Therapy Today For counselling May 2013 and Vol. 24 / Issue 4 Therapy professionals www.therapytoday.net Today

BACP Register: Haveup you yet?page signed See 48 May 2013, Vol. 24 4 Issue Pre-trial therapy Working with survivors When parents aren’t good-enough Therapy Today is published Editor Therapy Today is the official journal May 2013 by the British Association for Sarah Browne of the British Association for Counselling and Psychotherapy 01455 883317 Counselling and Psychotherapy. Volume 24 BACP House e: [email protected] Views expressed in the journal, and 15 St John’s Business Park signed by a writer, are the views of Issue 4 Lutterworth le17 4hb Deputy Editor the writer, not necessarily those of t: 01455 883300 Catherine Jackson BACP. Publication in this journal f: 01455 550243 01455 206369 does not imply endorsement of the text: 01455 560606 e: [email protected] writer’s view. Similarly, publication minicom: 01455 550307 of advertisements in Therapy Today w: www.bacp.co.uk Reviews Editor does not constitute endorsement w: www.therapytoday.net Catherine Jackson by BACP. Reasonable care has e: [email protected] e: [email protected] been taken to avoid error in the publication, but no liability will ISSN: 1748-7846 Associate Editor for Supervision be accepted for any errors that may Bernice Sorensen occur. If you visit a website from a Ten issues of Therapy Today are e: bernicesorensen@googlemail. link within the journal, the BACP/ mailed free of charge to every com TherapyToday.net privacy policies BACP member between 15–20 do not apply. We recommend you of each month. There are no Associate Editors for Groupwork examine privacy statements for all issues in January and August. Linda Watkinson third party websites to understand e: [email protected] their privacy procedures. Buying the journal Samantha Tarren Ten issues: £75 per annum (UK); e: [email protected] Copyright £94 per annum (overseas). Single Apart from fair dealing for the copies: £8.50 each (UK); £13.50 Associate Editor for Dilemmas purposes of research or private (overseas). Back copies of hard Heather Dale study, or criticism or review, as copy articles: £2.75 each. Visit e: [email protected] permitted under the UK Copyright, TherapyToday.net to buy articles, Designs and Patents Act 1998, no e-issues or access the e-library Production Co-ordinator part of this publication may be dating back to September 2005. Laura Hogan reproduced, stored or transmitted 01455 883361 in any form by any means without Contributions e: [email protected] the prior permission in writing Therapy Today welcomes feedback, of the publisher, or in accordance original articles and suggestions for Advertising Manager with the terms of licences issued features. For authors’ guidelines see Jinny Hughes by the Copyright Clearance w: www.therapytoday.net t: 01455 883314 Centre (CCC), the Copyright e: [email protected] e: [email protected] Licensing Agency (CLA), and other organisations authorised Advertising deadline Advertising Assistant by the publisher to administer 2pm on 19 June for the July 2013 Vicky Bourgault reprographic reproduction rights. issue. t: 01455 883398 Individual and organisational e: [email protected] members of BACP only may Circulation figure make photocopies for teaching 38,579 (from 1 January 2012 to Design purposes free of charge provided 31 December 2012). Esterson Associates such copies are not resold.

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The British Association for Patron Chief Executive Counselling and Psychotherapy Helen Bamber Laurie Clarke aims to: ••Promote the understanding President Treasurer and awareness of counselling Michael Shooter Keith Seeley and psychotherapy throughout society Vice Presidents Divisional journals ••Increase the availability of John Battle BACP also publishes a quarterly trained and supervised counsellors Robert Burden journal for each of its divisions: ••Maintain and raise standards Robert Burgess ••Association for Pastoral and of training and practice Bob Grove Spiritual Care and Counselling ••Provide support for counsellors Lynne Jones (APSCC) and those using counselling Martin Knapp ••BACP Children & Young People skills, and opportunities for Juliet Lyon ••BACP Coaching their continual professional Glenys Parry ••BACP Healthcare development Pamela Stephenson Connolly ••BACP Private Practice ••Respond to requests for David Weaver ••BACP Universities & Colleges and advice on ••BACP Workplace. matters relating to counselling Chair ••Represent counselling at Amanda Hawkins To join a division, please contact national and international levels. Divisional Officer Deputy Chair Julie Camfield Registered charity 298361 Elspeth Schwenk e: [email protected] Contents

I am grateful to Peter Jenkins for guiding us In many cases, Peter writes, there is a lack through the complex area of pre-trial therapy, of awareness even among therapists as to an area that we will surely be hearing much the specific requirements of pre-trial therapy. more about given the number of arrests of One mother of a six-year-old boy who was ageing celebrities currently being made for having nightmares and trouble sleeping historic sexual abuse following Operation was told by the police that her son could Yewtree. As Peter explains, pre-trial therapy have counselling if he was really ‘falling apart’ is viewed in the criminal justice system prior to the trial. When she tried to engage a as problematic because of its potential to counsellor to work with him, however, they all ‘contaminate’ evidence. Despite there being refused saying that the police would not like it. Sarah Browne clear guidance on pre-trial therapy for child From the therapist’s point of view there is and adult witnesses, in practice there seems the legal context of the therapy to consider, Editor to be much confusion about this. For example, not least the issue of confidentiality – or, rather, in the recent tragic case of Frances Andrade the lack of it. Not only may the police and who killed herself during the trial of her Crown Prosecution Service need to be kept former music teacher, Andrade was allegedly closely informed but both the prosecution warned by the police against having therapy and defence solicitors have access to the even though she was clearly a reluctant and therapist’s records. However difficult and vulnerable witness – her husband has said alien this work may be to counsellors, it that she had been completely distraught would seem also to be terribly important if at the idea of the past being churned up. the voices of victims are to come to the fore.

10 The magical mystery cure 24 When parents aren’t good-enough Features Richard Shrubb reports on controversial Joanna North explores how therapists can trials using Class A drugs to treat depression help children process the knowledge that and post-traumatic stress disorder. their parents couldn’t look after them. 14 Pre-trial therapy 35 Research in practice Peter Jenkins outlines the reforms needed Joe Armstrong, Amanda Hawkins and Mhairi to ensure witnesses and victims of crime Thurston discuss the benefits for counselling have access to expert pre-trial therapy. of practice research networks. 18 Working with cult survivors Gillie Jenkinson reveals how take Cover illustration by Clare Nicholas over their members’ minds and lives.

3 Editorial 30 Dilemmas Regulars 4 News Transgender disclosure 6 Columns 32 The interview Rachel Freeth Scott Miller Angela Smith 38 Letters Mel Perry 43 Reviews Barry McInnes 58 Classified 23 Talking point 59 Mini ads Alain de Botton 62 Recruitment 29 How I became a therapist 62 CPD Eugene Ellis

47 From the Chair BACP 48 BACP Register Colin Feltham ‘in conversation’ with Gillie 50 BACP Awards Jenkinson; Clare Nicholas explores the ideas 52 BACP Policy behind her illustrations; in ‘From the archive’ 53 BACP News Nina Rye writes about empowering parents 53 BACP AGM or carers as agents of therapeutic change; the 55 Professional standards TherapyToday.net Noticeboard with notices 56 BACP Research about supervision, placements, research and 57 Professional conduct networking; and our rolling news bulletin.

May 2013/www.therapytoday.net/Therapy Today 3 News

Time to Change misses targets

The Time to Change anti- and decrease discrimination were published in a special in public intended behaviour stigma campaign has failed reported by people with issue of the British Journal there was no improvement to convince the public of mental health problems. of Psychiatry in April. These in reported behaviour. the effectiveness of But the evaluation of its found that Time to Change Service users reported psychotherapy to treat social marketing campaign failed to achieve its target a small reduction in mental health problems. strand found that, while five per cent positive shift discrimination from family, The four-year Time to there was an increase in the in public attitudes towards friends and in their social life, Change programme was numbers of people agreeing people with mental health but no improvement in the launched in England 2007 that ‘psychotherapy can be problems and five per cent attitudes and behaviours of with £16 million from the an effective treatment for reduction in discrimination mental health practitioners, Big Lottery Fund and £4.5 mental health problems’ by 2012. There was no or the police or housing, million from Comic Relief. each time there was a media significant improvement education and other public It also received funding and publicity ‘burst’, overall in public knowledge; some sector provision. Training support from the Department levels of agreement dropped initial improvement in public medical students achieved of Health. Its aims were to over the period of activity. attitudes dropped back after only short-term improvement measurably increase public Evaluations of all the 2009 and, despite some in their attitudes (less than awareness of mental health strands of the programme significant improvement six months).

Genetics and Cuts to Deaf people’s therapy Assisted outcomes suicide poll

A research team based at Over two thirds of people the University of Texas at who identify themselves Austin is to carry out a study as religious support assisted into how genetic variation suicide, a YouGov poll shows. may influence outcomes The poll was commissioned from psychotherapy among by the & Society adults with depression. Programme for the 2013 The study will use saliva Westminster Faith Debates. samples to document Overall, 70 per cent of the connections between 4,500 people polled supported participants’ genetic make- a change in the law to legalise up and change in depression assisted suicide. Just 16 per symptoms following online cent were against and 14 per psychotherapy. The Deaf people in some parts the South Central and North cent were undecided. The researchers believe the genes of England may be denied West regions because Clinical main reasons for supporting that influence serotonin may therapy because of cuts in Commissioning Groups have legislative change included have a significant effect on funding, the Deaf charity withdrawn funding from the ‘An individual has the right how people respond to SignHealth has warned. service. In the North West, to choose when and how psychotherapy, as may SignHealth’s BSL Healthy BSL Healthy Minds will only to die’ and ‘It is preferable genes that make people Minds service employs be able to offer treatment to drawn-out suffering’. more sensitive to positive psychological wellbeing to half the 200 Deaf people Those against assisted environmental changes. practitioners (PWPs) who currently using their service. suicide were more likely to The hope is that these kinds are fluent in British Sign ‘Just as the Deaf community be strictly religious but an of studies in the emerging Language (BSL) to provide are becoming aware of the overall majority (64 per cent) field of therapygenetics one-to-one psychological service, it is being cut. Deaf of people who identified will eventually lead to therapy for Deaf people. people will not get the therapy with a religious tradition the possibility of tailoring SignHealth says that BSL they need in a language they supported a change in the psychotherapeutic treatments Healthy Minds is having to understand,’ SignHealth law, mainly because they for depression to match an make redundant some of Chief Executive Steve supported a person’s right

© STOCKBYTE/THINKSTOCK © individual’s genome. their Deaf BSL therapists in Powell said. to choose when to die.

4 Therapy Today/www.therapytoday.net/May 2013 Support for stroke patients Depression ‘contagious’ People with stroke are reported loss of confidence or partner as a result of a getting too little support and 48 per cent felt angry. stroke, and nearly three in Vulnerability to depression to help them cope with Nearly half (42 per cent) 10 had broken up with their may be contagious, a study the emotional impact, the felt abandoned by the partner or were considering of US ‘freshman’ university Stroke Association says. health service once they doing so. Carers were also students suggests. In a report, Feeling were discharged from emotionally affected: 79 The study, published in the Overwhelmed, the charity hospital and 79 per cent had per cent reported anxiety, journal Clinical Psychological says the emotional impact of received no information or 84 per cent felt frustrated, Science, assessed 103 pairs stroke can be as devastating practical advice to help them 56 per cent were depressed of roommates at one, three as the physical effects. Its cope with the emotional and 57 per cent felt stressed. and six months for cognitive survey of over 2,700 people impact of stroke. The Stroke Association vulnerability, exposure to affected by stroke found that Stroke also had a negative says the NHS should provide stressful life events and 59 per cent felt depressed, 67 impact on relationships. psychological treatment and symptoms of depression. per cent experienced anxiety Over half the stroke emotional support to people Students sharing with a as a direct result of their survivors (53 per cent) with stroke and their carers, roommate with high cognitive stroke, 63 per cent feared reported difficulties in their to avoid problems that could vulnerability were likely to a second stroke, 73 per cent relationships with a spouse delay their recovery. ‘catch’ their roommate’s cognitive style, and vice versa: those sharing with a roommate with low cognitive Mental health Therapets aid stressed students vulnerability became less vulnerable over time. ‘first aid’ The students who became more cognitively vulnerable Armed forces veterans and in the first three months of their families are to be offered college had nearly twice the training in mental health level of depressive symptoms first aid (MHFA) to help at six months than their less them support colleagues vulnerable peers. with mental health problems. Another US study, in the The Government is May issue of Psychotherapy providing £600,000 to and Psychosomatics, has pay for 200 veterans, family found that some three in members and others working five people diagnosed with with Armed Forces veterans major depression may not to learn the mental health meet the DSM-IV criteria. equivalent of first aid skills. Of 5,600 people receiving They will then go on to Edinburgh University Affairs, said: ‘Therapets is treatment in the community, teach others the same skills Students Association an excellent new initiative for just 38.4 per cent met the so they feel confident to (EUSA) has invited the students who are struggling DSM criteria, falling to just identify and help people in dog charity Canine Concern to cope with stress.’ But some 14.3 per cent of older people mental distress. The aim is to provide pet therapy for students have criticised the – one in seven. Those who to train some 6,200 people in stressed students during initiative. In a comment on didn’t meet the DSM criteria the Armed Forces community the April/May exam season. the EUSA website, student tended to report less distress by 2015. Tickets for the two April Amie Robertson said: ‘These and better functioning and The training will be sessions were sold out. dogs are being used purely made less use of mental designed and delivered Pets are often used in to fit the needs of stressed- health services. But the by the community interest care homes to aid residents’ out students. EUSA would majority of both groups company MHFA England, mental wellbeing. This is have spent much better were prescribed and taking in partnership with Combat the first time they have been time and money putting antidepressant medication. Stress, the Royal British introduced in a university real dedication towards Legion and SSAFA – the context in the UK. its counselling service and Soldiers, Sailors, Airmen Andrew Burnie, EUSA making it more accessible and Visit www.therapytoday.net to

© ISTOCKPHOTO/THINKSTOCK © and Families Association. Vice President Academic dynamic to fit student needs.’ read our weekly news bulletin.

May 2013/www.therapytoday.net/Therapy Today 5 In practice

One of the aspects of my ‘This medical model the main expert in the Fixing to work that I value is its variety room is the counsellor or and particularly the fact of helping, psychotherapist, and with facilitating that every person (patient) where the expertise is the expectation and hope I encounter is different – located in the helper, that they, the client, will indeed, unique. be fixed in some way? Rachel Freeth In my view it should not creates considerable Clearly, how therapists be difficult (although too dissonance with how respond to such often it seems that way) I have come to view expectations and hopes to see beyond diagnostic will be influenced by their labels to the person with mental distress’ philosophical orientation their unique personality and therapeutic model. and unique of past and honest, one about which I I have been thinking present circumstances, often have mixed feelings. about roles and expectations whose experience and On the one hand there a lot lately because I am expression of mental and is the seductive appeal of on the verge of returning emotional disturbance being considered an expert, to counselling practice. I and distress is also unique. and the satisfaction, esteem have been imagining how This, in turn, should lead and status this can bring. different I might feel being to a consideration of But with this comes the with someone as their helping responses likely sense of responsibility, counsellor. to best suit that individual. pressure to perform the I am sure I will bring Clearly such an attitude required task competently into the room just as great and approach will create (for the stakes are often a sense of responsibility and difficulties and challenges high), and the weighty burden desire to help as I do now as for helpers working in of trying to meet expectations a psychiatrist. Undoubtedly cultures and organisations – one’s own and those of I will also bring a certain where standardised helping others. Furthermore, for level of knowledge, expertise responses and ‘pathways’ me this medical model and clinical experience. have become the norm paradigm of helping, where What I hope I will not be and expectation. the expertise is predominantly bringing is an internalised While valuing the located in the helper, creates expectation that I can fix myriad differences between considerable dissonance my client. individuals seeking help, with how I have come to I anticipate that returning I also observe a feature view mental distress and to work within a counselling that many have in common. how individuals might best setting will prompt me This particular feature is far be helped and supported. to re-examine many of from universal but common This simple notion that my beliefs about human enough to merit highlighting. the job of a psychiatrist nature and human distress. I am referring to a patient’s or other mental health I imagine that, without or assumption that it professional is to fix the medical lens, I will is my job as a psychiatrist to people is, I suggest, strongly see people in a different ‘fix’ mental health problems. embedded both within way. Perhaps I will be more This notion of fixing can healthcare organisations sensitive to my clients’ be construed in many ways, and in our wider Western innate resourcefulness and of course, and carries with culture. In fact, it is held strength – their capabilities it a potential array of other to be so self-evident that it as human beings who, given assumptions. Put simply, often goes unacknowledged, the right conditions, can I am referring here to the unspoken and therefore find their own way through assumption that I will be unchallenged. Perhaps this their difficulties, using their able to diagnose the ‘fault’ is what makes it so powerful. own wisdom and expertise. and then ‘apply’ a remedy, I wonder in what way and Most of all I imagine I or at least know someone who to what degree therapists will experience a sense of can. It is an assumption that recognise these issues in freedom from the burden I have the answer and that I their work? I also wonder of fixing people. know what needs to be done. how many clients enter I will let you know This is a powerful position counselling or psychotherapy whether fantasy and to be in. It is also, if I am with the assumption that coincide.

6 Therapy Today/www.therapytoday.net/May 2013 In the client’s chair

I was involved in an accident It was a rage, an inward rage. posting them. While we were A fish out on a college trip to South I couldn’t tell anyone about on the trip I had kept a journal Africa with a group of students. it. I was angry with my dad, every day but I’d put it in a The bus we were travelling in with the bus driver, with the drawer and hadn’t shown of water came off the road and turned police. I was angry with myself it to anyone. I couldn’t face over. A lot of us were severely – why couldn’t I do anything reading about the good times injured and three of the to help the others after the we’d had when it had ended Angela Smith students were killed. Even accident? I understand now so awfully. Mary encouraged though I was hurt, I couldn’t that I was injured but I still me to share the journal with help but feel responsible. can’t help feeling I failed. her. Then I was able to read it And I felt awful to have Mary picked it up quite early myself and, after we’d talked survived when others didn’t. on. She said make an anger list more, to share it with others. I initially went to my doctor of all the people you are angry I saw Mary weekly for 12 because of the flashbacks. at, and she saw I had scrawled months and then towards I wasn’t sleeping; I was very really hard on the paper. I think the end it was every two weeks anxious and depressed. I lost it was the loss of control and and then every four weeks. I my confidence. I had some not being able to understand definitely feel more in control facial scarring that I was really what had happened. of my life, more confident, self-conscious about. I felt I felt my dad wasn’t there now. I’ve gone back to work. everyone was looking at me, for me. That wasn’t helping I’ve been able to accept what saying ‘She’s the one involved me get over things. I thought happened with the accident, in that coach crash’. My GP we were close but obviously and how things are with my said I had PTSD and needed it wasn’t as strong as I thought. dad. I have good days and to see a psychologist. But He would phone and ask how bad days but the good days there was a long wait list, I was but he was just going are more than the bad. so she suggested going to through the motions; he wasn’t I don’t feel 100 per cent the Haven while I waited, and really interested. I needed ready to move on because the counselling was working more from him. I needed him the official investigation into so well that I stayed there. to be here. Things had changed the accident is still ongoing. I It’s a voluntary organisation; since my mother passed away. need to know what happened. you give a donation, as much He’s more involved with his I think the authorities blame as you can afford. new partner now. My sister the driver – that’s difficult for I used to say to Mary, my says he isn’t there for her me. We had got to know him; counsellor, that I felt like a either but she’s got the same we had a bit of a relationship fish out of water. I was flopping – ‘Don’t dwell on it.’ with him. Do I forgive him? all over the place, not able In therapy we talked and Do I blame him for the rest of to function normally and not used some role-play and a my life? So I might go back to knowing what to do. I thought lot of visual stuff. When I the Haven to talk about that. I was the sort of person who couldn’t explain how I was I had God on my angry didn’t need therapy. That is feeling, we used sandplay. list too but we didn’t discuss one of the most important We created a timeline, that in counselling. When I things Mary made me realise which helped me process am ready, I will seek help with – that how I was feeling was what happened and put me that. I’m like that; once I’ve normal, and that I was safe back in control. We practised made up my mind, I do it. now, and I could talk to her. grounding techniques so there I felt almost embarrassed was something I could do if I Names have been changed to that I needed help still. It had a nightmare or flashbacks. protect identities. was almost a year down the We did a lot of writing work – line and I still couldn’t deal writing letters to people about The Haven is a therapy and with things and let it go and why I was angry, but not counselling service based in that wasn’t like me. I was Leicestershire working with angry and I don’t do anger. clients from any ethnic I’m a laid back person. I’d ‘I was flopping all background and of any faith or just go, ‘It’s happened, just over the place, not none. It is a registered charity get over it’. I’d never felt anger able to function supported by contributions and like this before, true anger, not donations and all its professional even when I was a kid. It was normally and not therapists give their time freely. physical as well as emotional. knowing what to do’ Visit www.thehavenahsby.org.uk

May 2013/www.therapytoday.net/Therapy Today 7 In training

‘For so long I’ve been ‘Three years on and was happening in the room, Learning battling my emotions, unseen the cough disappeared, I terrorists that hide behind I find that my clients could hold Janey’s feelings from my trees and around corners on are tutoring me in and was able to protect her sunny days – and then strike how to deal with space so she could test out me down. But somewhere her right to be and her clients along the line I learnt not these moments potency. to fall over, not to show an of doubt’ Then there was ‘Harry’, inkling of this... somehow a teenage lad who came Mel Perry I’m beginning to realise that in and told me that all the these terrorists are really my ‘it’s the first session and this people he’d seen in the freedom fighters.’ is what she needs to do, it’s past (counsellors, child This isn’t one of my clients. her space.’ About 20 minutes psychiatrist and other Before I started out on my in, I developed a very tickley mental health professionals) counselling course I used to cough (I didn’t have a cough had been ‘f---ing shit, useless have taped personal therapy or cold). I tried to fight it and patronising’. I’m sure and listening to this again down and keep the focus you can imagine what was reminded me of how I have on her. It defied me; the going through my mind at both moved forward but more I tried to suppress it, that point. Once I’d put my also have moments of doubt. the more it needed to come immediate feelings to one Brought up in this cognitive out. I had a serious coughing side, I could more clearly hear Western culture and having a fit, but recovered. The session his message: I was going to let difficult childhood had left me continued as it had started. him down just as others had; struggling to express myself. The second session was a he was beyond redemption. Three years on and I find that repeat of the first, including Yes, I could accept how my clients are tutoring me the coughing fit. I knew he felt towards himself in how to deal with these that I felt overwhelmed but instinctively, of course, moments of doubt, these and deskilled. When I did I could never concur with cries from the unconscious intervene Janey either his own judgment. Yet I’d that need to be heard. listened politely or just talked known that feeling and still I’ve been counselling now over me. It felt out of control. do sometimes. I was sitting for about eight months. Those When this happened again opposite myself; I heard first few terrifying sessions in the third session, and the my own beliefs and they are out of the way and both coughing fit was so bad that were shocking. His wrath counsellor and clients have she, parent-like, poured me at the world that he directed survived relatively unscathed. a drink of water, I knew that inward so destructively was I am slowly ditching the idea I had to find out what was heartbreaking, yet it didn’t that to be a counsellor I first going on. diminish me; it allowed me to need to be ‘sorted’ myself. I mulled this over for a feel a deep empathy not only It’s an ongoing process couple of days and then it with him but with the younger where I learn from my clients came to me: the cough was me that still sometimes in every session and hold happening because I felt I recklessly comes out to play. close to my heart the words couldn’t speak; the desire By listening to my clients of Barbara Somers: ‘If ever and need in me to ‘do my I’ve been able to start we think we have the answer work’ was so strong that I was listening more to myself. for another human being – unconsciously interrupting Perhaps this is my experience or indeed for ourselves – the session. My ability to have of what the philosopher we’d better pack it up and a voice was being taken away Heidegger meant by do something different.’1 from me to the extent that ‘coming-into-the-nearness References ‘Janey’, a 40-something I felt useless and impotent of distance’.2 By being witness 1. Somers B, Gordon-Brown I. Journey in depth: a transpersonal woman, came to counselling in the sessions. My client to the emotions of my clients, perspective. Blandford Forum: because she had been felt powerful but I felt I’ve felt the deep sadness and Archive Publishing; 2002. identified as suffering from fearful. Indeed, it seemed frustration of their struggle 2. Heidegger M. Conversation PTSD. In her early 20s she I was feeling as she had felt and within it are echoes of on a country path about thinking. had been overpowered, held during the attack – helpless, my own. In: Heidegger M. Discourse on thinking (trans. John M Anderson, down and sexually abused. powerless. Once I had E Hans Freund). New York: Harper In our first session she talked accepted this and reconciled The clients in this column are & Row; 1966 (p86). non-stop. ‘OK,’ I figured, my own feelings with what both composite case studies.

8 Therapy Today/www.therapytoday.net/May 2013 The researcher

April heralded the full pretend that psychological vested interests, some Compare implementation of the therapy will fill the unmet commissioners will be Government’s new need; there will need to be prepared to buck the framework for commissioning radical solutions, because current trend and commission the market NHS patient services. Control failure to achieve something outside the list of NICE- of the larger part of the NHS that looks like parity will compliant therapies if budget has now passed from not be an option. It will fall the alternatives offer Barry McInnes Primary Care Trusts to some to CCGs to find creative ways demonstrable advantages 212 Clinical Commissioning to implement new solutions (such as quicker access to Groups (CCGs). These CCGs and extend their reach. treatment) for their patients. are GP-led, and Government The NHS Confederation3 It is also likely that more ministers believe they will advocates e-mental health therapies will be approved be more attuned to and as part of the answer – web- by NICE over time, giving therefore better able to based platforms enabling greater meaning to the notion commission care that meets the delivery of therapy to of patient choice. Whatever the needs of local populations individuals and groups form these new therapies and individuals, as well as online, sites like the Big take, however, they will need make the NHS more efficient White Wall that offer self- to be demonstrably effective. and improve quality of care. help, peer support and online And remember that, while In the arena of primary therapy, and apps, either as CCGs will control much of care psychological health, aids to patient management the NHS budget, it will be the extent to which the new or as stand-alone solutions. limited to around 60 per cent framework will live up to For the latter, think of a of the total. Individual GPs expectations and deliver digital version of books on also have their own practice more effective and efficient prescription and you won’t budgets, as the following services to patients will be be too wide of the mark. example of a BACP member influenced by two critical There are undoubtedly demonstrates. and related factors. First is some people who, although The member in question the Government’s intention significantly troubled, are has a contract for service with to establish parity between nonetheless resourceful and a GP practice that was due for physical and mental health; will be able to benefit from review. The practice values second is the emergence of a minimal level intervention, her service in terms of speed technology-based solutions whatever that may be. What of access and client feedback, to mental health problems. concerns me about the drive but wanted to know how her Figures from the Psychiatric for parity is the form it will outcomes compare with IAPT Morbidity Survey (PMS)1 be seen to take, and whether benchmarks. She was already show that the proportion our current imperfect system routinely using both PHQ-9 of the population likely to be will be further compromised and GAD-7 so, with a little suffering a common mental by the introduction of a guidance, she was able to disorder (CMD) – anxiety, range of new interventions work out the proportion depression, phobias, mixed whose effectiveness it may be of her clients who recovered, anxiety and depression – difficult to properly evaluate. using the IAPT model. is around 15 per cent. Based What of counselling and In all, 77 per cent of her on UK census data,2 that psychotherapy in this brave clients reached the criteria References would mean almost eight new world? Forever the for recovery. The highest 1. NHS Information Centre. million people have a CMD. optimist, I believe there reported IAPT PCT recovery Adult psychiatric morbidity Even in the unlikely event are opportunities. Setting rate for which there were in England, 2007: Results of a that the IAPT programme aside the protection of finalised data at the time household survey. Leeds: NHS reaches its target of treating was 72 per cent. Our member Information Centre; 2007. had broken the IAPT ceiling 2. http://en.wikipedia.org/wiki/ 900,000 per year, this still Demography_of_the_United_ leaves an enormous level ‘There will need to – albeit based on PCT mean Kingdom of unmet need. recovery rates – by some 3. NHS Confederation Mental There will be no further be radical solutions, distance. That’s a nice Health Network. E-mental health: resources in CCG budgets because failure to message to be able to take what’s all the fuss about? London: to achieve the required to your commissioning GP. NHS Confederation; 2013. achieve something http://www.nhsconfed.org/ parity between physical Publications/discussion-paper/ and mental health, that that looks like parity To get in touch with Barry, email Pages/E-mental-health.aspx much is clear. We cannot will not be an option’ [email protected]

May 2013/www.therapytoday.net/Therapy Today 9 News feature The magical mystery cure

Richard Shrubb reports on controversial trials that use Class A drugs such as MDMA and LSD for psychotherapeutic purposes

A small number of pioneering treatments for depression with what of choice for the condition. NICE psychiatrists, psychologists and he says are its ‘irrational’ drugs laws. guidance recommends: ‘All people psychotherapists are researching Nutt wants to research the use of with PTSD should be offered a course of how certain Class A drugs can be used the chemical psilocybin, the psychedelic trauma-focused psychological treatment with very positive effect to help people ingredient in magic mushrooms, which (trauma-focused CBT or EMDR)’. with severe, chronic psychological and he says can suppress activity in the At the heart of PTSD is the issue emotional health problems. parts of the brain that are overactive in of avoidance: the patient finds the Despite the practical and legal severely depressed people. But, because experience too difficult to face and is difficulties, pilot trials are currently magic mushrooms are a Class A drug, therefore unable to process it. Clinical under way into the use of LSD, pure their active chemical ingredient cannot trials are being conducted in Israel, MDMA (ecstasy) and psilocybin be manufactured without a special the US, Canada and Switzerland into (magic mushrooms) as an adjunct licence. Despite a grant of £550,000 the use of MDMA-assisted psychotherapy to conventional talking therapies for from the Medical Research Council to treat PTSD. The trials are funded the treatment of post-traumatic stress to begin a three-year project to test the fully or in part by the US-based charity disorder (PTSD) and in end-of-life care. drug on people with depression, Nutt and Multidisciplinary Association for The therapeutic use of banned drugs his team have been unable to Psychedelic Studies (MAPS), a research has featured in the UK national media because they can’t get the comparatively and educational organisation dedicated headlines in recent months, thanks to small amount of the drug needed to to promoting use of psychedelics and the outspoken David Nutt, Professor conduct their trials. It isn’t easy to find marijuana for therapeutic purposes. of Neuropsychopharmacology at companies who can manufacture the South Carolina-based psychotherapist Imperial College London and former drug and are prepared to stump up the Michael Mithoefer is leading one of Chair of the Government’s Advisory estimated £100,000 and go through all the trials. Mithoefer, a psychiatrist by Council on the Misuse of Drugs. He the bureaucratic hoops to get a licence. training, that MDMA can open was sacked from the Advisory Council Nutt’s research has already established doors in the mind, whether the person in 2009 after declaring that ecstasy that psilocybin appears to switch off wants it or not. The MDMA-assisted was less dangerous than horse riding the ruminative parts of the brain that therapy sessions are eight hours long, (in terms of adverse incidents per use). are overactive in people with depression. with two therapists present – generally In a subsequent paper he classified ‘We badly need more types of treatment a male and a female so the client can drugs according to the harm they caused; [for depression] but we cannot pursue talk to either, as they prefer. Though alcohol and tobacco emerged as more these because the Government is an apparently intense session – 45 harmful than ecstasy and cannabis. denying scientists access to powerful minutes can be a lot for most patients In September last year, he, with tools that could help people in need,’ in traditional non-drug psychotherapy Val Curran, professor of psychology Nutt told the conference. ‘The whole – it is designed to be completely at University College London, joined field is so bedevilled by primitive old- relaxed and without pressure. forces with Channel 4 to film some of fashioned attitudes. Even if you have It takes place in a non-clinical setting the participants (including the novelist a good idea, you may never get it into and, as the drug takes effect and the Lionel Shriver) in a study that used the clinic, it seems.’ session progresses, the client finds fMRI imaging to examine the effects him/herself talking naturally about the of MDMA on the brain. In April this MDMA and PTSD stressor that is causing them so much year, in his presentation to the British Post-traumatic stress disorder (PTSD) trouble. ‘We have an agreement with Neuroscience Association’s biennial is notoriously difficult to treat, and a the client that if nothing comes up conference, he roundly condemned condition for which almost no drugs during the session at a certain point, the British Government for blocking are being developed. Psychotherapy the therapist can engage them. This attempts to develop more effective is generally regarded as the treatment has never happened yet,’ Mithoefer says.

10 Therapy Today/www.therapytoday.net/May 2013 © HEMERA/THINKSTOCK ©

May 2013/www.therapytoday.net/Therapy Today 11 News feature

‘By letting go I regained my mind’

Mikee (not his real PTSD is severely became violent on several By letting go and no longer name) was a Forward Air stigmatised in the US Army, occasions and had difficulty being in control, I regained Controller for the US Army particularly among elite reintegrating with civilian life. my mind.’ during the Surge in Iraq soldiers like Mikee. Until For Mikee, taking MDMA Asked how he has in 2006-07. He had to get he was medically discharged allowed him to let go of the changed, Mikee says: ‘I artillery and air strikes with a broken back, and his control, which allowed him feel as if I have grown as signed off by officers. behaviour in civilian life to understand what was a person. What doesn’t kill ‘There were so many forced his hand, he wouldn’t going on for him. ‘The feeling you makes you stronger!’ career officers in it for admit his problems. initially was extreme anxiety Mikee is now going to themselves that would ‘As a soldier your mind as I was about to come up on medical school to learn not sign off strikes when controls everything. You the drug, but when I became to be a doctor. He wants I deemed them necessary live in the next five seconds high I was only anxious to study psychedelics as that I had to sit by while in a structure that controls when I had a thought about part of therapy and help 20 men were killed in everything you do. In civilian my past and didn’t talk about his former buddies cope six months whose lives life there is no control of it. When I talked about the with civilian life when they I could have saved.’ your life,’ says Mikee. He thing, in my head I relaxed. too leave the Armed Forces.

Few of the clients found taking MDMA author of What Doesn’t Kill Us: a guide to Put very simply, MAPS is arguing an ‘ecstatic experience’, according to moving forward and overcoming adversity, that MDMA can address social anxiety Mithoefer, and all have been able to both on post-traumatic growth. He argues: by reducing the individual’s reactions face the trauma and not be traumatised ‘In a nurturing, supportive environment, to negative social interactions and by doing so. people can let go. If you rush them they enhancing the feel-good effect of Outcomes to date indicate that will become more avoidant. You have to positive interactions. The treatments MDMA-assisted psychotherapy is build up the client’s trust over a couple are once or twice only, several weeks achieving results.1, 2 Twenty patients with of months.’ Indeed, ‘it is important to apart. There is no suggestion that chronic PTSD that had not responded to spend a lot of time not talking about people should be regularly dosed other forms of psychotherapy and drug their trauma’. Joseph is concerned about with MDMA, like an antidepressant treatment were randomly assigned to the use of any kind of drug to treat PTSD: or antipsychotic. The theory is that psychotherapy with MDMA or a placebo. ‘PTSD is not a psychiatric disorder – MDMA is a ‘teacher’, not a ‘helper’. The participants had suffered PTSD for it is more of a bereavement. You cannot Julian, a Londoner who has Asperger’s, an average of 19 years. Most of those who medicate an existential crisis.’ But he has taken MDMA at raves and confirms underwent the MDMA-assisted therapy is prepared to be convinced: ‘I’d be this effect: ‘It seems to help filter out had not relapsed 3.5 years later. Four out interested to see where we are when the signals you normally get, teaching of five of the MDMA treatment group the research is complete in 10 years. you how others see social interaction.’ improved, compared with just one in I may well be surprised.’ To help design the pilot study, MAPS four of those in the placebo group. brought in Nick Walker, who has autism The study found no evidence of drug- MDMA and social anxiety and has taken MDMA recreationally. A related serious side effects or adverse The US Food and Drug Administration teacher on the Interdisciplinary Studies neurocognitive effects and concluded (FDA) is currently considering an programme at California Institute of that MDMA can be given safely to application from MAPS to conduct Integral Studies in San Francisco, Walker people with PTSD, and may be an MDMA-assisted psychotherapy trial says: ‘Though MDMA is empathogenic particularly useful for those who have for social anxiety among autistic adults. for most who take it, the theory that not responded to other treatments.2 Dr Berra Yazar-Klosinski, Lead autistic people lack empathy is complete Stephen Joseph, Professor of Clinical Research Assistant at MAPS, rubbish.’ He feels that social anxiety Psychology, Health and Social Care says there is a lot of anecdotal data results from the power imbalance at the University of Nottingham, is suggesting that MDMA can help with imposed on the autistic by ‘neurotypical’ sceptical. He has pioneered psychological social anxiety, ‘although there is little mainstream society. ‘Autistic people techniques to treat PTSD and is the hard science on the subject’. are generally bullied at school and

12 Therapy Today/www.therapytoday.net/May 2013 misunderstood as children. By their They had reservations about taking and is left to sleep overnight – although adolescence and adulthood they are the next trip but this proved more a therapist is there for them to speak to if traumatised from being taught they positive: ‘Suddenly there came a phase they wish at any time. Kirchner explains: are somehow wrong. MDMA makes of relaxation. Completely detached. ‘Patients often just need time to process you warm and welcoming. It helps you It became bright. Everything was light. their experience and understand what get involved in others’ interests. How It is a pleasant feeling, a warm feeling. they have seen and felt.’ They receive do you share your interests? By getting No pain. Almost like floating, like being talking therapy the next day, but again over your social fear.’ carried, and together with the music… in a non-traditional way – the therapist really wonderful…’ is there simply to listen and help the LSD-assisted therapy The protocol for the Gasser clinical person articulate what they felt, heard Dr Peter Gasser was able to practise trial explains that psychotherapy will and saw, not to interpret or analyse it. psychedelic assisted psychotherapy in take place before, during and after the In her thesis Kirchner argues that LSD the 1990s under licence in Switzerland, LSD session. During the experience, opens the individual’s mind to a different as a member of the Swiss Association ‘as appropriate, the investigators will viewpoint and way of thinking while they of Psychedelic Therapists. The licence engage with the participant to support remain conscious, so they gain a different was revoked when LSD and other and encourage emotional processing perspective on the seemingly intractable psychedelics were banned even for and resolution of whatever psychological issue (for example, their impending medical use in 1993, but Gasser has since material is emerging. The investigators death) facing them. Brad Burge, Director been given a licence to run a clinical trial will also encourage periods of time in of Communications at MAPS, puts it into its use in end-of-life psychotherapy, which the participant remains silent more simply: ‘With end of life therapy partly sponsored by MAPS.3 The results with eyes closed and with attention one comes to the understanding that have yet to be published. focused introspectively on his or her “I do not end where my body ends”.’ Taking LSD is a very intense and sense of self and life history in order As the end-of-life research progresses, transformative, almost religious to increase the psychological insights the hope is that enough scientific experience, according to research mediated by the LSD treatment’. evidence will be gathered to break assistant Katharina Kirchner, who Very simply, there are two forms of through the social and legal barriers worked with Gasser and wrote her experience, depending on the dose of that are currently blocking the Master’s thesis on LSD-assisted LSD. A low dose is known as ‘psycholytic’ therapeutic application of these and end-of-life psychotherapy. – it is still intense and transformative, other so-called recreational drugs. Many writers over the years have but the client doesn’t ‘leave the planet’ likened the experience of taking LSD or hallucinate bright lights, for instance. Richard Shrubb is a freelance journalist. to Eastern mystic religious experiences. The other dose is a ‘psychedelic’ Kirchner challenges this: ‘Those who experience and will result in complete References have the language of the Eastern mystic release from reality. Kirchner says 1. Mithoefer MC, Jerome L, Ruse JM, Doblin experience speak of an LSD trip on 300 microgrammes in most cases will R, Gibson E. MDMA-assisted psychotherapy those terms. An ordinary person from bring about a psycholytic experience, for the treatment of posttraumatic stress a village in Switzerland or Germany depending on the person’s body weight, disorder: a revised teaching manual. Santa doesn’t have that language to use, health and stage of illness; 400mcg is Cruz, CA; MAPS; 2011. www.maps.org/research/ mdma/Manual_MDMAPTSD_30Nov11.pdf so describes their experience on the minimum needed to achieve a peak [accessed 12 November 2012]. the terms they have for reference.’ psychedelic experience in a healthy 2. Mithoefer MC, Wagner MT, Mithoefer AT, Kirchner practises meditation and adult of a typical weight. Jerome L, Doblin R. The safety and efficacy of describes the LSD experience as like The therapy environment itself 3,4-methylenedioxymethamphetamine-assisted ‘taking a train to a peak meditative is similar to that for MDMA-assisted psychotherapy in subjects with chronic, treatment- experience. You arrive in under an hour therapy: a calm, relaxing and non- resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal where through learning meditation it clinical setting. The patient wears a of Psychopharmacology 2011; 25 (4): 439–452. sometimes takes years to achieve that blindfold and can choose to listen to www.ncbi.nlm.nih.gov/pmc/articles/PMC3122 destination – not unlike walking’. One music. They are given the LSD under 379/ [accessed 12 November 2012]. participant had a horrifying experience the supervision of two therapists. 3. Gasser P. Clinical Study Protocol: LSD Assisted in the first trip, which they described Kirchner says: ‘Therapists are there Psychotherapy in persons suffering anxiety associated with advanced stage life threatening as ‘… really black, the black side. I was to guide you through the experience diseases. A Phase II, double blind, dose–response afraid, was shaking [...] Really it was and help along the way.’ After the trip pilot study. Santa Cruz, CA; MAPS; 2007. www. a total strain, no way out, no escaping.’ has worn off, the client goes to bed maps.org/research/lsd/swisslsd/LDA1010707.pdf

May 2013/www.therapytoday.net/Therapy Today 13

Legislation Investigation and court proceedings It is important to distinguish carefully provided – that is, the relevant mental of alleged abuse seem to be a constant between the different types of support health and criminal law, court practice theme in the media, whether involving available: between preparation for giving and rules of evidence. They also need churches, schools, or high-profile media evidence in court on the one hand, and to be aware of the tensions between the personalities. However, there is also ongoing pre-trial therapy on the other. best interests of the client and the public increasing public concern about the It can also be important for support interest in prosecuting alleged offenders. levels of emotional support provided roles to be clearly demarcated, and for The criminal trial process affects the types for witnesses giving evidence in such the different forms of support provided of recording appropriate for this kind cases, following the recent tragic suicide by different people to be distinguished. of work; it needs to be factual, accurate of one such witness, in a widely publicised For example, support workers can and contextual (referring to date, times case. This led to accusatory headlines provide practical help to a rape survivor, and names of persons present at the in the press and even to a leader in while a counsellor carries out the session). Crucially for therapists, there The Times, declaring: ‘More help must therapeutic work, to avoid any overlap are potential limits on confidentiality be given to vulnerable witnesses unused or blurring of these roles and activities. arising first from the need for close to courtroom combat.’1 MP Keith Vaz liaison with the police and Crown called for the revision of the guidance Pre-trial therapy guidance Prosecution Service and, second, on support in such cases. Similarly, Pre-trial therapy, whether for adults from the requirement for both the Keir Starmer, the reforming head of or children, has long been viewed as prosecution and the defence solicitors the Crown Prosecution Service, has problematic and contentious within to have access to the therapist’s records. issued a call ‘to redouble our efforts the criminal justice system. In the eyes The CPS practice guidance covers to improve the criminal justice of the law, it carries two main risks. in detail the implications of the type response to sexual offending’ via First, unless carefully controlled, it of therapeutic approach used and the a series of roundtable discussions.2 may lead to ‘coaching’ of the witness, focus of the therapy for the viability In an adroit and timely response, by unwittingly helping the client to of the client’s evidence in court. The the Ministry of Justice has recently rehearse and go over their evidence guidance outlines: launched a consultation on a Draft Code prior to its actual presentation in court. ••the need to avoid any rehearsal of Practice for Victims of Crime, setting Second, there is the attendant risk of the client’s evidence out new entitlements for vulnerable, that the therapy will ‘contaminate’ the ••procedures for responding to the intimidated and child victims.3 evidence: that the client in therapy will client making allegations of further, incorporate their therapist’s reflecting previously undisclosed, offences Pre-trial support statements into their own understanding ••the need to avoid evidential problems Support for victims and witnesses prior and memory of the events. inherent in attempts by the therapist to a criminal trial can apply to a number In response to these concerns, in to distinguish fact from fantasy in the of distinct groups. These include: 2001 and 2002 the Crown Prosecution client’s account. ••children under the age of 18, who Service (CPS) issued separate practice In effect, the therapist has to show have been subjected to alleged abuse, guidance on pre-trial therapy for child a willingness to work as a member of including neglect or physical, emotional and adult witnesses.4, 5 These were a multi-disciplinary team that includes or sexual abuse, or who have been later incorporated into Achieving Best the CPS and police, with consequent exposed to domestic violence Evidence,6 which sets out clear standards clear limits to client confidentiality. ••adults who are intimidated because for the provision of pre-trial therapy In addition, an employer or agency of their fear and distress about testifying for both children and adults. that provides therapy under contract in court Therapists who take on pre-trial may be under an explicit obligation ••adults who are vulnerable – ie they therapy with a vulnerable adult or child to provide reports to the CPS on the have a mental disorder or impaired witness need to take account of a number process and outcome of therapy. intelligence or social functioning, of factors. They need to be fully aware The practice guidance sets out or a physical disability or disorder. of the legal context of the therapy being very clear parameters for therapy Pre-trial therapy Peter Jenkins outlines what the Government and Crown Prosecution Service are and should be doing to ensure victims and witnesses of crime have access to pre-trial therapy Illustration by Clare Nicholas

May 2013/www.therapytoday.net/Therapy Today 15 Legislation that essentially explain its role as a shred of an evidence base. Anecdotal for one of them. Post-trial therapy was secondary and supportive to the criminal evidence about its implementation in later offered to another six young people trial process. However, it also makes practice is also concerning. Numbers but by then only two of them wanted it. two crucial points: first, the CPS, and of counsellors report that the police Lara (15) told the researchers: ‘I was other bodies, do not have the legal and CPS still frequently refuse to allow offered a counsellor after the incident by power to veto therapy, either for adults or therapy, despite the positive ethos the police at the local hospital but when children; second, children have a right to expressed by the guidance. This is I called her to make an appointment a say in decisions about pre-trial therapy, supported by some findings by she said she didn’t really “do” children. under Article 12 of the United Nations Plotnikoff and Woolfson, drawing on The counsellor at school said she’d do on the Rights of the Child data from Devon and Cornwall NSPCC: it. She has been great.’ 1989 (respect for the views of the child). ‘Some police officers are unaware of The mother of a boy aged six said: ‘My Moreover, if the child’s need for therapy the guidance and families were advised main concern was that my son couldn’t conflicts with the needs of the trial, then that therapy could not take place until have counselling. The police said it might the child’s welfare must take priority after the trial’.7 the trial but I could do it if he and the trial should be abandoned. Overall, research into the detailed was really “falling apart”. He was having operation of the practice guidance nightmares and had trouble sleeping. Criticisms of the guidance is generally lacking. Jill Swindells I did too. I tried to follow up anyway For therapists, if not for lawyers, researched this for her counselling but counsellors wouldn’t touch him – the practice guidance is likely to make degree dissertation, and found a general they said the police wouldn’t like it.’ slightly strange reading. Psychotherapy lack of awareness about the specific Research into the STAR project and counselling are distinguished from requirements of pre-trial therapy (Surviving Sexual Trauma after Rape) each other as separate therapeutic among her small sample of 10 therapists. found positive experiences of counselling approaches – a feat not generally She concluded that ‘therapists must among young people aged 14–16 years, recommended for the faint-hearted. appreciate counselling has the potential but few had progressed successfully There is also a rather curious list of to make or break a trial; without through the criminal justice system.9 therapeutic approaches to be avoided counselling, a trial may falter or STAR separated the role of support as likely to prejudice evidence for fail; without a trial, the client has worker from that of counsellor and the trial. These include interpretive no chance of seeing justice done’.8 established a database for tracking psychodynamic psychotherapy, group cases through the criminal justice therapy, hypnotherapy, psychodrama Research into pre-trial therapy system. Of 45 survivors interviewed, and regression techniques. There is Most research into pre-trial therapy one third had contact with a counsellor, a marked preference for a therapeutic has tended to focus on the experiences with most rating the counselling focus on improving self-esteem and of children, rather than adults. Plotnikoff positively. Reasons for not using the self-confidence, using cognitive and and Woolfson explored the experiences service included not knowing it was behavioural techniques. Nevertheless, of 50 young people involved as witnesses available, support being obtained from the guidance does represent some sort in criminal proceedings, and their elsewhere, or people thinking ‘they of accommodation between therapy parents.7 The young people were could not be helped’. One finding may and the criminal justice system, albeit aged between six and 17 years, with an have wider implications for supporting very much on the latter’s terms. average age of 12 years. Most described this client group: ‘Developing a positive The original practice guidance is over themselves as feeling ‘very nervous or counsellor/survivor relationship tended 10 years old and, perhaps, badly in need scared’ before the trial. After the trial, to be linked to a flexible approach of revision and updating. Given the only a minority of the young people and where the survivor had control’.9 predominance of NICE guidelines and their parents were positive about the These benefits of client empowerment evidence-based practice, it is striking trial experience. Pre-trial therapy was were also reported in a multi-centre that the list of problematic therapies offered to seven of the young people, evaluation of counselling provision rests simply on expert opinion, without although social services vetoed this in sexual assault referral centres.10

References 3. Ministry of Justice. Draft code 6. Home Office/Lord Chancellor’s 8. Swindells J. Counselling victims 1. The Times. Trial of trials: more of practice for victims of crime. Department/Crown Prosecution and witnesses of crime – are help must be given to vulnerable London: the Stationery Office; 2013. Service/Department of Health/ they a specialist group requiring witnesses unused to courtroom 4. Crown Prosecution Service/ National Assembly for Wales. specific knowledge and expertise? combat. Leading article. The Department of Health/Home Office. Achieving best evidence in criminal Unpublished degree dissertation. Times; 9 February 2013. http:// Provision of therapy for child proceedings: guidance for vulnerable Coventry: University of Warwick; www.thetimes.co.uk/tto/opinion/ witnesses prior to a criminal trial: or intimidated witnesses, including 2012. leaders/article3683040.ece practice guidance. Bolton: CPS; children. London: Home Office 9. Skinner T, Taylor H. Providing 2. Starmer K. The criminal justice 2001. Communications Directorate; 2002. counselling, support and information response to child sexual abuse: 5. Crown Prosecution Service/ 7. Plotnikoff J, Woolfson R. In to survivors of rape: an evaluation time for a national consensus. Department of Health/Home their own words: the experiences of the ‘STAR’ young persons’ project. London: CPS; 2013. http://www.cps. Office. Provision of therapy for of 50 young witnesses in criminal Home Office online project 51/04. gov.uk/news/articles/the_criminal_ vulnerable or intimidated witnesses proceedings. London: NSPCC; 2004. Bath: Department of Social and justice_response_to_child_sexual_ prior to a criminal trial: practice Policy Sciences, University of Bath; abuse_-_time_for_a_national_ guidance. London: Home Office 2005. http://www.homeoffice.gov.uk/ consensus/ (accessed 10 April 2013). Communications Directorate; 2002. rds (accessed 22 February 2013).

16 Therapy Today/www.therapytoday.net/May 2013 Consultations on provision Draft Code of Practice for Victims.3 burden of providing this support falls on The adverse publicity arising from The stated purpose of the draft code hard-pressed statutory and third sector recent court cases has coincided, is ‘to provide victims with a clear idea agencies, who lack dedicated funding fortuitously, with recent consultations of the entitlements and services they for this purpose. One survey of young on the provisions for witnesses and can expect from the Criminal Justice survivors of sexual abuse has estimated victims of crime. In his foreword to Agencies’. It proposes that children that 90 per cent ‘do not receive any the 2012 Getting it Right for Victims and and vulnerable or intimidated adult substantial subsequent support’.13 In Witnesses consultation document,11 the witnesses should be able to claim Austria, by contrast, local authorities Lord Chancellor Kenneth Clarke called ‘enhanced entitlements’ beyond those are now legally required to provide for ‘first class support, such as practical available to other witnesses or victims. therapeutic help for young people advice and counselling services’. This These include automatic referral by who have been physically or sexually document set out two key principles the police to victims’ services within abused, under legislation sponsored underpinning the proposed nil-cost two days of making an allegation, and by their Children’s Commissioner. reforms of the criminal justice system: ‘to information on pre-trial therapy If the recent consultations really ••‘practical and emotional support and counselling where appropriate’. are going to provide ‘first class support’ should be given to those who need So child and adult victims would have for child and adult victims of crime, then it most a right to information about pre-trial adequate funding has to be a priority. ••‘victims should receive help as therapy. But there is, as yet, no proposal But there is also a case for taking stock and when they need it.’ to update or revise the practice guidance of the adversarial nature of the legal However, none of the 66 questions that governs its actual delivery. system itself, which dictates the posed in the consultation paper skewed priorities of pre-trial therapy dealt directly with pre-trial therapy. Reforming pre-trial therapy provision in the first place. New Zealand is now In the Ministry of Justice response Given this welcome opportunity for considering introducing elements of to the consultation,12 Kenneth Clarke revision and updating, the practice an inquisitorial system to address some warmed to his theme of the centrality guidance should be based on evidence- of the constraints on victims’ access to of emotional support: ‘If any of these based practice, rather than on simple justice.14, 15 In view of the current media victims and witnesses come away from assertion. It needs to include a much concern about vulnerable witnesses an investigation or trial feeling the wider spread of therapeutic approaches in abuse trials here in the UK, it would experience has added to their suffering with evidence of effectiveness. Jill seem to be an opportune time to then we have let them down.’ Criminal Swindells suggests specialist training introduce some much-needed change justice should therefore provide support for counsellors in pre-trial therapy, to the provision of pre-trial therapy. services that ‘aim to achieve the two with a register of suitably experienced outcomes of cope and recover’ for and trained counsellors in this modality.8 Peter Jenkins is a Senior Lecturer in such victims. The consultation response Research is urgently needed to check Counselling at the University of Manchester was geared to answering set questions, the extent of police and CPS , and the author of Counselling, of which question 18 – ‘What could or non-compliance, with the key Psychotherapy and the Law (2nd edition; be done to improve the experience of recommendations of the guidance. Sage, 2007) and co-author, with Debbie witnesses giving evidence in court?’ – Any reform of pre-trial therapy Daniels, of Therapy with Children could perhaps be loosely linked to the provision also needs to acknowledge the (2nd edition; Sage, 2010). issue of emotional support. However, thorny issue of funding. Currently, much the consultation responses to this of the therapy and support for child and Peter Jenkins will be running two BACP question (paragraphs 86–94)12 make adult victims and witnesses is provided Professional Development Day workshops no mention of pre-trial therapy. by rape support centres and agencies on ‘Legal issues in therapeutic work with Hopes may have been raised that that support vulnerable victims of crime, children and young people’, on 31 May in it would be addressed in the second, with government funding of around £40 Newcastle and 27 September in Manchester. follow-on consultation on the 2013 million.11 However, at least part of the For more details, see www.bacp.co.uk/events

10. Lovett J, Regan L, Kelly L. 13. Baginsky M. Summary of findings 14. Ministry of Justice, New 15. Ministry of Justice, New Zealand. Sexual assault referral centres: from the UK. In: Baginsky M (ed). Zealand. Alternative pre-trial and Child witnesses in the criminal developing good practice and Counselling and support services trial processes for child witnesses courts: proposed reforms: Cabinet maximising potentials. London: for young people aged 12–16 who in New Zealand’s criminal justice paper. Wellington: Ministry of Home Office Research, Development have experienced sexual abuse: system: issues paper. Wellington: Justice; 2011. http://www.justice. and Statistics Directorate; 2004. a study of the provision in Italy, Ministry of Justice; 2010. http:// govt.nz/publications/global- 11. Ministry of Justice. Getting the Netherlands and the United www.justice.govt.nz/publications/ publications/c/child-witnesses- it right for victims and witnesses. Kingdom. London: NSPCC; 2001 global-publications/a/alternative- in-the-criminal-courts-proposed- Consultation paper CP3/2012. (pp71–125). pre-trial-and-trial-processes-for- reforms (accessed 18 April 13). London: Stationery Office; 2012. child-witnesses-in-new-zealands- 12. Ministry of Justice. Getting it criminal-justice-system (accessed right for victims and witnesses: 9 April 2013). the Government response. Cm 8397. London: the Stationery Office; 2012.

May 2013/www.therapytoday.net/Therapy Today 17 Practice Working with cult survivors

In 1973, aged 21, I joined what I At first it was a very positive Gillie Jenkinson describes thought was a group of passionate, experience. But, with the arrival of the sophisticated loving people. I had no idea that I a new leader, the group changed; it would be trapped for years. It was the became authoritarian, dedicated to techniques used by cults start of a lost decade for me. The group a form of puritanical Christianity to manipulate members, I joined was called ‘The Love of God that demanded total obedience Community’ (LOGC). It had little from its members, and used physical and the lasting e�ects to do with love or with God. punishment and sexual abuse to on their sense of self I left the cult in 1980, and only when exert control. We were all harmed it imploded and ceased to exist. I have psychologically and many were harmed Illustration by Clare spent many years since processing my physically by sexual abuse and beatings, Nicholas own experience and researching the which were described as punishments experiences of others who also became for ‘sin’. I eventually managed to leave, involved in cults. After years of feeling but only because the group collapsed, convinced that my entrapment was and even then the controls and triggers somehow my fault, I know now that stayed with me. I remained trapped in it is nothing to do with personal fear and cultic thinking for a further 14 weakness or character defect; nor years. I continued to look to authority is it all about my childhood and figures to tell me what to do and family upbringing. Cults are powerful assumed they knew me better than bodies that use potent psychological I knew myself – and that has been techniques to entrap their victims. a hard one to break. People who are seduced into and abused in a cult deserve the same Why do people join? understanding as victims of rape. No one knowingly joins a group that For me, a good analogy is that of a is going to harm them. People join a frog in boiling water. If you put a frog group because of the benefits it seems into boiling water it will immediately to offer them. Cults can be predatory jump out to try to escape the danger. and, like any predator, they prey on But if you put it in cold water and then the vulnerable. They also tend to target slowly heat it up, by the time the frog people who are going to be of benefit realises it is in danger, it is too late. for them, financially or otherwise. I initially joined LOGC because they Anyone can be sucked in.1 Research offered free counselling and a radical does suggest that vulnerability to cult form of Christianity that seemed more recruitment is particularly high during interesting than that on offer in most key transitional periods,2 especially orthodox Anglican churches. Like many from child to adulthood.1 Family other young people then (and now), environment is not necessarily a I was looking for meaning in my life. significant factor in cult involvement,3 I wanted to feel less depressed, to make although key periods of vulnerability the world a better place and to belong. are the 12 months following a stressful I turned to spirituality and Christianity event, such as relationship breakdown, to try to fill the void. Many of the death of close friends or relatives, and people in LOGC were genuinely failure in school or at work. good and committed; a lot of love Cult leaders use highly sophisticated was shared; we had a vision. Looking techniques to keep their members. back, there was little substance to our Cialdini4 lists the weapons of influence vision but at the time it was exciting. that are used powerfully in the hothouse Many others have also described how atmosphere of a high demand group or this ‘’ drew them in. cult. They include:

18 Therapy Today/www.therapytoday.net/May 2013

Practice

References 3. Maron N, Braverman J. 5. Langone MD. Recovery from 7. Temerlin JW, Temerlin MK. 1. Singer MT. . Family environment as a cults. London: WW Norton and Some hazards of the therapeutic San Francisco, CA: Jossey-Bass; factor in vulnerability to cultic Sons, 1993. relationship. Cultic Studies 2003. involvement. Cultic Studies 6. Kendall L. A psychological Journal 1986; 3: 234–242. 2. Goldberg L. Guidelines for Journal 1988; 5(10): 23–37. exploration into the effects of 8. INFORM (www..ac). therapists. In MD Langone (ed). 4. Cialdini R. Influence: the former membership of extremist Accessed August 2011. . London: psychology of . New authoritarian . Doctoral 9. . WW Norton and Sons; 1993 York: HarperBusiness; 2006. dissertation. Chalfont St Giles: www.cultinformation.org.uk (pp232–250). Buckinghamshire Chilterns University College; 2006.

What is a cult?

Langone defines a cult as goals, and A cult can be any size. It therapist controls and ‘a group or movement that, e) causes psychological can even be a one-on-one micro-manages their lives. to a significant degree:5 harm to members, their relationship where one In some cases huge sums of a) exhibits great or families and the community.’ individual has a hold over money have been extracted excessive devotion Kendall6 uses the term the other and uses spiritual/ from clients. When a or dedication to some ‘high demand group’ to mental or physical violence therapist evolves into a person, idea, or thing describe cult-like groups. to exert their power. Some spiritual leader the dynamics b) uses a thought-reform This is a better description domestic violence situations of the ‘therapeutic’ and programme to persuade, for cults that have a very can be defined as cultic. ‘spiritual’ can combine in control, and socialise high intensity but are not Cults can be spiritual, a lethal mix to render their members (ie to integrate closed to outside influences. self-developmental or clients helpless, dependent, them into the group’s Another commonly used political. Psychotherapy traumatised and unique pattern of term is ‘extremist cults can be some of the psychologically imprisoned. relationships, beliefs, authoritarian ’.6 most damaging and toxic.7 Contrary to common values, and practices) Sociologists use the term A number of cases have belief, cults are not an c) systematically induces New Religious Movements been reported where a American phenomenon: states of psychological (NRMs) or New , therapist has drawn clients there are an estimated 800 dependency in members but not all cults are religious and therapeutic group NRMs8 and between 1,000 d) exploits members to and not all new religions members into an intense and 1,500 cults currently advance the leadership’s are cultic. relationship where the in the UK.9

••reciprocity – the pressure to repay victim of their privilege in being terminating clichés that only members what another person has provided. invited to become a member. understand or think they understand This rule can kick in from the very Many cults use thought reform to ••doctrine over person – the belief first contact with a cult when the victim create totalitarian control.10 Lifton system is more important than the is entrapped by the offer of spiritual identifies eight components of thought reality and wellbeing of individuals enlightenment, a free meal, mystical reform:10 ••dispensing of existence – the group experiences or simply love bombing ••milieu control – communication, or cult leader decides who has the right ••commitment and consistency – once and often access to TV, newspapers, to exist and who does not – those outside someone has been manipulated into food, sleep and sex, are controlled are ‘going to hell’, ‘part of the negativity’, making the initial commitment, they ••mystical manipulation – contrived ‘unenlightened’. will be more ready to agree to further spontaneity creates mystique, which Other common techniques include requests is then used to justify manipulation provoking phobias and fears to enforce •• – you are told that ••the demand for purity – who you obedience and ensure that members others, who may be role models, have were is of no account any more; you are too frightened to leave, for fear that done whatever they want you to do have to become ‘pure’ as defined by something awful will happen to them,11 ••liking – people tend to say yes to the group and separating people from all that is requests from people they know and ••the cult of confession – recruits are familiar, including family and friends. like, so cults will often present a friendly pressured into confessing ‘sins’, ‘lack New recruits may be taken away on and loving face of enlightenment’ or ‘negativity’ and encounter groups or high intensity ••authority – Milgram’s studies on this is then used against them by the training courses in an unfamiliar place, obedience demonstrate how easily group or cult leader which can very quickly destabilise them. we will comply with requests from ••the ‘sacred science’ – it is only the Some cults move their members around an authority figure cult leader or group that holds the the world; in some cases parents have ••scarcity – cults use high pressure ultimate moral vision not seen or heard from their adult sales techniques to persuade the ••loading the language – use of thought- children for many years.

20 Therapy Today/www.therapytoday.net/May 2013 10. Lifton RJ. Thought reform 12. Jenkinson G. An investigation 14. Lalich J, Tobias M. Take 15. Hall D. The effects of an and the psychology of totalism: into cult pseudo-personality: what back your life: recovery from African Caribbean heritage: a study of ‘’ in China. is it and how does it form? Cultic cults and abusive relationships. living as a problem. In: Lago C Chapel Hill, NC: University of Studies Review 2008; 7(3): 199. Pt Richmond, CA: Bay Tree (eds). The handbook of transcultural North Carolina Press; 1961. 13. West LJ. A psychiatric overview Publishing; 2009. counselling and psychotherapy. 11. Hassan S. Releasing the bonds: of cult-related phenomena. Journal Maidenhead, Berks: McGraw- empowering people to think for of Nervous and Mental Disorders Hill/Open University Press; themselves. Somerville, MA: 1994; 21: 1–19. 2012 (pp231–241). Freedom of Mind Press; 2000. 16. Lifton R. Thought reform and the psychology of totalism. Chapel Hill, NC: University of North Caroline Press, 1961.

All of these psychological techniques Writing this article has been hard I was able to go into psychotherapy create control and lead to identity loss for me. Even though I have spent safely. The key for me was understanding and confusion, which in turn lead to the many years researching and working the cult and how it operated; I think creation of a cult pseudo-personality.1, 12 through my cult experience and now this is true for other former members. In West’s words:13 ‘Individuals subjected work therapeutically with former With the right sort of support and to [prolonged stress] may adapt through cult members, I still fear that people therapy, former members can recover dissociation by generating an altered will judge me or think me stupid for well. I find this work hugely rewarding persona, or pseudo identity.’ joining a cult. This is why it can be as I see many former members gain I underwent a complete change in so hard for former cult members clarity on, and make meaning of, their personality after joining the cult. I had to go to a therapist for help.1 experiences and start to walk free. I use been feisty, flirtatious, depressed at You are likely to ask what drew my personal experience to inform my times and ‘quite a character’. When me into a cult. This will leave me work whilst ensuring I have necessary I left I was timid, cried a good deal feeling even more foolish: I should supervision and therapeutic support. of the time, was desperate to be ‘a have known better; obviously it was I have a passion for this work and this good girl’ and terrified I would step because I was so messed up. If you fuels my drive to see former members’ out of line or upset others. I now see had asked me ‘How does that feel?’ needs heard and attended to by the this as my ‘cult pseudo-personality’ I could not have told you, because therapeutic community. and it is one of the major issues with I spent years learning not to feel. I which former members may struggle (my cult pseudo-personality) was Gillie Jenkinson is a MBACP and accredited on leaving.12 The development of the defined by others; they told me who I with UKCP. She is an international speaker cult pseudo-personality can be seen was and what I believed. I had to sever and trainer. She has published a number of as a form of introjection. It was only all emotional ties with friends, family articles on cult recovery. She has developed when I began to understand how and with my heritage.15 I lost the ability an intensive, relational, psycho-educational these dynamics had worked on me to think my own thoughts and feel my counselling approach for former cult in LOGC that I was able to start my own feelings. All I knew was what the members called ‘Post Cult Counselling’ walk towards freedom. cult taught me: that it was my fault. (PCC) and is currently engaged in a PhD You might move on to ask me about programme to research the most effective How therapists can help my family. You are likely to assume the approach to working with former members. People leave a cult for a number cult was able to take me over because For further information on training or of reasons. Some are asked to leave of childhood issues. That is what you to take part in the research, please email (throw-aways); some leave of their are trained to do, but it just doesn’t help. [email protected] or visit own volition (runaways); some have The danger for therapists is that you www.hopevalleycounselling.com mental breakdowns and are no longer may be unknowingly dealing with the useful to the group and are therefore cult pseudo-personality; you aren’t The International Cultic Studies Association thrown out (castaways).14 It is difficult reaching the pre-cult personality. The Conference takes place in Trieste, Italy, on for anyone leaving a cult; throw-aways therapist needs to be able to provide 4–6 July 2013. See http://icsahome.com and castaways may feel rejected and information about cult techniques and a failure, alongside the feeling of how they work. This will help the client Gillie Jenkinson will be running two relief at being out. Those who leave identify and understand what was done BACP Professional Development Day a large group that continues after their to them and the tricks that were used workshops on ‘An introduction to working departure have particular difficulties, to lure them in and keep them in. therapeutically with former members of especially with self-doubt: if all those You need to understand and be able abusive groups and relationships’ on 22 June other people stayed, maybe I am wrong to explain thought reform, to help the in Bristol and 7 September in Manchester. and they are right? Some people may client identify how and where these For more information and to book, please be leaving family and friends behind influences are still dictating their life. visit www.bacp.co.uk/events in the cult – perhaps the only family When I found a specialist counsellor and friends they have – which is both who understood about cults and was difficult and dangerous because they able to give me information, I began Visit our website (www.therapytoday.net) may be at higher risk of going back or to recover quite quickly. Once I to read Colin Feltham ‘in conversation’ even suicide. understood about cultic dynamics, with Gillie Jenkinson.

May 2013/www.therapytoday.net/Therapy Today 21 Practice ‘Practitioners need to find the balance between not being overly neutral when listening to atrocities and being open to people’s feelings of loss and grief’

Curiosity and willingness to learn Linda Dubrow- Establishing a psychotherapists to mental health professionals psychotherapeutic or acknowledge the client’s need if there are signs of Marshall o�ers consultative relationship to express the positive side psychological difficulties. advice to therapists is a special challenge for of their relationships or what It is likely that counsellors working with people whose trust has been they may have learned or will at some point work betrayed. People who have enjoyed during an otherwise with people who have former cult been in cultic groups and traumatic experience, and been involved in cultic members experienced ‘love-bombing’ to deal with personal anger groups. I have not been and pseudo-intimate and countertransference in in a cult, although members relationships, where supervision and consultation. of my family have. But I sometimes people pretend Psycho-education is a key know what it is like to be to be similar to them in element, whether working influenced, manipulated order to influence them, tend with individuals or their and deceived, and I have to feel that the professional families, so that people can done things under group relationship is cold and understand the experience pressure that made me feel uncaring. Their experience and the principles behind uncomfortable. These are of feeling special, purposeful, undue influence. Lifton’s16 universal experiences that taken care of, and of living model is extremely helpful can help practitioners to with rules stating exactly in explaining the processes work with individuals and what to do can mean that of being in a totalistic families while displaying the clients pressure therapists environment. As family core conditions of empathy, to be directive. Some of the members come to understand unconditional positive key tasks in working with the power of undue influence, regard and congruence. current and former cultists their anger towards their Good counselling skills, are to help them to tolerate loved one’s withdrawal or coupled with curiosity and ambiguity and uncertainty, disturbing actions rightly willingness to learn about and to express and accept becomes focused on the the psychology of cultic a full range of emotions, destructive group. influence while listening including existential angst, The field has changed; carefully to the specifics anger and grief. A return in the early days there were of the person’s experience, to critical thinking and the some forced de-programmings will enable practitioners ability to make decisions is where people’s families to be helpful, and they of paramount importance. kidnapped them in a can refer to specialists for Practitioners need to desperate attempt to get consultation as needed. find the balance between them to listen to another not being overly neutral point of view. Voluntary Dr Linda Dubrow-Marshall, when listening to atrocities exit counselling has emerged MBACP (Accred), is an and being open to people’s since, often delivered by HCPC-registered counselling feelings of loss and grief former members who and clinical psychologist and when they leave the cult. have a great deal of specific lecturer in Applied Psychology These are the same skills information about the (Therapies) at the University needed to work with survivors practices of various groups. of Salford. She is co-founder of of domestic violence where Exit counsellors can also Re-Entry Therapy, Information it may alienate the client be called thought reform & Referral Network (see www. to demonise their former consultants or mediators, RETIRN.com/Dr._Linda.htm). partner. It is important for and they may refer clients to Email [email protected]

22 Therapy Today/www.therapytoday.net/May 2013 Talking point Care for the soul Alain de Botton For centuries in the West, that there are a number of for therapeutic conversation there was a figure in society ways in which contemporary with a sympathetic other. argues that who fulfilled a function that psychotherapy has failed to There’s also, in a serious therapists should is likely to sound very odd learn the right lessons from sense, an issue of branding be secular society’s to modern secular ears. He the priesthood and might here. Therapists are hidden (for there were no shes in the benefit from a more direct away. You don’t see them new priests role) was there to take care of comparison with it. on the high street. We don’t that part of you called rather My suggestion is that make a place for them among unusually ‘the soul’ – by society would benefit if other needs, like those for which we would understand therapists were more bread or electrical goods. the psychological inner part, explicitly reorganised Imagine if seeing a the seat of our emotions along the model set by the therapist wasn’t a strange and sense of deeper identity. priesthood – that therapists and still rather embarrassing I’m talking about the priest, should be secular society’s pursuit. Imagine if one could who would accompany you new priests. be guaranteed a certain level throughout your years, from For a start, therapy of service. Imagine if the earliest infancy to your dying remains a minority activity, consulting rooms looked breath, attempting to make out of reach of most people, better and were more sure that your soul was in a too expensive or simply not visible, to make a case for good state to meet its maker. available in certain parts the dignity of the activity. Because, in many Western of the country. There have Modern psychotherapists’ countries, the priesthood is been laudable efforts to understanding of how now a shadow of its former introduce therapy into the humans work and what they self, a key question to ask NHS, but progress is slow need to cope with existence might be: where have our and vulnerable. And the issue is, in my eyes, immensely soul-related needs gone? isn’t just economic. It’s one of more sophisticated than What are we doing with all attitudes. Whereas Christian that of priests. Nevertheless, the stuff we used to go to societies would imagine there religions have been expert at the priest for? Who is looking was something wrong with creating a proper role for the after it? The inner self hasn’t you if you didn’t visit a priest, priest, as a person to talk to given up its complexities and we tend to assume that at all important moments of vulnerabilities simply because therapists are there solely life, without this seeming like some scientific inaccuracies for moments of extreme crisis a slightly unhinged minority have been found in the tales – and a sign that the client thing to do. of the seven loaves and fishes. might be a little unbalanced, Many people may well The secular response to the rather than just human. say that the pub and a few needs of the soul has tended A principally physical mates are all they need; after to be private and informal: we model of the self is popular, one or two big challenges, find our own solutions, in our which leads to a preference a great many more may own time; we construct our for problems to be addressed feel that life is sufficiently own salvations as we see fit. by pills rather than complicated that they’d Yet there remains in many a interpersonal relationships. benefit from regular dialogue desire for more interpersonal, This isn’t to say that drugs with a sympathetic third party structured solutions to help are not important in many in a stigma-free, reassuring us deal with the serious issues situations; it is simply to location. For those interested life throws at us. Probably the make a supplementary case in the challenge, there’s a most sophisticated communal long way to go before therapy response we’ve so far come really plugs the gap opened up with is psychotherapy. ‘We bring the same up by the decline in the It is to psychotherapists kind of problems that priesthood. that we bring the same kind we would previously of problems that we would Alain de Botton is a writer previously have directed at have directed at a and philosopher. His books a priest: emotional confusion, priest: emotional include The Architecture loss of meaning, temptations confusion, loss of Of Happiness (2006) and of one kind or another and, Status Anxiety (2004). of course, anxiety about meaning... anxiety He is a founding member of mortality. Yet one could argue about mortality’ The School of Life, in London.

May 2013/www.therapytoday.net/Therapy Today 23 Practice When parents aren’t good- enough How do we help a child process the fact that their parents were unable to provide good- enough parenting? Joanna North o�ers guidance to therapists working with looked-after children Illustration by Clare Nicholas

I have been reflecting recently on how when parents become bad tempered we help children to make sense of the and illogical and take their minds off reality of a parent who has been abusive the job of parenting for a while. This or unable to provide good-enough can happen in any family system and parenting, and the child has been taken these days parents are frequently into care. But, before we can do this, stressed by the competing demands we need to understand why children of earning a living in a recession and are taken into care. What might have supporting children to grow into happy happened in their lives to precipitate this? and well-balanced young people who When a parent’s care has resulted in participate fully in the social world. or is ‘likely to’ result in significant harm Families are often short on time as well to a child, he or she will be placed into as money. They are stretched to their the care of the local authority and the limits but are able to take good-enough state becomes their parent. Contrary care of their children: to keep them to media myth, it is not possible for safe, help them to feel loved, and give a child to be taken away from a birth predictable and consistent levels of care. parent without a robust amount of In my work as an expert witness in evidence produced in court to prove family court cases, I see many parents that their care is not good-enough.1 who do not manage a good-enough We’re not talking here about families level of care; they can be divided into going through a period of adversity two categories. The first is when harm

24 Therapy Today/www.therapytoday.net/May 2013 May 2013/www.therapytoday.net/Therapy Today 25 Practice is based on cruelty and intent; the children, which places a burden on the psychotic states. Children in the care second is when harm arises from multiple older siblings and erases fun and play system are frequently trying to live with conspiring circumstances, such as when from their own lives. Parents often have unresolved trauma resulting from harm; a child’s needs are neglected because of had insecure backgrounds themselves it pervades their dreams and makes very poor parenting skills. I have come or may struggle to read their child’s them afraid to sleep. They can be left across very few cases in the first category, communications and distress signals, full of anxiety and unable to envision where parents are intentionally cruel culminating in great anxiety for the child. goals or experience happiness – let and harmful, but plenty of such cases We may think it would be easy for such alone get on with the developmental do exist. These cases become matters parents to change their behaviour but tasks of childhood through play and for criminal law, and children will be they often struggle with these problems forming relationships. Yet somehow placed in local authority care. Our and are unable to find the right amount the damaging and pathogenic parenting work in this field is often about helping of help within the given time frame, and relationships remain precious in the a child to integrate the trauma of harm so lose their children to the care system. child’s mind. So, what can we do to help? in their young and impressionable mind. The second category is most common, How can we help? Tread carefully and comprises about 90 per cent of the So, given that we are unable to prevent First, tread carefully around the cases with which I deal. These are cases children entering the care system in representations that a child may have of where a constellation of factors has the first place, how do we help a child their abusing or less-than-good-enough conspired to reduce the circumstances think about a parent who has not been parent. The representations will usually of the parent and the overall quality good-enough in any of these ways? idealise the parent and paint them as of care. These factors include stress, We are often faced with a paradox benign. We cannot take that safe haven undiagnosed and untreated mental in therapy, which can be stated as: ‘I away from a child. However the child health conditions, low income, learning love my parent even if they hurt me.’ will also frequently blame someone difficulties, problems with drug and Life cannot get more confusing for a else for the sense of harm or fear with alcohol addiction and domestic violence. child – or for an adult. I observe many which they are left. Because they are It is also highly likely, but not always the children and adults who struggle with likely to act out their fear, it is often case, that the parent will have an insecure their preoccupation with this dilemma. the substitute carer who has to organise pattern of attachment from their own Separation from a parent, even if they the waves of emotion that threaten childhood, when they experienced a are a harmful and neglectful parent, to overwhelm the child’s life and the lack of containment, safety, love and will always be a scar across the mind of carer’s relationship with the child. care. A parent’s childhood neglect a child and cause a deep sense of sadness A child will commonly internalise crosses the generations and is mirrored and loss – and probably some despair. abusive experiences: they will lock away and replicated in their care of their It will form part of their life story and, an experience in their mind and all the children. Parents are often completely at some stage, depending on the care time view themselves as the cause of the unconscious of neglectful tendencies or therapy that they receive, it will fall problem and blame themselves for what stored in their memory systems. to an adult to help a child to integrate has gone wrong. It is easier and more More usually, they have no idea of that unfathomable experience into their comfortable for the child to hold him or the developmental needs of their child. mind in order to bring some resolution. herself to blame for what has gone wrong They may expect the child to be more These conflicting tensions of love, than to accept that their parent has been independent and to be able to take care fear and harm can often disturb a child harmful to them. This redirecting of of their own needs, and so ignore their so deeply that it affects their learning, psychic energy then triggers a pattern need for support. Frequently, older disorganises their behaviour, makes or system that erodes the child’s self- children in the family are expected to them afraid of relationships with belief and undermines their self-esteem. take care of the needs of the younger carers and/or pushes them into They are bad – therefore they deserve ‘Separation from a parent, even if they are a harmful and neglectful parent, will always be a scar across the mind of a child and cause a deep sense of sadness and loss’

26 Therapy Today/www.therapytoday.net/May 2013 bad things. This is why we have to tread the effects of trauma and abuse both who have failed their children. We can carefully around their misconceptions. from themselves and from those who hardly say to a child ‘You drew the short care for them. So it is our job to create straw there!’ or ‘Nobody said life was a Pick up unconscious communication an environment where sharing thoughts level playing field’. It may be tempting I have spent many hours trying to and feelings about difficult things is to be over-sympathetic to the point come up with constructive ways to deeply acceptable and praiseworthy, of sentimentality. But the best stance help a child find peace of mind in so that ultimately we make it possible I have found is one of being able to relation to pathogenic parents. The for children to share their worst fears name the experience. So it could be most helpful and hopeful starting point or their worst secrets, their painful both helpful and accurate to say ‘Your is where the practitioner is able to pick dreams and their negative emotions. parents loved you but did not know up on the unconscious communication It is also our job to begin to imagine the rules of being a parent or have the of the child. This will often mean that how unimaginable this is for a child. skills to look after you, and they did not the therapist is affected by the child’s The best carers that I know, who get the understand how children think’. These fears or disturbance. But it is at the best results in terms of helping children descriptions tend to invoke discussion point where we can feel that despair or to settle, are those who can find ways at an age-appropriate level and at least where we can fear for and with the child to share the hidden or unconscious they separate out the manageable from that we can begin to show them that we story with the child and can organise the unmanageable. Besides, the statement understand their struggle. This is the it in their own mind before helping is true. I have never yet met a parent who signal that we are engaged in a healing the child to integrate it into theirs. lost their children into care who did not process. It is also why therapists need say ‘I love my kids, they mean everything supervision and why they may find this Never name and blame to me’. When parents say this, they really job difficult. I don’t know of any other If the first rule is to be open to the mean it. The inconvenient truth is that profession where being helpful involves communication, the second rule is not parents who harm their children or fail the deeply unsettling act of being to name and blame the parent. How to care for them to an acceptable standard disturbed by the disturbance of another. tempting it is to get mad at parental frequently adore them. And so, often, This might be described as ‘the use harm or incompetence. It is natural, they are left with the mind-numbing of empathy as a therapeutic tool’ or and part of the journey of protecting task of integrating (usually for the rest reading the transference material. the child, to want to condemn such a of their lives) the terrible thoughts of It is that – but it is more. It reflects, parent, but we cannot allow ourselves how they failed their child and lost them. in my view, the depth of communication to fall into this trap. We have to be that is possible between human beings able to tolerate various states of Help rewrite the script – whether that communication is joyful mind and emotions until we reach The next part of the process is for us or full of despair. Initially, we at least our destination, which is to help the as professionals to find ingenious and have to be open to these communications. child with integration, and this is often creative ways to rewrite the script in As therapists, we therefore need a good achieved by a deeper understanding a way that helps the child make sense store of information in our heads about of ourselves and our own processes. of their story, by breaking it up into this unique and primitive process of We might, for example, be hampered by digestible pieces. This is like putting communication if we are to help a our own worst fears; our own defences pills in jam so that the child doesn’t taste child with the processing of these may get in the way and inhibit the child’s their bitterness. I often begin ‘I knew a difficult states of mind. flow of emotional information. child who had that experience…’, so that young people can realise they are not Create the right environment Name the experience alone and that other children also have On the other hand, it’s worth noting that Good professionals find various positive these experiences. Our stories can give human beings are very efficient at hiding ways to begin to talk about the parents children a foothold into their own world. ‘It is at the point where we can feel that despair or where we can fear for and with the child that we can begin to show them that we understand their struggle’

May 2013/www.therapytoday.net/Therapy Today 27 Practice ‘Did I ever tell you about a boy I knew have to be informed enough to notice in adulthood. The wonderful thing called Danny? He had to go and get the signals that suggest that they want about the mind is that it will process looked after by someone else because to share their story, or a bite-sized piece and organise mental material into a tidy his mum got cross too much and it of it, with us. The right environment is cupboard when given the opportunity frightened him and upset him. One important and so too is the right time, for reflection and the right amount day, his teacher noticed that Danny in relation to the child’s developmental of information and psychological and was frightened and upset at school and stage, combined with their sense of emotional support. As practitioners, he could not go home to his mum that security. Sometimes enough information we are really helping the mind to do its night as the teacher called a social worker has to be fed into the hippocampus job of self-organisation. Ultimately, our who wanted him to go to someone safe.’ (the information-sorter in the brain) minds are capable of a flow of energy that A small child might ask, ‘Jo, do you see for the trauma to be released and enhances life. Freeing children’s minds other kids here or is it just me?’ Part processed. And when a child is dealing from the difficult circumstances of their of the child wants to be really special, with recall of trauma, we may have to parent’s not-good-enough care is one but it is a perfect opportunity for me to lower our expectations of their ability to more step towards helping them along to make up a story about another child just cope with everyday life, so that they can an equal playing field with children who like him or her who also struggles with re-process and recover from the trauma. come from ordinary and well-balanced painful thoughts. From then on, the child homes where no one is threatened by realises fully and quite excitedly that our Concluding thoughts harm – deliberate or otherwise. time is all about sharing their thoughts. To help children to integrate and come This flow of information can be to terms with the idea that their parent Joanna North is a BACP accredited achieved through any medium that really did not get things right for them, counsellor/psychotherapist working with best suits the child. Children can be first we have to be willing to engage children, adults and families, and a graduate engaged in art, music or dance. With in a process that may affect our own member of the British Psychological Society. older children, some plain talking and mind deeply. I recently presented this Her research has focused on case study and well-crafted counselling skills can be as the Five Rs – our capacity to ‘receive, helping carers to support children with just the right approach. A child can also resolve, respond, repair and repeat’ the complex behavioural difficulty. She works resolve these issues through work with communication with the child.3 Second, as an expert witness for the family court and animals or caring for pets. What is clear we have to learn not to judge the parents runs an Ofsted registered adoption support from the latest neuroscience is that who failed in the job and bear in mind agency. Email [email protected] our state of mind will have the biggest that they always would have preferred influence on the integration of difficult not to have failed. A compassionate A version of this article was first published states in a child’s mind. It is our kindly, response is our only option, and as ‘Thinking about the bad mum or dad’ secure and sensitive responses that will information processing on our part in the BACP Children & Young People dictate whether or not a child opens their can frequently help this journey along journal (March 2013; pp14–19). For more mind to resolution – or closes their mind (back to supervision again). Finally, we details, visit www.ccyp.co.uk/journal.php in the hope of stopping the flow of their give that story back to the child in an age- 2 story. As practitioners, we have to be appropriate and digestible format so that References in a psychologically and emotionally he or she can metabolise the story for 1. North J. Working with the State as parent. fit state to achieve this. now and make sense of their experience. Counselling Children and Young People. Of course, children will often revisit Lutterworth: BACP. March 2011; 14–16. Let them choose the time the story as their lives progress. A 2. Siegel J. The mindful therapist. London: Norton; 2010. We have to be wise enough to know that story accepted at the age of five can be 3. North J. How to think about caring for a a child has every right to close down their reprocessed in a dramatically different child with difficult behaviour. Devon: Watershed story for as long as they wish – and we way when the child is 10 or 15 – or even Publishing; 2010. ‘I have never yet met a parent who lost their children into care who did not say, “I love my kids, they mean everything to me.” When parents say this, they really mean it’

28 Therapy Today/www.therapytoday.net/May 2013 How I became a therapist Eugene Ellis

Eugene Ellis What made you decide cultural or race issues, which to become a therapist? can make therapy a bit hit describes how his In the mid 80s and early 90s or miss for some black and journey to become I spent a lot of time thinking minority ethnic clients. a therapist put him about what had shaped me Fortunately my first encounter as a person. In therapy, and with therapy was a positive back in touch with in other self-development one, but there are many for his whole self contexts, I developed a whom this is not the case. realisation that it was What values do you hold possible to make contact dear? with forgotten parts of Respectfulness – being myself and bring them open to seeing people in more to life. Slowly I turned new ways and integrity, what felt like my grey world and denial to understanding, where my actions are in into a world of colour. empathy and wisdom. harmony with my conscience. I was working in the What do you think makes Which books have inspired music industry as a sound a good therapist? you? engineer at the time, which For me, the most important Currently I’m reading a was a mesmerising place parts of being a therapist lot around the neurological for a young man. After a are keeping contact with impact of trauma and working while, however, I became ourselves as therapists with trauma and the body. aware of how narrow my through self-reflection of This has opened up many life had become. I thought our thoughts and behaviours possibilities for treating the I would take a six-month and keeping at the contact many traumatised children break, which turned into a boundary with our clients. that I work with in adoptive/ two-year break. In that time For me this means taking foster homes or in residential I began the process of training time away from ordinary life care. Authors like Pat Ogden to become an integrative arts to slow down, meditate and and Brian Post really inspire psychotherapist. become mindful of myself me. A book that still sits with My strongest recollection and my patterns with others. me, however, is Ben Okri’s of my own therapy was the What is the best advice you A Way of Being Free. feeling of being attended to, have received? Has becoming a therapist of being seen, of internalising It was while I was stressing changed you? this as my human right and with getting to the end of I feel my work has aligned me recognising the simple my psychotherapy training; to my values and as a result notion that validation is an I was told that it wasn’t really I feel less conflicted and I am essential part of attaining the end I was working towards now able to put myself into self-worth. but the beginning – the roles of leadership that do What were your hopes when beginning of the real journey not come easily to me. I set up you became a therapist? to becoming a therapist. the Black and Asian Therapist I have always been fascinated What do you enjoy about Network shortly after I with the power of personal being a therapist? qualified in 2004. I wanted and cultural stories. The I really honour being a therapy to play more of a stories we tell each other and witness to that moment part in the lives of Black and ourselves are the genesis of when clients begin to process, Asian people in the UK and all our actions, our reference make sense of and integrate to create a community that point for prioritising how aspects of their personal or would make this more of a we use our resources. My cultural stories – when their reality. That is still my aim. cultural heritage is from the perception of themselves Caribbean and as a colonised changes and I know their Eugene Ellis is an integrative people we have absorbed life will be changed. arts psychotherapist and many stories of being seen What do you find most founder of the Black and Asian as less than. My hope as a challenging? Therapists Network (BAATN). therapist was to create a That the general therapeutic He has a special interest in reflective space for new community does not yet have body-orientated therapies, stories, especially stories enough practitioners who feel including mindfulness, and of our culture; stories that confident in working with the facilitating dialogue around move us from blame, shame interpersonal dynamics of race and culture.

May 2013/www.therapytoday.net/Therapy Today 29 Dilemmas Transgender disclosure

This month’s dilemma Dominic Davies ‘It is important that relevant for Thomas and Thomas is an experienced BACP Fellow, Director Angela to discuss briefly and accredited counsellor of Pink Therapy we don’t infantilise how it might be for Angela if in private practice, working This case is very problematic our clients or collude she were to meet Thomas en in rented accommodation and sensitive. It raises many with prejudiced femme in the neighbourhood. just outside a small town. points that could be made He is a female identified and I’m going to address views under the Alex Drummond trans therapist who works just a few of them here. guise of “protecting Writer and therapist as Thomas but has times My initial reading of the vulnerable”’ It strikes me that ‘Thomas’ when he prefers to dress the dilemma, as originally (and we don’t have her and live as a woman. He presented in the April issue female name here) is in the has not been through any of Therapy Today, caused will want to be mindful of early stages of her transition. reassignment surgery me considerable concern the principles in the BACP It is understandable for her or hormone treatment. over the language used and Ethical Framework and, while to feel highly anxious about Thomas has been the way the dilemma was many colleagues (including, the process of transition, yet working with a client, framed. Thomas’s gender perhaps, Thomas) might we know from the experience Angela, for about a year, identity became a noun, consider non-maleficence of other trans therapists that and they have worked on ‘Thomas is a transgender’, as the core principle, I’m also it can be more straightforward deep and sensitive issues which immediately set my aware that there are other than she might imagine. that she is just beginning guard up. This has since principles to balance out here. First, medical intervention to resolve. Some of these been amended. Thomas We should not assume that (surgery and hormones issues are around anxiety. is ‘a transgender person’, the client is too vulnerable are mentioned) is not a Last week, Angela told or Thomas is ‘transgender’. to be able to manage this requirement for protection Thomas that she is going However the pronouns information as that denies in law from discrimination, to move to an area very used are entirely male, and Angela’s own autonomy and it would be prudent for near to where Thomas we are not given Thomas’s and the chance to grow Thomas and other therapists lives as she is starting a new preferred female name. and learn and demonstrate to become fully acquainted job. Thomas is concerned As Thomas’s preferred her own compassion and with the Single Equality Act about the kind of self- identification appears to so autonomy is worth 2010, since there is an ethical disclosure that this might be female, this feels as if Thomas’s consideration. principle of justice here. entail should he run into her identity is being denied. Not to disclose to Angela Second, it is important Angela in female clothes. One of the first things one is perhaps doing her and that we don’t infantilise Although heavily disguised, learns when working with their therapeutic relationship our clients – or collude this is a dilemma sent in by someone who is gender a great disservice. with prejudiced views under a reader who specifically variant or where their gender As Thomas is being mindful the guise of ‘protecting the asked to be addressed is ambiguous is to enquire of their personal boundaries vulnerable’. This was the using the male pronoun. how they would prefer to and psychological health, argument Richard Littlejohn The wording in this dilemma be referred to and, if they the principle of self-respect inappropriately used in has been revised since its are clearly presenting as is relevant. Exploring the the Lucy Meadows case publication in April's issue of the other gender, to use situation in supervision and we know the tragic Therapy Today, in the light of pronouns relevant to the and planning how to share outcome there. If a client is feedback from contributors. gender presented. this information, especially homophobic or transphobic, Opinions expressed in the The dilemma also if Thomas is considering a full- then a positive experience responses are those of the appears to make an implicit time transition to a female or of interacting with an LGBT writers and not necessarily assumption that to be a ‘real’ more explicitly transgender therapist can serve the greater those of the column editor trans person one should role, is also important. good: prejudice is borne of or BACP. undergo hormone treatment I think most therapists unfamiliarity so we serve an or surgery or both. It should have experience of dual ethic of beneficence towards be born in mind that this relationships and the both client and society. is not possible or desirable possibility of meeting my While clients retain the for many trans people. own clients in social settings ethic of autonomy to act out How Thomas chooses is something of which I’m on their prejudice (and that to live her life is her own always mindful. I think this could equally be because they business and she is afforded is best dealt with at the perceive the therapist as too some protection under the beginning of the relationship, young/old, too middle-class, law in the Single Equality Act by agreeing how we will too culturally different), we 2010 and the Human Rights manage any outside contact. should not as a profession Act. As a therapist, Thomas In this case, I think it is be guilty of the same.

30 Therapy Today/www.therapytoday.net/May 2013 My suggestion, given that counselling room is own wellbeing and impair Next month’s dilemma Thomas is currently living something most of us will the quality of care he is able Aadi and Martha are a dual-role identity, is that have considered at some to provide. trainees on their first year she lets go of the internalised stage, probably during our Thomas may be completely of a counselling diploma shame and embraces a training. What if we see a at ease with his transgender course. As they are both congruent trans identity: client on the street or in identity. However the single and of a similar age, upfront in a straightforward, the supermarket? Do we dilemma may be compounded in a group where most of the matter-of-fact manner. acknowledge them or not, by the often-held stigma students are in couples, they Simply saying to the and if we do, will that make about and misunderstanding have become close friends. client, ‘Coincidentally, I’m our professional relationship of transgender issues. They often go out drinking transgender and, although obvious to people they’re Thomas and Angela have together at the weekend. you’ll read me as male, I with? What if we see aspects probably built up a high One night, drinking in a identify as female so when of their lives we didn’t know level of trust over the year. nightclub, they see their I’m not working I present about and what if they see If Thomas doesn’t disclose course leader, clearly very as female,’ can be included aspects of our lives that now and waits until he bumps drunk, staggering around in the generic ‘If you meet we haven’t disclosed? into Angela, might she feel the floor and talking loudly me in Tesco’s’ conversation It would be a normal part betrayed by his secrecy, or and inappropriately. that we may have in initial of the contracting process to confused? Might she feel Aadi and Martha leave, contracting. discuss some of the ‘what ifs’, indifferent, accepting or rather embarrassed, but It would benefit Thomas especially for a counsellor rejecting? Might it impact later wonder what they to network with other working in a local community, on her wellbeing? Thomas should do. They recognise transgender counsellors such as ‘Do we say hello needs to guard against that the tutor is off duty and psychotherapists to or not?’. So I hope that making any assumptions and therefore is not in a gain support and insight Thomas would already have about Angela’s reactions. professional role, but they into best practice, to serve considered, perhaps with And from Thomas’s are concerned about the the ethic of self-care, and his supervisor, the possibility perspective, while being impact on them and the in the greater good of of meeting his clients outside transgender is part of his other students, should this the profession. of work. However, we don’t identity, he may resent become known. In particular, Counselling and know if Thomas’s supervisor the idea of having to share they are concerned that psychotherapy is aware of his transgender it, and possibly feel forced their own confidentiality are built on ideals of self- identity, or if Thomas is by circumstances. Has he may be at risk. actualisation, self-acceptance, prepared to share that. felt compelled to keep it What are the ethical congruence and the quest Working with transgender secret at work and also issues inherent in this for connection with and clients or colleagues is not in his wider life, or has he dilemma and what should expression of the true something I knowingly have made a considered choice of Aadi and Martha do? self. As an openly and experience of. I certainly privacy? It may be something Email your responses (500 ‘out’ transgender therapist, would encourage Thomas he’s already explored. If not, words max) to Heather Dale one has the potential to to talk this through with a he may find it useful to do at [email protected] before demonstrate this as an supervisor who has expertise so with a suitably trained 29 May. Readers can send achievable aspiration and in this area. This is not only counsellor who has a in their own dilemmas to be my experience two years a boundary issue that might sexually affirmative stance. considered for publication, post-transition is that clients affect his relationship with If he considers the although these will not be both recognise and respect Angela and impact on her personal qualities of the answered personally. this. As clients have remarked: anxiety; it may happen with therapist to which the BACP ‘You obviously know what other clients. If unresolved, Ethical Framework encourages you are talking about.’ Thomas’s concern could us to aspire, this may provide Counsellors are great at become anxiety, impair his rich ground for his thinking: talking the talk – I’d say it empathy, sincerity, integrity, serves the ethic of fidelity in resilience, respect, humility, the profession when therapists ‘If Thomas doesn’t competence, fairness, can actually show they walk disclose now and wisdom and courage. What the walk too. would each of these mean waits until he bumps in relation to this situation? Linda Aspey into Angela, might When Thomas has considered BACP Fellow, executive she feel betrayed all of these and other aspects, coach and coach-therapist ideally in supervision, I think The possibility of meeting by his secrecy, or he will be in a better position clients outside of the confused?’ to decide what to do.

May 2013/www.therapytoday.net/Therapy Today 31 The interview Excellence in therapy Scott D Miller, founder and Director of the International Center for Clinical Excellence, talks to Colin Feltham about what makes a good therapist great

Colin: Can you tell us how you came therapy’s outcomes are either as good Scott: Yes, this is to distinguish to be involved in psychotherapy? or better. Plus, we have a far better what we’re now doing from the CDOI Scott: I think it’s due to a series of side-effect profile. I’m surprised a) at (client-directed outcome informed) fortunate accidents and run-ins with the amount of money that’s spent on label. I was never comfortable with remarkable people. I started university medicine, b) how much positive press that, honestly. Why? I’m not interested at 18 as an accounting major. I grew up it gets, and c) how little positive press in telling therapists how to work. in a family of meagre means and the idea psychotherapy gets. Psychological There’s a ton of gurus and model was that, even if I couldn’t make much services are often on the chopping developers from whom to learn. What money, I could be around other people’s block compared with medicine. That I can do is help clinicians identify when money. I changed to experimental said, what we do is good but it can be what they’re doing isn’t engaging the psychology and had a professor called better. Like other professional groups, client or leading to progress. FIT is a Hal Miller, a protégé of BF Skinner. I we vastly over-estimate how effective ‘six sigma’ (continuous effort to improve loved Hal – he was inspiring and very we are, by 65 per cent on average. success) approach to clinical practice. stimulating. I wanted to be like him! I Additionally, our outcomes have Colin: As well as running many FIT discussed my future with him, thinking remained fairly level for some time now. workshops, you also apply it to clinical of becoming an assistant professor, Colin: Daniel Kahneman, in Thinking supervision (feedback-informed and he suggested broader avenues such Fast and Slow, says that clinicians work supervision, FIS)? as clinical work. Michael Lambert was well in the moment, working intuitively, Scott: We’re holding an FIS workshop in the department; I met him, changed but are not so good at seeing their this summer in Chicago, actually. to a clinical focus, and the rest is history. limitations in the longer view. You can check that out on my website: Colin: What are your views on Scott: Absolutely. I love that book. I tell www.scottdmiller.com. We show how assessment and diagnosis? people, ‘Don’t read my book, go and read the feedback data can be looked at Scott: I’ve always found the diagnostic Kahneman’s.’ In reading that we’ll see in supervision to improve the therapy code baffling – not very useful or where we need to go and why we haven’t process. Not to disparage the other informative. I’ve found myself more got much beyond where we were 30 or type of supervision, but much of it interested in the differences between 40 years ago in terms of outcomes. I think is either administrative (did you do my clients than in the similarities. That’s experienced practitioners find that you your paperwork?) or a kind of therapy where the work takes place, tailoring it gradually move from working in a way for the therapist. Another type is model- to the unique characteristics of clients. where you ponder every step to a much based (seeing that you’re doing this The truth is that clients tend to get the more intuitive way, but if you want to therapy the right way), which is what kind of therapy their therapist knows improve your work further you need I want to avoid. FIS is about using the how to give. Perhaps this will change to move into Kahneman’s System 2 feedback measures to identify where someday. Until then we can take some (deliberative, evaluative), which is you as a therapist need to stretch satisfaction in knowing that the average very time-consuming. Client feedback beyond your current way of working. treated client is better off than 80 per measures give you an idea of where Colin: Does that fit with the ethos of cent of the untreated sample. you should shift into a more deliberative the International Centre for Clinical Colin: You’ve said that ‘most process. As for therapist reluctance to use Excellence, where therapists from therapists do good work’ but also certain measures, we are like medical staff all over can discuss how they’re that ‘most therapists have an inflated inundated with accountability procedures; working with clients? assessment of their own competence’. it’s amazing that so many can be required Scott: Yes. I don’t believe expertise Can you explain this? without having any effect whatsoever. resides in people like me. Expertise Scott: It’s confusing on the face of Colin: I understand you now use the resides in the local community, but it but if you compare the services of term feedback-informed treatment practitioners seem to have fewer and psychotherapy with, say, medicine, (or therapy) – FIT? fewer opportunities to rub shoulders

32 Therapy Today/www.therapytoday.net/May 2013 May 2013/www.therapytoday.net/Therapy Today 33 The interview with people who understand clients’ the common factors, which indicated therapy? There isn’t a single therapy nuanced characteristics and contexts. a significant portion of the variability in an RCT that has reliably produced Expertise requires close, near- in outcome was attributable to negative effects. I think therapists and knowledge, deep, domain-specific client characteristics. However, and our field are a remarkably sane lot. ability, and I can’t do that from here importantly, it borders on presenting Colin: There’s a lot of concern with with someone in, say, Sheffield. I can help the common factors as a model of medication and the de-medicalisation them identify when they’re not engaging therapy when you say ‘focus on the of distress. Are there any signs that with clients and then put them together client’s strengths’. We know from psychotherapy is winning this battle? with a community that has something 30 years of research that there’s no Scott: I’m hugely optimistic but I useful, interesting or different to say. difference between approaches – don’t see it in terms of battle. I think Excellence never emerges in a vacuum. solution-focused or problem-focused. we’re a conservative species and things Colin: You travel the world giving talks What’s critical is having a choice or simply evolve very slowly. Our models and workshops. When Americans use alternative as a therapist. When I’m are representations, bound by current language like supershrinks, superior working with a therapist whose outcome culture and understanding. The ideas results and mastery, the British tend indicates the client isn’t engaged, it’s we embrace today will have to be to recoil. Is that your experience? probably an alliance problem. The key jettisoned in the future. This won’t Scott: We are not known for being an is for therapists to listen for how clients occur quickly, but it will occur. understated people! But we’ve known talk about their lives. If your therapy Colin: And sometimes things have for decades that certain therapists isn’t working, you can listen for the clients’ to get bad enough to change. Perhaps achieve better outcomes. It’s not about views, goals, strengths and resources. sometimes crisis pushes evolution? all becoming supershrinks but about Colin: You’ve written in Escape Scott: I’ve just been reading about learning the underlying processes from Babel and elsewhere about the the history of phrenology, which was that lead to superior results. problems of therapy models and their once influential in both our countries Colin: So it’s about helping people languages and you recently reported in determining people’s lives. Although to be the best they can be. But on on the Swedish experience of CBT hugely powerful, it was completely the other hand, about training and not living up to its research-grounded bogus. And how about pre-frontal selection, there is the question of hopes. What was going wrong there? lobotomy? It had virtually no evidence suitability. I’m thinking of James D Scott: I think the CBT folks in the mental of success – complete rumour – Guy’s work on therapist personalities health community got their act together before it was stopped, and there are and the fact that therapists come long before others. They saw that clinical still speculations about psychosurgery. from those who are self-selecting. trials were likely to have currency, they But human beings are hopeful and it Scott: I couldn’t agree more. But got them done, and as a result were able takes time for ideas to be adopted Anders Ericsson’s research on expert to claim they were in some way better. and, when necessary, rejected. The performance and deliberate practice The Swedish Government took this key is transparency. I’m hopeful, in indicates the selection process isn’t evidence seriously and funded CBT, part because social media serves to as important as the training process. as in the UK. But the Swedes found level the playing field a bit, giving There are identifiable processes among a CBT monopoly made no difference. voice to a wider group of people. musicians that suggest, regardless of The Western world is embedded in Colin: You come across as a high- where you start, you can achieve world- a medical perspective that thinks energy, optimistic person. Is that class performance levels. The expertise that effective care is finding the right in your nature, or do you have to process also applies to therapists. For treatment for the specific disorder. This push yourself? some time we didn’t have any way of is not what evidence-based practice is Scott: Ha! I love what I do, especially understanding superior performance, about, however. The correct and accepted the exploration. If I suddenly found out even from data from thousands of definition is, ‘using the best evidence what the secret was, the whole field would therapists. We looked at within-session delivered in the context of clients’ lose its allure to me. More important, I phenomena to try to understand this. needs, preferences and characteristics, think, is that I’m driven. This may sound But it’s before and after sessions where informed by ongoing feedback’. Let’s old-fashioned but I’m interested in the you see what makes the best great – insist that our leaders and regulators truth, the narrative that brings the parts they simply spend more time in stick to the accepted definition. together, helps me make sense of the reflection, planning, preparing, Colin: Take a polar opposite to CBT, world and know what to do in my work. reading and reviewing. like primal therapy from the 1970s, Colin: What’s next on your agenda? Colin: You’ve written about the ‘heroic sometimes now written off as a Scott: I’m convinced expertise is client’ with innate resources. Is that dangerous or ‘crazy therapy’. Is nothing to do with the measures something you genuinely believe – almost any therapy model and training we’ve developed. Some people I’ve that all clients, given the right therapist, OK if the therapist uses feedback? worked with are obsessed by them. can change, or are some hard to help Scott: Our field has done some wild This misses the point, and risks turning or so-called non-compliant? and experimental stuff, but far less measurement into another treatment Scott: Bringing up my former work than other fields, like medicine, where model. Indeed, claims are being made reminds me of looking at my prom thousands of people die annually from that their use is ‘the most effective pictures. I had a good time, at the time, medication errors alone. In the US we intervention created in the history of but can’t help but be embarrassed by whipped kids’ tonsils out and prescribed psychotherapy’. Bullshit. The measures how I looked! The same is true of my antibiotics for ear infections – both at are a prop, a tool. What really matters prior writing. It was good at the time. great risk and cost and with little effect. is the therapist, their desire to grow We used to talk about client strengths So, let’s get some perspective. How many and willingness to push beyond their and resources because of our work on people were really damaged by primal current realm of reliable performance.

34 Therapy Today/www.therapytoday.net/May 2013 Research This article grew out of our experience of facilitating the pre-conference workshop at the 18th Annual BACP Research Conference in Edinburgh in May 2012. The workshop, ‘Practice Research research networks: promises, pitfalls and potential’,1 generated lively debate not just about the practicalities of setting up and maintaining practice research networks (PRNs) but about their role and purpose as well. We in practice thought it would be worth sharing a flavour of the discussion here. The aim of the workshop was to Practice research networks (PRNs) form the vital engage participants in reflection and discussion about the value of PRNs bridge between frontline practice and academic as a vehicle for facilitating practitioner research, argue Joe Armstrong, Amanda Hawkins engagement in research, and their potential to contribute to building and Mhairi Thurston an evidence base for the effectiveness of counselling and psychotherapy. We structured the workshop around two brief presentations that outlined our own involvement in two PRNs (see the side bar overleaf), which we used as case studies to prompt discussion. Over 50 researchers, academics and practitioners attended the workshop, from the UK, the US, Australia, New Zealand and other countries.

What is a PRN? PRNs originated as a basic system for recording morbidity rates in primary medical care settings, and are now established in mental health and psychological therapy services in the UK and elsewhere.2,3 Essentially, a PRN provides an infrastructure for practitioners and researchers to work together to conduct research that is practice-based and relevant to everyday practice.4 Examples of PRNs in psychological therapies include the Pennsylvania Practice Research Network,5 the Human Givens Research Network (www.hgiprn.org), the Supervision Practice Research Network (SuPReNet), and Schools- based Counselling Practice Research Network (SCoPReNet) – information about the latter two PRNs can be found on the BACP website at www.bacp.co.uk There appears to be a growing interest in PRNs currently because this research model holds the promise that it may narrow the so-called research–practice gap,6,7 facilitate practitioner engagement in research and cultivate a more vibrant research culture in the counselling profession. However, while the PRN paradigm may offer the promise of such things, there are also significant challenges, all of which featured in the themes that arose during the workshop

May 2013/www.therapytoday.net/Therapy Today 35 Research discussions, as the remainder of this promoting practitioner research within Two UK networks article will report. the profession, there was some debate about where the focus of our research The Scottish Voluntary Sector Engaging practitioners in research activities should be. Participants Counselling Practice Research One of the first issues that emerged questioned the value of practitioner Network (SVSC PRN) in our discussions was the challenge research per se (which can be seen The SVSC PRN is a new collaborative of engaging practitioners in research. as fragmentary and idiosyncratic) project that is funded and supported A potential pitfall associated with and the extent to which counselling by the University of Abertay Dundee PRNs is that they may struggle to research should be about fulfilling and COSCA.8 It aims to enhance engage a broad spectrum of practitioners the demands of the evidence-based understanding and practice of and end up being ‘enthusiasts’ clubs’ agenda and influencing policy. voluntary sector counselling in for a small group of therapists and A concern was expressed that Scotland by pursuing a research academic researchers. In fact, many practitioner research within the agenda that is generated and practitioners regard research as time- context of a PRN may not really shaped by the concerns of the consuming, complicated or even boring.9 contribute to addressing important Scottish voluntary sector One workshop participant commented strategic questions for the profession counselling community and that lack of funding and increased (eg questions of efficacy/effectiveness). derived from issues that emerge demands on voluntary sector Another concern was that practitioner- from routine counselling practice counselling agencies, for example, researchers may lack the methodological within voluntary organisations. meant that survival was the order expertise and resources to conduct A primary function of the network of the day, leaving little if any time more sophisticated studies. There are, is to facilitate collaboration between to focus on research. Clearly, there clearly, important methodological and practitioners and researchers in are obstacles to be overcome to strategic issues that need to be addressed order to generate knowledge from engage practitioners in research. within a PRN. On the one hand, there practice-based research. So the question of what would was a strong argument for facilitating For further details, visit the SVSC motivate practitioners to take part practitioner research, and on the other website at www.svscprn.abertay.ac.uk in research is important and must be a recognition of the need to conduct or contact Dr Joe Armstrong, SVSC addressed for a PRN to be effective. research that is more methodologically Co-ordinator, University of Abertay There was consensus amongst sophisticated, in order to establish, Dundee, at [email protected] workshop participants that it was among other things, an externally essential to convey the importance of credible evidence base for counselling. The Vision Impairment Network research to practitioners and to work In relation to these issues, workshop for Counselling and Emotional at creating a stronger research culture participants raised several questions. Support (VINCE) within the profession. More specifically, ‘How can practitioners/counselling VINCE was established to if practitioners are to be enthused to agencies turn routine audit and provide a national network to: ‘buy into’ taking part in research within monitoring data into something ••support the development of a PRN, they need to have a sense of more useful?’ Is it possible to conduct collaborative working between ownership of the research strategy, more sophisticated, rigorous research counsellors, emotional support and the research questions themselves (eg random controlled trials) within service providers and commissioners must be derived from, and meaningful a PRN? ‘Which should come first? of services to, their everyday practice. This Practitioners coming together and ••provide a forum to share good ‘bottom-up’ approach may tap into deciding the , or do we practice, service developments, practitioners’ intrinsic motivation design the methodology first, then evaluation and research outcomes and curiosity about how to improve recruit practitioners (ie practice- ••influence the development of their practice. The imposition on research network versus research- counselling and emotional support practitioners of a less collaborative, practice network)?’ We didn’t come services for adults, children and ‘top-down’ approach to research or to any firm conclusions during our families affected by sight loss service evaluation is unlikely to harness discussions, but these and other ••support the 2008 UK Vision their enthusiasm and commitment. questions deserve more detailed Strategy outcome for the provision It was also noted that incentives consideration and debate. of emotional support for blind and may be needed to engage practitioners This debate may be particularly partially sighted people. in a PRN project. One popular suggestion important given the current concerns The VINCE research sub-committee that emerged from our discussions was that, unless the profession engages includes representation from the to offer CPD training events on topics with the evidence-based paradigm, major sight loss charities, service related to research and issues that are there is a very real danger that some providers and academics. It focuses pertinent to their practice. As we don’t counselling approaches may be side- on providing a national network have a comprehensive understanding lined in favour of therapies with a much for relevant research. The VINCE of the factors that facilitate or obstruct stronger research evidence base for their research sub committee is chaired participation in PRNs in different effectiveness.10, 11 We are sympathetic by Amanda Hawkins. practice contexts, this is an area to this view but, as many of our For further information, please that could be researched further. workshop participants reminded us, contact Mhairi Thurston, VINCE it is important not to lose sight of the Chair, University of Abertay Dundee, Where should we focus our research? value of conducting research that makes at [email protected] While workshop participants a more general contribution to knowledge acknowledged the importance of and understanding of our profession.

36 Therapy Today/www.therapytoday.net/May 2013 Disseminating research findings their practice, and to a range of different issues, the PRN model represents perhaps We had an interesting discussion about audiences, such as the general public the most viable model for developing disseminating research findings. One and policy makers. research capacity among counselling workshop participant described their practitioners, in collaboration with experience of disseminating research Other issues academic researchers. Counselling related to their agency through targeted Other issues that emerged during the practitioners are in the best position public awareness campaigns that workshop included the importance of to engage counselling clients in research, emphasised the human ‘story’ of their leadership and effective organisational to report their experiences of therapy clients’ engagement in counselling. structures within a PRN to facilitate and the outcomes they achieve and, The advantage of this kind of reporting collaboration and communication in turn, to generate knowledge and is that it makes a clear link between among members. We also discussed improve awareness of our profession. counselling research and people’s how we engage clients in research and experience of counselling and its agreed that data collection methods Dr Joe Armstrong is a lecturer in the Division social impact. should be practice-friendly and should of Nursing and Counselling, University A number of important points emerged not unduly burden clients. of Abertay Dundee. He is co-founder and about how we communicate these kinds Further important issues were the Chair of the Scottish Voluntary Sector of research stories to our different productivity and potential impact of Counselling Practice Research Network. audiences. When communicating with any given PRN on practice and policy. members of the public, funding bodies For instance, Amanda and Mhairi’s work Amanda Hawkins is Senior Manager, and policy makers, it was considered with VINCE (see sidebar) suggests that, Emotional Support at the RNIB and essential to: despite its strong membership, funding Chair of BACP. a) use a range of targeted media formats and expertise in counselling for sight to raise awareness of the problem or loss, it continues to struggle to make Mhairi Thurston is a lecturer in counselling particular issues affecting a client group an impact in the sight loss clinical world. at the University of Abertay Dundee and (or groups) In part, this may be because funding Chair of the Vision Impairment Network b) highlight the extent and pervasiveness for research into the effectiveness of for Counselling and Emotional Support. of the problem and its negative emotional support services tends to psychosocial effects, and go to sight loss clinicians rather than References c) make a case for the benefits of counselling researchers. It seems that 1. Norquist GS. Practice research networks: counselling in alleviating the problem. counselling has not yet gained credibility promises and pitfalls. Clinical Psychology: Science and Practice 2001; 8(2): 73–175. In short, the message is, ‘There is in this sector. Their experience with 2. Barkham M, Hardy GE, Mellor-Clark J. a real problem here; it’s worse than VINCE raises important questions Developing and delivering practice-based you think; counselling can help.’ about the structures and models that evidence: a guide for the psychological therapies. This use of research stories is would maximise a PRN’s potential to Chichester: Wiley; 2010. something that Joe and the Advisory have an impact on policy and practice. 3. McMillen JC, Lenze SL, Hawley KM, Osborne VA. Revisiting practice-based research networks Group for the SVSC PRN hope to use to as a platform for mental health services research. engage voluntary sector counsellors in Conclusion Administration and Policy in Mental Health 2009; Scotland in research and disseminating Essentially, the PRN model can be seen 36: 308–321. findings from their network’s research as an important way to embed research 4. Borkovec TD, Echemendia RJ, Ragusea SA, Ruiz activities. One idea they are currently in practice and develop a practitioner- M. The Pennsylvania Practice Research Network working on is to disseminate research led and client-led research agenda for and future possibilities for clinically meaningful and scientifically rigorous psychotherapy stories through the PRN website (www. the counselling profession. PRNs have effectiveness research. Clinical Psychology: svscprn.abertay.ac.uk) and its quarterly the potential to bridge the so-called Science and Practice 2001; 8(2): 155–167. newsletter. For example, they are research–practice gap by linking research 5. Audin K, Mellor-Clark J, Barkham M, Margison encouraging network members to submit to practice and vice versa. But, as we have F, McGrath G, Lewis S et al. Practice research brief ‘research biographies’ in which they noted in this article, there are challenges: networks for effective psychological therapies. Journal of Mental Health 2001; 10(3): 241–251. describe their own experiences of being a in engaging practitioners and clients 6. Castonguay LG, Nelson DL, Boutselis MA, researcher or conducting a specific study. in research, in developing a coherent Chiswick NR, Damer DD, Hemmelstein NA They are also planning to disseminate research strategy, in disseminating et al. Psychotherapists, researchers, or both? findings from their research through research findings effectively and A qualitative analysis of psychotherapists’ the same media in a way that is more also, more practically, in the funding, experiences in a practice research network. Psychotherapy: Theory, Research, Practice, accessible to practitioners with little organisation and co-ordination of a Training 2010; 47(3): 345–354. or no research experience. The hope PRN’s activities. Notwithstanding these 7. Morrow-Bradley C, Elliott R. Utilization is that this will stimulate counsellors’ of psychotherapy research by practicing interest in research and show, through psychotherapists. American Psychologist the stories of other researchers, that ‘PRNs hold the promise 1986; 48 (2): 188–197. participating in research can be a 8. Armstrong J. Introducing the voluntary that they may narrow the sector counselling practice research network. rewarding and empowering experience. so-called research–practice Counselling in Scotland 2012; Summer/Autumn: There is clearly a need to ensure 8–11. that counselling research is published gap, facilitate practitioner 9. Widdowson M. Perceptions of psychotherapy in professional and research journals. engagement in research trainees of psychotherapy research. Counselling However, no less important is the and Psychotherapy Research 2012; 12(3): 178–186. and cultivate a more vibrant 10. Pearce P, Sewell R, Hill A, Coles H. Counselling dissemination of findings in appropriate for depression. Therapy Today 2012; 23(1): 20–23. forms to front-line practitioners who research culture in the 11. Cooper M. Meeting the demand for evidence- may not always use research to inform counselling profession’ based practice. Therapy Today 2011; 22(4): 10–16.

May 2013/www.therapytoday.net/Therapy Today 37 Letters

I thoroughly welcomed the my own experience as a client, We need to inclusion of the ‘Class and can be strongly felt between Rendered counselling’ piece in the a client and counsellor who April issue of Therapy Today. belong to the same social class. invisible talk about It raised important points I am sure that the working- about our role as a profession class client must be at risk Thanks for a great discussion class in acknowledging the impact of feeling this more acutely article (‘Class and counselling’, that social, political and class with the double whammy Therapy Today, April 2013). issues can have on our clients of professional and societal Mike and Simone are much- – not least because of what power being present before needed pioneers! we ourselves bring into the them. While I have a passion It reminded me of an room with us. for learning and don’t see any experience I had when I I am very much the shame in pursuing a Master’s offered to volunteer as an white, educated middle- or Doctorate, I do believe that, (unpaid) counsellor for a class counsellor and my first as a profession, we are over- local staff counselling service. training placement was in a valuing academic prowess Another black woman and I local inner city community at the expense of essential were selected for interview. At counselling service. It was core personal attributes such the group interview the three very striking to me how so as capacity for attunement, white senior counsellors who many of my clients had issues humanity and self-reflection managed the service gathered. that directly related to or were – qualities that can be found The Head of Counselling severely impacted by poverty, among all sectors of society. started: ‘Let me tell you both in terms of money and This area is vast and why you are here: all our opportunity. I found myself complex but I do think a paid staff are white so we are thinking ‘There’s nothing I can good starting point would looking for a black volunteer.’ do about this’ and so classed it be further conversations, Said without a flicker of as ‘not relevant’ to our work. like Simone and Mike’s – understanding, thought, Over the years, as these particularly during training empathy or sensitivity issues have persisted in – in safe, non-judgmental (let alone any grasp of equal popping up regularly with spaces, about self-identity, opportunities policy and clients, my position and class, assumptions we make law). I really felt the sensation practice on this has changed about others, the social make- of not being ‘seen’ at all. I dramatically. Some of my up of counselling trainees was struck by the fact that current clients have been generally and potential/ the majority of their clients directly affected by the actual impact of counsellor are women from ethnic changes in the benefits background on different client minorities and I wondered system and I have seen first- groups. Class issues certainly about the possible impact hand how uncertainty about seem to permeate every area on clients of such a stance. future finances can exacerbate of my life on a day-to-day I can appreciate Mike’s pre-existing symptoms of basis and it would be good to discomfort at Simone’s use depression and anxiety and hear more from our profession of the word ‘perpetrator’ as how the social on this and great for BACP to it suggests a concrete action of those with long-term take a lead in facilitating it. against another rather than mental health conditions Rachel Shepley an unfortunate circumstance. can intensify feelings of MBACP (Accred) counsellor and However, I certainly shame and alienation. I believe student mental health mentor. experienced the Head of it is possible to acknowledge Email [email protected] Counselling as someone the impact of social/political spearheading inequality circumstances on a client’s within their organisation Contact us life as a real obstacle and ‘I do believe that, (albeit unconsciously) We welcome your letters. barrier to wellbeing without as a profession, and hence as a perpetrator Letters that are not published colluding with a stance of of oppression. in the journal may be published ‘You’re a victim and you we are over-valuing It is great that Simone is on TherapyToday.net subject have no responsibility for academic prowess suggesting that we actually to editorial discretion. Please what has happened to you’. at the expense of change these structures by email your letter to the editor I am acutely aware that, improving training standards. at [email protected] or as counsellors, we are in a essential core Ensuring that courses imbue post it to the address on page two. position of power that, from personal attributes’ all aspects of counselling

38 Therapy Today/www.therapytoday.net/May 2013 training with understanding remember, make up a fantasy confirm to the therapist the of the reality of issues such with yourself as hero/heroin) History of shortcomings of her working- as racism, class issues, sexism, t Stage 3 – When was there class upbringing. One client homophobia and poverty, a time I colluded with racism oppression described how she took for example, is crucial. Quite and did not stand up against great care to dress well when often those themes are the it? (Describe a specific I was interested to read she attended a counselling backdrop to all other issues incident) the debate about class in session. Alternatively, a client may bring to therapy. t Stage 4 – Re-tell Stage 3 April’s issue of Therapy another client’s pride in her In my opinion, it is crucial as a fantasy the way it should Today as it touched on many background meant that she that each and every therapist have happened.’ of the themes I found when adopted a more combative considers his or her own Akum Uwahemu researching this topic. I attitude to the therapist issues around class, gender, MBACP (Accred). Twitter: agree with Simone that and refused to cry in race, sexuality, disability, @akumefulee class is a neglected issue sessions, as it might seem transgender and creed, when compared with other like ‘capitulation’ to the power REFERENCE: before we inflict ourselves 1. Ernst S, Gooding L. In our own aspects of client–counsellor of the middle-class therapist. on our clients or colleagues. hands: a book of self-help therapy. difference such as gender, All the clients spoke of As the very brave and London: Women’s Press; 1981. sexuality or ethnicity. Social how being working class felt admirable Mike and Simone’s class has its own powerful like another world for their important discussion shows, history of oppression that, (perceived) middle-class if a therapist is worried that as counsellors, we cannot therapist, and one client they may be viewed as a Meaningful afford to ignore. reported how his therapist perpetrator, then what can In 2005 I carried out a found his values quite novel, ensue is a battle between debate research project (for an and expected him to educate client and therapist, re- MSc in counselling) into her on what it was like to be enacting the painful battles I have just read your article how clients’ experiences of working class. The therapists that go on in other aspects on class and wanted to thank perceived differences in social could not or would not of a client’s life. This battle you as it helps me to delve class between counsellor and move outside the ‘protective can be a challenging but deeper into this topic with client affect the therapeutic bubble’ that Mike describes sometimes useful exploration my student colleagues. I am relationship.1, 2 I interviewed in the debate. Inside this for both parties, but in my a second year CYP training five clients who identified bubble everything is secure opinion, it is not the client’s psychotherapist, with a as working class (and who and cannot be challenged; as role to educate the therapist. social work background. I identified their counsellor one client said, to be middle In response, I turn to In Our always leave my experiential as middle class). class is to be ‘on safer ground’ Own Hands: a book of self-help groups with a deep sense of The imbalance of power in than to be working class. therapy by Sheila Ernst and frustration, as my colleagues the relationship that Simone While I agree with Simone Lucy Gooding.1 The quoted cannot acknowledge that talked about (pp16–17) was that more diversity among section below is about racism, black/working-class people mentioned by all the clients. trainers would be welcome, but the writers note that you tend to have different One client described it as: I also feel that, as therapists, could work with other issues, experiences of the external ‘It felt like she [therapist] we each have a personal such as classism or sexism. world. It probably doesn’t was the figure of authority responsibility to address class ‘This exercise is based on help when the facilitators enact and I was this wee person for ourselves and become the idea that in order to have this lack of understanding by that needed help.’ Another aware of how it affects the become oppressors... we were terming my responses ‘angry’ client described it as a huge political values we bring ourselves first badly hurt: the or ‘prejudiced’. They too barrier in the room that was (albeit subconsciously) into racism masks grief. By starting seem unable to make ‘space never acknowledged. These the relationship with clients. from a position of pride in in their minds’ for this idea. feelings effectively disrupted It is all too easy to take refuge who we are and a sense of Just to highlight that I the therapeutic work for the in the feeling that ‘helping unity with all oppressed am the only working-class, clients, as they were unable people’ is non-political and people (by recalling how we black female in a year group to trust the therapist. ignore the covert assumptions are or have been oppressed), of 20. There are no lecturers As Simone mentioned, that clients may be making we can discharge the grief reflecting this demographic. clients’ conditions of worth about how we speak or where and let go of the racism [...] How do I support a were linked with their we live (if the counselling is t Stage 1 – How was/am I meaningful debate among background: one client in the therapist’s home); these oppressed? (Get in touch with my colleagues who will be felt ashamed when she did assumptions may in turn a particular incident) [...] working with young, working- not understand a word the affect what the client voices t Stage 2 – When was there class black CYP without being therapist used; another felt or withholds in therapy. a time I stood up against labelled as a ‘trouble maker’? unable to cry in therapy, When I asked the working- racism? (If you can’t Name withheld for fear that this would class clients if they would

May 2013/www.therapytoday.net/Therapy Today 39 Letters

prefer to have therapy with 2. Balmforth J. weight of class: ‘How should class be my fury at being utterly a counsellor of a similar clients’ experiences of how looked at in training?’ did misunderstood about this perceived differences in social class, most of the clients class between counsellor and client I fully engage with her and very matter – which started expressed a wish rather affect the therapeutic relationship. her viewpoint (up till then, the lengthy process of my for their counsellors to be British Journal of Guidance and disliking her stance as identity deconstruction- aware of the difference and Counselling 2009; 37: 375–386. victim). As much as I reconstruction.1 acknowledge it. In this way, appreciate the importance All aspects of relationship the power dynamic can be of looking at how our identity contain power dynamics, addressed in the relationship, affects the way we experience class no more no less than rather than covertly Relationship the world, looking at how the age, gender, race etc. Raising reproducing old patterns way we experience (and have this as a separate issue is of oppression. and class experienced) the world affects valuable but only as part Jane Balmforth our sense of who we are of integrating this particular PhD; MBACP (Accred) I was so pleased to see seems equally important. aspect of selfhood with the ‘Class and counselling’ as To assess anyone’s greater whole, so it doesn’t REFERENCES: 1. Balmforth J. Clients’ experiences the main headline on the background, including one’s remain split off as the ‘green- of how perceived differences in front cover of April’s Therapy own, as privileged or under- eyed monster’ of our culture social class between counsellor Today – this subject has been privileged is surely subjective and society. and client affect the therapeutic of particular relevance to and loaded with prejudice. Jane Barclay relationship. In: G Proctor, M me in my personal process Indeed, it was hearing my MBACP; AHPP; therapeutic Cooper, P Sanders, B Malcolm – and so I was disappointed therapist utter the word counsellor (eds). Politicizing the person- centred approach: an agenda to find but one article. ‘privileged’, after I’d disclosed REFERENCE: for social change. Ross-on-Wye: Only when I read Simone’s my private boarding school 1. Barclay J. Class, prejudice and PCCS Books; 2006 (pp215–224). answer to Mike’s question education, that unleashed privilege. Self & Society 2002; 30(4).

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40 Therapy Today/www.therapytoday.net/May 2013

Quarter - Horsforth (ROP 84x118mm).indd 1 22/04/2013 14:59 what he told me. I had just therapeutic relationship. They’ve seen managed to express this Many of my drug-using Multilingual when he told me about his clients look at me as a enough tears previous experience with solid and rational agent in client study the crying therapist and how their tremendously chaotic I wonder why such a little that made him lose trust in and emotionally charged I was pleased to see Dick report on therapists crying her. He never went back. lives. I feel that it is not my Blackwell’s letter in Therapy (News, Therapy Today, His said that if an place to feel the comfort Today (March 2013) in March 2013, p5) had such experienced therapist, of expressing my own response to Lysanne Sizoo’s an impact on me. Maybe accustomed to all sort of emotions. Many of them article (October 2012), it’s because recently I saw stories, situations and life have seen enough tears. where she comments on her one of my clients, who comes dramas, felt so sad for him I would be happy to decision to allow therapists to me as his drug counsellor, to the point of crying, what be challenged. I may be only to work in their mother and he told me about what kind of freak did that make missing something. Maybe tongue. I run a multilingual a freak he felt when he told him? Was she not concerned spontaneity has more room and multiethnic counselling his life story to a private for how he was feeling? than I give it credit for in a service called Mothertongue. therapist and she burst Perhaps he also felt that, therapeutic setting and a All our counsellors and into tears. if she could not contain client could see the therapist’s therapists are multilingual When this client told me herself and get a grip on tears as the humane side of and they work in their native his story, I felt tears forming her emotions, how would the profession. I am not sure. languages as well as in other in my eyes. I went to a great she be able to contain him? I will try, however to keep my languages. Not only are they extent to keep my eyes dry, I am not sure this eyes dry for the time being. able to work fully in a range but wanted to let him know demonstration of emotions Alberto Pavan of languages; they raise a that I was very moved by has a helpful effect in a CBT counsellor different issue about training.

May 2013/www.therapytoday.net/Therapy Today 41 Letters

Multilingual therapists what can be achieved through Service at the University interviewed for a recent Counselling these sessions. But often it of Leicester and a major research project1 mentioned is the first opportunity made contributor to BACP the problems of training in hearing loss available to people with committees and initiatives, English and then working hearing loss to talk through particularly around clinically in their native It is estimated that 150,000 their experiences so, while supervision and ethics. languages where they did not individuals have ‘profound or it may well be just the one One of the delights of have access to the professional severe’ hearing loss (July 2011, session, this short input working with her on ethical vocabulary or experience in Action on Hearing Loss). can still be of great value. issues for BACP was her relating professionally in their These individuals have lived The need for ‘deaf aware’ warmth, sense of fun, insight native language. Therapists in the hearing world and have counsellors has become and thoughtfulness around who answered an online gradually or suddenly lost apparent through our a wide variety of topics. questionnaire identified their hearing due to a variety work with Hearing Link Her contributions that there were also potential of causes. The impact of this and it is our wish that combined creativity with benefits of working in an loss can be likened to being this be addressed. BACP good judgment. Her style was additional language. at the centre of an earthquake, is exploring the possibility to understate the significance There will of course when everything that has of setting up a sub-section of what she was offering, so I always be those who share been taken for granted is no of their directory to identify often found myself reflecting Perez Foster’s concerns that more. The sound of a loved counsellors who would be on what she had said after work in English with non- one’s voice, music, traffic, able to respond to this need. a meeting as its significance native English speakers could the wind blowing through [Editor’s note: And also continued to grow. She was be ‘a “pseudotherapy” which the trees and the easy ability a sub-section of counsellors a very easy person to like, simply sides with the patient’s of being able to communicate with particular experience instinctively friendly and resistance to the mother with another are no longer of working with people who collegial, and a lot of us tongue and the mother era, available to them and this are visually impaired.] liked her a great deal. or a “quasitherapy” where is often combined with Equally Hearing Link would Moira also published the essential material is lost difficulty with balance. be pleased to receive names extensively, authoring over in the complex cognitive It is not only the individual of those counsellors who have six books, including one traffic of bilingualism…’2 who is subject to this impact experience of working with with her husband Michael We are currently collecting but also those closest to the the deafened and, also, would Jacobs, and made many information for a research epicentre of that shock wave be pleased to hear from those other contributions to edited project on the experiences of change. This means their who would be interested in collections and journals. of multilingual clients and partner, family members attending deaf awareness She is probably best known would welcome input from and friends all experience training. If you are interested for Women in Therapy and anyone who is interested the loss of the familiar and please make yourself known Counselling: out of the shadows in improving services for the ordinary. The loss of to BACP or Laura Turton, (Open University Press, people from diverse cultural hearing is life-changing for all Head of Services at Hearing 1990) and Surviving Secrets: and linguistic backgrounds. involved and can be regarded Link, on 0300 111 1113 or email the experience of abuse for The questionnaire can be as a hidden disability. [email protected] the child, the adult and helper found at http://bit.ly/ Hearing Link is a UK-wide Caroline Bickerton (Open University Press, Questionnaire_Patients charity that responds to the MBACP (Accred); RSLI 1992). Surviving Secrets Beverley Costa needs of the deafened, their Dick Hill was shortlisted for the Mind CEO and Clinical Director, partners, family and friends MBACP (Accred); MA Book of the Year and is now Mothertongue multiethnic through support and advice in its fourth reprint. Moira counselling service and, significantly, through also founded the charity the provision of a week-long Dorset Action on Abuse. REFERENCES: residential rehabilitation Moira Walker Moira died after a long 1. Costa B, Dewaele JM. programme. The Intensive illness. In his email informing Psychotherapy across languages: Rehabilitation Programme (1948–2013) BACP of her death, Michael beliefs, attitudes and practices (IRP) offers an opportunity talked about her struggles of monolingual and multilingual therapists with their multilingual to explore ways of overcoming All of us who knew Moira with her illness before patients. Language and the difficulties presented in person, which is a great slipping away peacefully. Psychoanalysis 2012; 1 (Autumn/ by the loss of hearing. An many people, or through her He concluded: ‘She was Winter): 19–41. http://dx.doi. integral part of the IRP is the writing, will be saddened to a fighter to the end, this org/10.7565/landp.2012.0003 opportunity for participants hear of her death on 25 March. time for herself, having 2. Perez Foster R. The power of language in the clinical process: to use the services of a Throughout much of the over her lifetime fought assessing and treating the bilingual counsellor. It is acknowledged time I have known Moira she for so many others.’ person. New Jersey: Aronson; 1998. that there are limitations to was Head of the Counselling Tim Bond

42 Therapy Today/www.therapytoday.net/May 2013 Reviews

When I became interested attention,1 and comes down and also to encourage Getting in jazz some years ago, I to earth with Ellen’s case greater co-operation and realised it had parallels history in the final chapter, understanding between them. with psychotherapy, in that ‘The musical and the clinical’. The book begins by looking with we know where we start For all Sapen’s learning, at their shared roots: how each but don’t know where the this is a modest and human arose from spiritual settings, the beat interplay will take us. Thus, account of a therapeutic with psychological insight we are creative. This book journey. It led me to consider at their heart, and how they Freud’s lost chord: deepened my appreciation anew the idea of music in developed uniquely from this. discovering jazz in of those parallels, which are clients’ voices, in the rhythms Chapters three and four then the resonant psyche present in both music and of sessions and groups of consider how successfully Daniel Sapen therapy, based on the pulses, sessions and repetitive psychotherapy now deals with Karnac, 2012 rhythms and breaths that choruses. It gives me, too, spiritual issues, and spiritual 240pp, £23.99 form our earliest experience a way of considering the direction with psychological ISBN 978-1780490120 in the womb. tenor of my own responses. concepts. The subsequent Reviewed by Chris Payne This book is bursting You may find yourself chapters focus on ethical with ideas and references – carrying Freud’s Lost Chord practice, and the contribution occasionally to excess for around for six months, still to this of the training in each me but better that than having only absorbed half of the disciplines. Harborne insufficiently challenging. of its ideas. I recommend it. ends by asking the reader to Daniel Sapen devotes the Chris Payne is a transpersonal/ look beyond the differences first chapters to the art psychodynamic psychotherapist and their own professional of therapy, moves on to and counsellor remit to appreciate, ‘resonant space’ and then respect and learn from REFERENCE: to fundamentally musical 1. Knoblauch S. The musical edge the other. While there ways of seeing the work of of therapeutic dialogue. Hillsdale, may be differences between the therapist. He describes NJ: The Analytic Press; 2001. them in nature, they share a the post-Freudian progression common functional purpose, from a focus on repressed she argues – and that drives towards an emphasis Spirit and purpose is one of ‘healing’. on potential and change. This is not purely a He points to the great overlap psyche book of appreciation; one and interplay between music Psychotherapy and of Harborne’s aims is to and emotion. He holds out spiritual direction: two challenge both disciplines. the musical model ‘as a field languages, one voice? She encourages therapists to of resonance into which Lynette Harborne engage with spiritual issues much of the psychoanalytical Karnac, 2012 more readily in their work, tradition then enters on a 153pp, £17.99 arguing that clients will bring new basis’ (p182). ISBN 978-1780490182 spirituality into the room He is both interesting and Reviewed by Caz Binstead whether we like it or not, clearly well versed in Jung and that therapists need (‘Freud’s first nemesis’) and to be less fearful of working Bion, but also refers across with their clients’ beliefs. philosophy, science and Equally, she asks that spiritual the intersubjective field. directors engage more with He then discusses the jazz psychological thinking. process of Miles Davis and Issues such as the underlying John Coltrane, who illustrate dynamics in the client/ ‘a particular marriage of Lynette Harborne is Chair practitioner relationship or disciplined form and affective, of the Association for the possibility of unconscious aesthetic freedom which Pastoral and Spiritual Care process must be taken serves as a musical cousin and Counselling and both seriously, she argues. of Bion and Winnicott’s a psychotherapist and a Chapter 10 asks, ‘Can analytic aesthetics’ (p156). spiritual director. This is spiritual direction be He goes on to consider her bold attempt to critically considered a modality analyst-musician Steven examine the two disciplines of psychotherapy?’ This Knoblauch’s fascinating of psychotherapy and spiritual is Harborne’s ‘heretical ideas on expanding clinical direction in their own right, question’. I find it an

May 2013/www.therapytoday.net/Therapy Today 43 Reviews

interesting consideration, and van den Bout are well arguments for and against but remained unconvinced. known in the field of research the diagnosis. Section IV, Whole- Given how many religions/ on bereavement. With the ‘Contemporary research denominations there are, controversy around the on risk factors, processes, earth healing and their myriad doctrines inclusion of the diagnosis of and mechanism’, provides The life of things: therapy of varying , ‘complicated grief diagnosis’ a deepening and broadening and the soul of the world there will inevitably be in the DSM-5, its publication understanding of our Bernie Neville incompatibilities with what is particularly timely. understanding. Section V, PCCS Books, 2012 is considered ethical practice The scepticism about ‘Treatment of complicated 203pp, £18.00 in the psychotherapy world. the need for a bereavement grief’, explores a range of ISBN 978-1906254469 Harborne herself points diagnosis and professional approaches, including Reviewed by Caroline Frizell to the lack of training in intervention following loss is cognitive-behavioural, family diversity in spiritual direction shared by many professionals, therapy, internet-based programmes, in glaring as well as the general public. bereavement interventions contrast to the importance This book addresses the and group therapies. In the accorded to culture and many questions about the final section the editors close diversity in psychotherapy scientific, clinical and societal by stressing the importance trainings. implications of healthcare of interdisciplinary But this is a valiant attempt professionals dealing with collaboration, especially to address a complex subject. complications of response between researchers and This is a significant Harborne’s passion for giving to loss, from theoretical, practitioners, as the best way contribution to a growing clients the best possible empirical and applied to develop our understanding body of work that questions service drives her arguments. perspectives. Readers will of the complexity of the egocentric and This book is an invigorating appreciate the scholarship complicated grief. anthropocentric assumptions mixture of opinion, and knowledge it contains The book provides an framing a conventional challenge and advice for and its contribution to the up-to-date, state-of-the-art approach to psychotherapy. the psychotherapist and in-depth consideration of focus on complicated grief. Neville’s scholarly writing spiritual director alike. the issues. It is addressed to researchers, draws on a wide range of Caz Binstead is a qualified, The list of contributors practitioners and policy- works as he seeks to discover integrative counsellor and is impressive. The chapters makers whose work an ecological-mindedness writer, working in private also contain expected brings them up against the in person-centred therapy, practice in London and unexpected topics. controversies. While any specifically in the writings An example of the former number of issues resurface of Carl Rogers. Neville is ‘Prolonged grief disorder time and again in different suggests that, at close Is grief a as a new diagnostic category chapters, the overall effect scrutiny, we find that Rogers in the DSM-5’, by Boelen is not one of unnecessary offers a perspective on the diagnosis? and Prigerson; ‘Complicated repetition but rather of a process of actualisation that Complicated grief: grief: philosophical deepening and broadening brings individual healing scientific foundations for perspective’ by Cooper of understanding. This book into an intimate alignment health care professionals is an example of the latter. makes it clear that the focus with the healing of a whole- Margaret Stroebe, Henk Schut The book is divided into on the complications of grief earth community. and Jan van den Bout (eds) six sections. Section I outlines has been positive and has One of the main strengths Routledge, 2012 the goals of the book, and accelerated the understanding of this book is the breadth 332pp, £29.99 contains an overview by the of loss, grief and mourning of material covered; each ISBN 978-0415625050 editors. Section II, on ‘The in both the professional chapter is packed with a Reviewed by Ruth Malkinson nature of complicated grief: and public spheres. density of ideas, including the and Simon Shimshon Rubin conceptual approaches’, Ruth Malkinson is Director mythologies of the classical addresses conceptual, of Training Programs at the cultures, philosophical cultural, clinical, and International Center for the perspectives, science, depth philosophical issues. Taken Study of Loss, Bereavement psychology, ‘right-brain’, together, they provide the and Human Resilience, transpersonal therapies and reader with a range of University of Haifa. Simon ecology. This book is one of a viewpoints and frames of Shimshon Rubin is Director number of recent publications reference for thinking about of the International Center for that have begun to map the complicated grief. Section III, the Study of Loss, Bereavement landscape of ecopsychology This book is a welcome ‘Diagnostic categorization: and Human Resilience and and through which a new addition to the literature. scientific clinical and societal Chairman of the Clinical language for therapy is Professors Stroebe, Schut implications’, presents Psychology Program emerging. It challenges

44 Therapy Today/www.therapytoday.net/May 2013 us as therapists to reframe of change for our culture – and daring nature of his the nature of our work and to adopt an environmentally work but also of the direct Practice- to operate from a place that sensitive professional way in which he addresses is simultaneously client- practice that honours his audience. based theory centred and planet-centred. individual pain and planetary Jan Abram’s introduction The presenting past: the The book may appeal to suffering simultaneously. argues that Winnicott’s work core of psychodynamic established professionals Caroline Frizell is a ‘creates a huge advance in counselling and therapy who want to reconsider the practising dance movement the concept of subjectivity’ (4th edition) nature of ‘things’ through psychotherapist and (p2). She delineates some Michael Jacobs which relationships flow, ecopsychologist areas of agreement with Klein Open University Press, 2012 such as consciousness, but sees Winnicott’s thinking 288pp, £26.99 empathy, communication, as essentially an extension ISBN 978-0335247189 memory, imagination, Winnicott of Freud’s, although she does Reviewed by Colin Feltham cognition and soul. Neville point out that Winnicott’s argues that this flow is part revisited starting point was different of a universal becoming, Donald Winnicott today – the ill baby with the experienced as a felt sense. Jan Abram (ed) presenting mother. Winnicott He demonstrates how, Routledge, 2012 himself seems disarmingly for Rogers, the actualising 408pp, £29.99 disengaged from the notion tendency, rather than being ISBN 978-0415564885 of continuity of influence a specific characteristic of Reviewed by Eileen Aird and association that books the human experience, is a like this strive to establish: Michael Jacobs remains ‘formative tendency at work ‘With me, just as with other one of the leading figures in in the universe as a whole’ people, the development psychodynamic counselling (p60). Whitehead’s notion of thought has been along and this book has been a of the universe and Gendlin’s the line of something that central and reliable source thinking on the focusing has to do with growth, and if since 1986. It’s important to process both serve to I happen to be like somebody note that, a prominent trainer support an argument for else, it just turns up because and writer for decades, Jacobs psychic growth as a cosmic Donald Winnicott’s we are all dealing with the has also maintained a clinical event in which we participate, unique contribution same material’ (p33). practice and this is the key rather than a private matter. to the development of On his part,Winnicott source of his own theorising. We (humans) are some of psychoanalysis has been is clear about his early debt In other words, this text is the many ‘things’ that make in the ascendancy for to Klein. He argues that her characterised by the insight up the body and soul of that some time. This volume is concept of the depressive and authority of practice- universe. a welcome addition to the position (a phrase that he based evidence rather than Towards the end of the growing body of commentary didn’t like, replacing it with being primarily theory book, the chapter entitled and scholarship available. the stage of concern) ranks applied to practice. ‘Self-realization and the Divided into three with Freud’s concept of the It is also written ecological self’ draws on sections, the book brings Oedipus complex. Where accessibly, with sometimes the work of Jungian analyst together published work he diverges from Klein is difficult psychodynamic Jerome Bernstein to discuss from Marion Milner’s 1972 in his belief in the initial concepts rendered into the indigenous wisdom paper ‘Winnicott: overlapping unity of mother and child plain but elegant prose. of the Navajo, in which circles and the two way as the source of development. Most readers will know the sacredness of life journey’ to Christopher Klein’s emphasis was much from previous editions itself is literally central. Reeves’ 2012 paper ‘On the more on the individual baby. that the book rests on the As we explore the concept margins: the role of the father There are many important principle that an individual’s of the ‘borderland’, the in Winnicott’s writings’, an papers in this volume. past, particularly in its incongruence between illuminating extension of Particularly noteworthy unresolved conflicts and our culture and nature Winnicott’s formulation of are Kenneth Wright’s ‘The limitations, continues to exert becomes apparent. Profound the significance of the father. search for form’ and Marion an influence on present life, healing can occur, it seems, The three sections, Milner’s paper mentioned acutely so in the therapeutic when we shift away from ‘Introductory overviews’, above, which emphasises the setting. But the present also a preoccupation with the ‘Personal perspectives’ and significance Winnicott saw in affects perception of the past. ego towards a sense of ‘Late Winnicott studies’, each preliminary chaos as the first The three parts of the book our ecological self. begin with one of Winnicott’s part of the creative process. are ‘Trust and attachment’, This book challenges own papers: each a reminder Eileen Aird is a psychoanalytic ‘Authority and autonomy’, therapists to become agents not only of the exploratory psychotherapist and supervisor and ‘Cooperation and

May 2013/www.therapytoday.net/Therapy Today 45 Reviews

competition’. Jacobs draws the analyst ‘stay alert to forms Snell argues. Snell moves on the developmental theories Romanticism of aliveness, even unwelcome on to exploring the ‘proto- of Freud, Erikson, Winnicott ones, in the deadest of analyst’ Dr Noir in de Vigny’s and Rayner, as well as Klein, and analysis material’ (p65). Goya forces novel Stello (1832) and then Bowlby, Stern and others. Uncertainties, mysteries, us to confront ‘what lurks the detective Auguste Dupin He has taken due care in doubts: romanticism in the shadows: the repressed in three stories by Poe (1841– this fourth edition to progress and the analytic attitude and denied, rage, perversity, 43). The latter’s ‘lateral mode from early stage theories to Robert Snell malignant narcissism’ (p65). of thinking adumbrates that developmental themes, and Routledge, 2012 Snell looks in detail at a of the working psychoanalyst’ a major aspect of the book £24.99, 217pp series of etchings entitled (p152). is to demonstrate what ISBN 978-0415 543866 Los Caprichos (1779), which When he finally, movingly, practitioners’ tasks are in Reviewed by Gillian Ingram he considers were deliberately engages with Keats, Snell relation to the key themes opaque, so that the viewer admires his courage in presented in counselling is forced to puzzle out their struggling to maintain and psychotherapy. ambiguous riddles, inevitably ‘negative capability’ and Convincing case studies beyond interpretation. Can stay true to his belief that it are used throughout and we, like the analyst, allow is not a poet’s role to soothe summaries helpfully link ourselves to float in this ( just as it is not the analyst’s) practice issues with theory. sea of signs? but rather to demonstrate Jacobs shows how early Through next exploring ‘how necessary a World ambivalence, the Robert Snell is an analytic the German writers Hölderlin of pains and troubles is internalisation of parental psychotherapist and his and Novalis, Snell argues to school an Intelligence control and Oedipal book is a timely reminder both writers ‘might help and make it a soul’ (1819). configurations, among in these days of brief, attune therapists to the As a practising therapist other psychodynamic economically driven therapy importance of the particular I found the second chapter phenomena, are understood of the need to stay true to word spoken – this word, of the book, which provides and skilfully worked with. the basic psychoanalytic not that – and to that fact an overview of the historical This edition is thoroughly stance of respecting the that the word is always development of ‘the updated and revised so as to client by maintaining an contingent and inadequate’ analytic attitude’, the most avoid unwieldiness. It is hard ‘evenly suspended attention’ (p65). Impenetrability in helpful. Intellectually, the to see how such a succinct – an undirected, actively the poetry has to be tolerated, consideration of Romantic and authoritative text can be receptive listening that just as it must be tolerated art forms was intriguing improved on. Mainly for those involves bearing not-knowing in the analytic session, until but tended to drift into the undertaking psychodynamic and not foreclosing. Snell some sense, unforced, begins over-detailed and esoteric. training courses, the book explores various Romantic to emerge. Those of a more disciplined will also be useful to those art forms that he feels can The chapter on Baudelaire intellectual bent might, working in other theoretical offer a parallel experience links the poet’s persona as however, ‘be challenged to approaches and experienced of this ‘analytic attitude’. a flâneur to ‘free-associative invent [their] own ways of practitioners, since the author The quote from Keats in wandering, a way of bearing reading’ (p150) by adopting clearly has such a wealth the title leads into his initial lostness and disconnection a free-floating, non logical of clinical experience and exploration of the extent at the same time as allowing and intuitive approach to wisdom himself. to which Romanticism was experiences and a hope for the works Snell suggests. Colin Feltham is Emeritus an essential part of Freud’s meanings in’ (p129). The poet Gillian Ingram is a BACP Professor of Critical cultural heritage. Snell starts must also, like the analyst, accredited psychodynamic Counselling Studies, with the Spanish artist Goya, hold himself together in such counsellor and a clinical Sheffield Hallam University claiming his work can help a free-floating multiplicity, supervisor

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Browse the BACP online bookshop for the full range of BACP publications including: training & legal resources, directories, research reviews, information sheets and more. Now available: Legal issues across counselling and psychotherapy settings: a guide to practice – by Barbara Mitchels & Tim Bond.

46 Therapy Today/www.therapytoday.net/May 2013 From the Chair

Sometimes things happen Obviously there was shock – achieved accreditation of that change the way your I wanted to reach out, have our voluntary register with life is going in a split second. someone tell me that what the Professional Standards This week I had one of those I was feeling was normal, Authority, and that we can experiences. I was on the because it all felt very now move on to other train back to London, from confusing, very surreal. issues. But, I admit, I was a meeting in Manchester. My iPhone allowed me premature; for you, our Just past Salford, the train to make contact with my members, there’s another hit something. At first I loved ones, who reassured stage still to be completed. thought it was a bit of debris me and gave me a sense We’ve had a very good – the train seemed to keep of safety. A little while initial response to our going despite the loud noise afterwards I felt a sense communications about of the collision, but eventually of loss – the loss of this the need to join the Register. it came to a halt. person’s life. I didn’t know many members who are Direction I noted the train manager who they were, but I couldn’t BACP accredited have made swiftly but calmly walking understand why they would the simple transition; many through the train, on her way take their life in such a violent who need to complete the of travel to see the driver. The sun was way. Then I (and this is the bit Certificate of Proficiency shining (uncharacteristically that surprised me) felt a sense (CoP) first have done so, Suicide confronts for this year), and I wasn’t of failure and responsibility or have booked their place too concerned about the in relation to our profession; at one of our regional events. us with our disruption to the journey. I wondered how matters had The feedback from BACP’s powerlessness and I didn’t need to be anywhere got so bad that this person Making Connections events our purpose, writes fast. I carried on writing couldn’t access help. It felt is that the CoP is relevant, my emails. overwhelmingly sad. I went meaningful, and possible! Amanda Hawkins Then there was an to a place where I had to Are you BACP accredited? announcement that question what I was doing Have you gone onto the BACP unfortunately there had in my job and whether it was Register website and signed been a fatality on the line really helping anyone if things the terms and conditions to – that a person had thrown like this can still happen. join the Register? If you aren’t themselves in front of our Ultimately, however, the BACP accredited, have you train. It took a few minutes experience has left me with signed up to take a Certificate for my brain to comprehend a renewed sense that what of Proficiency test? You’ll find what had happened, to we do is vitally important; all the information you need reprocess some of the that it does save lives; that at www.bacpregister.org.uk sounds that I had heard my role as BACP Chair, right I urge you to do this now and to make sense of them. here, at this time in relation – don’t wait until your Then the horror set in, the to this profession, is to make membership renewal date empathy with the driver and sure that as many people comes up. It’s important the realisation that (and I am have access to good, safe for you as a professional sorry if this sounds dramatic) therapeutic support as and practitioner, for the I had just witnessed the end need it. And it reminded counselling profession as of someone’s life in the most me that sometimes life gives a whole, and for our clients horrific of circumstances – you what you need, even if above all. The Register is part a thought that won’t stop it isn’t always what you want. of our continuing campaign running in my head. Taking us away from this to drive up standards, I have to say, the train sad topic, I wrote, a few ethical practice, safety crew and the train company columns ago, about my relief and our professional profile. handled the situation very that BACP has successfully Employers increasingly well. I felt held, understood will be looking to see that and looked after in my own ‘I wondered how you are on it. The standards reaction to the incident. The of protection and ethical train and all its passengers matters had got practice it enshrines put us were held up for quite some so bad that this on a par with our professional time until the initial police person couldn’t colleagues in the health and enquiry was completed. social care arena. Let’s all While waiting on the train, access help. It felt take this great step forward I had a number of reactions. overwhelmingly sad’ together!

May 2013/www.therapytoday.net/Therapy Today 47 Register

Are you registered? BACP is in the process of assisting all its practising members to meet the requirements for entry onto the BACP Register, writes Registrar Sally Aldridge

While many of you have Being on the BACP BACP Register website and sign up through the already been to the BACP Register demonstrates that a and sign up through the fully electronic process. Register website and counsellor or psychotherapist fully electronic process. signed up to the terms exceeds the minimum level Don’t forget to renew your MBACP who have not and conditions, some of competence that a client registration when you renew completed a BACP members haven’t yet has a right to expect from your membership. accredited course and/or done so. a practitioner. We are in are not BACP accredited The Register is the first the process of assisting all MBACP who have To go onto the Register psychological therapists’ BACP practising members completed an you will need to take register to be accredited to meet the requirements accredited course the BACP Certificate of under a new scheme set for entry onto the BACP Go to the prospective Proficiency (CoP). This is up by the Department of Register. Once this process registrants’ area of the BACP an online, case study-based Health and administered is complete, we will be Register website and sign up assessment. Details of the by an independent body – advising anyone who is through the fully electronic venues currently available the Professional Standards seeking therapy, or employing process. (You may be asked can be seen on the map Authority for Health and a therapist, to make sure to upload a certificate, which below and by visiting the Social Care (the Authority). that their counsellor or we will then need to verify BACP Register website. The Authority is working psychotherapist is on the before you proceed.) with the Department of BACP Register. Visit the BACP Register website Health to ensure that So sign up today! MBACP who have at www.bacpregister.org.uk. quality-assured registers Sally Aldridge passed the Certificate If you need further clarification, are promoted as the first of Proficiency (CoP) please contact 01455 883300 or port of call for members Accredited members Go to the prospective [email protected] or visit of the public, employers Go to the prospective registrants’ area of the the Frequently Asked Questions and commissioners. registrants’ area of the BACP Register website at www.bacpregister.org.uk/faq

Certificate of Proficiency

The Certificate of Proficiency CoP events are being (CoP) is a computer-based held across the UK. We assessment of ethical will continue to add to the practice, decision-making itinerary of dates and venues and knowledge, which and, once the venues are gives eligible members confirmed, you will be able a way onto the BACP to book your place online Register of Counsellors at www.bacp.co.uk/events/ and Psychotherapists. conferences.php The CoP provides a route The map opposite shows to registration for members new locations that have who aren’t BACP accredited been recently added to and haven’t done a BACP- the C0P itinerary. accredited course. To be eligible for the CoP, You can find out more about members need to be either the CoP and check your an Individual Member (if eligibility status on the Register they have joined this category website at www.bacpregister. since 1 April 2013) or MBACP. co.uk/prospective/CoP.php

48 Therapy Today/www.therapytoday.net/May 2013 Frequently asked questions

1. Why should a counsellor to reflect competent be on the BACP Register? practice. It is derived from Being on the BACP Register the competences developed demonstrates to the public, for the National Occupational employers and peers that Standards in psychological a practitioner exceeds the therapies. There are systems minimum level of competence in place to make sure that that a client has a right to the assessment is varied expect from them. and covers a range of areas, 2. Will counsellors have including ethical practice, to raise their standards establishing the therapeutic in order to join the BACP relationship and use of Register? supervision. During the The majority of our members assessment, candidates need are already practising at the to make appropriate choices 8. What about companies 11. How does the Register high standard of competence based on their experience and and organisations that help protect clients of required of them in order to the information that they are employ counsellors? therapy from malpractice? join the BACP Register. We are given. Members have three As with potential clients, As well as having proved working to advise and assist opportunities to pass the CoP. we would urge all employers that their practice exceeds a those members who have 6. How are you conducting of counsellors and minimum level of competency, not reached those standards. the assessments? psychotherapists to only all Registrants are bound by 3. Are all current members We have booked venues employ practitioners who the BACP Ethical Framework of BACP moving onto this across the country where are on the BACP Register. for Good Practice in Counselling new register? our members can take the 9. What about BACP’s and Psychotherapy and, Accredited members and assessment at a time and accredited counsellors? within this, our Professional those who have passed a location convenient to Are they better than Conduct Procedure. BACP accredited course have them. As of 7 May 2013, 1,579 those on the Register? 12. Don’t we already have already demonstrated and members had completed the The BACP Register also a register? Why do members evidenced the required level CoP assessment at sessions recognises members who need to sign up to this one? of competence to join the in 17 different towns and cities have achieved a substantial BACP has reviewed its BACP Register, and have been across the UK, and 92 per cent level of training and maturity existing register to more invited to sign up to its terms of these members achieved of experience, as assessed closely align it to the and conditions. All other the level required and became by BACP. We refer to Authority’s standards. Being practising members in the eligible to join the Register. them as accredited on the Accredited Voluntary eligible membership categories Members who have not yet BACP counsellors and Register demonstrates will have this opportunity booked their CoP assessment psychotherapists. These that a practitioner exceeds on achieving the Certificate can find out more about the BACP members have the minimum level of of Proficiency (CoP). process and book their session additional areas of expertise, competence that a client 4. Will new members at www.bacpregister.co.uk skills and knowledge, on has a right to expect. automatically join the 7. What are the implications top of their original training. 13. Didn’t BACP previously BACP Register? for a counsellor not on We recognise them as the oppose a voluntary register? Some members, such as the BACP Register? ‘gold standard’ within the BACP has long campaigned those who have passed a Following the transition profession. for tighter regulation of the BACP accredited course, period, BACP would not 10. So what does industry to provide protection are already eligible to sign up. recommend seeing a accreditation by the to both the public and All other practising members counsellor or psychotherapist Professional Standards practitioners. We believe that in the eligible membership who has not exceeded the Authority mean? the Authority’s accreditation categories will have this minimum level of competence It means that our Register of our register will assist us in opportunity following required to join the BACP meets the Authority’s our goal to advance standards achievement of the CoP. Register. This safeguard high standards in respect within counselling and 5. What does the CoP provides a vital benchmark to of governance, standard- psychotherapy and are proud assessment involve? help potential clients to find setting, education and to have been one of the first The CoP is delivered through their way in an increasingly training, management, professional organisations case studies and is designed busy marketplace. complaints and information. to be involved in the scheme.

May 2013/www.therapytoday.net/Therapy Today 49 Awards

Walking the talk A BACP award-winning initiative has transformed the counselling service at the Hospice in the Weald, reports Catherine Jackson

because they were there key themes, which he used to with the patients, day and inform his recommendations night. ‘For us the issue was for change. how could we better hold A major theme was some of the pain and alleviate access to and availability some of the anxiety of the of counselling: how did nurses’ role and how could the IPU multi-disciplinary we make ourselves more team (MDT) deal with accessible. If a nurse felt a situations where they felt patient would benefit from a patient might benefit from counselling they had to fill counselling but refused it; out a form, email it to us, was there a way in which and they had no control over the counselling team could how quickly we responded.’ offer less formal support Another challenge was that might be more the stigma attached to acceptable to a patient? counselling. ‘We wanted How too could it better to normalise emotional support non-counselling support, to convey the colleagues who were message to patients that fulfilling this role informally? having counselling isn’t Nursing staff in particular Martin Riley says the changes have radically increased patient contact a sign that you aren’t coping talked about the necessity or that you’re mentally ill. of being able to work with ‘Medical and nursing Its counselling service works There are a lot of false beliefs patients’ psychological colleagues saw us as very with patients, families and about counselling and, while needs when they arose. much sitting upstairs in carers, and includes outreach we need to recognise that Multi-disciplinary team our ivory tower. We were, counselling in the community counselling isn’t for everyone, (MDT) members talked essentially, waiting for and bereavement counselling. we also need to communicate of their anxieties about referrals to come to us. It The counselling team has that we are there to support ‘opening a can of worms’ if wasn’t how we felt we should always been well established: people through what is a they engaged with a patient’s be working.’ So says Martin Martin currently manages normal response to their psychological distress. Riley, Head of Counselling four permanent counsellors situation – who wouldn’t Formal referral to Support Services (CSS) at (one full-time, three be upset if they had a counselling was largely the Hospice in the Weald, part-time), 18 volunteer terminal diagnosis?’ considered too slow and one of the winners of the counsellors, a part-time Martin initiated a review difficult; the nurses said BACP 2012 Improving music therapist and a of how the counselling team the counsellors felt ‘a long Access to Counselling full-time administrator. worked in relation to the way away’ and ‘strangers and Psychotherapy Award. Two years ago Martin, IPU. He set up separate on the ward’. The clinical The Hospice in the Weald then a counsellor in the team, focus groups with the staff wanted a less formal is based in Pembury, Kent. launched a review of how hospice doctors, IPU introductory/referral process. Surrounded by orchards, deep they were meeting needs nursing staff, with the There was also recognition in the Kent countryside, it on the inpatient unit (IPU). chaplain, occupational that the counsellors had serves a 400-mile catchment ‘My sense was that counselling therapist and physiotherapist much of value to contribute area, and offers a Day was seen as detached, and with the counsellors. to the wider MDT and its Therapy Centre, a Hospice removed from the hands-on He also interviewed the holistic approach to care. in the Home Service, carer day-to-day work of the IPU,’ Nursing Director. He taped There were comments support, and respite, palliative he says. The nurses were and analysed the hour-long about ‘psychological aspects and end-of-life care in its also having to hold patients’ discussions and from the being missed in MDT’, and 17-bed inpatient unit (IPU). emotional distress, simply transcripts identified the ‘Counsellors will give a bit

50 Therapy Today/www.therapytoday.net/May 2013 of insight into somebody There was a mixed positive tale. In 26 returned There has been, she says, that helps us all’. One nurse response to attending questionnaires, the benefit an overall improvement commented: ‘… we do hear handovers and MDT listed by most was the in the emotional articulacy some quite sad and worrying meetings: some counsellors improved MDT working of the MDT. ‘Sometimes things... We probably go for saw this as an opportunity and holistic care, followed we’ll come out of a patient’s a more clinical point of view to learn more about the by the speed and ease of room and have a little debrief. rather than a psychological needs of the patients; others access. The majority felt Having the counsellor there point of view, so support felt less comfortable and that the amount of time that helps us acknowledge that there would be helpful.’ confident in a clinical team the counsellors now spent sometimes it’s not all about context. However, routinely on the ward was ‘just right’. what we have or have not Increased ward presence attending ward rounds was And, in comparison with the done; sometimes it’s about Based on the feedback, seen as advantageous in same periods in 2009 and where the patient is now.’ and drawing on the research improving MDT working. 2010, the counsellors recorded Paula Wilkins, Nursing and reports of good practice The counsellors also felt seven times more contacts Director, is similarly happy in other palliative care that patients were more with patients and relatives – with the way the counselling organisations, Martin receptive to the idea of an average of 22.75 face-to- service now operates. ‘The developed a new way of counselling if they met the face contacts over the six- role of the counselling service working. Counsellors would counsellor in person, rather week rotation, compared with on the ward has become be allocated to the ward than being given a referral 3.5 in 2009 and 3.75 in 2010. far more embedded since on a six-week rotation and to an anonymous service. the project. It’s helped to would attend the MDT weekly The IPU clinical team Removing the stigma demystify their role and given meetings and the weekly ward welcomed the contribution Dr Helen McGee, the hospice’s staff more confidence in their rounds. This was piloted over of the counsellors to ward Medical Director, is delighted own skills and abilities.’ four rotations: one for each rounds, and in particular with the changes. ‘It always In response to the of the counsellors. After each when they offered to take was a very accessible team feedback, the counsellors rotation the counsellor was the lead or stay behind but it did feel as though you now do a four-week rotation, interviewed and feedback to talk with patients and had to make a formal referral. not six, in recognition of their was invited from IPU relatives if something came Now, with the counsellors more emotionally demanding colleagues via a questionnaire. up during the ward round. on the ward round, it’s role. Says Martin: ‘The work When all the rotations were They also welcomed the much more informal and it can be very draining, very completed the MDT team was increased presence and removes that stigma – that intensive. It’s important not re-interviewed collectively availability of counsellors. sense that if a patient needs to underestimate the impact about the benefits of the There was clearly some to see a counsellor there of this way of working.’ new way of working and ideas emotional impact on the must be something wrong.’ What made such a radical for further improvements. counsellors from being on A major benefit is that change possible? ‘Right from Counsellors said they the ward and in closer and the anxiety about dealing the start it was a collaborative liked feeling part of the regular contact with patients with patients’ emotional endeavour – we thought it wider team and working and relatives; the ad hoc distress has been lifted. through very carefully; we more closely with clinical role was more demanding. ‘It really helps me out consulted with our MDT staff. They felt they now The traditional 50-minute when I find myself outside colleagues to find out what had a better understanding counselling session had, my comfort zone, if we are they felt and wanted,’ Martin of the IPU, how it operates effectively, been replaced exploring lots of emotional says. ‘This was about how we and how decisions are by a Monday to Friday, issues with a patient. Doctors all contribute to get the best made about patient care. 9–5 counselling week, the are used to asking questions, outcomes for our patients.’ They felt that the proactive counsellors pointed out. finding out what’s wrong approach relieved clinical The quantitative results and fixing it. Here you can’t For more details, email martin. staff of the responsibility from the questionnaires fix everything so it’s good [email protected] for deciding who might and from patient contact to have the counsellor there, or visit www.hospiceintheweald. benefit from counselling. statistics told a similar, if you do take the lid off.’ org.uk

May 2013/www.therapytoday.net/Therapy Today 51 Policy

Labour signals policy review Around the Parliaments Labour leader Ed Miliband the launch of an Independent The commission will has said that integration Commission on Whole-person produce recommendations It has been a quiet period of health and social care Care, which the Labour Party to achieve Labour's vision of for Parliamentary activity will be essential so that the has asked to explore ways to ‘whole-person care’, bringing as the four Parliaments of ‘NHS can be made financially integrate health and social together physical health, the UK have been in recess sustainable and provide a care. Whole-person care looks mental health and social care over the Easter period. better service for the future’. set to be one of Labour’s key into a single service to meet Charles Walker MP, Chair Milliband was speaking at policies for the 2015 election. all of a person’s care needs. of the All-Party Parliamentary Group for Mental Health, in a parliamentary question asked how the Government is going Early Intervention Foundation launched to measure the delivery of its commitment to create parity BACP was represented at creation of an independent alternative to late of esteem for physical and the launch on 15 April at 10 Foundation to promote intervention, which it mental health. Responding, Downing Street of the Early it. Now the serious work argues is more expensive Norman Lamb MP, Minister Intervention Foundation. begins on delivering our and less effective of State for Health, said the The Foundation has been three ‘As – Assessment, ••assess what programmes Government will assess designated by the Government Advice and Advocacy of work – to determine both whether NHS England is as the ‘What Works’ lead Early Intervention.’ the best early interventions meeting the objective ‘by its body on early intervention, David Cameron said: ‘I available and their relative practical actions, by whether working alongside the National am committed to improving value for money its overall programme of Institute for Health and Care the life chances of every ••advise local commissioners, work demonstrates that Excellence, and the Education child, but especially those service providers and commitment, as well as Endowment Foundation. It who come from troubled potential investors on the progress on the relevant was formally launched by backgrounds. I look forward best practical, evidence-based outcome measures in the the Prime Minister with the to seeing the Foundation get interventions for supporting NHS outcomes framework, backing of Liberal Democrat to work, not only assessing children and families. and the delivery of other leader Nick Clegg and Labour which programmes make a The Foundation will focus mental health commitments leader Ed Miliband, in a show difference but giving people initially on programmes in in the mandate’. of cross-party support. working in this field clear England but will also engage In response to a question Speaking at the launch, and practical advice about with partners across the from Conservative MP Eric Chair of the Early Intervention where money can be most UK and internationally. Ollerenshaw about mental Foundation Graham Allen effectively spent.’ More information is illness in young people, MP said: ‘All parties have The Foundation will: available on its website: Norman Lamb MP affirmed supported the drive towards ••advocate for early www.earlyintervention that the Government is early intervention and the intervention as a serious foundation.org.uk investing £54 million over the four-year period 2011–15 in the Children and Young People’s IAPT programme. Support for adults with multiple needs In the Northern Ireland Assembly, Chris Lyttle The Big Lottery Fund (BIG) and reoffending. The and drug use, improve MLA (Alliance) asked about has announced a £100 million programme is backed by their mental health and the provision of counselling programme to promote Channel 4 news presenter have stable accommodation. at primary school level, multi-agency collaboration to Jon Snow and Mitch Each of the 10 successful its impact and its funding. support people with multiple, Winehouse, father of the partnerships will receive The Minister’s reply was that complex needs. The £100 late singer Amy Winehouse. £50,000 in the first instance state-funded counselling is million will be shared between The aim is to bring together to put together a business provided to primary school- 10 partnership projects in organisations and public plan on how they will improve age pupils as part of a critical England to fund collaborative bodies to work to support and better coordinate services, incident response package work to address problems people with multiple and with the prospect of a further but that primary schools can including homelessness, complex needs to lead better £10 million should their plans also provide counselling from mental ill health, addiction lives, reducing offending prove robust and effective. within their own resources.

52 Therapy Today/www.therapytoday.net/May 2013 News/AGM

Date confirmed for 2013 BACP AGM

BACP’s next Annual General included with this (May) issue proxy voting forms and information on this option Meeting (AGM) 2013 will of Therapy Today (see also the Association’s financial will be included in October be held on 16 November over page). Ballot papers for statements will all be sent BACP News and on the at the London School of Governor elections and forms out with the October mailing. BACP website. Economics, in London. inviting member resolutions Members will be able to Questions relating to Governor and AGM for the AGM will be circulated access and return completed the AGM should be directed Business Sub-Committee with the July journal. The postal/proxy voting forms to [email protected] nomination forms are full AGM agenda, postal/ electronically. Further or call 01455 883383.

BACP Universities & Colleges election Coaching

BACP Universities & Colleges Chair Elect, who will take up Officer, Julie Camfield, at round table is looking for a new Chair the post as soon as possible [email protected] Elect for the division. after 24 June 2013. Current The BACP Universities & Barry White, BACP Coaching This is a one-year post at Chair, Charlotte Snoxall, Colleges annual conference Executive Specialist for the end of which the Chair will continue in the post takes place 24–26 June 2013 Professional Standards, Elect takes on the role of for one more year until June at Sheffield University. The has been representing BACP Chair for a two-year term, 2014, when the Chair Elect title is ‘A world of difference, Coaching in round table followed by a further one year will take over and Charlotte embrace and respond’. For discussions with the leading ‘mentoring’ role as Past Chair. will become Past Chair. further information about coaching organisations Nominations are being invited To request a nomination the conference, please visit across Europe and beyond. from the BACP Universities & form for the post of Chair www.bacp.co.uk/events or The Coaching Bodies Colleges membership for the Elect, email BACP Divisional www.bacpuc.org.uk Round Table (CBRT) UK has just set up a new website to begin to demonstrate the collaborative work Making Conference attendance costs they are doing. Barry says: ‘My role has Connections Members who wish to attend profession and where the been to hold open a space national and international applicant feels they can for BACP as an organisation BACP is holding two conferences are entitled to contribute from their own committed to standards Making Connections submit a request for financial experience and expertise. and good practice with its events this summer: on assistance to the BACP Applications should be counselling members and 3 June in Leicester and Conference Attendance submitted not less than now also its coaching on 9 July in Edinburgh. Working Group (CAWG) six weeks before the event members. I have taken For further details of for consideration. and prior to booking. part in helping formulate venues and programmes Requests will be considered For further information, commonalities and have visit the Events webpages for conferences that are of please contact Wendy Davis also looked at other ways at www.bacp.co.uk/events strategic importance to the at [email protected] in which we could be of help. To that end we have a fledgling website for the coaching bodies, which at the BACP Connect redesigned in website overhaul moment is simply a snapshot of all the differing attendees BACP has overhauled the friends and colleagues to Other improvements to but in time we hope will be design of the members’ share insights, ideas or come include an improved a vibrant “place to go” if website portal to allow a concerns. The new design search function and a more you want to know anything more comprehensive and fluid is intended to offer a more collaborative news feed about coaching.’ integration of BACP Connect. streamlined, consistent and active social network For more information BACP Connect provides a and user-friendly experience, presence. If you have any about the Coaching Bodies secure place where members which will underpin all future feedback or suggestions, Round Table, please visit can build networks with changes to the website. email [email protected] www.coachingbodies.org.uk

May 2013/www.therapytoday.net/Therapy Today 53 AGM/Professional standards

2012 AGM Open Forum responses

Question about attendance BACP response incorporated within this BACP response and the third sector All members receive review. A consultation event Electronic communication Val Potter commented on notification of the AGM with Accredited Services was and the BACP website will the low member attendance date and venue through the held in October 2012 on the be used more widely to at the AGM, despite the Association’s journal and proposed changes to criteria. advise and remind members importance and value of a personal communication, The focus of the scheme of the date and business members being present which includes all AGM was reconsidered in light of the 2013 AGM, as well and taking the opportunity details and papers detailing of feedback from that as continuing the traditional to vote on the important the business of the meeting. meeting. The criteria have notices in the journal and changes that were being Other AGM-related been further reviewed and circulation of the various brought for approval. She information is normally made we are now in the process documents in line with also commented on the lack available through Therapy of starting consultations legal requirements. of communication in the Today and the BACP website. with BACP Divisions prior context of the Third Sector The ongoing Divisional and to launching the new scheme. Further comment Forum/Reference Group Forum Review, which includes A further comment, not and the increasing difficulties the Third Sector Reference Question about reviewing requiring response, was faced by the third sector Group, is considering future how the AGM is publicised offered by Liam Lally, Chair through service and funding resourcing and a field of A member present of the National Association cuts. Val asked how the strategic imperatives in acknowledged the difficulty for Pastoral Counselling Association intended to order to form a view on in getting members to and Psychotherapy in support and represent how to support and represent attend AGMs and suggested Ireland. He welcomed the members and the third members from the Divisional reviewing how it was opportunity to attend the sector in the future, and and Forum perspectives. publicised in future AGM and congratulated also queried the position Support for, and representation and making more use of BACP on a very successful with service accreditation. of, the third sector will be electronic communication. year.

Nominations invited for BACP Board of Governors

Nominations for the do not represent any to and on behalf of the without a two-year break, vacancy for an elected particular modality, membership, and ensuring is nine years. This is broken Governor on BACP’s Board sector or interest within due compliance with down into three elected of Governors are invited membership. The Trustees’ Charity and Company Law. terms, each of three years, from the membership. focus, in accordance with The time commitment and there is no requirement BACP continues to legal requirements, is on Governors can expect to for any Governor to commit grow and thrive, with the following key areas: give is, on average, two to the full nine years when approximately 40,000 ••achievement of the days a month, in addition first standing for election. members, 125 professional Association’s vision to attending approximately If, after reading the staff and an annual turnover and mission within its six Board meetings a year. nomination form mailed in excess of £6 million. Charitable Objects and There may be tasks required with this issue of the The organisation is complex strategic objectives between these meetings, journal, you have any and the role of a Governor ••ensuring probity, which can involve reading, queries or would like is equally complex, holding particularly financial consulting, writing papers, any further information, a balance between the probity, in the attending other BACP please contact Jan Watson, needs of the organisation, management of the Committee meetings, Assistant to the Chief the needs of members, Association’s activities meeting with members Executive, on 01455 883383 the needs of those who ••development of policy and other constituents or [email protected]. use our services and the and strategy and monitoring and tele-conferencing. Completed nomination public perception and implementation To support and facilitate forms must reach the reputation of counselling ••holding accountability, continuity and succession Chief Executive/Company and psychotherapy. as required by Charity planning within the Board Secretary in Lutterworth It is important to be and Company Law, for of Governors, the maximum by 5pm on Monday 10 June aware that Governors the Association’s activities term a Governor may serve, 2013.

54 Therapy Today/www.therapytoday.net/May 2013 BACP AGM Business Sub-Committee election

An AGM Business Sub- to this Sub-Committee, ••manages and facilitates September/October) for Committee consisting which is concerned solely the smooth running of approximately three hours. of three members of the with the AGM. On behalf the meeting, and Any other contact and Association, and not members of the membership it: ••is responsible for voting communication is managed of the Board of Governors, ••ensures that the AGM that takes place at the by telephone, letter or email. shall be elected (for a three- runs in accordance with meeting. Nomination forms for year term) by postal vote the Association’s Articles As well as attending the the vacancy on the Sub- supervised by the Company of Association AGM, which will be held Committee are included Secretary to advise on the ••advises on the conduct on 16 November 2013, the in this mailing. For further conduct of the business of the of the business Committee meets, either details, please contact Jan AGM. There is currently one ••prepares and agrees face to face or by telephone Watson on 01455 883383 space available for election the timetable once a year (usually in or [email protected]

Newly accredited counsellors/ Pam Laurance Faye Walters Caroline Fry psychotherapists Carrie Lindsay Elizabeth Welch Hilary Gallacher Azeem Ali Khan Karen Lloyd Rick Wilson June Goble Julie Armitage Maureen Long Maureen Goodson Samantha Biswas Barbro Magnusson Newly senior accredited Dorothy Graham Jacqueline Bock Tiki Martel counsellors/psychotherapists Patricia Grant Aine Bourke David McAvoy Karen O’Neill Susan Griffiths Allison Bowden Terry McCourt Lesley Shrapnell Anne Gurd Toni Buffham Catherine McEvoy Ann Hall John Campbell Sarah McMichael Newly senior accredited Rose Hall Stephanie Cass Delores McPherson supervisors of individuals Judy Holman Alison Cathcart Ivan McStea Emma Redfern Florence Jackman Loretta Collins Lynne Milman Wendy Somerville Maureen John Stephanie Compton Caroline Mitchell Andrew Leatham Marcia Corlis Jeanette Moore Newly accredited counselling/ Pamela Lockett Deborah Crookston Ian Mounsdon psychotherapy service Gillian Loveday Lisa Cross Celia Murchan Ryedale Counselling Service Rhoda Luzio Julie Crowe Catherine Muston Yvonne Mahoney Mabel Doole Claire Parlane Members not renewing Jody Mardula Carole Edwards Jayshree Pattni accreditation Ann Newbould Linda-Jayne Elliott Lucy Pedrick Fernanda Barros Richard Noble Sharon Evans Kathryn Pierrepont Pauline Bauer Michael Partridge Gillian Finn Barbara Prager Eleanor Braterman Jean Potter Nigel Gibbons Beverley Price Lesley Brewerton Maria Rhodes Tara Gibson Elizabeth Pycroft Elaine Brooker Anita Roberts Carol Green Andrew Quarmby Heather Brown Caroline Russell Yvonne Green Catherine Quinn Karen Burnett Hilary Sheath Pam Hall Christine Roberts Elizabeth Calvert Judith Taylor Paul Harris Madi Ruby Claudio Calvi Lottie Taylor Oya Hassan Karen Savage Alan Carter Linda Wellens Sylvia Hemingway Ann Scanlon Tony Cashman Christina Wheatley Ilse Herlihy Jane Short Elizabeth Colley Julie Wilde Marian Hilditch Rajwinder Sidhu Madeleine Comben Gill Wilkinson Christopher Hollis Sue Simpson Ann Davis Tricia Young Kate Holt Alison Smyth Caroline Day Caterina Husbands Linda Steele Clare Dodgson Please note: details of members Martyn Hutchings Pamela Stocker Prunella Doherty whose accreditation has been Stephanie Hutchinson Claire Taylor Sue Edmans reinstated and successful service Fiona Hutchison Paul Toft Mary Edwards re-accreditations have been held Lilas Javeed Roland Tolley Margaret Evans over until the June issue due to Sharon Johal Marianna Urdhin Amanda Fox limited space in the May issue.

May 2013/www.therapytoday.net/Therapy Today 55 Research/Professional conduct

2013 research award winners Training the trainers The BACP Equality and and multilingual therapists working with sex-addiction’, Diversity Research Award work with clients whose which was also presented In 2007 BACP and the (£500) has been awarded to native language is not at the BACP research University of Leicester won Beverley Costa and Jean Marc English, with the ultimate conference. funding from the Economic Dewaele, from Mothertongue aim to improve access to The CPR New Researcher and Social Research multi-ethnic counselling therapeutic help for non- Prize (£500) has been Council (ESRC) researcher service, for their research native speakers of English. awarded to James McElvaney, development initiative to into ‘Psychotherapy across The PCCS Student poster from Trinity College Dublin, develop and enhance research languages: differences prize (£500) has been for research undertaken as capacity in counselling and between monolingual and awarded to Coral Russell and part of his PhD into ‘Clients’ psychotherapy. As part of multilingual therapists’, Anne Napier and colleagues experience of therapy and this project a training manual which was presented at the from Lewisham Counselling its outcomes in quantitatively and DVD were produced, BACP Research conference and Counsellor Training “good outcome” and “poor Training counsellors and earlier this month. This study Associates, for their poster outcome” psychological psychotherapists in research explored and compared the presentation ‘Person-centred therapy in a primary care skills: a manual of resources, ways in which monolingual counsellors’ experiences of setting’. which is now the best-selling BACP publication. Alongside the manual, there was a five-day summer Revised CYP counselling review published school to train the trainers in research methods, which BACP has published an McLaughlin, Carol Holliday, for children and young people, was so successful it was updated review of counselling Barbie Clarke and Sonia what types of counselling and repeated in 2008. The and psychotherapy with Ilie, from the University psychotherapy interventions trainers were Professors children and young people. of Cambridge. are effective, and which are John McLeod, Robert The review, ‘Research on BACP’s first review of the effective with which problems Elliott and Sue Wheeler. counselling and effectiveness of therapeutic and which client groups. As reported in the April psychotherapy with interventions with children The review can be issue of Therapy Today, off children and young people: and young people was downloaded for free from the back of the success of a systematic scoping review published in 2004. The www.bacp.co.uk/research/ these previous events, BACP of the evidence for its updated review investigates Systematic_Reviews_and_ will be running four one-day effectiveness from 2003- whether counselling and Publications/ccyp_update_ workshops, led by Professors 2011’, is written by Colleen psychotherapy are effective 2013.php Elliott, McLeod and Wheeler. Each workshop will be linked to elements from the research skills training manual. BACP research surgery evaluated The workshops are aimed at lecturers and trainers BACP Research contacted searches. The amount and Research surgery sessions of counselling and BACP members who have variety of additional support are offered throughout psychotherapy. They will used its research surgery accessed varied considerably the year and are available take place at Shelter Training, service over the past 12 and included academics and to any BACP member, London on 24 June 2013, months to ask what they supervisors, peers, textbooks whether new to research 21 October 2013, 10 March found helpful, what other and the internet. or an experienced researcher. 2014 and 20 October 2014. support they had accessed Some members had The sessions last 30 minutes Workshop prices start from and what future plans they published their research in and should be pre-booked. £85 each for BACP members. had for their research. Therapy Today, or had plans to. The next surgery dates The manual can be purchased Respondents said that it was Others had reached the point are Wednesday 26 June and for £30 for BACP members helpful to be able to discuss of obtaining ethical approval 24 July. To book a session, (£35 for non-members). methodology in a consistent to undertake their research. contact Stella Nichols in For further details and to and systematic manner and One had submitted findings advance on 01455 883372 book, visit www.bacp.co.uk/ that the surgery helped them to a large national charity, or [email protected]. events/conferences.php or with structuring research which plans to use the findings Slots are limited so book early contact BACP Customer questions and with literature for a benchmarking project. to avoid disappointment. Services on 01455 883300.

56 Therapy Today/www.therapytoday.net/May 2013 Youthhealthtalk on eating disorders

Youthhealthtalk.org, the youth Experiences Research Group, the experience of living with undiagnosed for a very health website, has launched University of Oxford. Funded and recovering from an eating long time. The longer eating a new section on young by Comic Relief, the research disorder. They highlight the disorders are left untreated, people and eating disorders. comprised video interviews many barriers they face to the more serious they can The section covers early with 39 young men and accessing the services and become and the harder it signs and symptoms of women aged 16-27 across support they need because can be to treat them. It is eating disorders, where to the UK. The young people of lack of awareness and paramount that we increase get help, different treatments, had a range of different eating poor understanding of the awareness of the issues and thought patterns and physical disorders, including anorexia illness and its effects among get rid of the barriers that symptoms, impact on social nervosa, bulimia nervosa, health professionals and young people face. We need life, education, family and binge-eating disorder, the general public. to make it easy for them how it feels to recover. EDNOS, ED-DMT1 and Ulla Räisänen, a senior to speak up and get help.’ The pages are based on disordered eating. researcher who conducted the For more details, see www. research with young people In the extracts on the study, said: ‘Eating disorders youthhealthtalk.org/young_ conducted by the Health website, they talk about are common and many go people_Eating_disorders

BACP Professional should reasonably be unanimous in its decision if any, would be appropriate Conduct Hearing expected from a member that these findings amounted and proportionate in the Findings, decision and of the profession. to professional malpractice circumstances. withdrawal of membership in that Mr Wheeler showed As a result of the Damien Black Sanction incompetence in his learning and understanding Reference No 641919 The Panel was unanimous understanding and use of the demonstrated by Mr Wheeler Mid-Glamorgan CF31 2JG that Mr Black’s membership Counselling Directory website. during the hearing and as of BACP should be withdrawn referred to above, the Panel The complaint against the and took the view that, on Mitigation considered that, in the above individual member the findings reached, any Mr Wheeler expressed his particular circumstances was heard under BACP’s lesser sanction would be sincere regrets and took full of this case, it would not Professional Conduct wholly disproportionate. responsibility for his errors be appropriate to impose Procedure 2010 and the Full details of the decision and lack of understanding. a sanction. Professional Conduct can be found at http://www. He took immediate steps Full details of the decision Panel considered the alleged bacp.co.uk/prof_conduct/ to rectify the entries on can be found at http://www. breaches of the BACP Ethical notices/termination.php the website as soon as bacp.co.uk/prof_conduct/ Framework for Good Practice in these were pointed out notices/hearings.php Counselling and Psychotherapy. BACP Professional to him by contacting both The Panel made a number Conduct Hearing the Counselling Directory Withdrawal of membership of findings. The Panel Findings, decision and BACP. Mr Wheeler Damon Bachegalup noted that these findings and sanction is undertaking further IT Reference No 611906 involved the exploitation Mark Wheeler training. He stated that Bolton BL1 6PU of a vulnerable client and that Reference No 651980 he has learned a valuable compliance with paragraph Harwich C012 lesson and would be very A sanction was imposed 17 of the Ethical Framework careful in future to ensure on Mr Bachegalup following for Good Practice in The complaint against the that information about a Professional Conduct Counselling and Psychotherapy above individual member his counselling and other Hearing. is mandatory (‘Practitioners was heard under BACP’s qualifications were accurate. Mr Bachegalup failed to must not abuse their client’s Professional Conduct The Panel was satisfied comply with the sanction trust in order to gain sexual Procedure 2010 and the that Mr Wheeler had and consequently his advantage’). Accordingly Professional Conduct demonstrated significant membership of BACP the Panel was unanimous Panel considered the alleged and sufficient learning was withdrawn. Any future in its decision that these breaches of the BACP Ethical from these events. application for membership findings amounted to Serious Framework for Good Practice in of BACP will be considered Professional Misconduct and Counselling and Psychotherapy. Sanction under Article 12.3 of the contravened the ethical and The Panel made a number The Panel carefully Memorandum and Articles behavioural standards that of findings and it was considered what sanction, of the Association.

May 2013/www.therapytoday.net/Therapy Today 57