find out more. Professional events like these, as well as the journals, help keep me in touch as I don’t have a lot of time to go to meetings and to access networks,’ she says.

To join BACP Healthcare or any of the other BACP divisions, email [email protected] +++ BACP Public affairs

BACP urges review of NICE processes

BACP is calling for an independent review of the way NICE produces its clinical guidelines on mental health interventions.

NICE is currently consulting on its procedures governing the production of its treatment guidelines. BACP has joined forces with the Royal College of Psychiatrists’ Faculty of Medical Psychotherapy, the UK Council for Psychotherapy (UKCP), the Tavistock Centre for Couple Relationships (TCCR), the Association of Child Psychotherapists (ACP) and the British Psychoanalytic Council (BPC) to argue that the current system gives too much weight to evidence of efficacy from randomised controlled trials (RCTs). They want NICE to give greater weighting to practice-based and qualitative ‘real world’ evidence, which they say is better at capturing key factors in the effectiveness of therapy, such as the client–therapist relationship and the therapist effect.

They argue that so few high quality RCTs have been conducted into psychological therapies that NICE inevitably has to base its guidelines on a very limited evidence base, relating primarily to manualised treatments such as CBT, ‘which are not panaceas and to which not all patients will respond’.

They also question whether treatments based on RCT evidence can be generalised to clinical settings. They want NICE to introduce a system for reviewing whether the outcomes achieved by its recommended treatments in trials are maintained when implemented in routine clinical practice.

The joint response also argues that NICE should act to address the gaps in the evidence base for talking treatments. ‘Few organisations have the means, responsibility and incentive to fund RCTs into psychological therapy. Yet treatments which are demonstrably effective in practice and have been practised for many years in the NHS are now being marginalised due to a lack of RCT evidence,’ the BACP response points out. It asks NICE to bring together the key stakeholders, including the Department of Health, research charities and the psychotherapy professions, to identify the gaps in the evidence and source funding so that research can be conducted to fill them.

For the full response to this and other consultations, visit www.bacp.co.uk/policy/consultations/index.php

Around the Parliaments

It was a quiet Queen’s Speech in terms of health policy and particularly mental health, with no Bills of note for our sector. As it will be the last before next May’s General Election, the Policy and Public Affairs team will be focusing on influencing what goes into the various parties’ election manifestos.

With a government reshuffle now expected for the summer, there has been a change of Chair of the House of Commons Health Select Committee, with Dr Sarah Wollaston MP (Conservative, Totnes) elected following Stephen Dorrell’s resignation in June. Before becoming an MP Dr Wollaston worked in the NHS for 24 years, mainly as a GP, although she was also involved in medical training and education.

On 10 June the Health Committee continued taking evidence for its inquiry into CAMHS. The committee considered evidence from a number of healthcare professionals, with questions focusing on the local provision of child mental health services and the challenges practitioners are facing. The committee was also interested to know more about tier 3.5 and 4 services and questioned witnesses on bed provision and funding for those tiers. Questions were also asked about early intervention and the accessibility of 24-hour emergency mental health services for young people. The committee also considered how children’s mental health services are commissioned and whether a more integrated approach might improve this.

BACP was represented at the final session of the All-Party Parliamentary Group for Mental Health inquiry on parity of esteem for physical and mental health. A report from the APPG is expected in the summer. BACP also attended the All-Party Parliamentary Group for Couple Relationships and the Welsh Assembly’s Cross Party Group for Mental Health.

The Welsh Government has recently announced a £650,000 funding boost to improve access to psychological therapies for people with mental health problems. The investment will be shared by the health boards and will be used to build on work already undertaken to train NHS staff to improve their skills and competencies in delivering evidence-based psychological therapies.

BACP will be holding a fringe event at the Labour Party’s Annual Conference in September. The event will be co-hosted with the British Psychological Society and will be focusing on Labour’s proposal for an integrated health and social care system.

Parity consultation

BACP is launching a consultation next month to seek the views of members and external stakeholder organisations about how parity of esteem between physical and mental health services could be made a reality in relation to psychological therapies.

The consultation follows on a breakfast meeting hosted by BACP in April. Members will be invited to participate through BACP’s e-bulletin and the Policy and Public Affairs pages on our website.

BACP welcomes NICE backing for fertility counselling

BACP has welcomed the National Institute for Health and Care Excellence’s (NICE) draft quality standard for fertility problems, which recognises the vital role counselling can play in supporting a couple before, during and after investigation and treatment.

BACP has proposed that the quality standard should include a more detailed definition of the required standards of training and qualifications expected of counsellors fulfilling this important role. This could be based on the Department of Health’s required standards for a counsellor or psychological therapist working in the NHS, which all BACP registered members and BACP accredited members meet. BACP is also recommending that counsellors working in this area should be required to have specific knowledge of working with fertility issues, either through continuing professional development or supervised practice.

Election manifestos

BACP is lobbying all the main political parties in the run up to the 2015 general election to ensure their manifestos commit to improving access to counselling and psychotherapy.

As part of this work, BACP has submitted a set of policy recommendations to the Labour Party’s current review of its policies on health, work, communities and education.

BACP is calling on a future Labour government to require all secondary schools in England to provide access to a trained counsellor for their pupils, as they do in Wales and Northern Ireland.

In relation to the workplace, BACP argues that all workplaces should provide easy access to counselling for their employees through Employee Assistance Programmes. Mental ill health costs the economy some £105 billion a year and workplaces offer an ideal opportunity for prevention and early intervention, BACP argues.

BACP wants the Labour Party to commit to ensuring low-risk female offenders are offered community-based counselling as an alternative to a prison sentence, to reduce the growing prison population and high reoffending rates.

On health, BACP says a future Labour government should build on the IAPT programme by investing further to reduce waiting times and extend the choice of therapies on offer. Currently half those referred to IAPT wait for more than three months for treatment and 58 per cent are not offered a choice of therapies. +++ BACP Professional Conduct

BACP Professional Conduct Appeal Hearing

Findings, decision and sanction Johnathan Pease Reference No: 551637 Hertfordshire, CM23

The complaint against the above individual member was taken to Adjudication in line with the Professional Conduct Procedure followed by an Appeal Hearing where the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy were considered.

Having fully considered the matter, the Appeal Panel concurred with the Professional Conduct Panel’s finding of professional malpractice in the provision of inadequate professional services.

Sanction

As part of the appeal was allowed, the sanction was amended in order to reflect this, as follows.

The Appeal Panel carefully considered what sanction, if any, would be appropriate and proportionate in the circumstances. The Appeal Panel noted that Mr Pease accepted that he had made a lapse in judgment in hugging the complainant at Tesco and accepted that he had breached the boundaries that he had set with the complainant. Further, following the complainant’s disclosure, Mr Pease increased the length of his supervision sessions and underwent additional training in order to better understand the feelings of the complainant. In view of the learning and understanding demonstrated by Mr Pease, the extra supervision he received and the training courses he attended, the Appeal Panel agreed that would it be disproportionate to impose a sanction. The Appeal Panel therefore concluded that the most appropriate sanction was that there be no sanction against Mr Pease.

In conclusion, the Appeal Panel allowed the appeal in part in accordance with the findings. Full details of the decision can be found at http://www.bacp.co.uk/prof_conduct/notices/hearings.php

BACP Professional Conduct Hearing Findings, decision and sanction Kerry North Reference No: 585063 Doncaster, DN7

The complaint against the above individual member was heard under BACP’s Professional Conduct Procedure and the Professional Conduct Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy. The Panel made a number of findings and the Panel was unanimous in its decision that these findings amounted to professional malpractice in that Miss North’s practice fell below the standards expected of a practitioner exercising reasonable care and skill. In particular, she provided the complainant with an inadequate professional service and further demonstrated incompetence and recklessness.

Mitigation

The Panel considered the fact that Miss North had apologised unreservedly both through her barrister at the hearing and also personally to the complainant.

The Panel also took into consideration that Miss North had taken no new private clients from Christmas 2012 and had undergone a brief two-hour training on boundaries.

The Panel further took into consideration the fact that Miss North was having personal therapy and in the light of the matters forming these allegations she had changed her supervisor.

The Panel also took account of her statement that she recognised the breaches as being serious and had sought assistance from the Panel during the hearing as to how she could remedy those breaches.

The Panel also took account of Miss North’s declaration that she would not work again in private practice without undertaking a substantial amount of further training.

The Panel also took cognisance of the testimonials that had been filed with the other documentation for the purposes of the hearing.

Sanction

The Panel decided on the following sanctions: within one month from the date of the imposition of this sanction, which will run from the expiration of the Appeal deadline and in the event of an appeal on exhaustion of the appeals process, Miss North is required to provide a written submission of no less than 2,000 words which evidences her immediate reflection on, learning from and understanding of, the issues raised in this complaint within 12 months from the date of the imposition of this sanction, Miss North is required to attend training courses covering the topics listed below, each course of six hours duration, and provide evidence of completion of same:

- The principles, practicalities and ethics of working in private practice

- The maintenance of boundaries and their importance in counselling relationships

- Transference, counter-transference and erotic transference in counselling relationships.

Miss North will be required to demonstrate her learning from the above trainings in a written submission of no less than 2,000 words. This submission to be made within three months of the completion of the training. These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines and will be independently considered by a Sanction Panel.

Full details of the decision can be found at http://www.bacp.co.uk/prof_conduct/notices/hearings.php

BACP Professional Conduct Hearing

Findings, decision and sanction Michael Rivers Reference No: 537825 Ipswich, IP4

The complaint against the above individual member/registrant was heard under BACP’s Professional Conduct Procedure and the Professional Conduct Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The Panel made a number of findings and the Panel was unanimous in its decision that these findings amounted to professional malpractice in that Mr Rivers’ practice fell below the standards expected of a practitioner exercising reasonable care and skill. In particular, he provided the complainant with an inadequate professional service in that he did not appropriately handle her complaint.

Mitigation

Mr Rivers demonstrated to the Panel that he had sought advice from his supervisor and insurers. He also indicated that he has had regular supervision. He has had personal therapy since these events and provided evidence that he has reflected deeply on these events. He indicates that he now has a written contract and further indicated learning as to how he would approach the situation now, with the benefit of hindsight.

Sanction

The Panel noted Mr Rivers’ thoughtful and thorough reflections from both his written and oral evidence, which were compelling. Mr Rivers documented in detail his reflections around how he would face the situation if it were to arise again and outlined the detailed steps he would take to deal with such a situation. He demonstrated to the Panel a deep awareness and strong evidence of learning. The Panel, in considering sanctions, took into consideration what sanction may be appropriate with regard to public protection and practitioner development in light of the findings. The Panel was satisfied that Mr Rivers had demonstrated considerable reflection and evidence of substantial learning. The Panel was also satisfied that Mr Rivers had demonstrated how he would behave differently in the future. As such, the Panel decided that, given the evidence of reflection, learning and change provided by Mr Rivers, no sanction would be imposed in this case.

Full details of the decision can be found at http://www.bacp.co.uk/prof_conduct/notices/hearings.php BACP Professional Conduct Hearing

Findings, decision and sanction Averil Wilkinson Reference no: 551194 Buckinghamshire, MK18

The complaint against the above individual member was heard under BACP’s Professional Conduct Procedure and the Professional Conduct Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The Panel made a number of findings and the Panel was unanimous in its decision that these findings amounted to professional malpractice in that Mrs Wilkinson provided inadequate professional services.

Mitigation

The Panel found that Mrs Wilkinson had contributed much to the drafting and implementation of the counselling policies adopted by […] School subsequent to the events which form the basis of this complaint. Further, the Panel found that, up until that stage, Mrs Wilkinson was following the policies that had been adopted by the school, albeit they had not been reduced into writing.

Sanction

Within one month from the date of imposition of this sanction, which will run from the expiration of the appeal deadline, Mrs Wilkinson is required to provide a written submission which evidences her immediate reflection on, learning from and understanding of the issues raised in this complaint.

Within four months from the date of imposition, Mrs Wilkinson shall provide a written statement setting out how she has addressed the changes required in her practice, which have been brought about by the allegations that have been found proved by this Adjudication Panel.

In particular, the changes the Panel would wish to see addressed by her are principally concerned with the contract, whether oral or written, which Mrs Wilkinson makes with her pupil clients and what she says to pupils at the first counselling session dealing with such matters as: the clarification of responsibilities of both parties throughout the counselling relationship what notes are made, how they are kept, what they are used for and when they are destroyed the frequency of reviews concerning the effectiveness of the counselling during the counselling period the duty of confidentiality and how it could affect vulnerable clients what clients should do if they have issues regarding the counselling sessions and how they should raise them with the counsellor.

These written submissions must be sent to the Deputy Registrar and Deputy Director of BACP Registers by the given deadlines, and will be independently considered by a Sanction Panel. Full details of the decision can be found at http://www.bacp.co.uk/prof_conduct/notices/hearings.php

(Ellipses […] indicate an omission of text.)

Withdrawal of membership

Richard Pickles Reference No: 575572 Berkshire, RG5 4LU

The complaint against the above individual member/registrant was heard under the BACP Professional Conduct Procedure and the Panel considered the alleged breaches of the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy.

The Panel made a number of findings and the Panel was unanimous in its decision that these findings amounted to bringing the profession into disrepute in that Mr Pickles’ behaviour amounted to disgraceful conduct. The Panel further agreed that the public’s trust in the profession would be undermined if they were accurately informed about all the circumstances of this case.

Mitigation

Mr Pickles accepted his part in this matter and made an admission to the allegations. Further, following this incident, Mr Pickles took time off work and has since engaged in therapy and attended courses to help him to learn from these incidents.

Mr Pickles apologised to the complainant.

Sanction

The Panel was unanimous that Mr Pickles’ membership of BACP should be withdrawn, given the serious nature of the findings and BACP’s remit of public protection.

Full details of the decision can be found at http://www.bacp.co.uk/prof_conduct/notices/termination.php +++ BACP Research

Routine outcome measures

The BACP Research department has a new web page on routine outcome measures, offering practical information about how and why to use them, and the different measures available.

Routine outcome data can be used to answer questions about the effectiveness of an intervention. It is necessary to collect this type of data on a large scale and collate it so it can be analysed using statistical methods to produce what is known as an ‘effect size’, which indicates how effective the therapy has been.

At a higher level, it is possible for this kind of data to be combined with other information such as the therapists’ modality (eg Humanistic, Psychodynamic, CBT etc) and the clients’ demographic information (eg gender, age, ethnicity, presenting issues etc) to help answer the question, ‘What works for whom?’

To access the routine outcomes page please go to www.bacp.co.uk/research/resources/using-routine-outcome-measures.php

Counselling for Depression web pages

The BACP Research department has developed a set of web pages providing further information about Counselling for Depression (CfD), including useful resources and information about training in this modality.

The pages describe what CfD is, how it was derived and the kinds of clients for whom it can be helpful. There are also links to additional resources, including the competence framework, training curriculum and guidance for commissioners, as well as a link to the recently published book, Counselling for Depression (Sage, 2014), edited by Pete Sanders and Andy Hill, which was launched in May.

The site also gives details of where counsellors can train in CfD. The training is now available at the Metanoia Institute in London and at the Universities of Colchester, London, Keele, Central Lancashire, Nottingham and York St John.

To access the CfD web pages, go to www.bacp.co.uk/research/CfD/index.php

Apply for a BACP Small Research Grant

BACP is inviting applications for the 2014 Small Research Grant for new and innovative research in counselling and psychotherapy. The grant is worth up to £5,000 and is intended to support BACP members to undertake either a pilot project that could lead to a larger study or a small-scale study that can be completed within that budget. Any BACP member is eligible to apply. BACP is especially keen to receive research proposals from practitioners.

The deadline for submissions is 15 September 2014. For further information or to apply for the Small Research Grant, please visit www.bacp.co.uk/research/resources/small_research_grant.php Calling all current PhD students – get in touch

Thank you to those who have been in touch with the Research team in response to our call for information from members who have completed their doctoral studies in the last five years.

We are seeking a better understanding of how many BACP members are currently undertaking or have recently completed doctoral studies.

If you are currently a PhD student we’d also like to hear from you. Please do get in touch to tell us about your area of research and when you are due to complete your studies.

Please email [email protected]

BACP research surgery

The BACP Research department has a regular research surgery to support members who do not have access to research supervision and have a research dilemma, question or problem. The research surgery is via telephone with Andy Hill (Head of Research) and Jo Pybis (Research Facilitator). If you would like to book a 30-minute session, the sessions are available throughout the year to any BACP member, whether you are new to research or an experienced researcher.

The next surgery will be on Wednesday 20 August at 2–4pm. To book a 30-minute session, please contact Stella Nichols: [email protected] or call 01455 883372.

Enquiry of the month

This month’s research enquiry of the month asked: ‘Is there any research available that has compared the efficacy of different therapeutic approaches?’.

There have been a number of systematic reviews and findings tend to differ depending on the presenting issue. For example, comparisons of cognitive behavioural therapy (CBT) or non-directive supportive therapy with waitlist or treatment-as-usual for patients with a diagnosis of generalised anxiety disorder suggest that both CBT and non-directive supportive therapy are equally effective.1 However, a systematic review that compared psychological therapies in the treatment of depression found some evidence that CBT was superior to other behavioural therapies, which in turn were somewhat superior to psychodynamic therapies.2

It is important to note that some of the research included in these reviews was of poor methodological quality. The authors also note that the evidence tends to be small and heterogeneous, making it more difficult to draw definite conclusions. For help with your research queries, please email [email protected]

References: 1. Hunot V, Churchill R, Teixeira V, Silva de Lima M. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews; 2007; 1. 2. Shinohara K, Honyashiki M, Imai H, Hunot V, Caldwell DM, Davies P, Moore THM, Furukawa TA, Churchill R. Behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews 2013; 10. +++ BACP Professional Standards

Newly accredited counsellors/psychotherapists

Lois Adams Carol Aitchison Geraldine Aitken Minoo Alirezai Jane Andrews Loredana Ania Annette Ansell Paloma Anton Ann Attwood Jan Bagley Abigail Bailey Adele Barakat Deborah Beckett Fiona Beckford Jane Bellars Mariam Bhunnoo Jane Bradley Amelda Brown Tony Capon Anita Clark Jane Clarke Julie Clarke Gary Cross Hannah Cummings Pamela Custers Cristina D’Agostino Vivienne Davidge Deborah Duggan Patrick Dunne Parvin Emampour Neelam Farzana Joanne Fear Marie Gavin Fiona Goodacre Lorna Grounsell Yvonne Hanspal Russ Hargreaves Val Harris Justin Havens Christopher Haylock Becci Hayward Diane Hearne Anthea Hollingworth Maxine Hoskins Catherine Hughes Adam Hussein Helen Ingram Julija Ivanova Dawn Jenkins Martyn Jessop Geraldine Johnson Paula Johnson Priscah Kago-Guede Paul Kerrison Sarah Kohler Kajal Kumar Tonie Lawrence-Mahrra Sara Loveday Patrick Maher Sarah-Jane McClelland Karen McDaid Alison McGregor Sue Miller Susan Moloney Tara Dawn Morrey Sarah Morton Gwen Murray Kim Murray Andrea Newman Valerie Northcote Shane O’Brien Susan Owen Anna Pal Jill Parlett Gill Pearce Joy Perry Debbie Petherick Marie Phillips Sue Phillips David Phipps Claire Pickering Jean Poyntz Marian Proctor Sandra Reid Janine Rios Jack Rochon Wendy Russell Christine Samuel Sue Santi Ireson Sally Shears Pompi Singh David Smith Saba Stefanos Carole-Anne Stevens Nicola Stewart Marilyn Tew Claire Thomson Elizabeth Urie Samantha Waller Christine Walter Daniella Weston Alexandra Williams Kate Williams Frances Woolman Julie Wright

Newly senior accredited counsellors/psychotherapists

Geoff Boutle Brian Charlesworth Clarissa Dennison Bob Froud Suzanne McCall

Newly senior accredited supervisor of individuals

Huw Davies

Service accreditations

Connect Counselling Service Durham University Counselling Service Walsall Pregnancy Help Specialist Counselling Service WPH Counselling

Service accreditation term renewals

Relate Mid Wiltshire United Churches Healing Ministry (UCHM)

Newly accredited course

Foundation Degree in Integrative Counselling, Newman University (Birmingham) – 7 May 2014

Members not renewing accreditation

Diana Brothers Mary Cameron Aileen Christopher Angela Clark Nonie Cohen Jeanette Cordery Janice Eacott Suzanne Ellis Ellen Fraser Susan Grant Barbara Guess Nicholas Gundry Jane Harding Frances Hayes Patricia Heaven Anne Howard Valerie Hughes Jennifer Jordan Lucinda Keenagh Sheila Kurowska Ronald Larty Christine Latham Jennifer Maclennan Jean McCaffrey-Imbush James McGhee Jennifer Melman Edith Morrison Helen Murphy Felicity Newport Patricia Philp June Platts Edna Purdue Mary Roe Vanessa Thomson Marilyn Trew Joan Wilkinson Annie Woolcock

Members whose accreditation has been reinstated

Jane Cherry Yvonne Hanspal Noelle Rorke

All details listed are correct at the time of going to print. +++ TherapyToday.net Noticeboard

Supervision

Bristol/Skype Experienced supervisor available for individual and group sessions. Skype sessions possible for individuals. Contact Rhonda 07443 046189; [email protected]

Essex/Hertfordshire border Supervision for individuals and groups. Extensive experience in statutory, voluntary and private sectors working with children, adults and couples. Contact Caroline Powell-Allen, MA, Registered Member MBACP (Snr Accred) 01371 873270

Leighton Buzzard/Milton Keynes/Skype Member MBACP (Snr Accred) counsellor and supervisor with psychodynamic training; also works with integrative approach. Europe-approved EMDR therapist and Human Givens practitioner. Experience working in primary care and with EAPs. Individual supervision; also interested in setting up a supervision group. Skype supervision available. Reduced rates for students. Contact 07720 319091; 01525 370445

London, EC2/W1/SW1/phone/Skype Experienced, integrative counsellor offers supervision in Central London and the City, as well as by phone and Skype. Contact 07948 353125; [email protected]; www.counselling-and- hypnotherapy.net

London, N4/N8/N10/N13 Member MBACP (Snr Accred) counsellor, author, hypnotherapist, mental health professional and experienced supervisor. Over 20 years’ experience. Integrative/psychosynthesis/psychodynamic. Contact Michael Bryant 07717 860876; [email protected]; www.mikebryant-counselling.co.uk

London, SE Integrative/humanistic/transpersonal supervisor. Also support with setting up in private practice and building business. Contact Fiona 020 8699 7288; [email protected]; www.innerway.co.uk

London, SE/Kent Member MBACP (Snr Accred) supervisor and counsellor with established private practice. Provides supervision to students and experienced practitioners working with private clients, agencies, EAP providers and within GP settings. Contact David Smith 020 8857 6018; www.smithpractice.com

London, SW16 Offering supervision to experienced practitioners and students. Experienced, person-centred/integrative, Registered Member MBACP (Accred) supervisor and counsellor. Negotiable rates for students and those on low income. Contact Anthony Johnson 07956 360874; [email protected]; www.anthonyjohnson-counselling.co.uk

Manchester Integrative, Member MBACP (Accred) supervisor offering individual supervision. Free 30-minute introductory meeting for all; discounted rates for students. Contact Janet Sneddon 07749 265964; [email protected]; www.janetsneddon.co.uk

Staffordshire, Rugeley/West Midlands/phone/online Experienced supervisor offers face-to-face, phone or online supervision for trainee and qualified counsellors. School counsellors and family/relationship counsellors welcome. Contact Carla Thompson, Registered Member MBACP (Accred), Dip CBT, Dip Supervision 07890 425960; www.ctcounselling.co.uk

Wolverhampton Experienced, psychodynamic/integrative, Registered Member MBACP (Accred) counsellor and supervisor in training with the University of Chester. Reduced rates whilst in training. Concessions for students. Contact Sukhi 07985 220773; [email protected]

Placements

Croydon, Selhurst BRIT School Counselling Service offers a placement opportunity for qualified and trainee counsellors. Free monthly group supervision; some free CPD events throughout the year; travel expenses paid for qualified counsellors. Contact Rasha Hammami at [email protected]

Leicester Placement for diploma-level and qualified therapists. Contact 0116 416 1626; www.rhcp.org.uk

London, NW1 Women and Health – a friendly and accessible women’s health centre providing integrative counselling/psychotherapy and complementary therapies in Camden – seeks volunteer counsellors/psychotherapists for our long-term service (one-year contracts) and placements on our IAPT short-term service (12–20 sessions). Free supervision for short-term service placements. Requirement: minimum of 45 hours of supervised adult client contact and must be in personal therapy/counselling. For application form, contact [email protected]

London, SW4 Clinical placements in NHS primary care, HM Prison Brixton and open-ended therapy at The Awareness Centre. Applicants to be training on a UKCP/BACP accredited course or working towards accreditation. Requirement: 65 supervised clinical hours and on-going personal therapy. Send a CV to the Counselling Administrator at [email protected]

Scarborough Placement vacancy in a secondary school from September 2014 for a student or voluntary counsellor seeking hours for accreditation. Independent supervision and incidental costs met by the school. Established service, originated by present lead counsellor. Send a CV to [email protected]

Sheffield Mind A leading, respected charity is looking to recruit experienced, volunteer art therapists for individual and/or group work. Regular clinical supervision provided, as well as up-to-date trauma knowledge and experience, a supportive environment and travel expenses. Contact [email protected]

Sheffield Mind A leading, respected charity is looking to recruit experienced, volunteer therapists and advanced trainees with knowledge/experience of, and an interest in, working with trauma. Regular clinical supervision, a supportive environment and travel expenses provided. Minimum of three clients per week and a one-year placement (minimum). Contact [email protected]

West Sussex Your Space Therapeutic Services provides counselling, psychotherapy and play therapy in schools and offers placements in all areas of West Sussex. Training and supervision is provided and trainees are supported on a path to find paid work with the service once qualified. For more information, contact Laura Creasey at [email protected] Research

Call for participants Research exploring the experience of counselling addicts, when the counsellor has not had a personal experience of substance abuse. Seeking volunteers who are willing to be interviewed about their counselling experience with addiction. Contact [email protected]

Call for participants Seeking trained counsellors who have experienced pregnancy loss in the later stages of fertility and remain childless. MA research exploring the impact of loss. Contact Amanda Sives at [email protected]

Erotic transference research Qualitative Master’s research into male therapists’ experience of working with female clients who they felt at times presented in a seductive manner towards them. Contact [email protected]

Research participants needed Counsellors/psychotherapists sought working in a secondary school setting. Is ‘talking’ enough in the 21st Century or does the use of creative intervention enhance the therapeutic relationship with the young person? If you are interested in participating, contact [email protected]

Networking groups

Atheism in counselling/psychotherapy Psychotherapist working in private practice looking to connect with other atheist counsellors/therapists for support and discussion of the issues of being an atheist and non-spiritual practitioner. Contact [email protected]

Milton Keynes MKARC is a networking group of accredited counsellors/psychotherapists based in Milton Keynes. BACP accredited, UKCP registered, and other equivalently registered counsellors/psychotherapists interested in joining the group are invited to get in touch for further information. Contact [email protected]

If you are a BACP member, you can place a free entry on the TherapyToday.net noticeboard under one of four headings: supervision, placements, research or networking groups. Please email your wording (approximately 30 words) and BACP membership number to [email protected]