ISSUE 72 / AUTUMN 2019 ISSN 2516 7162 ONLINE

TOMORROW’S WORLD Cancelled?

THE MAGAZINE FOR MEMBERS OF THE UK COUNCIL FOR PSYCHOTHERAPY

New Interview / Susie Orbach The magazine of the UK Council for Psychotherapy Welcome Editorial address: UK Council for Psychotherapy, America House, ISSUE 72 / AUTUMN 2019 2 America Square, London EC3N 2LU Published by: James Pembroke Media, 90 Walcot Street, Bath BA1 5BG Editor: Anna Scott, [email protected] Issue 72 consulting editors: Sarah Niblock, Martin Pollecoff, Sandra Scott Head of design: Simon Goddard t may be called ‘Sleepwalking Senior project manager: ‘I into the Anthropocene – the New Marianne Rawlins, marianne.rawlins Age of Anxiety’, but this year’s UKCP @jamespembrokemedia.co.uk Advertising: Hannah Sarsfield, hannah. conference is focused on hope and [email protected], resilience for very good reason. A shift 020 3859 7100 has occurred within debate about the Subscriptions: New Psychotherapist climate, away from the notion that is free to members of the UKCP. Non members can view the magazine at change is needed at some point in the psychotherapy.org.uk/join/the- future towards the idea that climate psychotherapist ANNA SCOTT change is an emergency that must be Anna Scott has been a journalist and dealt with now. Despite this, we should editor for 20 years, writing about health, be hopeful. education and management issues. Psychotherapists have a crucial role in She also works part time with primary helping people move away from dread, school-aged children, and has a keen helplessness and fear about climate change interest in psychotherapy, along with psychology, completing a Bachelor of to resilience, action and hope. UKCP Science in Psychology in her spare time members are seeing an increase of anxiety about what is happening to the planet within DIVERSITY AND EQUALITIES STATEMENT their consulting rooms, but are also able to The UK Council for Psychotherapy (UKCP) promotes an active engagement with di erence and therefore help clients face di cult truths about how they live their lives. seeks to provide a framework for the professions of As therapists, you are able to help people work through processes of despair, psychotherapy and psychotherapeutic counselling 3 which allows competing and diverse ideas and grief and guilt. You are able to o er solutions – both practical and philosophical perspectives on what it means to be human to be considered, respected and valued. UKCP is – to managing these emotions and doing something about what is happening committed to addressing issues of prejudice and to the planet. You are able to demonstrate the impact of the environment and discrimination in relation to the mental wellbeing, political belief, gender and gender identity, sexual nature on our mental wellbeing. preference or orientation, disability, marital or This issue of New Psychotherapist brings together many experts to consider partnership status, race, nationality, ethnic origin, heritage identity, religious or spiritual identity, age what impact climate change has on our mental health, how everyone can act to or socioeconomic class of individuals and groups. change things, and the role psychotherapy plays in all of this. Environmental UKCP keeps its policies and procedures under review in order to ensure that the realities of discrimination, writer Emma Marris explains that focusing on guilt and anxiety is not exclusion, oppression and alienation that may form necessarily a solution (page 32). Green MEP Molly Scott Cato highlights how part of the experience of its members, as well as of their clients, are addressed appropriately. UKCP our relationship with nature has a big impact on mental health (page 36). seeks to ensure that the practice of psychotherapy Psychotherapists Tree Staunton and Caroline Hickman describe the journey is utilised in the service of the celebration of human di erence and diversity, and that at no time is therapists must go through themselves in order to come to terms with climate psychotherapy used as a means of coercion or change (page 22). We also consider the role psychotherapy should play in how oppression of any group or individual. we plan the environment within our cities (page 27). EDITORIAL POLICY Elsewhere in the magazine, we see what our members are doing to help PTSD New Psychotherapist is published for UKCP members, to keep them informed of developments patients in the NHS (page 42), those visiting foodbanks (page 46) and people likely to impact on their practice and to provide an opportunity to share information and views struggling to come to terms with their mortality (page 48). on professional practice and topical issues. The We hope you enjoy it. contents of New Psychotherapist are provided for general information purposes and do not constitute professional advice of any nature. While every e ort is made to ensure the content in New Psychotherapist is accurate and true, on occasion there may be mistakes and readers are advised not to rely on its content. The editor and UKCP accept no responsibility Get in contact or liability for any loss which may arise from reliance Share your views and ideas on our on the information contained in New Psychotherapist. profession and this magazine: From time to time, New Psychotherapist may publish articles of a controversial nature. The views [email protected] expressed are those of the author and not of the ANNA SCOTT editor or of UKCP. UKCouncilForPsychotherapy Editor ADVERTISING POLICY twitter.com/UKCP_Updates Advertisements are the responsibility of the psychotherapy.org.uk advertiser and do not constitute UKCP’s endorsement of the advertiser, its products or services. The editor instagram.com/psychotherapiesuk reserves the right to reject or cancel advertisements without notice. Display ads: for a current advertising pack and rate card, please contact Hannah Sarsfi eld on 020 3859 7100 or email hannah.sarsfi eld@ jamespembrokemedia.co.uk New Psychotherapist / Autumn 2019

Contents ISSUE 72 / AUTUMN 2019

Cities: their emotional impact informs our 27 psychological relationship with them

On the Cover This issue, we explore the role of psychotherapists in helping clients Environmentalist and writer deal with climate change 32 Emma Marris discusses guilt

REGULARS FEATURES

06 Bulletin 14 The Big Report Research, reviews and member Building hope and resilience in the news to keep you informed face of climate change 5 10 Reviews and feedback 22 Interview Recommended books and podcasts, Tree Staunton and Caroline Hickman: and members’ feedback how climate change impacts therapy

50 Points to consider 27 Our surroundings Our Complaints and Conduct Team Hazel Davis delves into the offers notes on client confidentiality psychological effect cities have on us

52 Spotlight 32 Interview Join today! Professor Vicky Karkou reflects on her Emma Marris on how therapists can UKCP membership is a career in arts therapy navigate clients’ climate change guilt recognised quality standard – being able to use the UKCP members’ logo 54 On Screen 36 Interview will demonstrate the calibre of your training and practice to potential Sex Education’s small-screen Green MEP Molly Scott Cato on mental clients and employers and among portrayal of psychotherapy health provision and climate anxiety colleagues within the profession. psychotherapy.org.uk/join 42 Resilience and trauma Ed Fellows establishes a new way to Get in contact handle post-traumatic stress disorder Share your views and ideas on our profession and this magazine: 46 Charities [email protected] Free psychotherapy at a London food UKCouncilForPsychotherapy bank provides emotional sustenance twitter.com/UKCP_Updates 48 Feature psychotherapy.org.uk Facing our own mortality can help us instagram.com/ lead richer lives, discovers Anna Scott psychotherapiesuk

Clients with climate anxiety can be a 22 huge challenge for psychotherapists

New Psychotherapist / Autumn 2019 Bulletin ISSUE 72 /AUTUMN 2019

News, CPD, reviews and members updates – here’s what’s happening in the profession now

For every 100,000 young people, 9.4 beds are made available in the UK 64 beds are made available in GERMANY 1.2 The switch in status from child to beds are made adult can create difficulty for patients available in 6 SWEDEN RESEARCH Adolescent care a ‘weak link’ Long-term study finds gaps in mental health care for children when they become adults

cross Europe, young people with links’ in the provision of care via period in a locked, secure setting, to A mental health problems are CAMHS in 28 EU countries. The avoid them harming themselves and experiencing a discontinuity of care findings indicate that while a number others, where they can stabilise safely, as they become adults, a five-year of young people move on to adult and everyone gets a chance to think study of Child and Adolescent Mental mental health services with minimal about what they need longer term to Health Services (CAMHS) has found. disruption, a large proportion are become safe and well. The Milestone study found that discharged without guidance on ‘There is currently a double the period between childhood and continuing support. whammy in the loss of secure beds – adulthood is one of the ‘weakest The research also found that despite both a shortage of acute mental health having the largest number of services beds and the continued loss of beds in in the EU dedicated to child and the Local Authority Secure Estate.’ adolescent mental health (939), the Jocelyne Quennell, Director of the UK comes 18th out of 28 countries for Wellbeing Faculty at the Institute for Get in contact the availability of inpatient beds. For Arts in Therapy and Education, added Let us know what you think of your every 100,000 young people, just 9.4 that child mental health and wellbeing redesigned member magazine: beds are available. are not being taken seriously enough. [email protected] Stephen Blunden, Chair of UKCP’s ‘We also need therapeutic community UKCouncilForPsychotherapy College of Child and Adolescent resilience models to be embedded twitter.com/UKCP_Updates Psychotherapies, said that the medical within schools and local communities. psychotherapy.org.uk model is failing. ‘Many children who Addressing the causes of mental are presenting the most extreme health problems, as well as delivering instagram.com/ psychotherapiesuk emotional and behavioural states creative and therapeutic responses to simply need (and desperately want) a human suffering, is vital,’ she said.

New Psychotherapist / Autumn 2019 Bulletin Psychotherapy and the city Exploring the relationship between mental health and life in the urban jungle Pages 27-31

RIGHT: Spending time in nature seems PARTNERSHIP to encourage good moods NEW PSYCHOTHERAPY COURSE ANNOUNCED BY UKCP AND IMPERIAL COLLEGE

The UKCP has teamed up with Imperial College London to offer a new course, Understanding Psychotherapy: A Social History of the Mind. Starting in October 2019, the nine- MENTAL WELLBEING week course will explore the history of psychotherapy, stretching back to NATURE BENEFITS Hippocrates in the third century BC, through to the late 1800s work of PSYCHOLOGICAL WELLBEING Chalcot, and concluding with the post- Freudian understandings of the mind eople who spend at least background, and also to people and therapies used today. P two hours a week in nature suffering from long-term illnesses Professor Sarah Niblock, UKCP are more likely to report higher or living with disabilities. Chief Executive, Martin Pollecoff, UKCP 7 psychological wellbeing than ‘The majority of nature visits Chair, and leading psychotherapists those who don’t. in this research took place within Professor Brett Kahr, Dr Divine Charura Research led by the University two miles of home, so even and Dr Reenee Singh are among the of Exeter’s European Centre visiting local urban green spaces tutors on the course, which will take for Environment and Human seems to be a good thing,’ said Dr place at the South Kensington Campus Health also found that people Mathew White, Environmental of Imperial College London. who visited town or country Psychologist at the University of Dr Roberto Trotta, Imperial’s parks, woodlands and beaches Exeter Medical School, who led Director of the Centre for Languages, for less than two hours a week the study. ‘Two hours a week is Culture and Communication, said: experienced no such benefits. hopefully a realistic target for ‘This exciting course, which is open The study, ‘Spending at least many people, especially given to all, will broaden our offer of 120 minutes a week in nature that it can be spread over an courses for the general public, and is associated with good health entire week to get the benefit.’ will bring to Imperial the expertise of and wellbeing’, used data from UKCP-registered some of the best people working in nearly 20,000 people in England psychotherapist Hayley psychotherapy today … We very much and found that it didn’t matter Marshall, who specialises in hope it will be the first step towards whether the 120 minutes was outdoor therapy, said that the further collaboration and partnership achieved in a single visit or over research ‘provides part of a between Imperial and UKCP.’ several shorter visits. solid therapeutic rationale for It also found that the two- the growing tribe of outdoor For further information, hour threshold applied to men practitioners already drawing on visit bit.ly/2YVq8hY and women, irrespective of age, these benefits in their work’. socio-economic or occupational ‘It is true that a clearer understanding of how much we benefit from ‘Two hours a week [in contact with nature also nature] is hopefully prompts us to protect and care for it. We then take a realistic target for our place in a true cycle of many people’ reciprocal healing.’

New Psychotherapist / Autumn 2019 Member News ISSUE 72 / AUTUMN 2019

UKCP members share their news and updates. Let us know yours – email [email protected]

NORTHERN IRELAND INSTITUTE OF HUMAN RELATIONS Institute celebrates 30 years with art installation A dance piece aims to highlight the nature of the therapy relationship

he Northern Ireland Institute The NIIHR has 46 members T of Human Relations (NIIHR) from all over Northern Ireland, is using an art installation and offers a programme of CPD to commemorate its 30th events, including a clinical and anniversary, which takes place theoretical reading group, a film in 2020, writes Honorary club, a social concern group, Secretary and Associate Member a book club, a group analytic Cheryl Bleakley and David Smith 8 Rhoda Dorndorf. section, clinical seminars and The installation is a dance conferences. It has recently piece that aims ‘to give the public become the 30th organisation a glimpse of what goes on within to join the UKCP’s Council for engagement with popular the therapy relationship,’ said Psychoanalysis and Jungian culture and with social issues, to Vice-Chair Cheryl Bleakley, a Analysis. make psychoanalytic thinking psychoanalytic psychotherapist A long-valued core accessible to both the wider and artist who facilitated the member organisation of the mental health community and installation. psychoanalytic section of the the general public. In keeping David Smith, Chair of NIIHR, Dublin-based Irish Council for with the Winnicottian tradition, added: ‘The installation has Psychotherapy, NIIHR members we want to make ourselves been over two years in the continue to enjoy the fruits of available in a way that allows making and is the product of close cross-border collaboration, people to find their own creative a creative engagement with regularly attending events in ways of making use of us.’ Donald Kalsched’s beautifully Dublin and welcoming friends vivid Jungian redescription of and colleagues from the Republic Donald Winnicott’s concept of of Ireland to Belfast events. the false self.’ ‘Now, at this deeply divisive FORTHCOMING UKCP EVENTS moment in time, characterised by wall-building and talk of hard 19 OCTOBER 2019 borders, it’s more important than Sleepwalking into the Anthropocene – the new age of anxiety. London ever to maintain and deepen Get in contact healthy connections – both 23 NOVEMBER 2019 Let us know your news, within the island of Ireland, The elephant in the room: what is going on in views and updates: and between Great Britain and the supervisory relationship? Edinburgh Zoo [email protected] Ireland,’ Smith said. UKCouncilForPsychotherapy ‘The Institute is a welcoming, twitter.com/UKCP_Updates supportive, playful and facilitating community of psychotherapy.org.uk Diary dates therapists. It is outward- For more information on UKCP events instagram.com/ facing and aims, through its visit psychotherapy.org.uk/events psychotherapiesuk

New Psychotherapist / Autumn 2019

Reviews Psychotherapists review new and recent work in their own fields, and recommend essential additions to your bookshelves

Mind Kind: Your Child’s anxious about our environment to make sure it is safe for us – it’s Mental Health getting anxious about the anxiety that causes the problem. She suggests that talking about oanna North is both a UKCP the small things helps children to J Psychotherapist and Chair of the BPS talk about the big things, too. We Psychotherapy Section – she was the 2017 cannot suddenly expect children to winner of the BPS award for Distinguished start talking about how they feel if Contribution to Psychology in Practice. they have never learned to do this. Her book, Mind Kind, comes out of her She also clearly states what she Details 30 years of working with children and perceives to be parenting errors, Reviewed by: Martin parents, both in the NHS and private such as physical interventions, Pollecoff, Psychotherapist practice, and was inspired by a year spent over-critical and harsh parenting and UKCP Chair in Child and Adolescent Mental Health with poor use of language. Author: Dr Joanna North Services, where anxious parents had the There is a chapter on self-harm Publisher: Exisle Publishing same questions and concerns about their and suicidal ideation. Another Price: £12.99 child’s mental health. looks at divorce and separation, ISBN: 978-1925335941 10 There are many books that give advice and one covers eating and on childrearing, but what’s so refreshing self-worth. The final chapter of here is that rather than proffering advice the book covers the journey of it offers both parents and therapists a set development. of coherent values – a simple philosophy All told, Mind Kind is an of parenting. informative read that puts The book addresses the basis of anxiety, parents back into the driving seat explaining that it is not wrong to have of guiding their children to be anxiety – after all, we have evolved to be emotionally resilient.

PODCASTS WE’RE LISTENING TO

GRIEFCAST Comedian Cariad Lloyd has won even more than the loss of the most popular topic of conversation Details awards for her podcast in which she person we grieve. But hearing the (mostly due to the idea that it should Reviewed by talks to a different comedian in each different voices and perspectives in be broached with humourless Anoushka Beazley, episode about someone close to them each episode of Griefcast provides solemnity), why not get funny people who has died. Lloyd lost her father reassuring proof that grief is something to discuss how they feel about it? Student Psychotherapist aged 15 and says that, for many years, we share. There’s a kicker, however: Genius. It is for that reason Griefcast Creator: Cariad Lloyd she struggled to come to terms with almost everyone being interviewed has received widespread acclaim. Address: play.acast.com/s/ her grief. The intention behind her is a comedian, such as Robert Webb, But is there a pressure to be mirthful? griefcast podcast: to provide a space where who discusses his mother’s death And is some of the pathos lost in the people can ‘talk, share and laugh’. from cancer when he was 17, and laughter? In the genre of dramedy, We would like to publish more One of the strangest things about Sara Pascoe, who talks about her what is alluded to is done so with a podcast reviews in future grief, something we will all experience, grandfather’s death when she subtle hand. Griefcast may not be as is the feeling of being alone. The was a child. deep, or as raw or existential as some issues. If you are interested in sense of isolation and abandonment Being a writer, I appreciate a decent would like, but these stories could be reviewing a podcast, please can be profoundly painful, sometimes paradox and since death is not the exactly what you need. email: [email protected]

New Psychotherapist / Autumn 2019 Reviews

Psychology and the City: fact, they have created a city personality test, with seven The Hidden Dimension scales of measurement, to assess introversion vs extroversion and other human traits. have heard of the greatness of Their book is a call for I Liverpool, but the reality far surpasses close working ties between the expectation.’ (Prince Albert, 1846) psychologists and urban I became fascinated with the psyche decision-makers. By creating of the city as a local news journalist zones of encounter with reporting on Merseyside, but have never opportunities for citizens of all Details really put my finger on why Liverpool is ages and backgrounds to mix, Reviewed by: Professor always in my heart. Landry and Murray planners can harness what Sarah Niblock, UKCP Chief articulate the way in which the city unites rather than divides Executive impacts upon our mind and how, in communities. Authors: Charles Landry turn, our mental and emotional state The next step, they say, might and Chris Murray impacts upon the city. be a psychoanalysis of a city, Publisher: Comedia Their application of the term looking at what its history and Price: £6.88 ‘psychology’ is consciously catch- major events might reveal about ISBN: 1908777079 all, citing Jungian and humanistic its present and future potentials. approaches through to neuroscience Perhaps my enduring attachment and psychogeography in their close to Liverpool is because it’s a city 11 analysis of cities from Antwerp to that, no matter what befalls it, Minneapolis. The energy of cities needs continues to look outward, not identifying and harnessing as a force inward, with a human wit as for good, they urge, if we are to realise warm as the sandstone bedrock the basic human desire to connect. In upon which the region is built.

Fictional Clinical Narratives in Relational Psychoanalysis

he praxis of therapy and our desire such as in ‘The Crumpled Coat’. T to connect to it is underpinned by Her ability to convey the both our own complex histories and the context of our work means training journeys that follow. This is by this book would clearly benefit far the most important part of what we those thinking of embarking use in the consulting room. on training, as well as being a Details Moutsou’s writing has the flavour of resonating read to those already Reviewed by: Lakis Georghiou, the autobiographical, playfully blended practising. What we hear in Psychoanalytic Psychotherapist with similes and characterisations. She our client sessions is an honour Author: Christina Moutsou sometimes includes too much narrative and a privilege – this book Publisher: Taylor & Francis detail, though, which can be distracting. helps frame this experience. Group However, she has the ability to capture Moutsou’s stories skilfully infuse Price: £15.99 subtle yet deeply moving alienating the complexities of ordinary life ISBN: 9781138315495 experiences, such as that of teenage with sensitivity and fearlessness. Natalie in the first story, ‘On the Beach’. Her writing succeeds in breaking She also highlights important examples the spell of how this work can be of the need of therapists to self-reflect, written about.

New Psychotherapist / Autumn 2019 Feedback We want to hear your stories, news and views, so please get in touch

Report’s simplistic analysis misses the bigger picture

am the manager of one of the perhaps due to the nature of the service I staff counselling services that we offer. In the past nine years we have contributed data to the report that was built a level of trust in our in-house featured in your article, ‘Poor mental service from staff members and our health “epidemic” among academics’ colleagues in HR and other services, and (issue 71, page 8). I read both the report a 2016 review highlighted this. and your article with interest. We see the service as contributing The report argued that data, collected to a culture of effective help-seeking, through a Freedom of Information and enhancing individual and request, showing an increase in organisational health in the challenging staff accessing counselling was ‘firm socio-economic and structural evidence that university staff are conditions elucidated in the report. experiencing poor mental health at a So, while increased utilisation of greater rate than several years ago’. staff counselling may well reflect the I value the analyses of the nature and increased stressors and demands on Louise Knowles, Steering Group 12 sources of stress on people working in staff in higher education, it may also member of UKCP Higher Education higher education and the report nods indicate that leaders and managers are Special Interest Group (HESIG) to limitations of the evidence. But more responsive and that universities writes: Thank you for giving us your the simplistic interpretation of data increasingly recognise the positive perspective on the report, ‘Pressure weakens the report’s assertions and role counsellors and therapists have in Vessels: the epidemic of poor mental portrays a very limited view of the role bringing psychological perspectives to health in higher education staff’. It and use of such services. the world of work. is clear that more debate is needed. For example, the report speaks of The report pushes us to reflect on I am particularly interested in seeing ‘referrals’ to counselling, suggesting that the interaction between the socio- the patterns and similarities between people are referred by managers. This cultural environment and our clients’ the push for change in student mental is not the case – most staff self-refer. inner worlds. The report states that health services and those aimed at High demand for services may also intrinsically motivated staff are prone staff. You suggest that what we are relate to poor NHS provision. When to the ‘do more for less’ messages seeing may not be so much to do GPs know there is a service they push promulgated through neo-liberal with the increased levels of mental clients toward it. ideology and new-managerialism. As ill health, but improved service access Also, staff may be more willing to feminist therapists did for women’s and a de-stigmitisation of mental seek help now due to better mental psychology, work-based therapists can ill health. Interestingly, increased health awareness. National policy and add psychological perspectives to how demand, for whatever reason, can initiatives place more expectations on and why particular individuals may result in innovation, challenging the workplace as a setting in which identify with, adopt and enact such long-held beliefs about how services good mental health can be supported values. My experience is that we are should be provided and even and difficulties addressed. all influenced by these values and challenging our role as counsellors and We see much more proactive use of that their impact comes not just from psychotherapists. Some of the best- consultation counselling and coaching, the top-down, but from many levels. performing services have developed Indeed, it may be HR professionals who from this type of push. soften the effects of unrealistically I want to continue this debate with ‘The simplistic demanding managers rather than the people with experience of the HE interpretation of other way around. sector. That is why UKCP has launched Sally Rose, Manager, Staff Counselling HESIG – offering a voice to UKCP data weakens the and Psychological Support Service, members working in higher education. For report’s assertions’ University of Leeds more information visit bit.ly/33mluNB

New Psychotherapist / Autumn 2019 Have your say Tell us what you think of this issue. Email [email protected]

Addressing challenges and issues Sustainability felt compelled The summer edition ‘The work you welcome your move away I to write in and balanced the pulls I from an oil-derived plastic thank you for the of the issues and have done really mailing wrap. However, I question summer edition of obstacles that trouble matters to folk whether the new vegetable- New Psychotherapist. us as a profession, and based one is as compostable as a From its provocative professionals, with an like me’ shredded paper envelope, or as and brave cover to energising expression recyclable as no envelope at all – its range of content, of our real mission to is finally getting a just a name and address printed New Psychotherapist stretch and connect to look-in and that ‘our’ on the back cover. intelligently addresses the societies we serve. publication is giving As you say, it is intended to be the contemporary There was a platform to its fully compostable but, as yet, the issues that challenge, also inclusion of diverse members. research is not fully conclusive as and are challenged by, newsworthy and The work you have to whether vegetable-based plastic psychotherapy. It is uplifting items done really matters does completely biodegrade. UCL the first publication regarding UKCP’s to folk like me who, is currently researching this, and that I’ve felt I wanted genuine structural for years, have felt readers can find more information to set aside time to growth, such as the that we had to at plasticwastehub.org.uk read, and re-read, new appointments succeed despite the I think readers should be aware cover to cover. I’ve to the Board and the UKCP rather than as that, unless thrown away, your 13 also noticed how range of work that part of it. greener mailing wrap can only be much more time UKCP members bring Pamela Gawler-Wright composted. It is not suitable for our psychotherapy to, and from, their Director of Training plastic recycling, because it is trainees are giving to world of activity. It’s BeeLeaf Institute not compatible with other oil- the copies we have such a relief that our for Contemporary derived plastics. around the school. rich breadth of work Psychotherapy I couldn’t see any information on this, either on the wrap or inside the magazine, and I feel it’s important to point out, otherwise your very laudable Dealing with hatred effort to be sustainable may prove counterproductive. ust writing to say that, as a member of Lal Hitchcock J UKCP since its inception, I find the cover Integrative Psychotherapist of the summer issue of New Psychotherapist deeply offensive. I do not deal in hatred (with UKCP replies: Thank you for it, yes, of course). I cannot understand the highlighting this – you are right, thinking behind it – if there was any – and the magazine wrap is made from feel that, in case I’m not the only one taking potato starch. We were keen to find exception, it may well warrant an apology. an alternative to the previous plastic Gottfried Heuer wrap but still ensure the magazine Analytical Psychotherapist is protected in the postal system. After research, we found this to be UKCP replies: We are aware that the cover the best solution that’s currently has been a talking point. We apologise for any available. We will keep an eye on offence caused, this was not our intention. Our developments and are also looking intention was to encourage readers to open the at how we can make the magazine magazine and explore how the psychotherapy electronically available for those profession can help people work through issues who do not wish to receive a of hate and division in a troubled society. physical copy.

New Psychotherapist / Autumn 2019 The Big Report Hope and resilience

A CRUCIAL ROLE UNDERSTANDING OF THE PSYCHOLOGICAL IMPACT OF CLIMATE CHANGE IS GROWING. ENVIRONMENTALIST AND JOURNALIST ROS COWARD EXPLAINS HOW PSYCHOTHERAPY CAN BE A SOLUTION TO DEALING WITH CLIMATE ANXIETY

he latest data on climate change is both Nature’s Living Planet Index reveals humanity 14 irrefutable and alarming. According to has wiped out 60% of mammals, birds, fish T a new, authoritative report from the and reptiles since 1970. This is partly caused by American Meteorological Society, all major climate change, partly by human destruction indicators of climate change – namely record of habitat and methods of food production that temperatures, increased sea levels, sea ice at have wiped out functioning ecologies. Many a record low, coral reefs dying and extreme species, on whose existence we directly depend, weather events – ‘reflect trends consistent have declined drastically. Moths, bees and ROS COWARD with a warming planet1’. Meanwhile, there’s butterflies, the pollinators of our plants as well is a journalist, author as food for other species, are for the most part in and academic, with been no reduction in the greenhouse gases a special interest in responsible for global warming: indeed, in catastrophic decline. The widely accepted term the environment. 2018, carbon dioxide emissions were at the is Anthropocene, describing the geological era She regularly writes highest level since records began. where human activity is the dominant influence for Ecologist and Earlier this year the Intergovernmental Panel over climate and now shapes the environment Resurgence magazine on Climate Change spelled out the implications and the fate of other species. and between 2004 and of this for life on earth . The current temperature Climate warnings in the past felt abstract, and 2012 was on the board of rises of 1.5 degrees higher than pre-industrial environmentalists like me struggled to get media directors of Greenpeace levels are already creating dangerous changes coverage. Now the threat posed by humans to to the planet’s ecology. However, the report their own planet is staring us in the face. There continues, these temperature rises are likely to are powerful documentaries on plastic pollution go higher than this within as little as 12 years. of the ocean or the burning of the Amazon This is because of the ‘runaway effects’ of global rainforest. Rarely a day goes by without news warming caused by the melting ice cap. Without of some climate-related traumatic events like the ice cap, the effect of greenhouse gases is flooding, drought, extreme storms and wildfires. amplified. The implications are scary. Unless rises We can see it with our own eyes too. This year can be kept to under 1.5 degrees, we are ‘dicing I visited a glacier in Norway 28 years after my with the planet’s liveability’. first visit there. It had receded a full 300 metres, leaving bare rocks where before we had been HUMAN INTERFERENCE awed by groaning turquoise ice looming over Meanwhile ‘nature’ is disappearing before our us. Closer to home, I’m painfully aware of how eyes, such are the pressures on biodiversity depleted nature is compared with what it was like on land and sea. The World Wide Fund for when I was a child.

New Psychotherapist / Autumn 2019 15 Projects that help to restore nature, such as the rewilding of Knepp Castle in West Sussex (see p17), also help to inspire hope Report / Hope and resilience

‘But does this concern about the environment really have a place in therapy?’

Distressingly, governments don’t seem to take this seriously, prioritising support for economic development over environmental protection. But in the wider culture, alarm bells are well and truly ringing. The language is of urgency and imminent 16 extinction: ‘extinction rebellion’, ‘species extinction’, ‘climate emergency’, ‘climate crisis’, ‘climate catastrophe’. Far from offering consolation, new activists fan the flames. ‘Adults keep saying, we owe psychotherapists to change. Psychotherapist Tree it to the young people to give them hope,’ says Greta Staunton says: ‘While psychotherapists are trained Thunberg, founder of the school strike for climate to help their clients face difficult truths in their own movement in 2018, ‘but I don’t want your hope, I want lives, they have not previously had to face global you to panic.’ situations which place them in the same situation as As this urgency intensifies, so has individual anxiety. their clients: they too face an uncertain future for their Psychotherapists are encountering a new phenomenon children and grandchildren and must find ways to in their consulting rooms, anxiety about the planet manage their own responses, as well as helping their (see panel, page 19). They are meeting guilt at the clients. This is a new situation for all of us – we are “all consumerism that has gobbled up the earth, despair in the same boat”. My current focus as a counselling at the lost richness of nature, anger at fellow citizens and psychotherapy training provider is to ensure that who do nothing, impotence in the face of governments’ the therapists of tomorrow are adequately prepared failure to take it seriously, and often, a background fear – in terms of having managed their own feeling that an environmentally triggered disaster could strike. responses – to assist their future clients.’ Conflict is in-built, too – between nations where the Psychotherapist, eco-psychologist and author of ‘developed’ world is seen as hypocritical in criticising Climate on the Couch, Mary Jayne Rust, argues that developing nations for their treatment of nature, the challenge of climate change and the destruction and between generations where parents are seen as of nature requires ‘a sea change’ in psychotherapy’s, handing the next generation a trashed planet. and psychotherapists’, whole relation to nature. There But does this concern about the environment really needs to be a shift, she says, from a utilitarian idea of have a place in therapy? Does therapy have anything to what we can use nature for, to how can we give back offer a global problem? Are therapists equipped to cope to nature, an approach she thinks that challenges the with the issue? whole basis of what therapeutic knowledge is. For example, she now accepts that humans can and CHANGING PRACTICE do have as deep attachments to the natural world and It’s striking talking to psychotherapists concerned other species as they do to humans. If this comes up with the issue of climate anxiety, how all of in the consulting room, instead of approaching these them emphasise the need for psychotherapy and attachments as metaphoric, she allows them their full

New Psychotherapist / Autumn 2019 CASE STUDIES

RESTORATION PROJECTS Successful programmes it’s one of the last sets to face the reality that inspire hope of what’s happening.’ According to Chris Robertson, there are a number of key psychological issues Small-scale which eco-psychology is addressing both in restoration of relation to clients’ and to psychotherapists’ peat bogs in own responses. At the forefront are denial the UK and rationalisation. These are ‘the defences that we use to avoid facing these difficult feelings and which have become integral to sustaining our exploitative relations The reforestation of the Scottish with both the non-human and human Highlands worlds’. In contrast, eco-psychology allows the client to connect with feelings of depression and despair about the state of the environment. Interpersonal Restoration psychotherapist, Hilda Burke, explains: ‘I of Patagonian want people to feel depressed about climate wetlands change. This is about getting away from the heroic “Let’s all save the planet”, and a call to look under the surface, to go within, to Reintroduction be reflective, to feel sadness and loss and of keystone species despair and grief, because these feelings like beavers

Dave Bain Dave Illustration: and wolves hold transformational possibilities for us.’ 17 Along with facing depression is accepting the conflicts, dilemmas and paradoxes place and meaning. ‘What,’ she asks, ‘of the grief for that individuals and groups meet with in Rewilding project places, animals, trees that you may have lost? These negotiating change with family, friends, in Oostvaarders- are stories about love, awe and beauty, as well as grief, neighbours and colleagues. plassen, Holland rage and pain for the losses in the wider world now.’ The therapists interviewed for this article are all CHALLENGING ASSUMPTIONS members of the Climate Psychology Alliance, part of Another area requiring psychotherapists a growing movement of therapists foregrounding the to take a different approach is towards Recovery project implications of climate change for their profession. the cultural assumptions and practices of Knepp Castle in In 2008, the American Psychological Association ‘which have driven us to the climate crisis: West Sussex, UK established a climate change task force. In the UK, the the sense of privilege and entitlement, Climate Psychology Alliance came into being between materialism and consumerism, and the 2009 and 2012, developing out of a conference held at faith in progress,’ says Mary Jayne Rust. the University of the West of England in 2009 called Effecting change at the level of values These projects powerfully ‘Facing Climate Change’. has form in psychotherapy. She points send the message that ‘It was initially an informal group of to the way in which critiques of racism nature can recover. psychotherapists from a variety of therapeutic and gender stereotypes were illuminated Importantly, studies modalities who came together to discuss the possibility by – and illuminated – psychotherapy’s connected with these of forming an organisation to promote a deeper exploration of the inner world. Therapy projects also show that understanding of the psychological issues connected to could now use those insights in the nature’s recovery provides climate change,’ says Chris Robertson, psychotherapist, service of changing attitudes towards the at least a partial solution to trainer and chair of the Climate Psychology Alliance. environment. She also points to the way in climate change. Wetlands, Since then it has provided a network and which it was psychotherapy which ‘helped forests and even soil workshops for psychotherapists who want to take on find a language about the inner world; we sequester carbon and lower board the ‘existential’ implications of climate change now need to find a language about the temperatures, so to restore in their practice. Although the numbers are growing, relationship with the non-human world’. full biodiversity is also to those involved feel it’s been hard work getting to this Finally, says Chris Robertson, an eco- help slow down runaway point. ‘It’s been slow to catch on. I’m so embarrassed psychological approach is about helping rising temperatures. by my profession,’ says Mary Jayne Rust. ‘It feels like put people in touch with ‘the psychological

New Psychotherapist / Autumn 2019

Report / Hope and resilience

resources – resilience, courage, radical hope, new It’s not a matter of giving false hope, but of showing forms of imagination – that support change’. No one how once engaged, anxiety goes down. When they would disagree, and all the therapists I spoke to for take the first step, by taking up volunteering or joining this article raised the issue of helping clients – and Greenpeace, the client typically feels better.’ themselves – find hope. Much more complex are the underlying philosophical issues of how to hold onto hope GIVING HOPE IN A WORLD OF DESPAIR when the vision, accepted by ecologically aware The straightforward part of this is offering practical psychotherapists, is so dark. This is particularly help and many of the Climate Psychological Alliance problematic when eco-psychology adopts a more specifically offer their services to environmental hard-core deep-green agenda. At its most intense, this activists, such as those involved in Extinction agenda argues that the planet’s liveability is already Rebellion, recognising burn-out and the pressure to compromised, that difficult social change and chaos be cheerleaders leaving them unable to deal with their are inevitable. It emphasises grief and mourning as a own inner doubts and anxieties. Some therapists route to deep personal adaptation. also encourage clients ‘to use anxiety for good’, says Long-established NGOs and environmentalists Hilda Burke. ‘It’s about helping clients understand that focus as much on influencing governments that although they are one individual there are others and business as influencing individual behaviour concerned – that individual action can affect change. are suspicious of the somewhat millenarian nature

Climate anxiety was extremely distressed about the like that recently averted says Dr Courtney Howard, the level of waste at her workplace: her collapsing dam in Whaley Bridge board president of the Canadian Worry about climate change has colleagues didn’t seem to care and in Derbyshire; repeated trauma Association of Physicians for the now reached ‘record levels’, with she was distressed that her own such as farmers struggling with Environment. ‘We are searching for 85% of Britons surveyed by Ipsos efforts felt pointless in this context.’ the erosion of livelihood due to terms to capture this deep feeling MORI in July 2019 ‘concerned’ Psychotherapist Caroline rising temperatures; and the direct of pain in Arctic nations – words 19 and 52% ‘very concerned’ about Hickman reports similar consequence of temperatures going like “ecological grief” – but for rising temperatures5. These experiences. ‘I am aware of dozens above what we are acclimatised to. me, something called “solastalgia” are the highest levels since the of people – almost everyone who Far from being a western millennials’ perfectly sums up how people living survey began in 2005, and the is engaged in any activist work – all malaise, the people affected by on the frontline of climate change last time Britons were asked feeling it acutely. People have huge direct impact she says are ‘usually feel.’ The term is related to an Inuit about climate anxiety, in 2014, fears of impending environmental the most vulnerable in society’. word that refers to a friend behaving just 18% were very concerned disaster and social collapse. These Evidence of this is emerging from in an unfamiliar way. ‘It means about climate change. fears can feel overwhelming. many communities on the frontline. feeling homesick when you are Hilda Burke is one of many British All made worse by mainstream A funeral was held this year to home,’ says Howard. psychotherapists who thinks this (seeming) inaction, apathy, mourn the disappearance of the Anxiety about the planet is quite anxiety can no longer be avoided indifference and what seems to be Okjökull glacier in western Iceland, a unlike other anxieties, says Hilda in consulting rooms. ‘I have noticed a lack of taking these real threats ceremony which acknowledged the Burke. ‘Psychotherapy traditionally an increasing number of clients seriously. I think this anxiety is grief caused by the transformation has confronted most anxieties expressing anxiety over the state of massively increasing.’ of the landscape. In Greenland, by helping dismantle the client’s the planet, and indeed its survival,’ Other major mental health issues temperature rises have transformed fear and helping them understand she says. ‘Recently one of my clients arise from the direct impact of the familiar geography and where these fears come from. But climate change, about lifestyles that depend upon it, and anxiety about climate change is which the psychiatric 76% of people studied in a recent a qualitatively different worry in community has been report have experienced negative that the state of the environment aware for some effects of increased temperature, has to be tackled in a different time, says Jungian ‘from coping with dangerous sea way because there’s no refuting psychotherapist ice journeys to having sled dogs it. The climate crisis is real and Judith Anderson. euthanised for economic reasons unavoidable, concern about it She points to three tied to shorter winters6’. is substantiated by scientific main ways climate ‘There is no question Arctic data.’ For the psychologists and change is having an people are now showing symptoms psychotherapists facing climate impact on mental of anxiety, “ecological grief” and anxiety, the evidence points in one health: catastrophe, or even post-traumatic stress related direction: to change their practice, imminent catastrophe, to the effects of climate change,’ to understand the wider context.

Climate anxiety is felt acutely by those whose landscape and culture are directly affected by climate change New Psychotherapist / Autumn 2019 References and reading

(1) American Meteorological Society. (2019). Climate Change: An information statement of the American Meteorological Society. ametsoc.org/ams/assets/ Image/aboutams/statement_pdf/AMS_ Statement_Climate_Change_April2019.pdf (2) Intergovernmental Panel on Climate Change. (2019). Special Report. ipcc.ch/sr15 (3) World Wild Fund for Nature. (2018). Living Planet Report 2018. worldwildlife. org/publications/living-planet-report-2018 (4) Yale Program on Climate Change Communication, George Mason University Center for Climate Change Communication. (2018). Climate Change in the American Mind 2018. climatecommunication.yale.edu/wp- content/uploads/2019/01/Climate-Change- American-Mind-December-2018.pdf (5) Ipsos MORI. (2019). Climate change and the weather. ipsos.com/sites/default/ files/ct/news/documents/2019-08/ climate_change_charts.pdf. (6) Minor, K., Agneman, G., Davidsen, 20 N., Kleemann, N., Markussen, U., Olsen, A., Lassen, D. and Rosing, MT. (2019). Greenlandic Perspectives on Climate

Dave Bain Dave Illustration: Change 2018-2019 Results from a National Survey. kraksfondbyforskning.dk/en/blog/ gp-climatechange

of this language. When it comes to the to places I loved but also the sense of how science, there’s not much between the depleted nature had become. Having taken two approaches, but what’s really at the voluntary redundancy, I joined a small Climate change and the destruction of heart of this disagreement is whether group of conservation volunteers working nature are the most pressing issues of our foregrounding and endorsing anxiety on restoring the landscape and ecology of times. There’s no easy winner between about extreme climate change and the River Stour in Kent. hope and despair. But therapists who potential social collapse – the end of the This was an important move for me. have been thinking about these issues world as we know it – spurs action or On the one hand, I found a group of like- are united on one aspect of why they hopelessness. Environmentalists are more minded people, all, like myself, saddened can allow themselves some hope: they inclined to emphasise the possibility of by the loss of nature. On the other, I began feel hopeful that finally their profession solutions, however difficult, and therefore to understand how it was possible to repair is prepared to open up to the reality of caution against the despair that follows nature, and by doing so, repair ourselves. Of climate change. And this means that any approach that does not appear to offer course this intimate connection with the recognising and preparing for the scale of technical and political solutions. river meant coming up against the scale of the impact of climate change on mental It may be that developments within the problem first hand – the loss of habitat, wellbeing is crucial, and sufficient funding environmental thought and activism are ecosystem collapse, pollution, neglect. But must be directed to services to ensure recalibrating the balance between hope it also meant experiencing, through small everyone can access therapeutic support and despair, through a new emphasis on tasks in and around the river, glimmers no matter their background. the restoration of nature (p17). I have been of hope that nature wasn’t beyond repair, involved in environmental politics and indeed occasionally, a sense that the journalism for a long time, but a few years damage could be reversed. This project, and What do you think? ago I began to notice signs of burn-out others, send the message that nature can Share your thoughts and and distress about what was happening recover, and nature’s recovery provides at opinions by emailing: to nature, not just the immediate threat least a partial solution to climate change. [email protected]

New Psychotherapist / Autumn 2019

Interview / Tree Staunton & Caroline Hickman

We are all fully vulnerable to the climate emergency

HOW IS THE CLIMATE EMERGENCY IMPACTING THE CONSULTING ROOM? RADHIKA HOLMSTRÖM TALKS TO TWO PSYCHOTHERAPISTS WHO SPECIALISE IN THIS AREA

t’s taken me 10 years to really come to be ‘When you think about change, it’s something we effective about climate change – I had to go project into the future that we can deal with later, ‘I through my own process of despair and grief whereas, an “emergency” reframes it in the language 22 and the other things you go through when you used by the 16-year-old Swedish environmental realise what we’ve done.’ activist, Greta Thunberg: “Your house is on fire; why So says Tree Staunton, UKCP-accredited aren’t you reacting?”’ psychotherapist and Director of Training at the Bath Both Staunton and Hickman understand Centre for Psychotherapy & Counselling, who has a long- that therapists need to work through their own standing involvement in climate change activism. She responses, so that they can be there for their lives in Stroud, the home of Extinction Rebellion. clients, ‘in the same way we expect them to work on Caroline Hickman, Staunton’s co-speaker at UKCP’s their psychotherapy process when they are training, conference ‘Sleepwalking into the Anthropocene in order to understand their own issues that might – the new age of anxiety’, is a psychotherapist and get in the way and influence the nature of their teaching fellow at the University of Bath and part of relationship with clients,’ Staunton says. the Climate Psychology Alliance. She claims that the UK parliament’s declaration of a climate emergency, plus the fact that professional bodies and others are starting to make that definition, has also shifted an awareness of the issue in the public’s consciousness. ‘Changing the language to “emergency” shifts the emotional engagement with it,’ Hickman says.

‘Changing the language to “emergency” shifts the emotional engagement with it’

The new age of anxiety: therapists must first understand their own anxiety over climate change to help clients

New Psychotherapist / Autumn 2019 BELOW: Media coverage of retreating glaciers is raising public awareness of climate change

‘We are talking about mapping the process that people need to go through in order to come to an acceptance and resolution of the facts as we know them, and then be able to come through to some kind of action in themselves,’ she adds. ‘But the big difference is that with climate change, we are all in the same boat. It affects us all.’ Hickman and Staunton need no telling how the ‘climate emergency’ has become undeniable. However, it has only just started becoming an issue for the field of psychotherapy. ‘Last October I invited Caroline to come and speak at my conference on Being a Psychotherapist in a Time of Climate Catastrophe, and ‘Dealing with clients very few people attended. People said they wanted something more clinically focused,’ says Staunton. presenting with climate ‘Now, less than a year on, I would expect the outcome to be very different.’ Hickman adds, ‘For many, it’s a anxiety – as a mix of new thing to engage with.’ different traumas – is

VISIONS OF APOCALYPSE a huge challenge’ It’s new – and certainly for the individuals who are 23 presenting in the therapeutic space, it is literally too large to imagine, Hickman explains. ‘How is a comfortable falling back on ‘how things have always human supposed to cope with seeing images of the been’ is not available to them. ‘Parents say their Arctic on fire? What they are talking about is fear of children are full of rage and despair and grief. Young annihilation – and that is something that we’re not people are angry because their parents don’t feel the necessarily col lectively familiar with in the West, same way. Young women are wondering whether it where we don’t face naturally occurring events like is ethical to bring children into this world. There is a that. This is taking us psychologically into a new place huge generational divide.’ in our psyche. We are moving into an era that we have no blueprint for; many of us have only just started to RISING TO THE PROFESSIONAL CHALLENGE believe it is happening at all.’ Unsurprisingly, some For psychotherapists who may be in the midst of people reach the point where they cannot go to work working through their own responses to climate or function competently. emergency, dealing with clients presenting with ‘There may be very different aspects that people climate anxiety is a huge challenge: a mix of projected latch onto as the worst possible thing for them,’ trauma, fantasy trauma and actual trauma. To that Staunton points out. ‘We all have very different fears end, Staunton is working on a continuing professional and fantasies. For some it could be the fear of the development (CPD) programme for therapists, and displaced hordes banging on their door. For others it the Climate Psychology Alliance is developing might be being drowned in storms and hurricanes or workshops as well. for others it might be being hungry. There are different Both Staunton and Hickman point out that it is things that are more or less frightening on a fantasy a situation that is quite unique for practitioners. level.’ It is a mix of ‘vicarious trauma’ – empathising ‘If someone was coming to me with a marriage with others already experiencing the trauma that the problem, it would be unlikely for me 100% to connect emergency is inflicting – and fantasies of what may empathetically with what they are describing. This (or will) happen. ‘That is happening to all of us at the is different. We are fully vulnerable to the climate moment, being exposed to visual reports of extreme emergency,’ says Hickman. ‘I’ve noticed all the classic trauma in the rest of the world,’ says Staunton. defences of denial and disavowal, both within oneself It’s also not surprising, Hickman adds, that young and in the other person.’ She adds, ‘The first thing to people are finding it particularly difficult, because notice is your own feelings of anxiety. Then, rather this is the only world they have ever known; the than defend against it, make use of that feeling of

New Psychotherapist / Autumn 2019 Interview / Tree Staunton & Caroline Hickman

anxiety within the relationship to inform both of you about what is going on.’ At the moment, there is still a widespread tendency to pathologise that anxiety, especially for children. Hickman hears a lot of stories from RIGHT: children and young people about how they have been Swedish student given medication rather than having their feelings Greta Thunberg recognised and validated. ‘We are used, in the western leads the ‘School medical model, to the idea that adults know best and strike for climate’ there is a solution to distress and we particularly apply movement that to children. Instead, we should be empowering them to find some solutions to that distress.’ It is similar to the process of accepting a life- And how can psychotherapists be part of that threatening illness. ‘At the moment there is a lot solution? When it comes to dealing with vicarious about blame. We feel devastated and also that it’s our trauma, ‘Therapists clearly know quite a lot about fault,’ Staunton says. ‘We have to move beyond that bringing people back into experiencing themselves,’ blame to a kind of acceptance. With illness, we realise says Staunton. ‘Some of what we will be doing is that the end point of that bereavement process is noticing when people are going into a trauma space deep gratitude for and appreciation of this life – an and bringing them back. I think this is very important. appreciation of now – and you do see this here too, The skills of coping with “not knowing” can also come hanging on to an appreciation of this world.’ into play. In the same way that we don’t know what However, this also demands a considerable shift will happen with someone in a crisis, none of us know for practitioners too, because it’s a move, as Hickman how it is going to play out. When clients come with puts it, ‘from ego to eco’ – from the conventional 24 extreme fantasies, we need to be able to sit with them perspective to eco-psychology. ‘In some ways and not immediately find an answer.’ psychotherapy focuses on “me” without the wider concern about the bigger “we”. That’s why we are in FROM EGO TO ECO this situation in the first place,’ Staunton points out. The ‘not knowing’, however, does not mean that And indeed, both of them advocate (and take part in) they feel the climate emergency can be averted. ‘It’s climate emergency action that goes far beyond the already too late,’ Hickman says forcefully. ‘Millions therapist’s consulting room. ‘We are used to having of species and hundreds of thousands of people have our quite protected environment and can “hold” already died. Just because it’s not happening to you, things because of that frame, but we need to be going doesn’t mean it’s not happening. Instead of creating out into the community and making it possible to false hope we need to stay with the pain and deepen have those conversations,’ Staunton adds. ‘We need to psychologically, grow down into a kind of deeper use what we know and work with about safe space – capacity to engage with painful things.’ and that is very challenging for psychotherapists.’ And there is, Hickman argues, something that we can gain from the climate emergency, in all its destructiveness. ‘It doesn’t have to be all doom and gloom and loss. There is the transformational possibility if we move to a place of reconnection PODCASTING with the natural world, with family and children, the possibility that we can deepen and grow and Hickman and Staunton have made Climate Crisis Conversations ‘Catastrophe or re-engage with things we have lost. In these instances, Transformation’, a series hosted by Verity it’s the “other” inside ourselves that connects with this Sharp, for the Climate Psychology Alliance, Tree Staunton and ecological consciousness, not seeing nature as “out produced by Parity Audio. The series aims Caroline Hickman there”, but recognising that we are part of nature and to develop talks that mirror and build on the engaging with our dependence on nature.’ kinds of conversations they have with clients. public and psychotherapists can take part ‘We find it a useful way to explore these in too. My hope is that people can find one difficult issues, using a conversation style aspect there which is useful.’ Hickman and familiar to us as therapists,’ says Hickman. Staunton will be making a podcast from their What do you think? ‘We wanted to have a whole range of presentation at the UKCP conference. Share your thoughts and conversations between therapists that the climatepsychology.podbean.com/ opinions by emailing: [email protected]

New Psychotherapist / Autumn 2019

The Big Report Our surroundings

THE SOLUTION

NOT THE PROBLEM 27

VERY LITTLE IS KNOWN ABOUT OUR PSYCHOLOGICAL RELATIONSHIP WITH CITIES. HAZEL DAVIS EXPLAINS WHY PSYCHOTHERAPISTS ARE KEY TO UNCOVERING AND SHAPING IT

he city is not a safe space and does not give room gladly,’ artist Jane Samuels writes in ‘T 1 Psychogeography and Psychotherapy . ‘There is no active listening to be found from stone and steel and, often, very little offered by the councils and corporations that construct the streets and squares.’ Yet, more and more of us are heading into them. In fact, UN figures show that 55% of the world’s

Ikon Images Ikon Illustration: population currently live in urban areas and this figure is expected to increase to 68% by 20502. We are now a predominantly urban species, yet we know very little about the

New Psychotherapist / Autumn 2019 Report / Our surroundings

‘We must now accept a simple fact: the future success of our species is intimately linked to that of our cities’

impacts of urban life on the existential, emotional and psychological make-up of city residents. What we do know is that cities are often associated with higher rates of most mental health issues compared with rural areas – an almost 40% higher risk of depression and a 20% greater risk of anxiety. ‘While cities can serve as citadels of freedom, tolerance and creativity, arguably, the social determinants of poor mental health are today coalescing in especially intense ways in urban 28 centres, placing unique strains on the psychological vitality of urban citizens,’ says Professor Mark Boyle, Director of the Heseltine Institute for Public Policy, Practice and Place at the University of Liverpool. ‘Economic risk, precarity and vulnerability are good habitat for mountain gorillas than being felt deeply by many as the defining existential we do about living in our own cities”. This is challenges of today. These threats combine uniquely particularly the case for the emotional and mental in cities, jeopardising the wellbeing of communities health impacts of city living.’ dwelling in disempowered, disadvantaged, “left- behind” and discontented cities, towns and NEW COLLABORATION neighbourhoods. And this is to say nothing of the ‘The figures show that we like cities,’ Murray says. psychological wounds that result from eking out a life ‘But we know far too little about their emotional in the slums that scar mega-cities in the Global South impact. It is astonishing then that disciplines that and ever-growing refugee city-camps,’ he adds. are most concerned with emotional and mental Or perhaps we are too quick to point the finger at wellbeing, such as psychotherapy, are virtually city life. Research has also shown that lonely young unused as a tool in making and managing cities.’ people perceive their neighbourhoods as lacking in There is a growing appreciation that environments cohesion, suggesting that feeling lonely can put a that nurture wellbeing are good for social cohesion negative bias on people’s subjective perceptions of as well as economic productivity and growth, their area4. Is it how we use cities, rather than cities reflected in the emergence of a new movement: themselves, that is the problem? urban psychology. This collaboration between ‘The global rise in urban living is so staggering that planners and developers, the NHS, mental health we must now accept a simple fact: the future experts and academics is focused on how to create success of our species is intimately linked healthy cities. to that of our cities,’ says Chris Murray, In June 2019, academic, policy and therapy Director of Core Cities UK, an advocacy experts came together at the Urban Psychology 55% group with an aim to ‘unlock the full Summit, to explore these issues, such as how of the world’s potential of our great cities to create a psychotherapeutically informed design can population stronger, fairer economy and society.’ strengthen a city population’s mental health currently live in But, he adds, ‘as Danish architect Jan Gehl resilience for prevention and recovery, and what urban areas said, “We know more about what makes a can be done to achieve this.

New Psychotherapist / Autumn 2019 Report / Our surroundings

‘We only need to look at split City-dwellers are neighbourhoods between the haves and have-nots, 40% engendering feelings of more at risk of injustice and hopelessness, and experiences of prejudice depression compared and discrimination that may with rural affect mental health,’ Professor counterparts Niblock says. ‘This is of particular concern to those working with children who are seeing a higher incidence of mental health issues starting early in areas with more crime and a lack of social cohesion.’ With gentrification, people have to leave behind social and familial connections, ‘not to mention the sheer impact of overworking to pay extraordinary rents for less-than-ideal living conditions,’ she adds.

PSYCHOTHERAPY’S ROLE Up to 75% of mental health problems begin in childhood or adolescence, when the brain is developing rapidly. ‘There is an urgent need to create healthy environments for children where they can interact and learn safely through play,’ says Professor Niblock. ‘People who live in the city experience an increased stimulus level: density, crowding, noise, 29 smells, sights, disarray, pollution and intensity of other inputs. Every part of the urban environment is deliberately designed to assert meanings and Findings from the event, organised by the messages. Not only does it mean you’re always in a University of Liverpool’s Heseltine Institute, Core state of mental arousal, it also means you want to just Cities UK and the British Council, proved interesting: shut yourself away. Yet that can lead to social isolation ‘We need to think about person and place as one and loneliness, which is very bad for mental wellness.’ thing, not separate,’ Murray says, ‘because our So the work of mental health professionals, such as experience of place determines so much of our psychotherapists, in working with individual children wellbeing.’ He agrees that the richness of thinking and adults, and working systemically with groups of and evidence across different branches of psychology, people living in urban environments is crucial, and including psychotherapy, could greatly improve not just as a response to mental ill-health. the lives of people in cities, ‘but it is largely ‘Our therapists hold an incredible repository of unknown to those running [cities] or making knowledge and I would like to see the profession policy decisions and needs to be brought together What do represented on planning committees, boards and you think? and made more accessible.’ governing bodies where they can communicate the Share your thoughts We also need to remember that data don’t always human impact and potential to decision-makers,’ and opinions by tell the full story. ‘While the statistics may look stark, emailing: Professor Niblock says. ‘Psychotherapy tends to be the numbers don’t reflect the nuances,’ says Professor [email protected] thought of as a “treatment” for people in crisis, when Sarah Niblock, Chief Executive of the UK Council for it is a great deal more than that.’ Psychotherapy, who chaired the summit. ‘It isn’t the The UKCP is holding conversations with academic case necessarily that cities are mentally unhealthy partners such as the Heseltine Institute, Cities places to live. Some people move into cities to be UK and the British Council, as well as planners, close to mental health support because they have developers and the NHS. ‘We are all finally talking pre-existing experiences of depression together in new ways about shaping or anxiety. Cities can be as much the the future of cities. Our shared vision is solution to mental and emotional distress that cities become the solution and not as the cause.’ What city-living does illuminate, she the problem,’ Professor Niblock says. For example, adds, is how much mental and emotional ill-health is Murray suggests that we don’t see cities through a social issue, rather than a medical illness. a mechanical lens as ‘machines to be fixed’. They

New Psychotherapist / Autumn 2019

Report / Our surroundings

‘When we think about the many challenges of our age – such as inequality – it seems so often that cities are the problem’

are, he says, ‘living cultural organisms they are not fragmented they have a great made of people first, structures second capacity to improve wellbeing in a cost- – flipping that around will change effective and ecological way. Cities help us our understanding.’ to connect our innovation and creativity Although the evidence base is growing, that would allow us to thrive and grow.’ References Murray agrees that more direct research The way different people and activities into cities and psychology is urgently interconnect is important, she explains. needed: ‘This will help cities and those (1) Samuels, J. (2019). Taking Space. ‘Game theory shows how people respond living in them, but it will also, in a way, Psychogeography and Psychotherapy. to rules. If you want a different outcome help psychology by restating its urban Chris Rose (ed), PCCS Books then you need to change the rules. Those credentials and making it more relevant (2) population.un.org/wup conditions are not often the ones that 31 to place-makers and managers, across (3) jamanetwork.com/journals/ planners think are the good qualities.’ many disciplines and sectors.’ jamapsychiatry/fullarticle/2729441 ‘Place-making may be a powerful – if For example, a study of lottery winners (4) journals.sagepub.com/doi/ hitherto neglected – weapon in the has shown that the effects of winning full/10.1177/0956797619836102 therapeutic arsenal,’ agrees Professor Boyle. £500,000 wore off much quicker than the (5) ncbi.nlm.nih.gov/pmc/articles/ ‘It is clear that to become better incubators lasting benefits of living close to green PMC4180795 for human flourishing our cities need a new space5. But, according to the Green Space (6) Fields in Trust. (2019). Green Space generation of practitioners with fresh ideas.’ Index, 2.6 million people in Britain do not Index. fieldsintrust.org/green-space- Evolutionary psychology reminds us that live within a ten-minute walk of a park or index/faqs. poor mental health exists as an intrinsic green space, and across the country there and perhaps even necessary species are just 35 square metres of publicly- condition: ‘It is clear that psychotherapies accessible park and green space provision and in the same way that increased levels centred upon building personal resilience, per person6. of autonomy are good for individual mindfulness, meditation, exercise, diet, ‘But greenery and landscaping doesn’t mental health, they are good for the abstinence, sleep and medication have a necessary mean it’s an interactive space,’ health of cities as a whole.’ crucial role to play,’ says Professor Boyle. Professor Niblock warns. ‘Yes, we have ‘But long-term solutions will require more social networks, conferences and so on, FRESH IDEAS than self-help techniques and drugs: it but they only complement the public ‘We all have an idea why human-centred may be that nothing less than a shift to space. Public space should connect us all cities are important,’ says Professor a more hospitable social, economic and together. The more connections, the more Niblock, ‘but it’s important to gather political milieu will do.’ cylinders you are firing on. Excluding the evidence to show to those making So this new field of urban psychology parts of the population puts a drag on the decisions.’ And, she adds, ‘the evidence and those who practise it must throw whole city.’ is stronger than we might think. There a light on the implications of social, This, of course, means psychology are many ways cities can promote well- economic and political change upon our and psychotherapy need to engage more being. When we think about the many fragile psyche. Moreover, Professor Boyle with the political sphere to shape and challenges of our age – such as inequality believes, ‘it must fuel activism dedicated influence future policy. ‘Change in the – it seems so often that cities are the to building more therapeutic cities UK also means empowering cities more,’ problem. Seen in another way, cities and through systematic societal change. As says Murray. ‘We live in one of the most towns are the solution – but we need to such, it is clear that it needs to develop as centralised states in the developed world think about the way we build them. When a politically aware field of enquiry.’

New Psychotherapist / Autumn 2019 Interview / Emma Marris

Shame and guilt over one’s individual contribution to climate change isn’t helpful

ACCLAIMED ENVIRONMENTAL WRITER AND JOURNALIST EMMA MARRIS IS ‘MORE INTERESTED IN FINDING AND DESCRIBING SOLUTIONS’ THAN FOCUSING ON GUILT AND ANXIETY WHEN IT COMES TO CLIMATE CHANGE. RADHIKA HOLMSTRÖM TALKS TO HER 32

ow do we stop climate change? ‘I think many ‘Climate change is absolutely going to change things people see it as a situation in which “we a lot, and hurt people. It is appropriate and probably H must stop emitting and return to an earlier, healthy to mourn those changes. It is also appropriate less technological mode of life”. This framing of the to be angry. However, shame and guilt over one’s problem can be appealing; it taps into nostalgia for individual contribution to the problem is probably less “simpler times” and romanticism about nature.’ helpful. Focusing exclusively on reducing one’s own Emma Marris believes that the way we frame climate impact and achieving eco-sainthood is both practically change is very important. ‘The story can’t be about ineffective and less mentally healthy.’ a “return” – it has to be about creating a new future together in which technologies are used to benefit FROM PARALYSIS TO ACTION people, not just make profits. This also means that the Getting past the paralysis and guilt is of paramount future doesn’t have to be about giving things up.’ importance to Marris. ‘I don’t think we can solve Does this mean we should stop feeling guilty and this by shaming each other. That’s not going to work. step away from preparing ourselves for an abstemious Instead of shaming about flying, it’s much better to join future? ‘Reality is more about change – and that does together and demand better alternatives. If I stop flying include giving up wasteful use of fossil fuels. But and never drive again, I could stop my emissions. If we it doesn’t mean some austere frugality and a thin, stop the pipeline I’m driving to to protest [Marris is one oppressively overseen life. It’s important to have fully of many people opposing the proposed 369km Pacific fleshed-out visions of a good future to balance the Connector Gas Pipeline that would cross beneath the dystopias we imagine in regards to climate change.’ Klamath River near the city of Klamath Falls, Oregon], A speaker at UKCP’s conference, ‘Sleepwalking we could stop 100 times that every year. So I feel into the Anthropocene – The New Age of Anxiety’, totally fine about driving my petrol car to the capital to the writer, journalist and TED-talker – whose works protest, because I’m stopping far more emissions than focus on modern environmentalism – is particularly I’m emitting. The only way to effect change is through interested in finding out whether psychotherapists’ political action, lawsuits, regulation: all the things that experiences correspond with what she has seen require groups to come together and demand change.’ anecdotally: people becoming paralysed with guilt, Marris sees a role for psychotherapists in enabling anger and anxiety. individuals to negotiate the acute guilt, fear and grief

New Psychotherapist / Autumn 2019 EMMA MARRIS Environmentalist and journalist A TED speaker, Marris is a writer who focuses on environmental science and culture. She lives in Klamath Falls, Oregon and has written for The New York Times, Nature and Discover. Her book Rambunctious Garden: Saving Nature in the Post-Wild World was published in 2013.

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New Psychotherapist / Autumn 2019 Interview / Emma Marris

that can paralyse them. ‘I do think setting before clients the fact that they are never going to solve climate change themselves, will be helpful. So many people judge themselves constantly for their ecological sins and I think this is extremely counterproductive. Those clients didn’t design the system within which they live and they should be able to forgive themselves if they have to live in it to participate in the world. ‘Those emotions are also appropriate and therapists can help clients feel them in a healthy way. Sometimes they can make you more likely to engage and act; but sometimes they can make you more Emma Marris believes that working together to likely to disengage, shut down and hide, fight climate change is not only ethical, it’s good and that’s when they are not serving you. collective therapy, too So I don’t think people should be trying to eliminate these emotions completely. Rather, they should be experiencing legacies of colonialism, slavery and using them as fuel for their actions. ‘If you have a client and so on; they’re all part of Last summer, we had so many wildfires who says “We’re totally the same project. In my own here that my children weren’t able area, the local Klamath tribe to leave the house for 10 days. I was doomed; I’m miserable”, is firmly against this pipeline 34 extremely angry, but I think that anger and yet the state of Oregon was justified and acceptable, and I used it helps to have the facts is taking no notice. Giving it to get up in the morning and go fight and vision to present indigenous people the right to this pipeline. But if I’d stayed angry and decide over their land is almost stayed at home, that anger could have another possibility’ a key strategy towards fighting grown pretty toxic.’ climate change and saving She adds: ‘I’m all about creating a species. Not every indigenous narrative where there is a positive future. want ‘authentic’, original flora and fauna group will make the decisions a green This might not be something for every around them. Instead, she suggests, a key NGO would make, but a lot of the area we psychotherapist, but it doesn’t hurt to element of the future we can envisage is still consider biodiverse and worth saving create relationships with researchers one that actively embraces hybridity and is that way because indigenous people who are working on how we can get to new possibilities. were running the place. It’s also a matter those good futures. If you’ve got a client In the same way, Marris’s belief in of justice. We should take indigenous who says “We’re totally doomed; I’m the need to reconnect with the natural sovereignty seriously.’ miserable”, it helps if you have the facts world is very different from ideas of ‘deep Despite everything, she concludes, and vision to present another possibility, ecology’ – an environmental philosophy a good future is still possible. ‘A good with options for groups to connect with that regards human life as one of many 2070 won’t look like 1950, but there is or futures to envision.’ equal components of a global ecosystem. no threshold after which it is “too late”. ‘I think deep ecology has specific roots We can always make things better by IMAGINING THE FUTURE and I’m sceptical about this. There can acting now. And the best way to act is Marris would also like to engage with be a certain machismo and purism, together. Happily, becoming part of a psychotherapists in starting to visualise that nature is holy and we’re not good group working for a better future is also a future that is genuinely new. ‘For many enough for it. We need a broad, inclusive an excellent form of therapy, providing of us, our sense of a “healthy” or “good” movement, not least because it’s right.’ social connection, community, and nature is very much about putting things building a sense of efficacy and agency. back to how they used to be: native, pure. PEOPLE AND PLANET You don’t have to be the leader or devote Providing alternative models of what Inevitably, social and environmental your every spare moment to the cause. could be a successful outcome is really justice are also inextricably linked in her Tailor your engagement to your skills, important.’ It’s ironic, she points out, vision. ‘The more I research this, the interests and abilities. Forgive yourself, that people who are very welcoming of more I see that bringing about climate join up with others, and allow yourself to human diversity are often the ones who justice is going to involve addressing the hope for a good, green future.’

New Psychotherapist / Autumn 2019

Interview / Molly Scott Cato MEP

MOLLY SCOTT CATO Green Party MEP for the South West of England and Gibraltar Scott Cato is an economist and writer and has been a campaigner for green issues throughout her adult life. Before being elected to the European Parliament, she served on Stroud District Council and 36 worked as a professor of economics at the University of Roehampton We need to move away from the idea that there are people with mental health issues and then there is everyone else

GREEN MEP MOLLY SCOTT CATO TALKS TO ANNA SCOTT ABOUT MENTAL HEALTH PROVISION AND RESILIENCE IN THE FACE OF CLIMATE CHANGE

37

have spent a lot of time in counselling during along with universal high-quality healthcare. This my life. It’s been an attempt to make myself a is particularly important given the growing sense of ‘I healthier person and achieve self-actualisation. To anxiety individuals feel about climate change. me that’s an incredibly valuable thing.’ Molly Scott Cato believes mental healthcare should A SHARED CONCERN be about treating the whole person to enable them to be ‘What has been really interesting about the Extinction as fulfilled and successful as they can. The Green MEP Rebellion movement is that it has shown how people for the South West of England and Gibraltar was re- have been worrying about climate change, but quietly elected in May this year with 18% of the vote, having in their own homes, without really sharing it,’ she says. first been elected in May 2014 with a 7% share. ‘It’s the worst kind of anxiety: when you feel like you A member of the Green Party since 1988, Scott Cato are alone with it and that nobody else feels the same has had a long career in politics – standing as the way. But Extinction Rebellion has given everybody the Green Party candidate for the Preseli Pembrokeshire chance to say, “no, actually, we all feel that way”.’ constituency in the 1997 and 2005 General Elections, Extinction Rebellion’s first demand is that finishing in third place in the 2017 General Election in ‘government must tell the truth by declaring a the Bristol West constituency, and spending three years climate and ecological emergency, working with other representing Valley Ward on Stroud District Council. institutions to communicate the urgency for change1’. ‘In the Green Party there aren’t many elected ‘We can see that climate change is happening but politicians so I have done a lot of campaigning, people in authority are lying about it. That is bad for standing for elections and not getting elected. But I’ve mental health,’ says Scott Cato. ‘The other thing is the always been interested in politics – I studied politics cognitive dissonance, where people pass a motion that at university,’ she says. ‘I was, and am, interested says we are living in a climate emergency and then in changing the world and I first did that through decide to expand an airport or build another road. campaigns and later through political activities.’ That is also a source of anxiety.’ The Green Party wants an EU-wide ‘Green New If governments were honest, consistent in their Deal’ that puts a social agenda at the heart of the fight responses and gave people clear guidance about what against climate change – providing new and better to do, ‘I think that the anxiety would be turned from jobs, improved welfare and reduced carbon emissions something that’s destructive into a source of energy for

New Psychotherapist / Autumn 2019 38 New Psychotherapist sense of being able to do things that make make able that of to being do things sense to astronger feel change climate about someone who worried is empower also could Therapy active. more to be them solace, or enabling find can they where situations to people seek encouraging outdoors, sessions holding is therapy that whether she adds, role to this, play in intervention. on government relying than rather wellbeing, own their toability find the have individuals because money NHS the save happier and them make it to would nature access more people nature.’ in time to spend opportunity the had never who have of children think you when sad It’snature. particularly don’t and to access environment have urban an up in grow some people it. But experienced Ihave because that’s ‘I she adds. know what Ineed important,’ really are quiet and peace for light noise, and me, and like things therapeutic. more environment natural a It’s find would we that understandable relaxation. enables that of stimulation level amuch lower provides birdsong with atree sitting under Whereas for wellbeing. mental not good clearly is of light noise. Overstimulation and lots is there where environments made man- in time of most our spend we now important.’ really is behaviour this –modelling nature in and relationships healthy in enough time enough, spend rest we sure ‘Making Cato out,Scott herself. points including don’tfor others example, agood set better life making about concerned doing.’ on focus action,’ ‘That’s should she says. what we everyone’ to happens that something lives… Ithink it’s their in crises health mental from suffers ‘Almost everybody Interview The psychotherapy profession has a a profession has psychotherapy The more give we if that CatoScott suggests towards person ‘I’m sensitive avery world yet natural ‘We the in evolve to be But alot claiming of people /Molly Scott Cato MEP / Autumn 2019

we can do,’ can we she adds. lots of things are there change, climate of case the not impotentin But are we depression. and anxiety in result can that ‘It’s a difference. of impotence sense the well-balanced mentally.’ and to happy feel struggle at times, will, who beings human sensitive and creative as We ourselves see should to everybody. it’s that happens that think something I difficulties. health mental experience at may work –we or stress bereavement –whether stress of great atthat times We lives. know their in crises health lead to depression. also can illness aphysical from suffering Similarly, Cato Scott conflict,’ says. mental conditions are the result of unaddressed physical many Ithink at all, separate as else. everyone and issues health mental with people are there idea that the from away move and look at health we mental that way to the consider need But also we CREATING PARITY Among the Green Party’s commitments Party’s commitments Green the Among mental from suffers ‘Almost everybody ‘I don’t health mental and physical see society, the party points out points society, party the wider within issue on the dialogue open amore to encourage introduced be should public sector the in training awareness health Mental networks. support and homes to their close supported are crises health mental experiencing people that to ensure and healthcare physical with line in healthcare pledge mental to bring the is public services and to NHS the some of UKCP’s major concerns. to address begin finally may guidelines of the draft third the that hope is there NICE and from concessions lead to several helped has securing, role in instrumental an UKCP played which campaign, for this support mental ill health ill mental with people against discriminates …actively guidelines new the to develop used stated ‘the that methodology year letter to NICE last across-party signed Lucas Caroline leader party former and MP Party Green groups. stakeholder health of mental coalition awider with for adults in depression NICE guidelines to the major changes to make campaign The party has also supported UKCP’s supported also has party The 3 ’. The parliamentary ’. parliamentary The 2 .

Photo: James Barke

Interview / Molly Scott Cato MEP

References

(1) Extinction Rebellion. (2019). Demands. rebellion.earth/the-truth/ demands (2) The Green Party. (2017). Our NHS and Public Services. greenparty.org.uk/ green-guarantee/our-nhs-and-public- services.html (3) Cross-party letter to NICE. (2018). twitter.com/normanlamb/ status/1019955921164828672 (4) Extinction Rebellion. (2019). A long-time resident of south- west England, Molly Scott Demands. rebellion.earth/the-truth/ Cato is now the region’s MEP demands

TREATMENTS should be making more situations ideal Scott Cato is ‘concerned’ about the for human beings to exist in. We should prevalence of cognitive behavioural be trying to create the ideal society where therapy in the NHS, which she feels people can achieve happiness.’ focuses on getting people to function The Green Party’s view is that a 41 effectively in situations that, actually, capitalist economy creates pressure to the problems that have arisen in they shouldn’t have to accept. ‘You’re in sell people products and the companies their lives. ‘There is a role for talking an impossibly stressful work situation or selling those products have a lot of policy therapies to encourage people to say that a relationship that you are encouraged to influence, compared to organisations the lives they are living are not good find a way to reframe for yourself so that offering human care, Scott Cato says. enough and something needs to change,’ it is acceptable.’ ‘I think you can clearly see that in the Scott Cato says. Similarly, she is ‘very disturbed’ by NHS. But it’s almost certainly cheaper Another of Extinction Rebellion’s the increasing rate of antidepressant and more effective to encourage people demands that interests her is the idea of prescriptions, which, she believes, is to have a talking therapy, to reduce their a citizens’ assembly, which brings people reaching a level of mass medication. need to keep going back to the doctor and together in a similar way to jury service, UKCP has been working with the All- getting prescriptions. to deliberate and make recommendations Party Parliamentary Group on Prescribed ‘One of the most frustrating things on issues of public concern4. ‘I don’t see Drug Dependence to raise awareness of with mental health is that there’s no it as an alternative to representative these rates, as well as to produce guidance sense of seeking out the causes, for government, but it could be a really enabling therapists to more comfortably example, testing children so much in useful addition,’ she adds. ‘Rather than discuss issues around psychiatric schools. It’s very much about managing government doing something that is medications their clients may be taking. symptoms. We should focus on how against people’s interests and then Scott Cato believes a major change unhealthy our societies are, whether spinning a line about why it is good for of approach is needed: ‘If that many we’re talking about how we treat each them (something else that creates mental people in our society need to take drugs other or not having enough opportunities health stress), we should be encouraging to get through their ordinary lives then to cycle in cities. We should change the people to share views with each other something about our society is wrong. We structure of society and the economy to about how to improve society.’ one in which people can thrive. There are days when Molly Scott That’s the major shift that I Cato finds it really hard to deal with ‘We should be trying to suggest we make.’ what is happening in politics but, at the same time, she sees big opportunities create an ideal society ENCOURAGING CHANGE to improve things. ‘I am absolutely where people can There is obviously a role for optimistic that we can turn this around psychotherapies, to help people and transform our society. And that’s achieve happiness’ when they are trying to unpick why I do the work that I do.’

New Psychotherapist / Autumn 2019 Feature Resilience and trauma

APPROACHING HUMAN DISTRESS

ED FELLOWS SET UP A GROUP TO TACKLE POST- TRAUMATIC STRESS DISORDER IN THE NHS. HE DESCRIBES HOW HE USES PSYCHOTHERAPY TO TREAT TRAUMA

he year 1992 marked a revolution ashamed, angry and cognitively confused. 42 in trauma psychotherapy practice In all trauma our older brain systems T with the publication of Judith take over and our rational, present-focused Herman’s book, Trauma and Recovery . cognitive functioning shuts down. Yet In the decades since, our understanding cognitive treatment attempts to approach of trauma has developed rapidly. We the client from a rationalistic perspective. now have clear knowledge of the way the Therefore, a purely cognitive approach can’t nervous system adjusts to cope with the address the fundamental ways that humans extreme threats that cause trauma. respond to trauma: how relationships with ED FELLOWS In primary care, people with post- others become frightening as trust is lost and is a UKCP-registered Gestalt psychotherapist traumatic stress disorder (PTSD) present the sense of threat becomes overwhelming. who also trained with a wide range of symptoms: anxiety, In PTSD with multiple underlying factors, in sensorimotor depression, interpersonal problems, physical it is mostly the embodied emotional memory psychotherapy, EMDR, pains, digestive problems and cognitive that drives behaviour. The emotions are yoga, mindfulness- difficulties, all relating to difficulties in overwhelming and create extreme bodily based cognitive therapy autonomic regulation. When the nervous reactions. In order to get cognition switched and counselling for system is stressed, we see all of these back on, we need to prioritise a safe relational depression. He began expressed as hyper-reactive states (for context, regulating with bodily awareness, working on inpatient example, moving erratically, having jumbled breathing, boundaries, centring and psychiatric wards thoughts, perhaps being hypervigilant grounding movements. 20 years ago and continues to work with and preoccupied), and also the opposite, inpatient groups, as well as apparently unresponsive and low-affect A TRAUMA GROUP as primary and secondary states (for example, being uncommunicative To establish a context where this is possible, care groups. and feeling numb, and finding questions I set up a trauma group within a London overwhelming). Improving Access to Psychological Therapies Post-traumatic stress is an embodied (IAPT) service. This is a four-session weekly response where the sense of self is group attended by up to 15 people of mixed fragmented. Relationship with one’s whole genders, cultures and ages who all share a self and others is interrupted by impulsive range of PTSD symptoms. actions driven by fear . These different The experiences that the group shares are parts of the self operate independently, only interwoven with trauma psycho-education5. increasing the sense of being out of control, The key elements of these groups are:

New Psychotherapist / Autumn 2019 Tom doesn’t have an incident to report, he has a life to report. A life of violence, of failed relationships that remind him of being threatened, beaten and neglected. Tom finds himself retreating from others, sometimes shouting at strangers, because any contact, in shops, on public transport or in the street, is too stressful. As with many trauma survivors, Tom is angry – and he’s direct with me; I like him. Going well over our allocated time, Tom and I agree to do a formal trauma assessment. We both discover he scores high on PTSD symptoms. This helps us identify some of his symptoms and helps me to give him some responses that indicate he’s having normal responses to difficult experiences. I mention that I facilitate a PTSD group where we help people to identify and 43 manage their symptoms. He sounds a bit unsure, so I let him know he will not have to talk about the traumatic events. He exhales deeply and decides to give it a try. At the start of the group Tom sits silent, completely still in his body, only his eyes darting around. His hypervigilance is running overtime. After brief introductions, I say that attending the Recognising symptoms as memories: screening, Tom offers little information group today probably contradicts every body sensations, thoughts, emotions, except he seems clear he wants help. impulse that goes with the post-traumatic movements Tom had liked his CBT therapist, but symptoms. How many people thought of Understanding how symptoms have was unable to remember details or say not turning up? Several smiles and nods. helped survival in the past what had helped in sessions. Under the Who has twitching legs? I show what Appreciating how members already spotlight of this cognitive approach, Tom’s movements can go with these impulses. manage their symptoms ability to cognitively process had reduced More smiles, then the room starts to Trying out new trauma-informed – a typical consequence of trauma. breathe more freely. I want to appreciate ways of relating to symptoms and In his notes, there is not enough how coming into this room is such an present experience. information about Tom. There is no achievement. I pass around stress balls, description of his life before his first make suggestions about using them, and How the trauma group works is best encounter with the service five years invite people to choose an essential oil shown by illustrating a patient’s journey ago, except that he attempted suicide at they find calming. Already, we start to through the IAPT service. Tom, for 15 years old. There are no clues as to why. relate to each other. I’ve hardly mentioned example, is a 54-year-old man who has symptoms, yet we had several previous treatments with are working with IAPT for anxiety and depression. Tom them, together. comes to IAPT for the fourth time asking ‘I’ve hardly mentioned Next, the group for help. Despite several previous CBT symptoms, yet we are is invited to share treatments, he is still struggling with some difficulties depression and outbursts of anger. In the working with them, together’ they think might

New Psychotherapist / Autumn 2019 Feature / Resilience and trauma

be related to trauma. Tom describes how being physically close to anyone makes him feel uneasy. I say this is a brilliant example of what happens when we’ve been hurt by others. We don’t want to be with them. People around Tom are sympathetic and try to give him more space. I ask how much distance would feel right for Tom. He says he would need the whole room to himself, ‘no one else here’. Another great example of how we end up feeling like withdrawing or pushing others away. Most trauma survivors are isolated by self-blame and are terrified of their own symptoms. If we appreciate how symptoms like Tom’s fear of others are reactions to being unsafe in the past, then we can develop a present perspective from which to build a new relationship with our past. People survive because of their symptoms, and when this is appreciated, the person can a significant gap in the system that is ill-equipped make more informed choices about how to assess and successfully treat people with post- they manage here and now. traumatic stress. With only a 40-minute phone call to 44 What often defines trauma is the take patient details, do a risk assessment and work out absence of cognitive memory. People what treatment they need, few therapists have time References don’t know their story in their thoughts: to pick up on the complexity of peoples’ lives. Many they live it in their bodies. No wonder trauma survivors slip through the net. (1) Herman, J. the mental health system so often fails If the therapist is able to move between cognitive (1992). Trauma and to recognise the effects of trauma. With and emotional ways of relating, then they can offer Recovery. New York: the absence of a clear cause and effect the patient an attuned and healing relationship. Routledge. narrative, patients’ symptoms are picked When we hold one or the other exclusively, we are (2) Van Der Kolk, B., up as anxiety, panic attacks, physical likely to be experienced as aggressive, neglectful or Hopper, J. and Osterman, health difficulties, depression, personality abandoning, a process of re-enactment that is re- J. (2001). Exploring the disorders, psychosis and other ‘disorders’. traumatising for the patient. Either way, as relational Nature of Traumatic psychotherapists and cognitive psychologists, it is Memory: Combining ROLE OF PSYCHOTHERAPY easy to impose our own needs on the patient. We Clinical Knowledge with To treat trauma effectively it’s essential become perpetrators. In my experience, the therapist Laboratory Methods. Phil. to work relationally. If we’re not socially needs to oscillate between different ways of being USA: The Haworth Press. engaged, we are unlikely to have well- with each patient. The challenge is to track our own, (3) Fisher, J. (2017). regulated nervous systems. If our nervous and the patient’s, embodied communication to know Healing the Fragmented systems are not well regulated, we are how they need us to stay regulating with them. Selves of Trauma Survivors. unlikely to be able to think clearly. With PTSD, the biggest challenge is for the therapist New York: Routledge. Without individual and group to stay attuned to the client, so that they can avoid (4) Porges, S.W. psychotherapeutic work there would be harmful re-enactments. As psychotherapists we have (2004) Neuroception: A a vital place in mental health services to Subconscious System for work collaboratively, and to communicate Detecting Threats and ‘With PTSD, the biggest with colleagues who may not understand Safety, in Zero to Three, our perspectives. I feel a responsibility v24 n5 p19-24. challenge is to stay to help provide more ethical therapies to (5) Taylor, M. (2014). the patients that all my colleagues and I Trauma Therapy and attuned to the client care about. If we work together, as whole Clinical Practice, to avoid harmful human beings, with whole human beings, Neuroscience, Gestalt our meetings can be experiences of hope and the Body. UK: Open re-enactments’ and healing. University Press.

New Psychotherapist / Autumn 2019

Feature Charities

EMOTIONAL SUSTENANCE VISITORS TO THE HAMMERSMITH AND FULHAM FOODBANK CAN ACCESS FREE PSYCHOTHERAPY FROM UKCP MEMBERS. JACQUELINE MCCOUAT EXPLAINS WHAT HER ORGANISATION DOES FOR THOSE IN CRISIS 46 quiet and leafy road in Counselling. From the start, Pollecoff West London is home to the and Cottom insisted that although UKCP Hammersmith and Fulham would help, the therapists delivering the Foodbank,A a member of The Trussell Trust. work must be paid, oppo sing the idea that Founded and run by CEO Daphine Aikens therapists should work for free. and a team of dedicated volunteers, the After initial discussions, things moved food bank has been helping local people in very quickly and within a couple of months, crisis since 2010. Anchor Counselling had set up a therapy JACQUELINE Always looking for ways to improve the service pilot in the Hammersmith and MCCOUAT support available to food bank users, Aikens Fulham Foodbank to test the idea of offering is a UKCP-registered Gestalt psychotherapist and one of the volunteers, Rob Howell, came psychological services to its users. and counsellor, and CEO up with the idea of offering free psychological Anchor Counselling supplied the therapists of Anchor Counselling support. They envisioned a quick-to-access and managed the administration. A room Services, a counselling therapy service that would complement the was set aside to provide a private space for and psychotherapy other support available to food bank users. people to drop in and sign up for six sessions services organisation Howell is an artist whose work is born out of therapy. Part of the pilot was to understand providing services to of his struggles with mental health. Through if six sessions could provide a sufficiently those who would not his charity, Food for Thought, funds were valuable and constructive benefit, rather than otherwise be able to raised to start searching for a suitable partner having people opening up and then having access support organisation to provide therapy services. support withdrawn.

A PILOT SERVICE A REASSURING PRESENCE It proved a challenge to find an organisation People using the food bank’s weekly that complemented the values and culture vouchers often don’t know if they will be of the food bank and could work alongside eligible the following week. It can be an its volunteers. Psychotherapists Martin uncertain and chaotic way to live, which not Pollecoff and Andy Cottom, Chair and only contributes hugely to a general sense of Vice Chair of UKCP respectively, brokered uncertainty and anxiety, but also makes it discussions between Aikens and Anchor hard to plan sessions ahead of time.

New Psychotherapist / Autumn 2019 in an ad hoc way – some might only –some might only way ad hoc an in therapy and support topeople access presence made a big difference, enabling met. being both needs psychological and physical atherapist, see then and parcel food their get asnack, ofa cup tea and have bank, comePeople to food could the on-site to access. provided flexible and was therapy the that appreciation an was didn’t they if to. want toservices comment on their experience therapy the for using anyone pressure no was There Advice. Citizens example for services, who provide advisors other and volunteers bank, food the using Feedback was gathered from people positive. overwhelmingly were results the and pilot for the weeks 12 ran Mason with my family’ family’ my with relationship the in improvement an was ‘There Anchor Counselling having a physical aphysical having Counselling Anchor feedback the in theme A recurring Gareth and Wiseman Giulia Therapists

Photos: Sarah Challacombe their situation generally. improve can they how to as them up, providing insights take who those to useful sessions have been highly people who use it. The sessionssupport to the offers psychotherapy Fulham Foodbank now The Hammersmith and more accessible attainable. and seem idea of the therapy made choice and a users bank and/or food gave sessions six option of the adrop-in approach Having improved. things clients, with rhythm into got But a once they difficult. ahead planning made which to week, week from eligible for vouchers be food would they didn’t whether bank food know the using people because at start miss’ the and ‘hit was pilot scheme the Engagement with CONCLUSIVE FEEDBACK all deserve the help,’ the said. one deserve user all it. ‘We who needs to everyone available it that be should view despite a general of support, kind to this access who have it’snoted that privileged the only usually also received feedback of Some the wait. to having them without counsellors to the through people directing and Challacombe, answering questions Sarah Manager, Quality Counselling’s Anchor with together bank at food the due of to to funds. unable ring lack be for help, ringing put from off or be could for who, people forpresence example, areassuring counsellors the making users, bank among food trust grew rapidly presence and visibility Having welcomed. warmly is everyone whereby bank food of the culture the with well fitted approach This offered. being was out to what about more find wanted others of while achat, felt need in have There was always a therapist available available atherapist always was There to expand the service into the future. into future. the service the to expand funds further to raise planning are They 2019. continue through will service the so Worshipful of Company The Grocers, from funding further raised has Aikens to success. key the been has operations daily bank’s to food adapting the that clear my family.’ with relationship the in improvement an was ‘There saying: client another with bank, food the beyond extended also impact The said. client my about situation,’do differently one what Ican and better myself understand me helped dots ‘Joining the bank. food for a help need from current their and lives past of their areas certain between links were there that to realise them helpful.’ very is facility acouple only drop-in of sessions; the after improvement ‘I an said: feel client One time. ashort in achieved be what could surprising but it sessions, was six than more were there that wished clients Some service’. the recommend definitely ‘would and ‘heard’ been had felt they that they to people’. more extended is said Clients service ‘I the and hope my therapist’ in ‘I confidence included: had that comments

robhowellart.com hammersmithfulham.foodbank.org.uk anchorcounselling.org Further information New Psychotherapist As the pilot continues, it has become pilot continues, become the itAs has enabled For therapy the some clients client 100% with was positive, Feedback Feature Charities / / Autumn 2019 47 Feature Mortality and hope

LETTING GO FACING OUR MORTALITY COULD TRANSFORM SOCIETY, AND PSYCHOTHERAPY HAS A KEY ROLE TO PLAY IN HELPING PEOPLE ACCEPT REALITY, AS ANNA SCOTT DISCOVERS

any individuals do not want to face the emergency of climate change because they fear loss and death, according Mto psychotherapist Josefine Speyer. ‘I think our society has a real problem dealing with the urgent need for change, because it means there are things we need to give up. Change is disorders, according to Julia Samuel, a psychotherapist and author frightening. We are a consumer society that of Grief Works. If mortality was discussed more openly, ‘There 48 defends against loss, lack of power and control by would be more knowledge and information for people to know shopping,’ she adds. ‘It is a form of addiction to that what they’re feeling is normal. And it would mean they defend against the reality of death.’ would get the right support rather than use maladaptive coping If individuals were able to face their own mechanisms.’ mortality, society would benefit. ‘It would mean open communication and allow people to be THE CRUCIAL ROLE OF PSYCHOTHERAPY depressed without others saying, “What’s wrong The problem is that imagining ourselves ceasing to exist is with you!” It would make people less lonely,’ she frightening, Barnett says. ‘When we consider our mortality we says. ‘We might be able to relate to ourselves and realise the finality of life. We cannot control our demise (apart each other better.’ from suicide – even then not completely) and many people are Aviva Barnett, a psychotherapist who specialises petrified of pain, which they associate with dying.’ in working with people affected by loss, has a similar Psychotherapists are no different. ‘Death was never hidden opinion of the potentially transformational effect of away during my upbringing in rural Ireland in the 1960s,’ says realising that we only have one life, which we should psychotherapist Neil Jordan. ‘Yet none of us would ever mention want to live fully. ‘People might just be kinder to each our own deaths. Bringing it back to my own demise was the other, might be less judgemental and might be able to biggest challenge of all.’ (See ‘Life stage’, opposite.) take more risks in relationships because they’re less Psychotherapists have an absolutely crucial role in helping fearful of what others think about them.’ individuals face their own mortality, not least by giving clients Facing mortality could also help us with our own the space to discuss their fears of mortality and what they can processes of grief. ‘I would like to think the more prepare for. Therapy also brings up the fragility of life naturally prepared you are, the more manageable the process through the work itself, Barnett says. ‘Losses arise in the form of of grief and mourning can be,’ says bereavement relationships, jobs and pets dying. Therapists can help the client expert and psychotherapist explore how they relate to loss and learn what it means to them.’ Juliet Rosenfeld. ‘I found She worked with a woman living with breast cancer, who had a ‘Therapists can bereavement so utterly double mastectomy and chemotherapy. The woman would come help the client shocking and unbearable to sessions and talk about her work, saying that she felt like she when I was young and had a lot to contribute to meetings, but was unable to because explore how suddenly widowed.’ she was so shy. they relate Unresolved grief is ‘She simply did not have the self-belief to take risks,’ Barnett thought to be behind continues. ‘But after going through treatment, she cared less to loss’ 15% of all psychological about what others thought of her. She was able to get her voice

New Psychotherapist / Autumn 2019 Feature / Mortality and hope

heard and said what she wanted at meetings. She lost parts of her body but she gained parts Life stage of her self.’ But psychotherapists raise mortality with clients only where it is appropriate, either when ‘Facing death sharpens our senses’ the latter feels it needs to be explored or the What we avoid reduces our capacity to live, writes Neil former feels it is being avoided. ‘Therapy has Jordan. Yet, the fear of dying makes us avoid facing it great value for people who have never been carefully listened to,’ says Rosenfeld. ‘So I would The process of opening up to more wait for the patient to raise it, rather than tell of who we are fits with Carl Rogers’ them where we need to go. I wait, listen and see description of the therapeutic process what comes up. For some people, at a certain in which we move from fixed to fluid, point in their lives, this is a subject they want to from closed to open, from rigid to think about aloud, with me as their witness.’ flowing and from stasis to process1. Cut off from death, our lives are smaller. TALKING THERAPIES Irvin Yalom points out that by grasping NEIL JORDAN ‘When someone comes to you who has had a our human condition, what he describes is a UKCP-registered bereavement or is terminally ill, you can’t just as ‘our brief time in the light – we will psychotherapist who offer them “tea and sympathy”,’ Speyer says. come… to savour the preciousness of has worked in many ‘We need to address endings. Therapists can help each moment and the sheer pleasure settings: a GP surgery, 2 people put things they want to say into words.’ of being ’. Facing death sharpens our university student Psychotherapists can also support clients in senses. And it’s a two-way process – if we services, a hospice reconnecting with their bodies, where many open up to death we engage more fully and a voluntary organisation. feelings are held, says Jordan. ‘Another important with life – yet by living our lives more fully 49 part of the work is in helping clients explore new behaviours, we are also more likely to approach death natureconnect.org.uk some of which may feel scary,’ he adds. with greater openness. This is particularly important given that many professionals Given the importance of mortality in who work with the dying, offering medical care or who work in each of our lives, as psychotherapists, the funeral industry, don’t have any supervision or a space where if we are to effectively support clients they can reflect on their work, Speyer says. ‘Somehow there is the in exploring their mortality, we need to notion that this is not needed. They just have the medical model be open to engaging with our own finite References which doesn’t consider relationships. Given permission to explore nature. Having been in psychotherapy for and share experiences, people love talking about death. It is very many years, I’ve grown my sense of self (1) Tudor, K. and life-affirming, you simply can’t stop them, there is so much they to include my embodied, ecological and Worrall, M. (2006). want to say.’ spiritual self, and a wider sense of myself Person-Centred Therapy. This is the philosophy behind death cafés, founded in 2010 by as an emotional man. This integrated East Sussex, England: the late Jon Underwood. ‘Jon’s idea was that people come together sense of self holds so much more than the Routledge. to drink tea, eat cake and talk about death,’ says Speyer, who has old self I was years ago. It also holds my (2) Yalom, I. D. (2008) run death cafés since 2012. ‘Death Cafe is free and the hosts are fear of death. If I am part of nature, part of Staring at the Sun. fellow mortals who participate in the conversation.’ life itself, how could it be any other way? London: Piatkus. ‘We have people sitting around a table and start off the conversation by asking “What brings you to Death Cafe?”,’ Speyer says. ‘The conversation flows from there. People of all ages talk about their experiences, or lack of, of death, bereavement, of caring for the dying, organising funerals, preparing for dying or was soaring. She was incredible, and I was so moved fears and concerns, etc. by her,’ Speyer says. ‘We can all teach each other about ‘A terminally ill woman who regularly attended our monthly mortality, and we should all be talking about death death café regularly told us how fellow cancer patients waiting as easily as we talk about birth,’ says Julia Samuel. for treatment would not speak to each other in the waiting room. For psychotherapists, ‘We should include it as part The anxiety was palpable but could not be shared. She felt great of our clients’ overall wellbeing,’ she adds. ‘In the benefit from being able to talk about her dying, and living fully in same way as we may want to discuss their sex life, the process of it. The last time she came back was a month before their relationships – not hammering it home all the she died. She was literally fading, could hardly breathe, and when time, but using it as part of our holistic response to she spoke she had to sit back to catch her breath. But her spirit our clients’ mental health.’

New Psychotherapist / Autumn 2019 Points to consider Confidentiality

Points to consider… SHARING CONFIDENTIAL NOTES

BEING ASKED TO BREAK CONFIDENTIALITY CAN POSE SIGNIFICANT DILEMMAS FOR THERAPISTS. OUR COMPLAINTS AND CONDUCT TEAM OFFERS GUIDANCE Receiving a request from police or lawyers – this will usually be in connection with legal proceedings, whether to see a client’s therapy 50 notes or when asking a therapist to provide a lient confidentiality is one of the central tenets report or opinion about the client or someone else. of psychotherapy – the trust that is shared Pre-trial therapy – when therapy is provided to a C between therapist and client is an essential witness in a prosecution such as a rape trial, client part of the therapeutic relationship. But legislation confidentiality cannot be guaranteed at the outset. and good practice mean there are situations where you may have to break this confidentiality. It can be a daunting prospect to be faced with what During the course of client relationships, you will may feel like an assault on the important information gain knowledge about your clients ranging from the you hold on clients, so it’s crucial to understand your incidental (address and phone number, for example), obligations, discuss concerns with your supervisor to the highly confidential, intimate and personal. and turn to your indemnity providers for advice. Confidentiality is a continuing duty, and keeping client information safely should occur even after the SUBJECT ACCESS REQUESTS therapeutic relationships have ended, irrespective of Subject Access Requests do not need to reference whether you saw a client for a few minutes, a single laws or legislation, nor be in writing, and this can session or several years. Clients’ reliance on that make them difficult to spot. Therapists need to confidence is essential in creating a safe space where acknowledge and respond to requests (which are therapy can take place and breakthroughs can be made. for all the information they hold on an individual) But what happens when therapists are asked within 30 days. If the request comes from the client to break client confidentiality? Here are the most directly, a therapist may not consider this breach of common situations in which therapists are asked for confidentiality to be an issue, especially if the request confidential information: comes from a former client. However, if the request is from a current client, you will have to consider Receiving a Subject what implications, if any, this might have on your ‘Clients’ reliance Access Request (SAR) therapeutic relationship. on confidence is – a provision under the General Data Protection REQUEST FROM POLICE OR LAWYERS essential in creating Regulations (GDPR) that It can be intimidating being contacted by the police a safe space where gives clients the right to and/or lawyers, especially out of the blue, and ask for all information therapists should think very carefully about how to therapy can occur’ someone holds on them. respond to requests for notes.

New Psychotherapist / Autumn 2019 not scaremongering: it’s a case References and reading of being transparent at the beginning of a relationship that Waxman, C. (2019). The London you are subject to other pressures. Rape Review: Reflections and It may help reassure a client that Recommendations. london.gov.uk/sites/ you are being open and clear default/files/vcl_rape_review_-_final_- with them. _31st_july_2019.pdf cps.gov.uk/legal-guidance/therapy- CONSENT provision-therapy-child-witnesses-prior- You may need to breach criminal-trial client confidentiality to meet cps.gov.uk/legal-guidance/therapy- reporting requirements such provision-therapy-vulnerable-or- as safeguarding, publishing intimidated-adult-witnesses material or discussing clients with gmc-uk.org/ethical-guidance/ethical- colleagues. In these cases, you guidance-for-doctors/confidentiality must be familiar with safeguarding ico.org.uk/for-organisations/guide-to- requirements and ensure that data-protection/guide-to-the-general- information you share is limited to data-protection-regulation-gdpr/ that which is strictly necessary. individual-rights/right-of-access/ If you wish to publish psychotherapy.org.uk/registers- information about your clients, standards/complaints/learning-from- they must give their verifiable complaints You must get your client’s consent (ideally in consent (written), even where writing). They may not be aware that you have you have anonymised their been approached and may not want you to disclose information and they are unable everything – they may have shared other intimate to recognise themselves. If you 51 details that are not related to the request from the are discussing a client with and therapists, meaning that police or lawyers. other colleagues, you must also all relevant information must Think about the impact this might have on your anonymise their information. be preserved. Requests for client, your relationship with your client, and why information are likely to be made the police or lawyers are asking for information. If PRE-TRIAL THERAPY by the CPS, the prosecutor, the you’re being asked to write a report, you need to think In the case of therapy provided defence and/or the court. With carefully about whether you’re qualified to do so, and to witnesses involved in the this knowledge, victims have, whether it will be in the client’s best interests. With prosecution of an alleged unsurprisingly, been reluctant to each decision you make, document why you’re making offender – pre-trial therapy – enter therapy, yet this is a time it: any reports or notes you submit may be disclosed client confidentiality cannot when they may need it most, to other parties, not just those who requested it. be guaranteed at the outset of as they face the intimidating therapy, according to the Crown prospect of seeing the perpetrator SAYING NO Prosecution Service’s guidelines. and hostile cross-examination. You can say no to requests from police or lawyers The need to ensure a fair trial At the outset of therapy, unless you are issued with a court order. The duty demands that any information therapists should reach an of confidentiality you owe to your client and your that could have an impact on understanding with clients of understanding of their situation can give you a the decision to prosecute, the circumstances under which gateway to providing a reasoned decision for not conduct of the case or the outcome information obtained during supplying information. When declining requests of the trial is made available to therapy may need to be disclosed. make sure you record why you came to this decision, the police and CPS. So therapists Great care should be taken who you spoke to for advice, and the factors you took must make the police and CPS whenever anything is likely into account. Then, if you’re asked to justify your aware that therapy is proposed, to infringe on confidentiality. decision, you have a record of it. is being undertaken or has been But for those times where you undertaken. You must keep must breach it (with consent or THE THERAPEUTIC RELATIONSHIP records including details of those not), forward planning is key to Whether you say yes or no is likely to have some in the therapy, the content and ensuring minimal impact. Legal impact on the therapist–client relationship, and length of the therapy sessions. advice and a firm understanding of you will need to think carefully about managing In these circumstances your rights and duties mean you’ll this. Be clear with clients about the limits of your the rules of disclosure place be able to respond appropriately or confidentiality at the outset of therapy. This is responsibilities on the CPS turn down requests.

New Psychotherapist / Autumn 2019 Spotlight Vicky Karkou

RIGHT: ‘I thought my visit to the UK was going to be the first stop on my travels around the world. It became a journey The arts can into psychotherapy’ vitalise support relationships AN ACADEMIC AND THERAPIST RESEARCHING THE BENEFITS OF ARTS PSYCHOTHERAPIES, PROFESSOR VICKY KARKOU OUTLINES THE STEPS ON HER CAREER PATH AND WHAT’S KEPT HER MOTIVATED ALONG THE WAY

52 rofessor Vicky Karkou grew up in Greece surrounded psychology or the arts found a happy solution. I was by ancient texts. Greek myths were the bedtime stories introduced to dance movement psychotherapy, a field Pshe play-acted and ancient ruins the playground in that supports deep explorations of one’s inner and which she brought her characters to life. She is now one of relational self through body sensations and creative the UK’s leading academics examining the use of creative movement, and as such it sits clearly across practices. methods in psychotherapy. The second stop was a scholarship from the I was brought up valuing knowledge and creativity, often Economic and Social Research Council (ESRC) for debating whether I preferred thinking or doing. I would re-tell doctoral studies, which enabled me to study arts Greek myths with full poetic licence, creating new characters and psychotherapies – music, art, drama and dance. endings. I would enact these stories. I was convinced that I needed After that I began a research career at the University to engage with them with full physicality, adding my best moves of Hertfordshire, one of the first universities to offer to the characters in order to bring them to life. In the playground, postgraduate training and a licence to practise arts I was able to transform my knowledge of myths in new creative psychotherapy. While the theoretical and research configurations and integrate thinking with doing. components continue to grow, my need to understand the process of therapy took over. I grew up to become an unruly teenager. Socrates and Plato felt dated and restrictive; as did most things during this transitional I completed my clinical training as a dance period. As a way of processing frustrations, I started painting on movement psychotherapist at the University anything that I could find. With my parents’ support, I started of Roehampton while I continued working as painting the walls of our summer house. Artistically, the work a researcher. Clinical work became an additional had varied in quality, but no one seemed to bother. Our walls had component to my research work. This took place colour; they were dark and messy in places, but seemed alive. in and around London, with people from all kinds of backgrounds and cultures. Creative means and After my undergraduate studies in Greece, I made my way to sensitive uses of the arts become an attractive reference the UK. I thought it was going to be the first stop on my travels point for people whose understanding of mental health around the world. It ended up becoming a journey into the use of and psychological wellbeing is different. creative methods in psychotherapy. I moved to Edinburgh to work on developing a new My first stop was a master’s in Dance/Arts Education at the MSc in dance movement psychotherapy while University of Manchester. My inability to choose between beginning to supervise PhD students. My research

New Psychotherapist / Autumn 2019 Spotlight / Vicky Karkou

References and reading

Karkou, V. and Sanderson, P. (2006). Arts Therapies: A Research-Based Map of the Field. Edinburgh: Elsevier Karkou, V. (2010). Arts Therapies in Schools. London: Jessica Kingsley Oliver, S. and Lycouris, S. (2017). The Oxford Handbook of Dance and Wellbeing. New York: Oxford work in health contexts developed; health diagnoses has been made University Press collaboration with NHS Scotland by the National Institute for Health took place. I began training in group Research. And the Liverpool Clinical Timeline analysis and completed my training in Commissioning Group is interested in supervision. The cold of Edinburgh was supporting new projects such as the PROFESSOR VICKY alleviated by the warmth and creativity Arts for the Blues, which is developing KARKOU’S JOURNEY of my students, colleagues and friends. a new intervention that uses creative IN PSYCHOTHERAPY The sparse population of Scotland was methods in psychotherapy as a 53 balanced by the sense of community treatment for depression. I felt in the group analysis training Graduated with a Bachelor of Science and Education at in Glasgow. Academic demands were The European Union is also 1991 balanced by beginning private practice. supporting research into the the Aristotle University of All of which took place under the potential contribution of dance and Thessaloniki in Greece. frenzy of the annual Edinburgh Festival creative movement in different and regular classes at Dance Base. client populations, such as those Finished a master’s in Arts recovering from cancer, demonstrating 1994 Education and Arts Therapies at I have now returned to the north that there is interest in the use of the the University of Manchester. west of England. As a professor at arts and creativity in the wellbeing of Edge Hill University, I am given space people with diverse clinical concerns. to play with ideas and develop new These kinds of research activities are Joined the University of Hertfordshire, UK, as a research. Creativity is valued and expected to be taken even further with 2000 Postdoctoral Research Fellow psychotherapy is celebrated. Numerous the development of the new Research in Arts Therapies. events and masterclasses bring people Centre in the Arts and Wellbeing at together from the local, national Edge Hill University. and international community, while Began lecturing in Art Therapy new research projects deepen our I am convinced that the arts and 2003 at Queen Margaret University understanding of the use of creative creativity, when used appropriately, in Scotland. media in psychotherapy. can vitalise support relationships, offer insights and allow for new Became Programme Leader of This Since my early explorations of Greek and integrated ways of being. the MSc in Dance Movement 2008 myths in ancient ruins, things conviction is not confined to the Psychotherapy programme at appear to have moved on, both ancient ruins of Greece anymore and Queen Margaret University. for me as a professional as well it is not the gut feelings of a child as for the subject area. Substantial playing. It is met with an increasing investment in investigations into the interest from wider afield, which, as Joined Edge Hill University in effectiveness of dance movement, the research evidence grows, is gaining 2013 the UK as a Professor of Arts music and art psychotherapies with momentum and expands its potential and Wellbeing. groups of people with mixed mental applications.

New Psychotherapist / Autumn 2019 On Screen A 16-year-old offers sex and relationship counselling to his peers, but what kind of therapist is his mother? John Taggart considers Sex Education’s portrayal of therapy

Dr Jean F Milburn Sex Education

ex Education is a light- ‘She is a therapist hearted Netflix miniseries without boundaries S about adolescents and their struggles with sex and finding and an appalling out who they are. Otis starts his mother’ own illicit sex therapy counselling business at school. Both his mother, Jean, and estranged dad, but him. Reluctantly, Jean herself Remi, are sex and relationship can admit that at times she dislikes therapists. Otis finds he has her son. absorbed quite a lot from them. But that is a rare moment of He is rather good at it. But he’s reflection for this most unaware of not so good at sorting out his own therapists. Otis himself has to put a sexual inhibitions. lock on his door. His mother kicks it in. The comic premise of the series She follows him on dates and wonders 54 is that Jean, despite her apparent why she is doing it. success as a sex therapist, is basically By episode six we learn that Otis dysfunctional in her private life and has deep subconscious blocks to unaware of her failings as the mother masturbation and to sexual intercourse of an adolescent boy. Who is more because as a boy he observed his father psychologically aware and a better therapist: Jean, or ABOVE: Jean’s lack of having passionate sex with a client. There seems to be her 16-year-old son? boundaries denies Otis the no therapist in the programme, other than Otis, who Jean explains that a good therapist listens to space and privacy he needs has firm boundaries. people without ‘inserting yourself into their reality’. to deal with his own issues Some sensible lines are given to Jean – ‘middle The problem is that her only reality seems to be the adolescence is a tumultuous stage of development’ life of her son. She is lonely, but doesn’t recognise – but she is a therapist without boundaries and an it. She has multiple sexual partners, but, as she says appalling mother. She has one book published and to one of them, ‘I have no room in my life for the has another about to be accepted, but these are at the intimacy you are clearly craving’. expense of her son and also, presumably, her clients. Though she speaks in a calm and authoritative Perhaps it is amusing to see a therapist interpret manner that is quite infuriating – ‘I want to give you his client’s erotic crush on him as transference and the opportunity to express your feelings’ – it is her then cast aside the boundaries because she wants son who is given the truly insightful lines – ‘This is not ‘to have sex right now!’. Perhaps it’s amusing to see a a safe place, Mum. It’s like you want to consume me’. psychotherapist dispense wisdom and be blinkered in On the surface, Sex Education is a frivolous drama her own life. But if a 16-year-old can do it better than about young people and sex. In fact, it has a lot more we can, are we therapists better advised to laugh at to say about adolescents and the hurdles of separation. ourselves, or be just a little offended? An important part of this struggle is to separate from their parents. This is particularly true for Otis whose mother seems determined to have nothing in her life Next issue: Dr Sean Maguire in Good Will Hunting

What have you seen on screen that has annoyed or inspired you? We’d love to hear your stories. Email [email protected]

New Psychotherapist / Autumn 2019