For counselling and psychotherapy professionals
Therapy Today
Therapy
Today
March 2016, Volume 27, Issue 2
Embodied therapy
and dementia
Men and perinatal depression
The trauma of death
March 2016, Volume 27, Issue 2
March 2016, Volume 27, Issue 2
Contents
Features
8. Dementia and embodied
psychotherapy
Beatrice Allegranti describes
her new film that tries to
help carers understand better
the experience of dementia.
14. Men and perinatal
depression
James Costello finds that
male partners of women
with perinatal depression can
learn a lot from groupwork.
18. Trauma and the dying
It’s important to know about
the effects of severe trauma
if you work with dying
people, says Louis Heyse-
Regulars
3. Editorial
4. Your views
6. News
13. How I became a therapist
Ayesha Aslam
30.Dilemmas
Pursuing missed payments
33.Letters
38.Reviews
42.From the Deputy Chair
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Moore.
22. Asexuals – a hidden
one per cent
Joanna Russell urges
therapists not to ignore
the existence of people
who, like her, are asexual.
26. Older women and
domestic violence
Older women can also be
victims of domestic violence,
say Hannah Bows and
Jeannette Roddy.
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Behind the pictures
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43.BACP News
45.Professional conduct
46.BACP Public affairs
47. BACP Research
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Editorial
Depression,
dementia,
death – hope
Cover illustration by
Chiara Criniti
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Dementia, dying, perinatal depression
and domestic violence. The headlines
in this month’s issue don’t promise
much joy. And yet, and yet... read the
articles; you may come away inspired.
First we have Beatrice Allegranti’s
article on her film I Can’t Find Myself.
Dementia is often seen as stealing the
person and leaving only a body behind.
Beatrice’s film will, she hopes, inspire
carers to work kinaesthetically, literally
with the body, and new ways of relating.
Then we hear from Louis Heyse-Moore,
who argues that too little consideration
is given to the effects of severe trauma
in counselling and psychotherapy with
the dying and their bereaved. There are
good deaths, but there are also deaths that
are protracted, violent, scarring (mentally
and physically) and terrifying, he writes;
counsellors and psychotherapists, of
all professionals, surely owe it to their
clients to help them name that terror and
so deprive it of at least some of its power.
What do men know about perinatal
depression, James Costello was asked
when he joined a team developing
workshops for families affected by
perinatal depression? Well, not a lot,
‘It is useful to
experience therapy
as a trainee therapist
but I am unconvinced
that this is necessary
every week for
five years’
David Blowers (p33)
he readily admits. And this readiness
to admit ignorance is, perhaps, one of
the keys to men being able to help their
partner through PND. Perhaps the hardest
yet most important step is for men to give
up ‘elements of [their] masculine sense of
autonomy and competence’, James writes.
In short, it is when men can admit they
can’t fix the problem that they find they
are better able to be of use to their partner
and children through the depression and
despair. And perhaps groupwork is also
a key element: perhaps men are more able
to take up this challenge from other men?
And, talking of changing masculine
behaviour, we cover the roll-out of the
new Drive programme for very violent
perpetrators of domestic abuse, which has
been accused of diverting resources away
from the victims (see News p6). Contrast
this with Hannah Bows’ research into the
overlooked and unseen needs of older
victims of domestic violence. The issue
shouldn’t be about competing priorities;
in a compassionate world we have to
hold on to counselling’s fundamental
belief in the possibility of change.
Catherine Jackson
Acting Editor
‘I learned how much
can be achieved
collectively if we
speak up. I think the
time to do so is now,
before more course
closures take place’
Lisa Berry (p5)
‘As a Sri Lankan,
female, heterosexual
and mother, do I
know what it is like
for my client to be
Sri Lankan, female,
heterosexual or a
mother? The answer
is, how could I?’
Angela Mooney (p36)
March 2016/www.therapytoday.net/Therapy Today 3
Your views
Susie Orbach
does it again
Marie Adams applauds
Susie Orbach’s recent
Radio 4 series ‘In Therapy’
I’ll admit it, hearing that Susie Orbach
was going to broadcast a series of
‘therapy sessions’ on BBC Radio 4 over
one week in February, I felt positively
gloomy. I would be expected to listen,
to discuss what I thought and not be
able to criticise, for fear of being seen
as envious. Which I knew I would be.
Orbach has an unrivalled ability to
convey the complexities of therapeutic
engagement in straightforward language.
She has proved this over and over again.
Her 1978 book Fat is a Feminist Issue is
a seminal text (now being re-issued).
Her regular column in the Guardian
was essential reading, making sense
of the world through the prism of
psychoanalytic thought. Now, in this
series of five 15-minute broadcasts at
lunchtime from 15–19 February, she
has demonstrated to the nation the
nuances of psychotherapeutic practice.
The clients were played by actors, but
they were given a thorough grounding
in their character and the sessions
were improvised. Orbach may have
been familiar with the characters but
she clearly did not know what would
happen in the sessions. Like any of us,
she was sometimes caught off guard –
particularly, I thought, by Jo, the out
of work actor who could not stay in
contact with the therapy or her own
emotions long enough to make sense of
her self-sabotage, and by Helen, whose
concrete thinking left so little space for
reflection. When Orbach spoke of feeling
the ‘pull’ into Helen’s black and white
world-view, we know what she means;
we have all been there, falling into the
trap of our client’s habitual behaviour,
rather than seeking to understand it.
Fifteen-minute chunks of ‘artificial’
therapy may seem laughably condensed
to illustrate the power of long-term,
in-depth work. Regardless, these were
meaningful encounters, demonstrating
4 Therapy Today/www.therapytoday.net/March 2016
to the listener the importance of being
truly heard and understood. Orbach
managed her session with John, the last
in the series, with great compassion and
tenderness. In the face of his declaration
of love for her, she was straightforward:
nothing could or would happen between
them and she would not be doing what
he was paying her to do if she extended
support beyond the exploration of his
feelings and experience.
These broadcasts were, in my view,
courageous, and a brilliant way of
exploring the potential of therapy in
an accessible format, doing what radio
does so well – bringing issues right into
our homes. We live in an era where
‘evidence-based practice’ is essential.
Although these were actors, there was
a qualitative truth to the characters they
presented: the warring couple about to
have their first child, the grieving middleaged woman who has abandoned her
whole life after two failed attempts at
IVF, and John, with his desperate need
for, and terror of, intimacy.
In my experience, the general public
has an insatiable interest in what goes
on in the therapy room. It may be simple
curiosity, or morbid interest in someone
else’s misery. Who was listening at
1:45pm every day that week? You’d
be surprised by the reach of Radio 4.
Will any of those listeners attend therapy
as a result? I hope so, and I would like
to think that no one was put off.
I wonder if we therapists listened to
these sessions differently? Is it Orbach
we hear most clearly, or the anguish of
her patients? What are we listening for?
These five sessions were tiny master
classes, whether or not we agree with
her approach, her interventions or her
interpretations. It is too easy to say,
‘I wouldn’t have said that,’ or ‘I would
have done it differently.’ Orbach
functions from a particular therapeutic
position, as do we all, and none of us is
the same. Few psychotherapists I know,
including me, would be willing (or able)
to put our clinical practice under such
public scrutiny. Orbach has acted once
again as an incredible ambassador for
the profession. I hope she delivers more.
Marie Adams is a psychotherapist, a former
Radio 4 producer and author of The Myth
of the Untroubled Therapist and a recent
novel, Telling Time (Karnac, 2015).
Surviving work
in the NHS
NHS workers are bearing
the brunt of a steady erosion
in employment rights and
standards of care, writes
Elizabeth Cotton
After four years of talking to mental
health workers and, now, carrying out
the Surviving Work Survey to map jobs
and working conditions in the mental
health sector, I think it’s fair to say
that we are experiencing a rise in
what psychoanalyst and climate
change activist Sally Weintrobe calls
Noah’s-arkism – the people who still
have financial security and leadership
positions are snugly sailing along in the
Ark, protecting their position, while the
rest of us are drowning around them.
In the NHS this tier of workers
includes IAPT psychological wellbeing
practitioners (PWPs), the practitioners
providing counselling and therapy for
free in the NHS, the people staffing
mental health crisis call centres, the
clinicians carrying out disability welfare
assessments and those working in social
care and support services who have
been forced to leave their clinical
jobs. All can be described as being
in precarious employment.
The debate about precarious work
encompasses the nation-wide cuts in
state funding, the spreading culture
of targets and outcome measures, the
privatisation of health and social care
services, the shift of the health and
social care labour to employers outside
the core public sector, the shifts and
confusion over commissioning powers,
the use of command and control
management, the intensification of
work and the spread of bullying cultures.
The continuous privatisation and
restructuring of the NHS and shift of
commissioning powers to local level has
radically changed the working lives of the
NHS workforce. Over the last five years
there has been a 50 per cent increase in
the proportion of NHS services provided
by non-NHS providers, with expenditure
rising from £6.6 billion to £10 billion.
And from April the commissioning
support units set up to administer
the NHS contracting process are also
to be contracted out – you read that
right: the administrators responsible
for monitoring third party contracts will
themselves be working for third parties.
Although it’s possible that the third
parties may currently offer a goodenough service, if the experience of
every other sector is anything to go by,
within two years the contracts will be
downgraded to compete with ever
stringent budgets and within five years
the clinicians and managers in these
private companies that came from the
public sector will have retired or moved
on, leaving a new generation of workers
without any living memory of good
clinical practice or decent work. Given
that there is little to no governance
of private contractors in the NHS, this
will happen without even the slightest
fuss over patient safety.
Our professional bodies are in crisis –
torn between defending the sector and
defending themselves – a double act
that is becoming increasingly impossible.
Our unions are asleep at the wheel, with
a growing gap between the rhetoric
and reality of collective action. We
may be within a decade of seeing our
profession dying out as we become
de-professionalised, downgraded and
demoralised, and our experienced
leaders retire.
What we workers in the mental
health sector still have is each other,
right now – a relational model of
solidarity where we make the best of
the people around us and the bad lot
we have been left with in mental health.
If you work in mental health,
particularly if you work for IAPT,
a private contractor or a private
employment agency or are working
in an NHS service for free, help us
map what’s happening in our sector by
completing our anonymous Surviving
Work Survey at www.survivingwork.org/
surviving-work-survey
Elizabeth Cotton is a writer and educator
in the field of mental health at work. She
writes a blog (www.survivingwork.org/blog)
and runs The Surviving Work Library
(www.survivingwork.org/library)
Why we should
never give up
Lisa Berry has learned
several important lessons
from the campaign to save
Strathclyde University’s
counselling courses
As a student on the postgraduate
Diploma in Counselling at the University
of Strathclyde, I was determined not
to let the university authorities go
ahead with their plans to suspend all
its postgraduate counselling courses
(see News this month) without speaking
up. What’s amazing is that the university
has rescinded its decision.
I’m writing to share my experience of
the campaign and some of the concerns I
am left with. I question what’s happening
to counselling training courses across
the UK in the current political climate,
how they are perceived within the
higher education system, and the lack
of funding for them. I believe that the
fight is far from over and that the battle
was never just about Strathclyde; we
all need to continue to raise awareness
and campaign to safeguard the future of
counselling training courses nationwide.
The implications for the counselling
profession are too serious to stand by.
We all recognise that counselling is
a vital element of efforts to promote
and protect good mental health in
our communities. The massive
support for the Strathclyde campaign
has demonstrated a widely shared
determination to protect counselling
training and, by inference, public
access to counselling. There was shock
and disbelief that such highly regarded
courses could be discontinued without
consideration of the wider impact of the
decision. It would have meant the loss
of training opportunities for hundreds
of counsellors, and the loss of thousands
of counselling hours offered voluntarily
to agencies who rely on students on
placement to maintain their services.
I was overwhelmed by the amount of
support we received. The Psychotherapy
and Counselling Union stood side by
side with staff and students throughout,
as did the University of Strathclyde
Student Union and the National Union
of Students. We had backing from
counselling agencies, students from
other institutions, academics worldwide,
MSPs (including Nicola Sturgeon),
Person-Centred Therapy Scotland,
and COSCA and BACP. The issue
was discussed in the local and national
press and by the Scottish Parliament
cross-party group on mental health.
Here at Strathclyde we were lucky
that the university listened to the
concerns of the counselling community.
But the decision was only revised,
not reversed, and not without cost.
I believe that the way in which the
original decision was made has had a
considerable impact on the perception
of counselling as a profession. It has
been made clear to me that the higher
education system doesn’t see counselling
training as a necessity and that it
prioritises budgets/profits over mental
health. I think this can be seen also in
the closure of counselling courses at
the universities of Manchester and
Hertfordshire.
The Scottish Government has
pledged millions in funding over the
next few years to train mental health
professionals. There are calls for
counsellors to be available in all schools
and for action to be taken to decrease
waiting times and offer alternatives to
medication for people struggling with
mental health difficulties. Yet, how are
these extra thousands of professionals
supposed to be trained if respected
counselling training courses are
simultaneously being discontinued?
On a positive note, I learned from this
campaign that we don’t need to speak
very loudly for people to understand
the importance of counselling training
courses. I learned how much can be
achieved collectively if we speak up.
I think the time to do so is now,
before more course closures take
place, with further negative impact
on the counselling profession and
our communities.
Lisa Berry is a postgraduate student at
Strathclyde University. To find out more
about the campaign, go to www.facebook.
com/savecounsellingtraining
March 2016/www.therapytoday.net/Therapy Today 5
News
IAPT sta� report increased stress
Work-related stress,
depression and dissatisfaction
with the target-driven
culture are increasing among
practitioners working in
NHS psychology services,
including IAPT staff.
In a survey of psychology
staff working in the NHS
and IAPT services conducted
jointly by the New Savoy
Partnership (NSP) and the
British Psychological Society
(BPS) in November and
December 2015, 46 per cent
said they were depressed,
and 49.5 per cent said they
‘felt like a failure’; 70 per cent
said they felt stressed often
or all the time– up from 58
per cent in 2014 when the
same survey was conducted.
More also reported feeling
under pressure to meet
targets (up from 41% to 45%),
bullying (up from 10% to 14%)
and that they spent too much
time on administration
(up from 87% to 94%).
Survey questionnaires
were returned by just over
1,100 staff working in IAPT
and NHS psychology services.
The largest proportion (29%)
were band 7 practitioners (the
usual salary scale of IAPT high
intensity therapists); some
30 per cent were on bands
4, 5 and 6 (PWP pay scales).
Comments included: ‘IAPT
is a politically-driven monster
which does not cater for staff
feedback/input in any way. All
we are told is TARGETS!!! and
work harder,’ and ‘Working
in the context of IAPT is like
loving animals and finding
yourself working on a battery
farm.’ Another respondent
wrote: ‘I am so disappointed
I have just resigned.’
Significantly, respondents
also reported an increase
in personal wellbeing: 50
per cent said they often felt
positive about themselves
(up from 48%), suggesting
the negative findings relate to
their work environment, not
to other factors in their lives.
The NSP and BPS have
jointly launched a Charter
for Staff Wellbeing in
Psychological Therapies.
The Charter aims to achieve
a better balance between the
pressures to meet targets and
the wellbeing of staff on the
frontline. ‘The overall picture
is one of burnout, low morale
and worrying levels of stress
and depression in a key
workforce that is responsible
for improving the public’s
mental health,’ the BPS said.
Responding to the survey’s
findings, Alistair Burt,
Minister for Community and
Social Care, said: ‘I take the
findings of this survey very
seriously because they show
something is going badly
wrong. I cannot be standing
on a platform telling everyone
we have a world-leading
programme when the whole
thing is rusting away beneath
me because of the way we
are treating the very staff
it depends on.’
The Charter can be downloaded
at http://tinyurl.com/j6ddrbs
© HALFPOINT/ISTOCK/THINKSTOCK (POSED BY MODEL)
Domestic violence project sparks questions about funding
A new project that delivers
intensive one-to-one
interventions to very highrisk perpetrators of domestic
abuse is to be piloted in three
local authorities in a bid to
prevent abusers re-offending.
But some groups says the
funding should go to helping
their victims.
Two women a week die
because of domestic violence.
The focus on most domestic
abuse programmes is on the
victims and the families; only
one per cent of perpetrators
get any specialist help to
change their behaviour.
Domestic abuse charities
SafeLives and Respect and
the not-for-profit organisation
Social Finance are to pilot
the Drive project in Essex,
Sussex and South Wales from
6 Therapy Today/www.therapytoday.net/March 2016
April. The scheme is funded
by Lloyds Bank Foundation
for England and Wales, the
Tudor Trust, Comic Relief
and supported by the Police
and Crime Commissioners
in the three areas. Drive will
develop, test and evaluate a
new, preventive model that
aims to permanently change
perpetrator behaviour to keep
victims and families safe.
The backing for specialist
one-to-one work with abusers
has been welcomed by
Nick Young, who facilitates
Strength to Change, a
one-to-one programme for
perpetrators developed by
Bracknell Forest Council’s
Social Care department.
‘The vast range of factors
that can drive abusive
behaviour often cannot
be addressed sufficiently
by a “one-size-fits-all”
group intervention. The
Drive programme represents
a change of emphasis, placing
the onus on the perpetrator
to change to keep victims
and children safe, rather than
expecting the victim to leave
the relationship,’ he said.
However, Sandra Horley,
Chief Executive of victimsupport charity Refuge, said
she was ‘gravely concerned’
over prioritising perpetrator
programmes above services
for women and children.
She said: ‘The women’s
refuge sector is being
decimated. Refuge has
experienced funding cuts
to 80 per cent of its services
since 2011. How can we
justify spending money
on therapy for perpetrators
when terrified and brutalised
women and children have
nowhere to go?’
NHS England to boost IAPT
© KATARZYNA BIALASIEWICZ/ISTOCK/THINKSTOCK (POSED BY MODELS)
The NHS is to fund the
expansion of IAPT services
in England, in response to
recommendations from
a government-backed
independent mental
health taskforce.
NHS England has
accepted the Task Force’s
main recommendations
and pledged to increase
funding for NHS mental
health services by £1 billion
by 2020/21 to raise standards
to an equivalent with
physical health care.
In its report setting out
a five-year vision for mental
health in the NHS, the
Mental Health Taskforce,
chaired by Paul Farmer,
Chief Executive of Mind,
sets out key priorities for
increased spending. It says
only 15 per cent of people
who need talking therapies
currently get help from IAPT
services. It wants services
to expand so they can treat
25 per cent of those in need
by 2020 – an increase of
600,000 people. It also sets a
target for IAPT and specialist
employment support services
to help a total of 29,000 more
people to find or stay in work.
The Task Force points
out that one in five mothers
suffers from mental health
problems during pregnancy
or in the first year after
childbirth, yet fewer than
15 per cent of areas offer
perinatal mental health care
and more than 40 per cent
provide none at all. It wants
new funding to support at
least 30,000 more women
each year to access evidencebased specialist perinatal
mental health care.
To combat the recent
upturn in suicide rates, it says
all areas should have multiagency suicide prevention
plans in place by 2017, with
the aim to reduce suicides
by 10 per cent by 2020.
On children and young
people, the report backs the
2015 Future in Mind report
and its recommendations
for increased investment to
provide mental health care
to at least 70,000 more
children and young people.
‘Putting mental and
physical health on an equal
footing will require... a large
increase in psychological
therapies... That’s what
today’s taskforce report calls
for, and it’s what the NHS is
now committed to pursuing,’
said Chief Executive of NHS
England, Simon Stevens.
http://ow.ly/YE7RF
See BACP News (page 46)
for further comment on the
Taskforce recommendations.
Strathclyde steps back from course closures
The University of Strathclyde
has stepped back from total
closure of its postgraduate
counselling courses. As
reported in last month’s issue,
the university had announced
plans to end its certificate,
diploma and masters in
counselling from 2016 and
replace them with a new joint
undergraduate degree and
later a master’s degree in
psychology and counselling.
However, following
protests from students,
staff and counselling
bodies, including BACP,
the university has announced
it will continue to offer a parttime postgraduate diploma
in counselling from 2016 to
2018, and will bring forward
the launch of the masters in
psychology and counselling
to 2017/18, to ‘bridge the
gap between the current
and revised programmes’.
The new undergraduate
course will also be brought
forward to launch in 2017/18.
Some 2,000 protesters
signed a petition against
the closures. Counselling
student and campaign
spokeswoman Lisa Berry said:
‘It is unusual for a university
to reconsider a decision like
this. It shows the impact of
the campaign.’
Counselling
in workplaces
Two in five workers have
no access to counselling
through their workplace,
the Chartered Institute of
Personnel and Development
(CIPD) has found. Many
are working in a ‘wellbeing
vacuum,’ it says.
In a survey, less than
half of the employers (49%)
used an employee assistance
programme (EAP) and 40
per cent provided no access
to counselling for their staff.
The CIPD also found that
many employee wellbeing
programmes are one-off
initiatives that have no
long-term impact. It wants
the Government to introduce
financial incentives for
companies to invest in
employee wellbeing schemes.
Rick Hughes, BACP Lead
Advisor, Workplace said:
‘Employees who have access
to counselling have a crucial
resource to turn to so they
can deal with these issues
before they trigger absence.’
http://ow.ly/XT50L
Priorities
for research
A national consultation
has identified the top 10
‘unanswered questions’
for depression research.
A survey of 3,000 people
with depression by the charity
MQ: Transforming Mental
Health puts prevention at the
top, followed by the impact
of waiting times for treatment
and links between depression
and the workplace. Most
depression research is
focused on biological causes.
http://ow.ly/YH3bE
March 2016/www.therapytoday.net/Therapy Today 7
Dementia
Dementia is under scrutiny: 850,000
people in the UK are living with the
illness, and one in three people aged
over 65 will have dementia by the time
they die.1 This is predicted to rise to over
two million by 2051. There is an urgent
socio-political call for action,2 driving
up research into causes and for a cure,
looking towards prevention, improving
treatment and raising care standards.1
As a feminist and dance movement
psychotherapist with a background
in choreography and filmmaking, my
response to this socio-political call is
to turn my lens to the collaborative and
embodied experience of dementia: the
dynamic confluence of the psychological,
social and biological across our lifespan.
Informed by my own clinical practice
in the NHS with older adults living with
dementia, as well as my experience of
creating artistic work for the purposes
of social intervention, I collaborated
with composer Jill Halstead in a
piece of internationally funded artsbased research, including the short
film I Can’t Find Myself.
People’s voices and lived experiences
are at the heart of I Can’t Find Myself.
I developed the choreography and Jill
created the sound score for the film
and these elements are based on our
collaborative fieldwork and verbatim
interviews undertaken with people who
live with dementia and with their carers,
from a variety of cultural backgrounds.
These voices speak of the urgent
psychosocial requirement to improve
wellbeing and enhance the quality
of everyday relationships for people
living with dementia. Every time we
screen I Can’t Find Myself we call out
to all those family members as well
as clinical and care staff, who act as
extended ‘family’, in order to explore
collaborative and creative solutions.
To this end, throughout 2015–16, we are
distributing the film via the project team
partners (Dementia Pathfinders, the
University of Roehampton Department
of Psychology and the Grieg Academy
of Music at the University of Bergen)
for education and training purposes.
We want it to be seen by people
employed in services that are concerned
with people living with dementia, such
as care home and domiciliary care staff,
mental health nurses and doctors,
emergency services and hospital A&E
staff. Our aim is for the film to act as a
reflexive social tool in order to develop
support and understanding, improve the
quality of relationships and raise care
standards in a creatively conscious way.
A rich journey of the senses
I am interested in finding ways in
which counsellors and psychotherapists
can creatively engage with people
experiencing dementia. How can we
reach both lay and professional carers
in order to enhance and sustain empathic
and intimate relational engagement and
understanding of how to communicate
with, and care for, those living with
dementia? To explore some embodied
possibilities in therapy practice, I invited
a professional dementia educator and
carer, a psychotherapist and a counsellor
to respond to the film. Their comments
are included below. My own response
to each of the three professional voices
aims to highlight embodied awareness
and understanding of how to engage
with and re-build the often fractured
intimacy of relationships with self and
others that can occur with the onset
and development of dementia.
Specifically, our aim for the film is to
create a wider understanding of people
living with dementia and to highlight
how engagement with the entangled
relationship between dance and music
can enhance affective and kinaesthetic
responses – not only for those who
live with dementia but also, crucially,
for their network of carers.
The recent turn towards re-defining
‘affect’ describes it as a process of
embodied meaning making.3 A crucial
aspect of embodied meaning making
involves how we quite literally ‘make
sense’. Kinesthesia can be defined as
‘the sense of movement’ and is informed
by all the senses, as well as internal
sensations of muscle tension and
body position. Also, we know, through
research in the fields of cultural studies
and neuroscience, that all the senses
interrelate.4 Here Julia Burton-Jones,
a professional dementia educator and
carer who works for the social enterprise
Dementia Pathfinders (www.dementia
pathfinders.org), reflects on her
kinaesthetic response when watching
the film and how the moving body can
be seen as a vehicle for kinaestheticallymediated empathic responses.
‘For people with dementia, it can be
difficult to put into words the feelings and
experiences they face in living day-to-day
with the uncertainty and confusion caused
by the condition. I Can’t Find Myself takes
us on a rich journey of the senses and leaves
a profound impression on the audience,
conveying the truth that dementia touches
us in body, soul and spirit, and not just in
mind. The film packs an emotional punch:
it does not hide the pain and distress that
can be caused, but offers hope in showing
glimpses of the warmth and connection
that remain...
‘[W]hether they are a person living with
dementia, supporting a relative or friend,
Dementia and embodied
psychotherapy
Beatrice Allegranti has created a short film to help clinicians and professional
and family carers develop their understanding of the experience of people with
dementia and support them creatively
8 Therapy Today/www.therapytoday.net/March 2016
March 2016/www.therapytoday.net/Therapy Today 9
© SARAH LAM. PRODUCTION PHOTO FROM I CAN’T FIND MYSELF
Dementia
or someone concerned, [the film] could be
used as a staff development tool but also as
a vehicle for allowing people with dementia
and their families to open up about their
feelings and the impact of the condition
on their relationships.’
I am struck by Julia’s affect-laden words:
‘The film packs an emotional punch.’
Dementia is a visceral and inexplicable
experience and the relationship between
language and the body is both changed
and challenged – for the person living
with dementia and for everyone around
them. As I write this I am transported
to the private and public screenings
and subsequent discussions of the
film within a variety of professional
contexts where I kept hearing the
words: ‘I didn’t know what to expect’
and ‘I didn’t expect to be so moved.’
These realisations throw into relief a
parallel process: the audience’s affective
engagement when witnessing the film,
as well as their lived personal and
professional experience of dementia
relationships. There is kinaesthetic
intimacy in watching the film: it
activates our senses5 and directs
our attention through camera angles,
proximity, colour, sound, igniting our
own personal embodied responses,
sensations and memories in ways that
may invite us to see and feel ‘otherwise’.
Often, the focus on understanding
dementia, providing treatment and
engaging in communication can
emphasise verbal interaction, and the
value of non-verbal communication can
be ignored. As Julia states, continued
connection is important, and, as such,
attention to kinaesthetic engagement is
key – not only when people’s cognitive
faculties are impaired but more so
within/in dementia relationships where
meaning making through language as
we ‘know it’ is changed and challenged.
We cannot escape embodied
entanglements in life or in
psychotherapy. Changes in physicality
or gesture influence affective state, and
the implications for this are profound.
As people move together they learn
different ways of relating; they develop
shared networks of meaning making and
communication that are important to
intersubjective relating, neurologically
and psychodynamically.6 Both dance
movement psychotherapy and
neuroscientific research highlight how
our ability to feel with others is intimately
connected with our capacity to move
with others, and for our bodies in turn
to move in response to such feelings.7, 8
Moving with others, as Julia says, touches.
The intimate dances that unfold in the
therapy relationship also mean working
with difficult, often taboo feelings
around loss – the emotional punch. In
the context of dementia, loss is acutely
present for the person living with the
experience, as well as for family and
carers who are witnessing the change.
After one private screening and feedback
session, a member of the audience
became angry that the film evoked a
sense of loss, and targeted their anger
towards me. As I travelled back on the
underground, head in my notebook,
trying to stifle my tears on a crowded
rush hour train, I was aware that
these were old tears, relating to my
own resonating experience of care,
nurturance, love and loss. What sense
can we, the family and the professional
carers, make of being in a place where
we can no longer recall significant
memories in our lifespan and the
people associated with them? For the
person living with dementia, as for all
‘People’s voices and lived experiences are at
the heart of I Can’t Find Myself… These voices
speak of the urgent psychosocial requirement
to improve wellbeing and enhance the quality
of everyday relationships’
10 Therapy Today/www.therapytoday.net/March 2016
of us, developmental memory is
embedded; we bear the imprint of our
bodily experiences over time. So how
can the family and extended family of
carers and therapists work towards a
safe and fulfilling holding of these new
identity shifts? How is it possible to hold
the tension of witnessing a loved one’s
simultaneous presence and absence?
Remembering and finding
Who am ‘I’ without the other? Amidst the
personal and public picture of isolation,
stigma and lack of understanding about
dementia, there is a vital campaign for
person-centred care that emphasises
the lived experience of people with
dementia and their relationships.9, 10
Emphasising personhood means
understanding that the person living
with dementia undergoes neural,
cognitive and affective change and
that this change is a distributed and
dynamic embodied process.11 Also
crucial to an understanding of selfhood
in psychotherapy is acknowledgement
of the relational process – all the more
significant in the context of dementia
where a network of individuals can
be seen to be creating embodied
meaning together.
Collaborative meaning making is,
of course, an intersubjective process:
one of mutual recognition where we
can shift between being in relationship
as well as observing relationships around
us. In the dementia relationship, as with
any traumatic experiences, the capacity
to observe breaks down. Therefore, as
therapists and carers, the intersubjective
question we may find ourselves asking
is, ‘How can I remember for the person
living with dementia?’
The second response to I Can’t Find
Myself is from Marina Rova, a dance
movement psychotherapist based at
East London NHS Foundation Trust,
who has worked on an NHS continuing
care dementia unit. Marina describes her
own embodied resonance as a starting
point for intersubjective relating:
‘This short multi-layered film speaks, sings
and dances the lived experience of dementia.
If, as witnesses, we become baffled in trying
to solve the puzzle of the, at times, peculiar
and other-worldly narrative (and imagery)
of I Can’t Find Myself, it is because we
are not looking, feeling or listening hard
enough. Because dementia is peculiar,
other-worldly and alienating. Most
importantly, the film highlights that
dementia is unavoidably an embodied,
relational and affective experience.
‘As a clinician (and researcher) I am
particularly interested in continuously
developing relational and embodied
approaches in supporting those who live
with dementia and their carers. Watching
I Can’t Find Myself brought back stories
of the people (and their family members) I
have worked with. Whole lifetimes captured
in the fleeting moments of connection,
companionship, seeing, bearing (the pain)
together: a breath, a touch, the intimacy of
sharing the unspoken. I Can’t Find Myself
reminded me that attending to what I can
know (with)in my own (relational) body
helps me understand what the other may be
experiencing in theirs. When all that is lost
for the person living with dementia leaves a
gaping numbness and disorientation, what
remains becomes a possibility, a bridge we
can both walk and meet halfway to find
each other. And if you (the person living
with dementia) can only manage a few
steps, I (the carer, the family member,
the clinician) can walk the extra steps
for both of us. And maybe if I can see you
through the veil of distortion and isolation
that dementia skilfully weaves between us,
then you may be able to see yourself for a
moment. If I can find you, I may be able to
help you find yourself.
‘I Can’t Find Myself communicates all
that is unspoken in the lived experience of
dementia. It calls for our attention (and
intention) in our relational and kinaesthetic
engagement with people living with the
illness. It is not about what we can do for
people living with dementia; it is about how
we can be with them.’
When I read Marina’s words I
immediately hear Judith Butler’s
voice:12 ‘The boundary of who I am is the
boundary of the body, but the boundary
of the body never fully belongs to me.’
What is afforded to us, as therapists,
as carers, I wonder, if we begin to
understand in our intersubjective
engagements that we do not inhabit
ourselves by ourselves? Our sense of
self emerges from our developmental
relationships; we learn to understand
not from conceptual knowledge but
through intersubjective bodily
interactions and feelings during an
early intimate dance with our primary
caregiver. A common experience for
the person living with dementia is
losing a sense of self – what, then, of
their experience of loss, vulnerability,
intimacy and dependence?
We can support those living with
dementia to learn to move themselves
into life after loss. As Marina reminds
us, perhaps as witnesses ‘we are not
looking, feeling or listening hard enough’.
Embodied interventions suggest that
movement, emotions, cognitions and
the body are not separate – they are
entangled. A kinaesthetic awareness
when engaging with a person living
with dementia can allow for a relational
intimacy – however fleeting (to borrow
Marina’s words) such moments of
connection, companionship, seeing
and bearing (the pain) together may be.
Biologist Ann Fausto-Sterling13 points
out that our bodily self-perception is
formed on the basis of past information,
which by definition is always out of
date with our current physical body.
So, embodied attention during the
psychotherapeutic relationship with
people who live with dementia offers
a crucial possibility to activate the
mirror neuron system in the brain, thus
linking bodily awareness, empathy and
intersubjective processes.14 We can invite
the person with dementia to re-member
through the body. In my role as both
clinician and educator I have observed
over the years how the materiality of
movement exchange between self and
other can allow for an experience of
finding self in other. For the dementia
family this can mean re-connecting
and building new kinds of relational
intimacies with a loved one; for
professional carers it can mean relearning about a relational intimacy.
Summoned
Bearing witness to dementia and
holding an embodied awareness in
dementia relationships is a political
call – we are summoned both personally
and professionally. In this last reflection
on the film, Jonathan Wyatt, Director
of Counselling and Psychotherapy at
the School of Health in Social Science,
University of Edinburgh, speaks of
this kinaesthetic and affective call:
‘You hear the guitar’s summons, sense
the soft/hard touch of fingers on taut nylon,
the crystal moment of a note, then another,
and another, together. You hear voices.
‘When all that is lost for the person living
with dementia leaves a gaping numbness
and disorientation, what remains becomes
a possibility, a bridge we can both walk and
meet halfway to find each other’
March 2016/www.therapytoday.net/Therapy Today 11
Dementia
Her song; a call, a break in the air, words
that reach you, reach in, hands stretched
to find you, to take you. You hear his, her
voice, others’ voices, spoken, soft, harsh,
lost, loved, loving. Sad. Hopeful. And you
see, too, of course; you see, you watch.
You watch stories, broken. Fragments
of living, like dreams. Across the screen,
back and forth, here, there. Flows of touch
and holding, knowing and unknowing;
recognition gained then – snap – strange.
Estranged. All. Nightmares of the lost and
found and lost.
‘You see, hear, watch, feel, bodies.
The way bodies make contact; embracing,
falling, rolling. Gestures that convey
memories. Memories and their exquisite,
fleeting joy; and their loss. Loss that only
others can mourn. He shows her the
movement of a hand, the way it shapes
an invitation; you see her see, you see
her know, you see her raise her hand,
you see her make that same, that very
same gesture; you see her emerge, for a
moment, a moment, the joy, then – snap –
lost. Loss. His. You watch bodies embrace,
you watch skin against earth, earth on
clothing, earth on skin, daubed, a covering.
A recovering.
‘You pause when it ends. You sit. You
look out of your half-window and its
dull, half-light on Tuesday’s late summer
evening. You touch the skin on your cheek,
feel its roughness; you try to take breath,
try to feel the breath from further down,
but it’s difficult. You have with you the
sense of the man you will see, who will
sit with you here for the nearly-hour, in
this room. You and he together. The man
who is losing. The man who is losing her,
the one he can no longer find. You think
about them, their embraces, their touches;
their fleeting, momentary contact, which
he cherishes and longs for and is losing.
And you wonder if you, perhaps, between
References
1. Alzheimer’s Society (online).
Dementia infographic 2014. https://
www.alzheimers.org.uk/infographic
2. Department of Health. 2010 to
2015 Government policy: dementia.
London: www.gov.uk/government/
publications/2010-to-2015government-policy-dementia
3. Whetherell M. Affect and
emotion. London: Sage; 2012.
4. Howes D. Empire of the senses:
the sensual cultural reader. Oxford:
Berg Publishers; 2004.
you, can shape mirrored gestures even if
they are but there then and – snap – gone.’
A range of vulnerabilities is present
in the experience of loss. Loss evokes
the disruption of ipseity – the feeling
of identity, corporeality, existential
orientation and being the perspectival
origin of one’s own experience – all these
are basic components of the experienced
differentiation of self from non-self.15
And yet gestures and memories,
embodied attention in the counselling
and psychotherapy relationship, can be
a way of reminding us to remain open
to the possibilities through which bodies
make sense; new kinaesthetic memories
can be created.
A sense of loss and disorientation is
not uncommon in psychotic experiences
generally and is a common feature of
the advanced stages of dementia. This
sense of loss exists in a tangled web of
self–other relationships.16 What happens
when, inside the therapy room, we bear
witness to a life’s unravelling? A body’s
unraveling (snap – lost)? Loss of tangles
and plaques – the ruthless biological
process that biomedical science is
labouring to impede.
What is it to step into the other’s
world when they have lost their
moorings? How can we be with this
in our own bodies as counsellors and
psychotherapists? Confronted by loss,
carers and therapists can experience
strong embodied counter/transferential
feelings for the person with dementia.
Butler is aware of this incorporation too:
‘I think I have lost “you” only to discover
that “I” have gone missing as well.’17 How
does the body of the other summon us
to engage? It is the embodied relational
engagement that sustains us in the living
of everyday life. And, as Jonathan’s
5. Reason M, Reynolds D.
Kinesthetic empathy in creative and
cultural practices. Bristol: Intellect
Books; 2012.
6. Ammaniti M, Gallese V. The birth
of intersubjectivity: psychodynamics,
neurobiology and the self. London/
New York: WW Norton & Co; 2014.
7. Allegranti B. Embodied
performances: sexuality, gender,
bodies. London: Palgrave Macmillan;
2011.
8.Berrol C. Neuroscience meets
dance/movement therapy: mirror
neurons, the therapeutic process
and empathy. The Arts in
Psychotherapy 2006; 33: 302–315.
12 Therapy Today/www.therapytoday.net/March 2016
words vividly attest, relationships
are made up of gesture, voices, spoken,
soft, harsh, touch, skin, breath, embrace.
An individual’s embodied loss is
entangled within the wider social
context of care. Addressing the
multilayered aspects of loss inside the
therapy room can have reverberations
in the wider socio-political context.
Perhaps we can address our cultural
relationship with loss, aging, illness
and death in a way that helps us to enter
into new types of relationships, free from
fears about differences between self and
other and with the respect and courage
to learn from the person living with
dementia. Dementia is part of everyday
life – we are all summoned to this reality
of loving, losing and living.
Beatrice Allegranti is Reader in Dance
Movement Psychotherapy and Director of
the Centre for Arts Therapies Research in
the Department of Psychology, University
of Roehampton. Over the past two decades
her international experience encompasses
choreography and filmmaking, clinical
practice, supervision and consultancy.
Visit www.beatriceallegranti.com
I Can’t Find Myself (directed by Beatrice
Allegranti, 2015, 12 minutes) was premiered
at the Olympic Studios Cinema, London
on 9 May 2015 and has subsequently
been screened across the UK and Europe.
Forthcoming screenings and accompanying
short seminars will be at Hampton Hill
Theatre, London on Wednesday 16 March
2016, in partnership with Dementia
Pathfinders and St George’s NHS Trust,
and Friday 10 June 2016, as part of the
Embodying Social Justice Conference
at the University of Roehampton. For
booking details and updates, please see
www.beatriceallegranti.com/news
9. Brooker D. Person-centered
dementia care: making services
better. London: Jessica Kingsley
Publishers; 2007.
10. Kitwood T. The experience of
dementia. Aging and Mental Health
1997; 1: 13–22.
11. Bluhm R, Jacobson J, Maibom
L (eds). Neurofeminism: issues at
the intersection of feminist theory
and cognitive science. Basingstoke:
Palgrave Macmillan; 2012.
12. Butler J. Frames of war: When is
a life grievable: London: Verso; 2010.
13. Fausto-Sterling A. Sexing the body:
gender politics and the construction
of sexuality. New York: Basic Books;
2000.
14. Allegranti B, Silas J. Embodied
signatures: a neurofeminist
investigation of kinaesthetic
intersubjectivity in capoeira.
The Arts in Psychotherapy
(forthcoming).
15. Gallagher S. How the body
shapes the mind. UK: Oxford
University Press; 2013.
16. Allegranti B, Wyatt J. Witnessing
loss: a feminist material-discursive
account. Qualitative Inquiry 2014;
20(4): 533–543.
17. Butler J. Precarious life: the
powers of mourning and violence.
London: Verso; 2006.
How I became a therapist
Ayesha Aslam
The consonance between
the principles and values
that underlie her spiritual
beliefs and her counselling
practice has inspired
Ayesha Aslam’s career
It all started in 1997 when I was 15. At
school I was known as the ‘agony aunt’
because all my friends came to me with
their problems. They used to tell me I
would become a good counsellor when
I was older. And to my surprise here I
am, doing what I did when I was a child,
but professionally.
I did a psychology degree and worked
voluntarily in various support roles to
gain experience in different settings
and with different client groups. I
then went on to take a postgraduate
diploma in integrative counselling and
psychotherapy. This was when I first
encountered Rogers’ core conditions,
which reconnected me with my Islamic
faith. Rogers’ theories reminded me
of Adaab – good manners or courtesy
– which all Muslims are expected to
show towards one another. Several of
the principles of person-centred theory
connected directly with Islam for me,
such as self-awareness, self-acceptance,
being non-judgmental, and the healing
power of unconditional positive
regard. I felt validated in my belief that
spirituality is an important element of
the therapeutic process.
I was looking for a way to combine
my spiritual beliefs with counselling but,
when I asked about Islamic counselling,
I was often told that the two were not
compatible. If you’re depressed read
the Quran, people would say. In my
researches I found a book by Malik Badri,
Contemplation: An Islamic Psychospiritual
Study (International Institute of Islamic
Thought, 2000). He argues that
psychology’s ability to heal is limited by
its denial of the existence of the soul, and
that it treats human beings as machines
that respond only to external stimuli.
His approach to understanding the
human psyche foregrounds meditation
and contemplation, both key elements
of Islamic worship. His thinking
inspired me to pursue my passion and
set up a counselling service to meet
the needs of the Muslim community –
Sakoon, which in Arabic means ‘peace
of mind’. This was in 2006, and I took
a supervision course in 2011 (while six
months pregnant with my second child)
so I could supervise and pass on my
knowledge and experience to counsellors
to help them develop their skills to work
with the community as a whole.
Today I am often asked the same
question that I used to ask: ‘What is the
difference between Western mainstream
counselling and Islamic counselling?’
Now I have the confidence to answer.
Western psychology attempts to
answer questions such as who we are,
our thoughts, feelings and behaviour
through research and experimentation
but it ignores the most important part
of the human being – the soul. It focuses
on tangible aspects of humans and
ignores the spiritual and unseen. Islamic
counselling includes the study of the soul
and encompasses both the seen and
unseen world that may influence us.
‘Rogers’ theories reminded
me of Adaab – good manners
or courtesy – which all
Muslims are expected to
show towards one another’
There are many different forms of
Islamic counselling. Some base the
counselling purely on Islam and ignore
Western psychology. I found this model
doesn’t help the clients I work with.
Other models are more about advice
giving. This too is something that I am
uncomfortable with as I strongly believe
that empowerment is the key to help
people move forward. In addition it
goes against my ethical code of practice.
I have not trained formally as an
Islamic counsellor (unfortunately there
is no regulatory requirement to do so
in order to practise as such); rather, I
have devised my own model over time,
which we offer at Sakoon. Put very
simply, it combines spirituality and
cultural awareness with counselling; it
applies spirituality when it is therapeutic
for the client, without imposing Islamic
beliefs or values.
For example, I have a presentation
on OCD and Islam that I deliver to
Muslim communities in an attempt
to break down the stigma associated
with counselling. I use the psychological
theory of the OCD cycle and combine
this with the Islamic concept of the
unseen. Research acknowledges that
we have an inner voice that can direct
our behaviours and we don’t always
know where this inner voice comes from.
From an Islamic perspective, this inner
voice is Waswas (whispers of Satan).
Explained in these terms, the concept
of the compelling inner voice that tells us
to complete repetitive rituals resonates
with a lot of my Muslim clients. Then it’s
a matter of using counselling techniques
to decrease the power of this inner voice
so the person’s own voice becomes
louder and they take back control.
I’ve found this combination of
spiritual knowledge and psychological
techniques helps clients move forward
faster and I now deliver accredited
Islamic counselling courses to help all
counsellors understand and work with
their Muslim clients.
Ayesha Aslam MBACP (Accred) is Director
of www.sakoon.co.uk
March 2016/www.therapytoday.net/Therapy Today 13
Practice
Men and perinatal
depression
James Costello describes
his own experiences as
a ‘fellow traveller in a
foreign land’, supporting
partners of women with
perinatal depression
Illustration by Chiara
Criniti
14 Therapy Today/www.therapytoday.net/March 2016
Strangely, perhaps, I want to start this
article with a quote from Robert Louis
Stevenson, an inveterate traveller:
‘There is no foreign land,’ he wrote;
‘it is the traveller only that is foreign.’
Working for an NHS counselling
service some years ago, I was asked if I
might like to get involved in developing
and piloting psycho-educational
workshops for families affected by
perinatal depression (PND). Up until
that time, I had never really considered
PND to be part of my life experience;
it was like some foreign land I had
heard of but never visited. However,
the stories my mother told me about
my first months returned to me with
renewed meaning: ‘I would creep up
to your cot as you slept and startle
you awake… just so I could cuddle you
when you cried.’ Her father died shortly
before I was born, and so, on reflection,
I wonder who was actually comforting
whom during those dark winter days
when she was alone, grieving, and my
father was at work? Maybe it wasn’t
such a foreign country after all, I told
myself. As a male counsellor, this felt
like a unique opportunity to explore the
needs of the mother’s partner – often,
but not always, a man – in the context
of supporting their family system.1
This article describes my own
experience as a foreigner in a world
that is, more than most others,
exclusively female.
I was standing in for a male colleague
who had withdrawn for reasons
unknown, leaving his female colleagues
metaphorically ‘holding the baby’. I was
aware that I was a foreigner in this land,
and was viewed sceptically by my new
colleagues. Expectations were low; as
a female colleague remarked, ‘What do
you know about PND? You’re a man.’
My experience perhaps paralleled that
of men living with PND. Giving birth
and adapting to the new mother role is
without question a unique and specific
experience; unfortunately the experience
can trigger the onset of depression in
some women who are already predisposed
to this, and can exacerbate recurrent
low mood in others. Situational factors
such as bereavement, birth complications
and temperamentally difficult infants
are other risk factors. Women with
PND often feel their partner is not
offering adequate practical and
emotional support.2
The structure and content of the
workshops were adapted from a CBTbased model developed by Milgrom and
colleagues.3 Eight day-time sessions were
offered to mothers, and three shorter
evening sessions were organised for their
partners, supporters and other family
members. Through feedback, I quickly
learnt that these ‘partner workshops’
weren’t meeting participants’ needs.
Some practical changes made an
immediate improvement to their
experience. These included providing
more and longer sessions on a Saturday
morning, and a crèche. But in addition
to these practical changes, I gave
some careful thought to the nature
of masculinity itself, and to what
the literature tells us about men’s
experiences of PND,4 with the aim
to ensure that the workshops more
accurately met participants’ needs.
Working with men
Research tells us that men seek help,
including psychiatric and counselling
services, less often than do women.5
In the past it was assumed that women
accessed help for emotional distress
more often simply because they were
more vulnerable to depression.6 The
higher rates of suicide among men
in almost every culture suggest that
a more sophisticated analysis of the
relationship between gender and helpseeking is required.
Boys are taught to avoid revealing our
emotional vulnerability – our basic need
March 2016/www.therapytoday.net/Therapy Today 15
Practice
‘Men are much more likely to seek help when
they perceive there is also an opportunity
to help others. Masculine ideals of strength
and competence can be preserved when
they don’t feel indebted to anyone else’
for human connection – because it may
threaten our socially-constructed sense
of identity. For men, help-seeking for an
emotional problem can conflict with the
multiple messages we are given about
what it is to be masculine – the emphasis
on physical toughness; the preoccupation
with power and competition, selfreliance and emotional control; the fear
of intimacy; homophobia. To me, and
to many others, gender is more usefully
understood not simply as a property of
individuals but as nested layers of highly
situated and contested social practices,
where we are taught to ‘do this’ and
‘not to do that’.7 For example, through
the cultural influence of being married
to an Italian, I am much more likely
to greet another man with a kiss when
I am in Italy than when I’m in the UK.
Normalising the problem
Given the dynamic nature of gender, it
became clear that I would better serve
my clients by meeting them where they
were, rather than where I wished they
could be. Bringing this awareness to bear
on the PND workshops meant that I could
use gendered social cues that made sense
to men, enabling them to more readily
engage their usual behaviours to support
their partners with PND.
Below, I outline the recurring themes
that evolved from my research with
men whose partners were experiencing
PND, through focus groups, research
interviews and, of course, through
my own clinical experience. Their
words are communicated here
through fictionalised narratives.
For men to manage the knock to
our self-esteem when we encounter
a problem we find perplexing, it seems
particularly important for us to establish
whether or not our problem is ‘normal’.
This process of normalising is often best
facilitated through sharing with others
who have experienced similar situations.
Belonging to a network where others
16 Therapy Today/www.therapytoday.net/March 2016
are willing to share experiences, and
sometimes vulnerabilities, helps mitigate
the negative effects of isolation. As Harry
explained: ‘For me, it was about hearing
“Many go through it and survive… you’ll
be OK”… that was the turning point…
meeting other guys who have been
through it and survived. At the time I got
no support at all; as a man… I was quite
literally on my own. It wasn’t something
I talked about with my mates at work.
And even if I could talk to somebody,
what would I say…? “My wife’s gone
loopy”? Men would make a joke about
it in the way they joke about PMT.’ And
in one of the most severe cases of PND
I encountered, Mark described how, ‘I
was so desperate that when they came to
section her, I asked the ambulance guy:
“Do you want to go for a curry after?”’
Accessing networks through which
men caring for their partners can
feel understood and be reassured
about the future is a crucial step
towards normalisation, along with
clear signposting to information
about depression and its causes.
Charities that support people affected
by PND, such as Bristol-based Bluebell
(www.bluebellnurses.org), recognise
the importance of reducing the
barriers to men’s help-seeking by
creating readily accessible online
resources (see, for example, the videos at
www.dropbox.com/sh/9w87e71lonwf8ez/
AAD-s_bEDTiN0JTIzmanYh6ga?dl=0),
which aim to help normalise men’s
experiences).
Reframing a technical problem
Roy quickly seized on the practical things
he could do to help his partner: ‘I read
on the internet that ginger biscuits and
ginger beer were helpful for morning
sickness, so I went out in the middle
of the night to find those things for her.’
But the ‘up and down’ of his partner’s
mood reflected the unpredictability and
loss of control that PND introduces.
Communication becomes almost
non-existent and, like many men in
his position, Roy felt exasperated when
his offers of practical help were received
unsympathetically: ‘It’s like walking
on eggshells… almost everything I did
was wrong… and that included trying
to help with the baby.’ He struggled
to understand his partner’s depression:
‘You can’t say or do anything right…
it’s all wrong… no end of reassurance or
comforting works… there isn’t the logical
response to it that you would normally
expect… it’s so irrational… nothing gets
through.’ It was, he said, ‘much harder
for a man to empathise with.’
Roy framed depression as an external
experience: ‘You just take pills for it.’
This approach is consistent with a
more masculine understanding of the
condition.8 He explained: ‘I dreaded
coming home from work to find her
crying… day after day… having to cope
with her… and our son… I found it really
depressing.’9 He wasn’t going to take
pills himself though: ‘I had different
options… I just got on with it… went
to the gym… kept busy.’
Roy recognised that this was his way
of trying to ‘take control’ of a situation
over which he felt completely powerless.
He preferred to socialise with friends
who didn’t have children: ‘They were
easier to get hold of, and the conversation
wasn’t about kids… Friends with kids saw
hardship and sleep deprivation almost
as a badge of honour… as if the greater
the suffering endured… the better the
parent you were.’10
Roy ultimately recognised that, by
relinquishing elements of his masculine
sense of autonomy and competence,
he could play an important part in his
partner’s recovery: ‘At one point, Maria
and the baby moved back home to be
with her parents… I wondered whether
she would come back.’ Reflecting upon
his role as a carer, he recalled wondering:
‘Have I failed? Was I good enough to look
References
1. Fletcher R. Promoting infant
well-being in the context of maternal
depression by supporting the father.
Infant Mental Health Journal 2009;
30(1): 95–102.
2. O’Hara M. Social support, life
events and depression during
pregnancy and the puerperium.
Archives of General Psychiatry
1986; 43: 569–573.
3. Milgrom J, Martin PR, Negri
LM. Treating postnatal depression:
a psychological approach for health
care practitioners. Chichester:
John Wiley & Sons; 1999.
4. Muchena G. Men’s experiences
of partner’s postnatal mental illness.
Nursing Times 2007; 103: 32–33.
5. Addis ME, Mahalik JR. Men,
masculinity, and the contexts of
help seeking. American Psychologist
2003; 58(1): 5–14.
after my own wife? In some respects,
you know… I wasn’t. I failed at a practical
level… because I just couldn’t provide
the support.’
Toby re-framed his technical problem
and adapted: ‘I suspect my mum had
PND so it wasn’t unfamiliar to me… I
changed my role at work so that I could
spend two or three days a week at home
caring for them both... I didn’t expect my
boss to be so brilliant… Molly’s parents
were often down to share the care… and
they would also spend a week or so with
her parents so that she could have 24/7
support.’ Toby had respite when the
care was shared with Molly’s parents:
‘That’s when I had a break… I played
sport… and even with Molly here I
managed a bit of me time… it’s really
important and not so difficult to find.’
Toby managed to create an
environment in which Molly could
concentrate wholly on her recovery
by 1) being open about the mood
disorder; 2) accessing a supportive
network of friends, family and
professionals; 3) taking on much of the
child care, and all of the day-to-day tasks
of running the home, and 4) attending to
self-care. As a result, Molly emerged from
depression within about six months.
In my experience of facilitating
PND groups for partners, I found men
were more likely to come to the group
believing that some technical problem lay
with their partner. And that’s fine; it’s the
first step; in this way, men feel they are
taking emotional control without there
being an immediate threat to their selfesteem. Ultimately, however, a process
of re-framing the issue may be required,
during which they recognise that
some of their masculine norms require
renegotiation. I’ve witnessed many times
the inspirational transformation that
occurs during groupwork as men begin
to gently challenge each other’s gendered
perspectives and develop more adaptive
solutions, as was the case for Toby.
6. Weissman MM, Klerman GL. Sex
differences and the epidemiology
of depression. Archives of General
Psychiatry 1977; 34: 98–111.
7. Addis ME, Mansfield AK, Syzdek
MR. Is ‘masculinity’ a problem?
Framing the effects of gendered
social learning in men. Psychology of
Men & Masculinity 2010; 11(2): 77–90.
8. Danielsson U, Bengs C, Lehti A,
Hammarström A, Johansson E.
Struck by lightning or slowly
suffocating – gendered trajectories
into depression. BMC Family
Practice 2009; 10: 56.
Reciprocity and indebtedness
Men are much more likely to seek
help when they perceive there is also
an opportunity to help others. Masculine
ideals of strength and competence
can be preserved when they don’t
feel indebted to anyone else. This is a
surprisingly strong drive. For example,
one cold, dark winter evening I found
myself preferring to struggle on trying
to repair a puncture rather than accept
the offer of help from a fellow cyclist!
The masculine norms of self-reliance
and the avoidance of dependence help
maintain a man’s sense of power and
control. However, in PND groupwork,
as soon as men notice that they are
able to empathise with others who are
experiencing something similar, they
become more available to offering their
perspectives and support to their peers.
I have been often moved and humbled
by the levels of disclosure and intimacy
that unfold in groupwork as men wander
away from their more usual masculine
identities. As Chris explained: ‘I’m happy
to help other guys... the key for me is
to forget the nurses in uniform and
all that kind of stuff… and give guys
the opportunity to talk to those who
have been through it… From a selfish
perspective, it’s really good for me too.’
Simply loving… and willing
In short, I noticed how it seemed
important for men to normalise
their experiences, re-frame technical
problems into adaptive ones, and
engage in peer-to-peer support. I
incorporated these elements into a
variety of activities in the workshops.
Single-gender (and later whole-group)
work offers an accessible means for
men to renegotiate masculine norms.
Single-gender groups are congruent
with the work of reciprocity and
reframing. The male counsellor may
safely challenge norms here, and even
find himself nominated to voice the
9. Ramchandani PG, Stein A,
O’Connor TG, Evans J, Heron
J, Murray L, Evans J. Depression
in men in the postnatal period
and later child psychopathology:
a population cohort study. Journal
of the American Academy of Child
and Adolescent Psychiatry 2008;
47(4): 390–398.
10. Rotkirch A. Maternal guilt.
Evolutionary Psychology 2009;
8(1): 90–106.
anxieties of the sub-group, conveying
the male partners’ perspectives that
were previously unvoiced for fear of
appearing disloyal (I was affectionately
termed ‘the nominated bastard’). Wholegroup and couple work offer men the
opportunity to support each other, as
well as access their partner’s experiences
of depression, hone communication
skills, and develop deeper empathy.
PND seems a particularly genderspecific issue, and it isn’t uncommon
to overlook the positive role men can
play. Austerity has meant that NHS
trusts are now less able to reach out
and engage men in wrestling with their
social conditioning, and help them
overcome their barriers to help-seeking
and support their partners and families
through PND. I have been inspired by the
support, compassion and understanding
offered by men during these PND
partner workshops, not because they
are men but because they model positive
qualities for all human beings. As Sam,
a valued co-facilitator who herself
experienced PND, put it: ‘Feeling like
a traveller in a foreign land mirrors
our own role as counsellors… We don’t
need to experience what our clients do
in order to be helpful and supportive…
If men are simply loving and willing,
they can help a great deal.’
James Costello is a registered MBACP
(accredited) counsellor, who also teaches
counselling in the Department of Psychology,
University of the West of England, Bristol.
He specialises in workplace relations/
wellbeing, advocacy and conflict resolution.
Elements of this work were presented at the
18th Annual BACP Research Conference
in Edinburgh, 2012.
James is happy to share the resources
he developed for the psycho-education
workshops. They are available to download
for free from http://people.uwe.ac.uk
(type ‘Costello’ into the search box).
March 2016/www.therapytoday.net/Therapy Today 17
Practice
Louis Heyse-Moore argues
that therapists working
with the dying and
bereaved need to have a
thorough understanding
of the e�ects of severe
trauma Illustration by
Chiara Criniti
Andrzej was in his 80s when he was
admitted with terminal cancer to a
hospice where I was working as a doctor.
He was a small, bear-like man, with short
white hair, a strong but soft-spoken
Eastern European accent and a greyish
pallor to his skin. A few days later he
went quietly psychotic. He was, we
gathered, back in the Second World War
prison camp where he had been interned.
The other patients were his fellow
inmates and the nurses and doctors
were the camp guards. When he saw a
person who had just died in one of the
single rooms, he was not surprised; he
had seen many such deaths in the camp.
He had managed to contain the
memories of his internment for over
30 years, but now, as his defences
weakened with his advancing illness, it
rose inexorably to the surface of his mind
and he fell into a nightmare psychosis,
reliving his brutal experiences. I felt
for him. We were able to alleviate his
distress with antipsychotic drugs but he
was beyond any form of talking therapy.
This was my introduction to the world
of trauma and the havoc it wreaks. Over
my years working in palliative medicine,
trauma would occasionally be mentioned
as a possibility; mostly as above, in those
whose war memories were reactivated
by the stress of their final illness. But
this was rare. Looking back, however,
there was no shortage of patients and
relatives who were intensely distressed,
yet trauma was hardly ever mentioned
as a possible factor. Rather, diagnoses
such as anxiety, agitated depression or
terminal restlessness were suggested,
or occasionally bipolar disorder or
borderline personality disorder.
With hindsight, I believe many
showed signs of traumatic stress and
many others had post-traumatic stress
disorder (PTSD). Why, then, was this
not noted? It is surely important – how
else could effective therapy be provided?
When I met Andrzej, PTSD had not
long been recognised as a diagnosis in
the Diagnostic and Statistical Manual of
Psychiatric Diseases (DSM), so there was
some reason for our missing what was
happening to him. But that was over
30 years ago. Recently I did an online
search for palliative care and PTSD
in the world research literature. I came
up with a meagre dozen papers, some of
which only mentioned PTSD in passing,
or in intensive care units (ITUs). I was
surprised; I expected to find hundreds
of papers. Why is there still so little
awareness of it?
One reason may be about complexity.
Dying people often have numerous
symptoms, such as pain, vomiting and
breathlessness; they may be taking many
drugs; some of these, such as sedatives
or antidepressants, mask psychological
symptoms – or cause them; they may
be confused, drowsy, delirious or
even unconscious and so unable to
communicate how they feel.
Traumatic stress
Doctors and nurses, the front-line
clinicians in palliative care, are not
usually trained in psychological
therapies. They may use to good effect
the counselling skills they learned as
students, but this level of skill isn’t
enough to diagnose and work with
a chameleon condition like PTSD.
Traumatic stress may be expressed
in varied puzzling physical symptoms
– breathlessness, abdominal pains,
palpitations, diarrhoea, muscle aches,
weakness, headaches, insomnia and so
on. It is only too easy to attribute these
complaints to the effects of advanced
cancer, or, confusingly, they may be due
partly to the cancer and partly to PTSD.
Often, trauma starts before referral
to a palliative care unit, even from
the moment the diagnosis of cancer
or other life-threatening illness is
given, no matter how carefully and
compassionately this is done. Having
broken bad news thousands of times,
I’m all too familiar with the shocked
Trauma and
the dying
18 Therapy Today/www.therapytoday.net/March 2016
March 2016/www.therapytoday.net/Therapy Today 19
Practice
state into which some people go. Their
eyes glaze, they seem not to be listening,
to be far away. They ask the same question
repeatedly and then forget the answer.
Cancer has a unique ability to inspire
fear. There are many other illnesses
just as serious – motor neurone disease
and end-stage heart failure, for example
– that don’t necessarily engender the
terror that cancer evokes. It has an
archetypal quality: the pitiless, devouring
predator that seizes its victim and never
lets go. Just mentioning the word was
enough to evoke horror and disgust in
patients and clients with whom I worked.
There are, too, the rigours of surgery,
chemotherapy and radiotherapy. These
life-saving treatments may be intensely
taxing: vomiting, loss of hair, prostrating
weakness, life-threatening infections,
drips, kidney failure, pain, artificial
ventilation, ITU psychosis. For some,
it’s a hellish ride.
When those with advanced cancer
are referred for palliative care, they
come carrying with them their wounds
– physical and psychological – and the
attendant traumatic stress. Some have
been relatively unaffected by their
hospital odyssey, but not so others.
They may be skeletal, or terribly swollen
with oedema. Their skin may have
changed colour to grey or pale brown or
jaundiced yellow. A woman’s breast may
have been replaced by a tumour. A man’s
face may have been partly eaten away
by cancer. They may have lost a limb, an
eye, or any one of their internal organs.
Some maintain their cheerfulness
and courage; others curl up in bed and
retreat to a frozen, inner hiding place.
Yet others are consumed by fear or
rage or grief. The shocked faces of the
families I met reflected their distress
at seeing their loved one so changed
and brought so low.
Palliative care units are experienced
in addressing these frightening
conditions and working to ensure that
the dying have a peaceful death. I used
to think this was enough for the families
sitting with the dying person, but I was
mistaken. When I started to counsel
bereaved people, I was surprised to
find that, despite the quiet, symptomfree death of their loved one, they would,
months afterwards, still have distressing
flashbacks to the time of dying. Many of
the bereaved people with whom I worked
had symptoms of some level of traumatic
stress, especially if their experience had
re-awoken memories of past traumas.
The person they loved looked radically
different; his breathing might have
been irregular and stertorous; if he
20 Therapy Today/www.therapytoday.net/March 2016
didn’t breathe for a while, did this mean
he had died? And then he took another
breath – he hadn’t died. He might have
vomited blood earlier or had a fit
requiring anticonvulsant medication.
This was unexplored and frightening
territory for them.
Learning to work with trauma
So what’s to be done? The priority,
surely, is recognition. This is where
psychological therapists and
psychiatrists who work in palliative
care – still a small group – have a vital
role to play, in educating other palliative
care workers about trauma. Without
this knowledge, how can they provide
the right support? This is all the more
important now that there are effective
therapies available. Bessel van der
Kolk comments on the three forms
of therapy for PTSD:1 top-down talking,
understanding and re-connecting;
drugs to shut down alarm reactions,
and bottom-up, body-based therapies
such as eye movement desensitisation
and reprocessing (EMDR) or somatic
experiencing (SE), which may work when
talking approaches don’t. ‘Most people,’
he says, ‘require a combination.’ Indeed.
This is particularly important in the
dying, many of whom simply can’t do
formal talking therapies. They are too
weak, can’t concentrate long enough,
can’t speak or are confused. This is a
challenge to therapists working with
the dying. The traditional hour-long
session once a week usually has to go
by the board. Instead, a session may
last anywhere from five minutes to
well over an hour. Equally, it may be
necessary to see the dying person daily
– if a person has only a week or so to
live, every moment counts. Or you
may only see a person once and then
find that they have died the next day.
For them, something else is needed,
something that speaks to them at a
body level when words alone are not
enough. The net needs to be spread
wide: therapists for adults, children
and families; doctors, pharmacists and
nurses; complementary therapists such
as reflexologists, acupuncturists and
massage therapists (patients universally
love massage); chaplains, who bring
the comfort of ritual; art therapists –
all work in hospices. Such a pool of
expertise. They just need to know
what they are dealing with – the hidden
trauma – and what combination of
therapies suits each individual.
The Jungian analyst Arnold Mindell,2
for example, describes using image work
in an encounter with John, a confused
elderly black man, ‘stuck at the edge
of life, unable to die… moaning and
shouting’ incomprehensibly, over several
months. Mindell sits with him, groaning
with him, and squeezing his hand in
synchrony with his breathing and pulse:
entrainment, in other words. After 20
minutes, John becomes comprehensible.
‘Yeah. Wow, no, yeah…,’ he says. Then,
a little later: ‘Shhh… Yeah. A b… bb…
bbbbiiig, a big shhhhhip.’ Mindell
responds in kind: ‘Shhhhiiiip… yeah.’
A ship is coming for John. ‘You
gonna take it?’ asks Mindell. John yells:
‘No man, not me!!’ The ship is going on
vacation but John has to get up and go to
work. Mindell suggests he takes a good
look at the ship. John looks: ‘Oh wow!!
Wow… There are angels in that ship,
driving it.’ Angels everywhere. Mindell
asks him how much it costs to get on
that ship: ‘Yeah… that… well… it costs
nothing. Ze…ro.’ So Mindell suggests he
‘consider a little trip. If you don’t like it,
you can come back.’ John quietens down,
mutters about going to the Bahamas and
falls asleep. Mindell leaves and returns
half an hour later to find John has died.
‘I was both sad and happy. The old man
had decided to go on vacation.’
A sense of safety is, of course,
essential. Peter Cornish3 describes an
unusual way he provided this for his wife,
Harriet, who was dying of cancer. They
were Tibetan Buddhists and, when she
was admitted to a Catholic hospice in
Ireland, they, in cooperation with the
staff, redecorated the room with Tibetan
rugs, cushions and curtains, thangkas
(paintings of Buddhist saints), her
shrine (which was placed by her bed),
candles, incense and flowers and a
crystal sphere in the window. Peter
and their friends stayed with her at all
times, watching with her and meditating.
As she approached death, he writes,
‘I united my breathing with hers. In the
background, a recording of the Dalai
Lama chanting the “mandala offering”
was playing. She gave three long, gentle
outbreaths. Her last outbreath coincided
exactly with the last long deep syllable,
and the chanting ceased.’ Afterwards
staff commented, some in tears, on
the extraordinary peace in the room.
It’s true this setting and the rituals
practised were unique to Harriet, but
surely we can exert some ingenuity as
therapists in finding ways our clients
might feel something like that sense
of peaceful security?3
The emphasis on the body and its
felt sense, as practised in SE, is in fact
familiar to those working in palliative
care. Perhaps the simplest and most
‘When I started to
counsel bereaved people,
I was surprised to find
that, despite the quiet,
symptom-free death
of their loved one,
they would, months
afterwards, still have
distressing flashbacks
to the time of dying’
obvious way is through touch: ‘A doctor
is visiting a patient at home. Carefully
and gently she examines him. It is as
though she is having a conversation
with his body. His stomach hurts. She
takes extra care not to cause him pain.
Later, his wife massages his hands and
feet, comforting him. Earlier that day
a nurse had visited and helped his wife
to reposition him in his bed. All through
the day, then, hands are laid on him.
He is calmed by their contact.’4
Sometimes I think palliative care
workers miss the profound effect they
are having when their skin touches
the skin of a dying person. It is the
most fundamental of communications,
speaking to and soothing the reptilian
and mammalian aspects of our triune
brains. Some patients live alone and
have hardly been touched in years – a
kind of sensory starvation. In a number
of therapies, however, touch is taboo.
Doesn’t this need rethinking? When I
worked medically, I was keenly aware
that, when I examined a person, I was
doing more than applying a stethoscope
or feeling for lumps. I was listening to
and sensing the person as well as their
physiology. For many I could see how
calming this was for them. They had
been recognised.
I remember talking to one woman with
advanced cancer who had a nightmare of
a demonic figure staring at her – perhaps
a symbol of her cancer. I have rarely
seen anyone so frightened. Her family
would hold her and calm her – they
knew instinctively what to do. Touch,
yes, but they were also unknowingly
grounding her – another SE practice.
‘It takes very little for [the traumatised
dying] to spin back into their dark
memories, memories that speed their
heart, quicken their breathing and
tighten their throat… We stop and
ground, making a verb of action out of
a noun of a place. It is disarmingly literal.
“Just notice your feet on the ground,”
I say. “No need to change anything,
simply notice the sensations of your
feet…” Her attention is shifting to the
subtleties of sensation of the skin of
her feet. She is coming back into her
body and out of the terrifying, mythic
Underworld into which she has fallen.’
I turn to her other senses; I ask her
what she hears, what she sees: ‘Her eyes
move slowly around, taking in the room,
me… the soft light from the window…
She is here again. “How do you feel?”
I ask. “Better,” she says; “calmer.” Good.’4
Often when I visited those close to
death, music would be playing in the
background – Classic FM, jazz, big band,
blues or perhaps Sinatra. Their families
knew this would help, the beat of the
music resonating, perhaps, with the
beating of a heart, the first sounds we
know in the womb. I learnt about this
therapeutic effect of sound in an unusual
way. One day I heard music coming
from a hospice ward: ‘[I] pushed open
the swing doors. The volume of sound
doubled. Two violinists from the Yehudi
Menuhin School were standing in the
middle of the ward. One was playing
a Bach partita. It was one of those
moments. I had been feeling distracted
and scattered. Then, in a moment,
my whole attention was centred on the
music and its player. I felt myself coming
alive... It was entrancing. The notes
sounded cool, liquid, like patterned
rain. The whole ward was still and music
filled it. They played for a quarter of an
hour or so, then took up their music and
stands and quietly left to go to another
ward. For a while afterwards the ward
seemed imbued with a silent afterglow.
The patients continued to be ill; some
were close to dying. But, for a little
while, the suffering on the ward
seemed transformed.’4
Conclusion
Traumatic stress and PTSD are common
in the dying and the bereaved but often
missed. These patients and clients may
therefore not receive effective therapies
for their suffering. How can this be
remedied? First by raising awareness
in palliative care workers and second by
having available a wide range of therapies
tailored to the individual that address
psyche and soma, neurochemistry,
emotions and relationships.
© Copyright Louis Heyse-Moore.
Louis Heyse-Moore is a retired palliative
medicine physician, an integrative
psychosynthesis practitioner trained at
Re.Vision, and a somatic experiencing
practitioner (SEP). He is also a writer on
psychological, medical and spiritual subjects.
His most recent book is The Case of the
Disappearing Cancer: and other stories
of illness and healing, life and death
(Ayni Books, 2014, isbn 978-1782796145).
References
1. van der Kolk B. The body keeps the score.
London: Allen Lane; 2014.
2. Mindell A. Coma: the dreambody near death.
London: Arkana; 1994.
3. Cornish P. In memory of Harriet. View 1994;
1: 16–19.
4. Heyse-Moore LH. The case of the disappearing
cancer: and other stories of illness and healing,
life and death. Winchester: Ayni; 2014.
March 2016/www.therapytoday.net/Therapy Today 21
Sexuality
Asexuals – a hidden
one per cent
22 Therapy Today/www.therapytoday.net/March 2016
Counsellor Joanna Russell talks about her
personal experience as someone who defines
herself as asexual Illustration by Chiara Criniti
‘At least no-one sends you homophobic
hate mail,’ was the reply from a trusted
friend when I told him I had come to
the conclusion that I was asexual. I felt
dismissed, discounted, pathetic – as if
my experience of the world was somehow
less significant than his.
This exchange took place about five
years ago, fairly early on in my journey.
I had always sensed that I was somehow
different. I shrank with anxiety when,
during my teenage years, my friends
talked about the boys they fancied;
I didn’t understand what they meant
and I was afraid of being found out.
As my peers began to pair up, marry
and produce offspring, I was left on the
shelf and experienced a renewed fear
of being found wanting. I was tired of
hearing ‘There are plenty of fish in the
sea. You’ll find someone who is right for
you.’ I didn’t want anyone. Didn’t they
get that? At least, I didn’t want anyone
who would want to do THAT with me:
‘You really want to put that, there? I
don’t think so.’
I didn’t know anyone else like me.
Sure, I knew some other single people
– people not in relationships – but they
were constantly looking for Mr or Ms
Right. I felt defective, damaged, utterly
different, and I feared exposure. Then a
friend asked if I had heard of asexuality.
Could this be my answer? Perhaps there
was nothing wrong with me? Perhaps I
was just differently wired?
So what is asexuality? Is it a sexual
orientation? Is it solely a choice? Is it
the same as being frigid? Is it the same
as celibacy? In the last eight years I have
read everything I can find on the subject:
academic research papers, newspaper
and magazine articles, books (in several
languages) and websites. I have joined
online communities and started to
socialise with some of those communities
in the real world. The clearest definition
of asexuality I have found is the one
used by AVEN (Asexuality Visibility
and Education Network), one of the
most popular online communities
for asexuals: ‘An asexual person is a
person who does not experience sexual
attraction.’1 Someone from the US who
chose to remain anonymous described
it thus: ‘I have never had interest in
sex all my life, at all. It’s like algebra.
I understand the concept, but have no
interest. I don’t have the strong feeling
about it that the rest of the world has.’2
There are asexual people who have
chosen to be married to access the
lifestyle that would be unavailable
to them otherwise, and who engage
in sexual behaviours for the sake of
their partner. There are asexual people
who experience sexual arousal but,
as one of them said: ‘... many sexual
people are sexually aroused by leather,
but they are not sexually attracted to
leather.’3 The key factor is that, for an
asexual person, sexual behaviour has
no connection or meaning in terms
of another person: ‘They get erections
and some masturbate, although even
while experiencing the physical cues
March 2016/www.therapytoday.net/Therapy Today 23
Sexuality
of arousal, there is never an impulse
to do anything sexual with another
person. A number of asexuals told me
that watching porn or looking at erotic
pictures were awkward experiences
that they couldn’t relate to.’2
For some sexual people, kissing,
cuddling and hugging are not thought
of as sexual behaviours; for others they
are associated with foreplay to other
sexual activity. The same is true for
asexual people: such behaviours are not
only not necessarily thought of as sexual;
they are rarely seen as the overtures to a
sexual encounter. To put it more plainly,
asexual people in relationships may have
sex with their partners, for the partner’s
sake. The alternatives may be stark:
not be in a relationship at all, find an
asexual partner (not easy), or agree that
the partner can go elsewhere for sex.
Definitions of asexuality
The notion of asexuality as a sexual
orientation is relatively recent.
Previously descriptions of (human)
asexuality would have been reserved
for those who were unable to experience
sex for reasons of physical incapacity
resulting from injury or trauma.
Those reporting no subjective sense
of sexual attraction might well have
been given a diagnosis of hypoactive
sexual desire disorder, following the
DSM-IV guidelines.
So is asexuality really best understood
as pathology, or should it be recognised
as a fourth sexual orientation? If so, how
to describe an orientation that is about
a lack of behaviour, desires, attractions
and fantasies? A disorientation? Some
writers today think of asexuality as
a meta-category – ie sexual/asexual.
DSM-5 is an improvement in that it
makes provision for an asexual identity
and, as a qualifier to its diagnostic
criteria, adds: ‘If a lifelong lack of
sexual desire is better explained by
one’s self-identification as “asexual”,
then a diagnosis of female sexual
interest/arousal disorder would not
be made.’4
If the ‘cause’ or ‘causes’ of asexuality
could be identified, would that make it
more legitimately a sexual orientation?
Theories abound as to the ‘causes’ and
stability of sexual orientations; although
many studies have looked at the possible
genetic, hormonal, developmental,
social and cultural influences on
sexual orientation, no definitive
answers have emerged that show
that a particular sexual orientation
is determined by any given factor or
factors. Many think that nature and
24 Therapy Today/www.therapytoday.net/March 2016
nurture both play a role; certainly most
people report little or no sense of choice
about their sexual orientation.
Canadian researcher Anthony
Bogaert based his 2004 paper ‘Asexuality:
prevalence and associated factors in
a national probability sample’5 on
information from the 1990 survey
Sexual Behaviour in Britain: the national
survey of sexual attitudes and lifestyles.6
This survey had been prompted by the
threat of AIDS; it asked almost 19,000
members of the British public about
their sexual habits. One of the questions
was about sexual attraction and included
a possible response of ‘I have never
felt sexually attracted to anyone at all.’
Just 1.05 per cent of respondents chose
this answer. Bogaert’s paper was among
the first published research showing
that a group of people existed who
could be described as asexual.
Not so long ago sex was one of the
things that defined liberation – as in
‘free love’. But for those who have no
sexual desire or fantasies, it represents
an anomaly, an aspect of ‘normality’
from which they are excluded. One
lesbian friend used to tell me that she
felt alienated in what was then very
much a ‘hetero-normative’ world. She
spoke of her straight friends who could
get married, raise families and live their
sexuality publicly, while these options
have only recently become available
for her. I understand that. For an asexual
person, the ‘heteronormative’ society
that my lesbian friend described
goes one degree further and becomes
a ‘sexual-normative’ world. Most
people don’t understand that.
There is strong but subtle pressure
to conform, to fit the mould. I referred
earlier to my own feeling that I was
somehow different and unacceptable,
as if a part of me that ought to be there
was missing. Even in the relatively
undersexed world of organised Christian
religion there is an implicit expectation
of heterosexuality, marriage and
procreation. In some Christian teaching,
marriage and childbearing form a central
part of a woman’s identity. The pressure
to remain celibate until marriage, as we
have seen, assumes that sexual desire
is present. Some go even further; on a
website about religious vocation I found
this question: ‘What do you call a person
who is asexual? Answer: Not a person.
Asexual people do not exist. Sexuality is
a gift from God and thus a fundamental
part of our human identity. Those who
repress their sexuality are not living
as God created them to be: fully alive
and well. As such, they’re most likely
unhappy.’6 I find this statement both
dismissive and offensive.
Connecting with others
The asexual community is still largely
virtual and invisible. How do you find
others based on a shared negatively
defined identity? How would you
find other people who don’t eat toast?
During the first four years of my journey
of learning about asexuality, not once
did I (knowingly) meet another asexual
person. I searched, I dropped hints
among groups of friends, I longed
for someone to show me ‘how’ to be
asexual, and for intimate friendships
without expectations that sexual
intimacy would follow. Everyone I
met I had to educate.
No, asexuality is not the same as
celibacy – celibacy implies giving up
something you like. No, it is not the
same as being disabled – all the bits
work as they should. No, it is not
the same as hypoactive sexual desire
disorder. No, it can’t be treated with
hormones. I am not just a late bloomer,
and no, I am not lying. I have been asked
a few polite questions but most people’s
responses range around total disinterest,
confusion and an assumption that
childhood sexual abuse is part of my
story. Many wonder how I can know I
am asexual if I haven’t ‘tried it’. One has
even offered to ‘sort me out’. I have yet
to meet another therapist who identifies
as asexual.
My friends’ reactions to my ‘coming
out’ have been seriously underwhelming.
‘So, you are asexual, and...?’ You see,
there is nothing to report. It is an
orientation that is defined by what is not
happening. What’s the problem? There
is little danger of spreading HIV, there
are no unwanted pregnancies. The whole
point is that no one is doing anything!
Having now connected with a local
AVEN group, I am discovering others
have had similar experiences. At my
first meeting I met six other asexual
people. None were ‘out’ to their families,
and most had told only a few trusted
friends. None had knowingly met any
other asexual people, other than those
at the AVEN group. All felt isolated and
misunderstood.
I am learning that there is an
enormous breadth within the asexual
spectrum. New vocabulary is constantly
evolving. Some asexuals would identify
as demisexual (feeling sexual attraction
only to people with whom they have
an emotional bond); some would
identify as grey-asexual (experiencing
very occasional and very low levels
‘I have never had
interest in sex all my
life, at all. It’s like algebra.
I understand the concept,
but have no interest.
I don’t have the strong
feeling about it that the
rest of the world has’
of desire); others describe themselves
as sex averse; some prefer not to be
sexual but would enjoy a romantic
relationship with someone of the
opposite gender (hetero-romantic), or
of the same gender (homo-romantic), or
don’t want a romantic relationship at all
(a-romantic). Others are pan-romantic.
I believe that it is time for us, as
therapists, to become aware of this
hidden one per cent of the population.7
That may be a relatively small proportion,
but it means in the UK as a whole about
630,000 people may be asexual. While
asexuality itself would not be likely to
cause an individual enough distress to
present for counselling, it could be that
asexual people are disproportionately
represented in our client groups, just
as those of other gender and sexual
diversities tend to seek counselling or
psychotherapy because of secondary
difficulties (for example, in their
relationships, or because of loneliness).
‘Gay men and lesbians have been found
to have elevated mental health issues...
these people (and homosexuality in
general) are not viewed as pathological
from a modern medical or psychological
perspective.’8 How do we work with
clients who report very low or absent
sexual attraction? What if they have
never heard of asexuality? How do we
work with the internalised oppression
of feeling broken that becomes deep
shame? How do we work with the
hypervigilance that develops when
someone is hiding the feeling that they
don’t share what is assumed to be a
universal experience?
Very little research has been carried
out thus far into asexuality in relation
to counselling. Very few asexual voices
are being heard. As an asexual person,
I often don’t feel heard. Both in therapy
and with therapist friends, I have
encountered people who would like
to dismiss me with the label of low
sexual desire. I can understand why,
but I feel pathologised; they are saying
that there is something wrong with me;
something is not normal and needs to
be fixed. There are others who wish
me to resist labelling myself; for them
I have to describe myself as asexual,
rather than identify myself as such.
So, no I don’t receive homophobic
hate mail. On the surface I transgress
no codes of conduct. But on another
level I represent an ever-more visible
group of people who challenge some
of the deepest meanings of what it is
to be human: ‘the usually unexamined
presupposition that sexual attraction
is both universal (everyone “has it”)
and uniform (it’s fundamentally the
same thing in all instances).’9
Joanna Russell (MBACP) is a counsellor
in private practice, living and working in
Glasgow. After qualifying as a counsellor in
2003, she completed an MSc in Counselling
Studies (Advanced Practice) at Edinburgh
University in 2009. She is an accredited
sexual diversity therapist (Pink Therapy).
She also has a particular interest in
spirituality. Email [email protected]
References
1. Jay D. Asexuality visibility and education
network. [Online]. www.asexuality.org/home/
(accessed 12 February 2016).
2. Pagan Westphal S. Glad to be asexual. New
Scientist 2004; 14 October.
3. Mang M. Asexuality. [Online]. H2G2: the
hitchhiker’s guide to the galaxy: earth edition.
Created 2 September, 2005; updated 8 October,
2013. www.bbc.co.uk/dna/h2g2/A4455263
(accessed 12 February 2016).
4. American Psychiatric Association. Diagnostic
and statistical manual of mental disorders:
DSM-5. Washington, DC: American Psychiatric
Association; 2013.
5. Bogaert AF. Asexuality: prevalence and
associated factors in a national probability sample.
The Journal of Sex Research 2004; 41(3): 279–287.
6. Wellings K, Field J, Johnson AM, Wadsworth
J, Bradshaw S. Sexual behaviour in Britain: the
national survey of sexual attitudes and lifestyles.
London: Penguin Books; 1994.
7. Nantais D, Opperman S. Eight myths about
religious life. [Online]. Vision Vocation Network;
2002. www.vocation-network.org/articles/show/
49 (accessed 12 February 2016).
8. Bogaert AF. Toward a conceptual understanding
of asexuality. Review of General Psychology. 10(3):
241–250.
9. Carrigan M. Why sexual people don’t get
asexuality and why it matters. [Online.]
markcarrigan.net; 21 August 2012. http://
markcarrigan.net/2012/08/21/why-sexual-peopledont-get-asexuality-and-why-it-matters/ (accessed
12 February 2016).
Further information and resources
• Pink Therapy is the UK’s largest independent
therapy organisation working with gender and
sexual diversity clients. It offers training, clinical
supervision and consultation for therapists who
are working with sexual diversity clients, including
a one-day workshop on working with asexualities,
particularly around intimacy and desire.
• Asexuality Archive. Asexuality: a brief
introduction. Asexuality Archive; 2012.
• Bogaert AF. Understanding asexuality.
Plymouth: Rowman & Littlefield; 2012.
• Carrigan M, Gupta K, Morrison TG (eds).
Asexuality and sexual normativity: an anthology.
London: Routledge; 2014.
• Decker JS. The invisible orientation. New York:
Carrel Books; 2014.
• Van Houdenhove E, Gijs L, T’Sjoen G, Enzlin
P. Asexuality: few facts, many questions. Journal
of Sex & Marital Therapy 2014; 40(3): 175–192.
• Rothblum E, Brehony K (eds). Boston marriages.
Amherst MA: University of Massachusetts Press;
1993.
• Sastre P. No sex: avoir envie de ne pas faire
l’amour. Paris: La Musardine; 2012.
March 2016/www.therapytoday.net/Therapy Today 25
Domestic violence
Older women and
domestic violence
Hannah Bows and
Jeannette Roddy highlight
the overlooked support
and counselling needs
of mid-life and older
women who are living
with domestic violence
26 Therapy Today/www.therapytoday.net/March 2016
Domestic violence is a public health
issue affecting the lives of millions
of people worldwide, the majority of
whom are women. Some 36 per cent
of women will experience sexual or
physical violence in their lifetime.1 In
the UK, the Home Office estimates that
1.2 million women and 700,000 men are
victims of domestic violence each year.2
These statistics are based on the Crime
Survey for England and Wales (CSEW),
the national victimisation survey. This
reports that those aged 16–30 are most
at risk, consistent with research findings
in other countries.3 Consequently, most
domestic violence research, policy and
practice have focused on victims in this
age group.
However, one of the major limitations
of the CSEW is that it imposes an age
cap of 59 on the ‘intimate violence’
module under which domestic violence
falls (but not the rest of the survey).
So the experiences of domestic violence
among people aged 60 and over are
not captured, and there is no national
estimate of prevalence among older
age groups. Moreover, most research
in the UK and elsewhere tends to focus
on women aged up to 45, so there is little
available data on the experiences of midlife and older women in the literature.
More recently, studies in Europe
and, lately, in the UK have specifically
explored domestic violence against
women in mid- and later life. So where
the CSEW estimates that 7.4 per cent
of women aged 45–59 experience
domestic violence each year, elsewhere
in Europe it is estimated that 28.1 per
cent of women aged 60 and over have
experienced some form of domestic
abuse in the previous 12 months.3 Karen
Ingala Smith’s project ‘Counting Dead
Women’ has found that the majority
of women killed by men in 2013 and
2014 were aged 40 and over.4 In most
of these cases the perpetrator was
a partner or family member, bringing
the deaths within the formal definition
of domestic homicide.
The needs of survivors
The impact of domestic violence on
women in mid life and older are similar
to those reported by younger victims.
However, they are arguably magnified
for women aged 45 and over.5 As well
as physical injuries, domestic violence
can result in a range of mental health
effects, including depression, anxiety,
sleep disorders, panic attacks and posttraumatic stress disorder (PTSD).6-8
Research I conducted in the north east
of England in 2013 explored the support
needs of women aged 45 and over who
had experienced recent domestic
violence.9 The study was conducted
with Durham Constabulary, who were
concerned about the disproportionate
number of women aged over 50 who
were victims of domestic homicides
in the preceding two years. Of particular
concern was that none of the victims
had ever reported any incidents of
domestic violence to the police.
The study involved interviews
with practitioners working in domestic
violence organisations in a range of roles,
including independent domestic violence
advisors (IDVAs), domestic violence
suite managers, refuge support workers
and three practitioners in therapy or
counselling roles. Individual interviews
were also conducted with eight women
aged between 40 and 70, who had
experienced domestic violence recently
and who were accessing support
through the services where practitioners
interviewed for the research were based.
Practitioners generally felt that
women aged 40 and older were less
likely than younger women to access
support from helping agencies, for a
range of reasons. First, they felt
that older women were less likely to
know about support services because
advertising and campaigns are mainly
aimed at younger people and placed
in locations where younger people are
more likely to see them, such as on the
back of toilet doors in bars and clubs
or in universities. This was confirmed
in interviews with survivors who all
said they had either been unaware of
the support services available or felt
they were for younger people only.
This view of domestic violence as a
‘young persons’ problem is compounded
by media coverage and an absence of
older people from campaigns and
posters about domestic violence.
Second, the women interviewed in the
study had experienced abuse over many
years and, in many cases, for decades;
their shame and embarrassment were
deeply embedded. Practitioners felt this
was a huge barrier to accessing support,
which could be compounded for women
in older age groups (particularly 60
and over) who grew up in a time when
women were expected to tolerate abuse,
women’s rights were limited and there
was pressure to keep knowledge of
abuse ‘within the family’.
The counsellors and therapeutic leads
who participated in the study highlighted
a number of specific challenges for
survivors aged 40 and over: the longevity
of abuse; their complex mental health
support needs; inappropriate referrals;
unhelpful coping mechanisms, including
alcohol misuse, and negative previous
experiences of counselling.
All the practitioners, and particularly
the counsellors, felt that the longer
women experienced domestic violence,
the more detrimental the effects and
the harder it was for them to access
support. This was particularly the case
if the women had mental health issues,
which counsellors felt were often
much deeper and more complex if they
had experienced abuse for a number of
years. Survivors also spoke about this in
interviews. As one woman put it: ‘From
my own perspective, you are conditioned
for so long and it has been so many years,
and it is all depending on your childhood
background, if you believe that that is
normal. The hardest part is admitting
this is wrong; you are being abused.
When that realisation kicks in, you need
to get away, quickly. ’Cause even just
being in the house another day with the
perpetrator is too much. But I do believe
the older you get, the harder it becomes.’
The lack of confidence, low self-worth
and high levels of dependency on the
perpetrator, who often has total control
over the victim, compound pre-existing
mental health problems and create
multiple support needs. For this reason,
counsellors felt that long-term one-toone support was usually more effective
and acceptable than groupwork.
Practitioners also felt that GPs were
more likely to refer women in these
age groups to the mental health services,
without exploring the reasons underlying
their mental distress, and survivors
gave examples where this had happened.
Some counsellors expressed concern
about this. One counsellor said: ‘I think
‘The older you get and the
longer you have lived with
domestic abuse, the harder
it is to access support
and therefore the bigger
the impact of negative
experiences when women
do summon up the courage
to seek help’
once they have been labelled with a
mental health issue people are very
reluctant to look under the surface of
that as to what are the causes. So I think
we work with a lot of women that have
got complex mental health issues and it
is really purely because the abuse hasn’t
been addressed at an earlier age. But
then they have entered the mental health
services with all kinds of other issues
and have been labelled with personality
disorders or whatever and that makes
life much more complicated for them.’
A counselling service lead agreed: ‘We
are getting a lot of mental health referrals
and I am really concerned that they may
have been going for 20 or 30 years and
nobody has asked about domestic abuse.
In fact one woman was telling me the
other day she went to see a psychiatrist
and said, “I have been seeing you for
30 years and I have been seeing [support
service] for three weeks and they have
done more for me in those three weeks.”’
However, some women reported
negative previous experiences with
counsellors, which could act as a major
barrier to accessing further support.
One survivor said: ‘I was appointed a
counsellor… [but] she was looking at
her watch all the time, yawning, quite
inadequate. I didn’t feel like I could
trust the counsellor. I was therefore
sent to a psychiatrist as well because
I tried to take my own life. All he did
was just up my antidepressant tablets
to 200mg.’ After this experience,
the victim continued to live with
the perpetrator and didn’t seek any
further support for a number of years.
While this can affect women of all
age groups, practitioners felt it might
be compounded for older women.
There was a general feeling that the
older you get and the longer you have
lived with domestic abuse, the harder
it is to access support and therefore the
March 2016/www.therapytoday.net/Therapy Today 27
Domestic violence
References
1. World Health Organisation.
Global and regional estimates of
violence against women. Prevalence
and health effects of intimate
partner violence and non-partner
sexual violence. Geneva: WHO; 2013.
2. Ministry of Justice/Home Office/
the Office for National Statistics.
An overview of sexual offending
in England and Wales. Statistics
bulletin. London: Home Office; 2013.
3. Luoma M-L, Koivusilta M, Lang
G et al. Prevalence study of abuse
and violence against older women:
results of a multi-cultural survey
in Austria, Belgium, Finland,
Lithuania, and Portugal (European
Report of the AVOW Project).
Finland: National Institute for
Health and Welfare (THL); 2011.
bigger the impact of negative experiences
when women do summon up the courage
to seek help.
Supporting survivors
Interviewees discussed a range of support
needs. As well as one-to-one counselling
and support work, counsellors stressed
the need to understand the complex
needs of older women experiencing
domestic violence, especially if they
had experienced it over a long period
of time. Practitioners all felt that
women aged 40 and over were more
comfortable working with counsellors
and support workers of a similar age,
and many cited clients who had asked
to change counsellors because they
felt uncomfortable discussing issues
with someone young enough to be
their daughter or granddaughter.
Counsellors also stressed the
importance of understanding the
generational norms and upbringing
of women aged 60 and over – women
who grew up in a time where they had
limited rights, rape was still legal in
marriage and there was a general silence
around domestic violence and child
sexual abuse. Older women may struggle
to report historic experiences that
they have never previously disclosed.
One survivor explained how long she
had experienced abuse and how normal
it had become: ‘[I experienced abuse
for] 16 years. But then it was also
intermingled with childhood abuse.
So to be honest with you, it is all
normal, quite routine.’
The practitioners all felt training
should include case studies of women
from the different age groups and
cover issues specifically relating to
older women, to ensure practitioners
are equipped to fully support all women.
All of the services said they felt campaigns
to raise awareness of domestic violence
28 Therapy Today/www.therapytoday.net/March 2016
4. Ingala Smith K. Counting dead
women. [Online.] Undated. http://
kareningalasmith.com/countingdead-women (accessed 28 July 2015).
5. Scott M, McKie L, Morton S,
Seddon E, Wassof F. Older women
and domestic violence in Scotland:
‘... and for 39 years I got on with it.’
Scotland: Centre for Research on
Families and Relationships/NHS
Health Scotland; 2004.
should include women in older age
groups, and that there was a need to
develop links with organisations and
agencies who work with older age
groups to ensure there are clear referral
pathways and that older women are
signposted towards the help they need.
None of the practitioners interviewed
had ever run specific campaigns targeting
women over the age of 40, and only one
domestic violence centre worked with
organisations (including the local church
and Women’s Institute) to specifically
reach older women.
A number of services have begun
to address the gaps in support for
older survivors of domestic violence.
In 2007 Women’s Aid published a report
on older women and domestic violence
that included a review of the existing
literature and recommendations to
agencies and organisations working
with domestic violence survivors
and older people. In terms of practical
developments, Solace Women’s Aid in
London runs the Silver Project, which
works specifically with women aged 55
and over who have experienced domestic
and/or sexual violence. In the north east,
EVA Women’s Aid opened the first
domestic violence refuge specifically
for women aged between 45 and 80
in Redcar in June 2015. The refuge
can support up to four women at a
time and was established in recognition
‘Older women may
struggle to report historic
experiences that they have
never previously disclosed.
One survivor explained how
long she had experienced
abuse and how normal it
had become’
6. Fisher B, Regan S. The extent and
frequency of abuse in the lives of
older women and their relationship
with health outcomes. The
Gerontologist 2006; 46(2): 200–209.
7. Fisher B, Zink T, Regan SL. Abuse
against older women: prevalence
and health effects. Journal of
Interpersonal Violence 2011;
26(2): 254–268.
of the growing need for separate
support services for women aged 45
and over. According to Richinda Taylor,
Chief Executive of EVA: ‘Women over 45
have different needs to younger victims
and we have found that when they are
housed together, the older women tend
to take on a maternal role. This can be
at the cost of their own personal needs
and we want to ensure that they’re not
overlooked.’10
My own research suggests a clear
need for further research into women’s
experiences of domestic violence in
mid- and later life; research, policy and
practice should not group together all
women over a certain age and assume
their needs are the same. Training for
practitioners working with domestic
violence should include case studies
of women across all age groups, and
campaigns and adverts should portray
women at different stages in life and be
placed in locations accessed by women
of all ages. Special efforts should be
made to actively engage with services
that offer support to older women,
and particularly the least visible, such
as women aged over 70. Therapy and
counselling services should be sensitive
to the differences in the experiences and
needs of women in different age groups
and make necessary adjustments, such as
asking if older clients would prefer to see
a counsellor who is close to them in age.
All these will spread the message
that services recognise that older women
may also be victims of domestic violence
and that help is available to them if they
need it.
Hannah Bows is a final year doctoral
researcher in the Centre for Research into
Violence and Abuse (CRiVA) at Durham
University. Her PhD explores sexual violence
against people aged over 60. You can follow
Hannah on Twitter @Hannah_Bows.
8. Flueckiger J. Older women
and domestic violence in Scotland.
Edinburgh: Edinburgh University
Centre for Research into Families
and Relationships; 2008.
9. Bows H. A delicate balance.
Domestic violence: the reporting
decisions of women aged over 40.
Durham: Durham University; 2013.
http://hannahbows.pbworks.com/
w/file/fetch/97282788/Final%20
disseration.pdf.
10. Hetherington G. Country’s
first refuge for older victims of
domestic violence abuse opens its
doors. Northern Echo 2015; 1 June.
http://www.thenorthernecho.co.uk/
news/13215978.Country_s_first_
refuge_for_older_victims_of_
domestic_abuse_opens_its_doors/
(accessed 28 July 2015).
11. Beaulaurier RL, Seff LR, Newman
FL. Barriers to help-seeking for older
women who experience intimate
partner violence: a descriptive
model. Journal of Women &
Aging 2008; 20(3-4): 231–248.
12. Walker LE. The battered woman.
New York: Harper & Row; 1979.
13. Roddy JK. A client informed view
of domestic violence counselling.
PhD thesis. Leeds: University of
Leeds; 2014.
14. Seeley J, Plunkett C. Women
and domestic violence: standards
for counselling practice. Victoria,
Australia: The Salvation Army
Crisis Service; 2002.
15. Farmer K, Morgan A, Bohne S,
Silva MJ, Calvaresi G, Dilba J et al.
Comparative analysis of perceptions
of domestic violence counselling:
counsellors and clients. Eu
comparative: counselling survivors
of domestic violence. Report 1.
Wolverhampton: The Haven; 2013.
16. Mayer RC, Davis JH, Schoorman
FD. An integrative model of
organizational trust. Academy of
Management Review 1995; 20(3):
709–734.
Working with domestic violence: how can counsellors help?
Jeannette Roddy highlights
the specific issues for
counsellors working with
women in mid-life and
older who seek their help
with domestic violence
Seeking support can be
difficult for older women
who experience domestic
violence. In mid-life or older,
with children grown and
their abuser often exerting
control by psychological
rather than physical means,
the opportunities for older
women to seek support
from health workers, the
police or social services
can be limited. Years of
social isolation, physical and
psychological intimidation
and a sense of duty to
their family can take a toll.11
To compound the difficulties,
over time it can be harder
to know who to trust.12
My own qualitative
study13 with women aged
on average 45 years who
had received counselling
for their experiences of
domestic violence highlights
the importance of finding the
right pathway to appropriate
support. The women in the
study described how, having
coped on their own without
seeking help, they had each
experienced a tipping point;
they realised that they did
not know how they could
change their situation or
what to do next and that
they needed someone else’s
help. They mostly sought
advice from the police or
health professionals who
had previously been helpful to
them, or from work colleagues
or friends who they thought
might know what they could
do or who had had similar
experiences. Importantly,
they deliberately went to
these sources because they
believed they could help; it
was not a random choice.
However, getting help is not
necessarily the only problem.
Counselling has not always
gone well for women who
have experienced domestic
violence. This finding noted in
Hannah’s article is consistent
with other research.13-15 So,
once we have facilitated the
right referral pathway into
counselling, how then do
we ensure women get the
right support?
The participants in my own
study were very clear about
what they needed. First, they
wanted a counsellor who could
understand their experiences
and help them to understand
how those experiences
could result in their own
symptoms and behaviours.
They wanted someone with
whom they could discuss
their experiences and who
they believed could cope with
any disclosures they made;
someone who would not offer
pity, judgment or sympathy
but would show care and
compassion in a confidential
setting. This combination
of knowledge, benevolence
and integrity helped them
to develop trust16 in both the
counsellor and the agency.
Second, they needed time,
initially to build up trust in
the counsellor (up to eight
sessions) and then to work
through the multiple traumas
they may have experienced
during many years of
abuse. While the age of the
counsellor may be important
to some older clients, having
a counsellor with the right
knowledge and experience
is more important, they said.
When considering the
needs of the participants,
it becomes easier to
understand how they might
have had a poor experience
of counselling. A counsellor
without any specialist
experience in this field,
perhaps working to a model
that offers a limited number
of sessions, may find it difficult
to establish the therapeutic
relationship required to work
effectively with such clients,
no matter how experienced
and compassionate they are.
There are no easy answers
to improving access to
counselling for older victims
of domestic violence. We can
encourage professionals to
listen carefully when a former
client returns. We could
provide additional training
for counsellors on the
experiences and
psychological effects of
domestic violence and share
the success of our practices
more widely. We may need
to provide our clients, and
those who refer to us, with
more information about
our work so they feel better
able to trust us and want to
work with us.
Despite the reported
difficulties, it is important to
remember that counselling
can be transformational.
One of the oldest
participants in my own
research told me that, after
counselling, she felt she now
had a life, whereas before
she had simply existed. Her
only regret was that she had
so few years left to enjoy it.
She said that participating
in my research was her
way of helping others to
receive that support earlier.
I sincerely hope that we as a
profession can fulfil her wish.
Jeannette Roddy is a senior
lecturer at the University of
Sunderland, a Registered
MBACP (Accred) and
author of Counselling
and Psychotherapy after
Domestic Violence: a client
view of what helps recovery
(Palgrave Macmillan, 2015)
reviewed in last month’s
Therapy Today.
March 2016/www.therapytoday.net/Therapy Today 29
Dilemmas
Pursuing missed
payments
This month’s
dilemma
Find a sustainable
therapeutic position
Michael Soth
Broad-spectrum integrative, embodied
and relational therapist, supervisor
and trainer
The way Beata is described (and her
relational stance) has aspects of her
own wounding in it (perhaps issues
of self-worth, indicated by her fear
of being seen as unreasonable) – not
just occasionally but as a baseline of
her therapeutic position. Any further
thought about Laurie’s missed payment
is a waste of time. Instead, Beata should
invest in further CPD and supervision
to find a therapeutic position that’s
realistic, robust and sustainable.
It’s likely her own abandonment and
shame issues have been leaking into
the therapeutic space and weakening
the working alliance, so it’s not
surprising Laurie voted with his feet.
This is exacerbated by the fact that
counselling is often antagonistic towards
30 Therapy Today/www.therapytoday.net/March 2016
Beata, a counsellor in private practice,
operates a sliding scale and allows
clients to follow their own conscience
when negotiating fees. She asks for
24 hours’ notice in case of cancellation
but doesn’t consistently apply this
policy, because she’s anxious clients
might think her terms unreasonable
and terminate their therapy if she
does so, and she relies on her income
from private practice to survive.
Laurie, a successful businessman,
has been seeing Beata for six months.
He appears to have no money issues
and was unhesitating about paying
Beata’s maximum fee. One day Laurie
misses his session without notice and
fails to respond to emails or to a letter
Beata sends to his home address.
In view of her lack of information
as to what has happened to him,
Beata abandons further attempts
to contact him and feels it would
be inappropriate to pursue him for
payment for the missed session.
A year later, Beata is angered when
she discovers by indirect means that
Laurie is alive and well. She is aware
of the personal abandonment issues
that this arouses, and knows that she
needs to step back before deciding
what further action, if any, to take.
What should Beata do?
Please note that opinions expressed
in these responses are those of the
writers alone and not necessarily
those of the column editor or of
BACP. You can read additional
responses to this month’s dilemma
at TherapyToday.net.
the corporate culture from which Laurie
comes and with which he identifies.
When there’s a ‘culture clash’, it is
our task to meet the client where they
are, rather than imposing the rules of
engagement dictated by the textbooks.
On what basis would we presume that
Laurie understands the purpose and
rationale of the commitment to an
ongoing process that we require, when
it may have taken us years to develop
a full appreciation of it?
A sliding scale provides a frame for
negotiation, not a blank cheque for the
client to set their own fee. It’s interesting
to wonder what would have happened
if Laurie had set his fee two pounds
lower – over six months, that would
have amounted to the fee for the missed
session, in which case Beata wouldn’t
have had any feelings about this issue.
Why be so lenient at the beginning
and then a stickler for rules at the end?
Beata requires support to become
sufficiently solid in her therapeutic
position to actively negotiate the
fee, not on the basis of arbitrary
and financial reasons but by applying
therapeutic considerations, including
Laurie’s goals and his emotional reality,
life story and patterns.
The key issue in most dilemmas
around money – and the valid reason
why therapists are reluctant to state
their fees and policies – is an underlying
paradigm clash between the counsellor’s
and client’s constructions of the
therapeutic space: many clients think
they’re paying their counsellor as they
would a plumber – per minute spent
on the job. A client is ‘renting’ my
psychological space, irrespective of
whether they turn up or how many
minutes we spend in my consulting
room. But I wouldn’t want to assume
‘It’s likely her own
abandonment and shame
issues have been leaking
into the therapeutic space
and weakening the working
alliance, so it’s not surprising
Laurie voted with his feet’
ILLUSTRATION BY LARA HARWOOD
This is a complex dilemma for which
there is no simple solution. Besides
speaking to her supervisor, Beata could
share her experience with a colleague,
or with a professional networking group,
for support and insights. She could
consider using a small claims court to
reclaim the missing fee – although, given
the small amount and the length of time
that has passed, this could be thought
disproportionate. It is also a concrete
measure, and the meaning of the
transaction still needs to be understood.
It may be more helpful for Beata to
put this episode down to experience
and reflect on her policies (perhaps
attend a workshop about the meaning of
money in the therapeutic relationship),
boundaries, business skills and
confidence levels, to help prevent
such a situation arising again. That
Beata recognises her abandonment
issues and the need to ‘take a step
back’ may indicate a need for further
personal therapy.
that a client understands or shares that
perspective; I would want to meet them
in their construction of what therapy
is about for them, and what they think
they’re paying for. Any challenge of
that construction and its underlying
assumptions that I might make,
including negotiations about the fee,
can then be seen as part of the therapy.
Therapy hangs uncomfortably in
a limbo between love and business.
To some extent we make a living from
other people’s suffering, and the fact that
‘the cure is essentially effected by love’,
as Freud observed, means that clients
can legitimately consider our work
as emotional prostitution. We don’t
want to absolve ourselves from these
dilemmas by imagining there are rules
regarding boundaries and money to
which we simply need to stick, nor by
divesting ourselves of all requirements
for holding authority and a containing
frame by being so adaptive to the client
that no clash arises.
Explore the meaning
of the transaction
Roslyn Byfield
Counsellor in private practice
We can empathise with Beata’s sense
of betrayal on finding that Laurie is alive
and well when she had been left in the
dark as to his reasons for his sudden
departure. Although it could be thought
to suggest trust and reliance on clients’
adult ego state to allow them to decide
their own fee, for Beata this is possibly
an abdication of responsibility; it
suggests she lacks confidence in her
skills and business acumen. We cannot
assume that clients will be in adult mode
when they first present in therapy, and
we know how complex people’s attitudes
towards money can be. Clients will
unconsciously sense a lack of confidence
in their therapy, and the therapist’s
need for them (at any cost?), and could
be tempted to exploit the situation.
On the other hand, Laurie’s sudden
departure could relate to a mishap
or some problem in the work with
Beata, which he might not have felt
able to speak about. Although it would
be unhelpful to pursue a departed client,
Beata could be seen to have given up too
soon, and this could convey a number
of messages to Laurie.
Beata does not come across as
confident about her skills and fees; she
doesn’t charge for all missed sessions
and she doesn’t consistently apply
her own policy. Such inconsistency
could be experienced by the client
as uncontaining. If they feel unsafe
and too aware of the counsellor’s own
needs, this could prompt an unplanned
ending and a sense of ‘unfinished
business’, without the opportunity
for conscious processing.
She should seek
support for her
abandonment issues
Liz Jeffries
Psychotherapist in advanced
clinical training in private practice
in Manchester
There are a number of aspects to Beata’s
dilemma: the nature of the business
contract, maintaining a therapeutic
frame, the worth of the therapist and
the therapy, and abandonment scenarios
recreated in the therapy relationship.
One function of the business
contract is the defining and setting of
boundaries for business transactions.
Beata needs to maintain this boundary
if she is to sustain her practice as a
viable business. Setting boundaries for
business transactions also contributes
to setting a frame for the therapy that
provides safety and certainty about the
endeavour. An appropriate fee makes
it clear that Beata is employed by and
accountable to Laurie, and the fee
she chooses gives an implicit message
about her level of competence, skills
and ability to help Laurie with his
difficulties. In allowing him to follow
his own conscience in setting a fee
and then later not enforcing payment,
she gives an alternative implicit message
that her worth and level of competence
is questionable.
March 2016/www.therapytoday.net/Therapy Today 31
It’s unclear why Beata feels it’s
inappropriate to pursue Laurie for the
missed fee. It’s also unclear why she
didn’t follow up to check that Laurie
was safe and well before learning of
his wellbeing a year later. Perhaps
there were no issues in her risk
assessment to give her cause for
concern. It may be that she didn’t
pursue the fee or try to check he was
alright because of her own fears of
abandonment. Abandonment is often
feared when there are shaky foundations
for a relationship. For Beata, the lack of
boundaries around fees seems to have
contributed to such shaky foundations
in her relationship with Laurie and also
allowed a space for a parallel process
to emerge related to her personal
abandonment issues.
A year after the therapy with Laurie
has ended, recovery of the missed
session fee seems unlikely. Beata’s
initial decision not to pursue the fee
would seem to represent an implicit
permission not to pay. Her anger
seems justified, however, and in
part related to what in transactional
analysis would be described as an
incomplete transaction (both a
financial and communicative one).
Such transactions can lead to difficult
feelings for the therapist. Exploration
in supervision of issues around the
frame of therapy, the value of the
therapist and the business of therapy
would be useful. In addition, Beata
might find some personal therapy
helpful to explore her own abandonment
issues and how these are re-created in
her work with clients.
April’s dilemma
32 Therapy Today/www.therapytoday.net/March 2016
She needs a new
pricing strategy
Paul Silver-Myer
Psychotherapist in private practice,
accountant, accredited coach and
mediator
Beata should indeed step back and
reflect on the various issues that
Laurie’s unpaid fee has brought to
light, such as whether to pursue him
for the outstanding charge; whether
to persist with the current sliding scale
when negotiating fees and re-evaluate
her cancellation policy, and whether,
on an emotional level, to consider the
effect that her personal abandonment
issues are having on her ability to run
a profitable private practice.
Indeed, this last point is perhaps
the core issue: Beata is reliant on her
counselling for her survival, but there
is a sense that she is running her
private practice more like a charity
than a business.
To ensure she earns enough each
week to cover her living costs and
business expenses, she needs to
tighten her financial boundaries.
The sliding scale she uses is essentially
a pricing strategy that allows clients
to pay what they want. Beata has no
safeguards to ensure that some pay
enough to cover those who pay very
little, and so is at her clients’ mercy.
Introducing a standard fee, and offering
perhaps one or two concessionary
fees would give her some income
certainty, and is also likely to enhance
Tom works as a counsellor in a busy
GP surgery supporting clients from a
broad range of ethnicities and cultural
backgrounds. As a white, middle-class,
heterosexual male, he is acutely aware
of how his clients might experience
him, particularly in relation to often
unexpressed power dynamics and
being seen as an authority figure.
Tom has been seeing Manar, a
19-year-old refugee from Syria who
has been relocated to England from
a camp in Lebanon. She fled the
trauma of heavy fighting in Syria
to a life in a refugee camp that left
her feeling displaced, humiliated and
disrespected. She is finding it difficult
adjusting to her new life in England
and has been referred to counselling
for support.
Tom feels he has formed a good
therapeutic alliance with Manar,
‘She is running her private
practice more like a charity
than a business. To ensure
she earns enough each week
to cover her living costs
and business expenses,
she needs to tighten her
financial boundaries’
her feelings of self-worth, which may
well be vulnerable when one or more
clients decide to pay less than she feels
she deserves.
Beata’s inconsistently applied
cancellation policy is again leaving
her with no room to receive or recover
income owed to her. I would suggest
she sets her cancellation policy at one
week and only deviates from that in
exceptional circumstances. She might
feel more assertive if she wrote out her
terms of business and, if appropriate,
shared the document with each client
at the start of their course of therapy.
Finally, all of Beata’s practical and
financial decisions seem to be strongly
influenced by her personal abandonment
issues, for which she might need some
further therapy herself. Since clients
respond better to strength than to
weakness – hence the concept of
boundaries – it would be a shame if
Beata’s sense of her own self-worth as
a counsellor is financially undermined,
leading her to believe that she is unable
to continue in the business of running
a profitable private practice.
although he’s aware that the
assumptions that lie behind the
therapeutic encounter are very alien
to her. Manar’s final session falls on
the Muslim festival of Eid and she has
brought some homemade sweets as
a gift for Tom, to celebrate.
The GP surgery has a policy that
does not allow counsellors to accept
gifts from clients, but Tom is anxious
not to offend Manar by refusing
the sweets.
What should Tom do?
Please email your responses (500
words maximum) to John Daniel at
[email protected] by 24 March
2016. The editor reserves the right to
cut and edit contributions. Readers
are welcome to send in suggestions
for dilemmas to be considered for
publication, but they will not be
answered personally.
Letters
Why do we need
personal therapy?
Following the recent letters from
Roslyn Byfield and Jane Barclay
(Letters, Therapy Today, December
2015) expressing concern about BACP
not mandating personal therapy for
accredited courses, I’d like to express
a different point of view.
On my person-centred psychotherapy
course, we need to attend weekly therapy
to meet UKCP requirements, and there
are a few of us who are unsure this is
always the best use of our time and
money. There are times when we don’t
feel vulnerable or anxious, so are not
sure we meet Rogers’ second condition
for therapeutic change. The therapy
provides a valuable support with the
weight of the course commitments,
but it also adds to them.
While it is useful to experience therapy
as a trainee therapist, I am unconvinced
that this is necessary every week for five
years, and often consider other ways
in which I could develop as a therapist.
Perhaps focusing sessions would help
me become more congruent; more
time to spend in meditation classes
would help me stay in the moment
with the client, or involvement in the
performing arts would help me become
more expressive and thus develop
my communication skills. I could
develop my understanding of culturally
different groups in my locality through
community activity or additional
education. All of these directions are
curtailed because I lack time and money,
and I suspect diverting some of my
personal therapy time over the years
to these pursuits would provide more
value in my education as a therapist. I
suspect there are as many directions for
self-development as there are trainees.
I am, therefore, pleased that BACP has
decided to grant each training institution
the autonomy to make these decisions
themselves. While I appreciate the
concern that trainee therapists should
themselves experience personal therapy,
perhaps a requirement for trainees
to spend 50 per cent of their course
duration in therapy would address this,
while still largely trusting the trainees
to listen to their instincts about how
best to grow. The complete reversal
suggested by previous correspondents
seems to me a retrograde step – and
on person-centred courses would
demonstrate a lack of trust in the
actualising tendency of the trainees.
David Blowers
Trainee person-centred psychotherapist
It is all about love
I love Anne Geraghty’s viewpoint
(‘We need to talk about love’, Therapy
Today, February 2016). I know for myself
that, through my process towards
authenticity, I have found a profound
and deeply resonating love for myself.
By experiencing my own therapeutic
journey and finding counsellors who
loved me, I have been able to engage
fully and seek out the many different
modalities that fitted my process at
the time.
My work as a counsellor in private
practice has been informed by my
own process. The more of my authentic
self I bring into my work, the more I am
able to model for my clients the true
possibilities. I rise to the challenge
of holding the balance of authenticity
while maintaining a professional, ethical
and moral way of working and, as I have
gained experience, I have been able to
do so with fluidity rather than rigidity.
My love for my clients does not come
from a place of reciprocal neediness
but simply from a place of being. I agree
with Anne that our supervisors need to be
able to hold and support us from a place
of heart and soul. This relationship is,
in my judgment, at the centre of
therapeutic change for all participants.
David Goodall
BA (Hons) Humanistic Counselling,
University Nottingham
‘As therapist, I’m hesitant –
when I open my heart I’m
aware too of holding back...
As client, I needed my
therapist to take the risk
of loving me’
Love is a risky
business
Mega-thanks to Anne Geraghty for using
the ‘L’ word (‘We need to talk about love’,
Therapy Today, February 2016), which
brought heart-warming memories of
my therapist flooding back.
The time, early on in our relationship,
when I asked to borrow something of
his to take home between sessions, which
he referred to as a transitional object:
‘It’s not a transitional object, it’s a teddy
bear,’ was my retort. I wasn’t going to
be fobbed off with therapy-speak. A year
later, as I struggled to verbalise what
every cell in my body was straining for,
he got it at last: ‘You want me to love
you, don’t you? Well, I do, but I’m scared
that it won’t be enough.’ ‘Enough? It’s
everything,’ I answered. Well, it was,
and it wasn’t, of course. But without
his love, without feeling cocooned, I
could not have borne my pain of losing
loved-one after loved-one, and of being
sent to boarding school.
And yet, as therapist, I’m hesitant –
when I open my heart I’m aware too of
holding back. I warm towards a client,
and retreat behind professionalism. My
scared-I’ll-be-abandoned-yet-again little
girl shores up her defences. As client, I
needed my therapist to take the risk of
loving me; I needed to know I could hurt
him; I needed him to be vulnerable. As
a therapist, this is my edge and it is one,
thanks to Anne, I passionately want to
work more on – and will.
Jane Barclay
Psychotherapeutic counsellor in Exeter.
www.jbcounselling.co.uk
Is counselling
really a profession?
Prompted by a number of letters
published in Therapy Today over recent
months about the lack of paid work
for qualified counsellors, and having
recently viewed the CPCAB interviews
about BACP (see www.cpcab.co.uk/
learners/videos), I have come to the
conclusion that counselling isn’t a
March 2016/www.therapytoday.net/Therapy Today 33
Letters
profession at all, even though most of
us work in a very professional way with
our clients and do our best to help them.
The definition of a profession is ‘any
type of work that needs special training
or a particular skill, often one that is
respected because it involves a high level
of education’ (Cambridge Dictionaries
Online, January 2016). Yes, many of
us have special training and skills,
but are we really respected as having
a high level of education? I’m not sure –
indeed, you only have to see the number
of complaints made against counsellors
in Therapy Today to wonder about the
skills and education of some of our
practitioners.
Rather than being a disciplined group
of individuals, counselling always feels
rather chaotic to me, due to the diversity
of our training routes and qualification
levels, which I would argue are not
easily recognised and understood by
clients and maybe other groups too –
for example, the Government, the
NHS etc. At what point is any counsellor
really qualified? Well, probably never;
there’s always yet another course to be
undertaken, at great expense. And does
all this diversity of training help clients
choose a practitioner? Probably not –
it’s confusing.
BACP has tried to tackle this chaotic
situation by developing Certificate
of Proficiency tests, the Register and
accreditation, to show a commitment
to standards. However commendable
this may be, I feel it is still insufficient for
us to be taken seriously as a profession.
The most well-known professions of
law, teaching, medicine, dentistry and
nursing all require their practitioners
to have a recognised degree in order
to practise. My view is that we too, if we
want counselling to be our chosen career
path, need to be qualified to degree level.
We can be as diverse as we like once the
firm academic foundations are in place.
BACP already undertakes many of
the functions of a professional body by
providing CPD opportunities, publishing
professional journals and magazines,
setting ethical standards and dealing
with complaints. However, I feel it
has fallen short in setting and assessing
professional examinations and providing
careers support and opportunities.
Focusing on the Register and
34 Therapy Today/www.therapytoday.net/March 2016
‘Rather than being a
disciplined group of
individuals, counselling
always feels rather chaotic
to me, due to the diversity
of our training routes and
qualification levels’
accreditation is tinkering with a deeper
problem rather than facing it head on.
Instead of bickering among ourselves
about counselling or psychotherapy and
being precious about which theoretical
model is best, we need to grow up and
become organised. As BACP has a
new CEO and is working on its new
strategic plan, I am hoping that the
standardisation of training and
qualifications to degree level will be an
absolute priority over the next five to 10
years so that we can be taken seriously
as a profession at last. If not, psychology
might sort out the problem for us. It’s
already starting!
Liz Marley
Counsellor and supervisor
Do we need
accreditation?
With the ongoing debate about the lack
of paid work for qualified counsellors,
I had a ‘lightbulb moment’ when
reading the latest (February) issue
of Therapy Today. I noticed in the
various advertisements for qualified
‘volunteer counsellors’, the recruiters
try to make these posts seem attractive
by mentioning that they are a way of
building up hours towards BACP
accreditation.
And there’s the rub: is the existence of
BACP accreditation a contributory factor
to the scandalous notion that qualified
professionals should work for free? It
seems as if organisations, such as the
NHS and schools, are well aware of the
‘chicken and egg’ situation that newlyqualified counsellors find themselves
in – namely, needing to reach a certain
amount of practice hours in order to
reach this arbitrary goal of accreditation.
Has BACP itself in fact created this
state of affairs by making accreditation
seem like a qualification rather than
a choice?
In actual fact there are thousands
of well-regarded, successful counsellors
and psychotherapists who see no need
to go down the accreditation route. Yes,
it’s a mark of an experienced, regulated
and ethical practitioner; however,
doesn’t membership of a professional
body also convey this status, with the
requirements for supervision, CPD
and adherence to a professional code
of conduct? Accreditation can open
doors to being able to work in some large
organisations and EAPs. But how many
desperate people on an NHS waiting list
would understand or even care about the
difference between an accredited or nonaccredited registered member of BACP?
Many counsellors contribute some
counselling free to a charity, alongside
their paid work, and this is laudable.
But if we made a conscious decision
not to accept voluntary positions in
organisations that should be able to
afford to pay us because they receive
government funding, there would have
to be a serious political debate about
what is an acceptable level of pay for
mental health professionals. Should
we really be propping up a woefully
underfunded CAMHS or acting as a
free crutch for the NHS?
I was clear from the outset of my
career that I could not work as an unpaid
counsellor (apart from contributions
to charitable organisations). Having
completed my placement in the
occupational health department of a
major NHS foundation trust hospital,
I was asked whether I would like to
take up a post in the counselling team.
I asked about pay, and was told that
there was none – this from a hospital
trust with a budget of millions. The role
of the counsellor in such a setting is to
support key NHS staff and help them
cope with workplace or personal issues.
Often counselling keeps vital frontline
staff in work when they might otherwise
go off sick. As much as I wanted to
continue in my role, I also wanted
to feel valued (not to mention earn
a living), so I politely said no thanks.
Perhaps if qualified practitioners
stopped focusing on the idea of
accreditation and instead had a zerotolerance policy towards unpaid work
(except for charities who truly have to
keep costs down), organisations such
as the NHS and the state would have
to react to the dearth of volunteers
and start paying. And, dare I say it, I
think BACP has to look closely at the
role accreditation has in perpetuating
the status quo of the unpaid counsellor.
How can we expect others to value the
profession if we don’t value ourselves?
Louise Tyler, BACP (Accred)
Counsellor in occupational health and
private practice. www.personalresilience.co.uk
Look behind the
headlines
I would like to advise caution with
regards to the claim that ‘CBT can help
ME’, as reported in the November 2015
Therapy Today news pages. The news
report concerned the results of the PACE
trial that claimed to show moderate
improvement in participants with
myalgic encephalopathy (ME) receiving
CBT and graded exercise therapy (GET).
Although it is still currently unknown
what causes ME/chronic fatigue
syndrome (CFS), and reputable
research has identified many physical
abnormalities in patients, CBT offered
to patients on the NHS is based on
the assumption that the illness,
while originally triggered by a virus,
is maintained by fearful beliefs. Dr
Charles Shepherd of the ME Association
believes this is a flawed hypothesis, and
there are concerns that this assumption
leads to patients feeling overly
responsible when they do not recover.
Patient surveys conducted by charities
such as the ME Association and Action
for ME have repeatedly found that
CBT is often ineffective and GET can
be potentially harmful. This has been
supported by empirical research and, as an
ME sufferer, my own experience concurs
with this. Several years ago, I had 20
sessions of CBT at one of the treatment
centres used in the PACE trial. Although
I found that CBT was a useful tool that
gave me hope for recovery, it did not
reduce my symptoms in the long term.
This is significant for therapists,
particularly when many BACP members
indicate that they are able to work
with ME/CFS. It is important that our
views are not based on or influenced
by incorrect evidence. While we make
every effort to bracket our assumptions,
inevitably they will find their way into
the therapy room. Many people with
ME/CFS have suffered disbelief from
the medical profession, employers,
the benefits system, friends and family.
When they turn to us for help (whether
their illness is a presenting or contextual
issue), it is vital that they feel believed
by us and that we do not inadvertently
convey the impression that they are not
doing enough to help themselves recover.
As the authors of the PACE trial point
out, more research is needed to ascertain
the long-term effects of CBT and GET.
I would also argue that qualitative
research would better reveal the lived
experience of ME/CFS patients who
have received such treatments, giving
more accurate results. Until then, we
must hold these results lightly.
Jane Harris
BACP student member
CBT: another view
After reading a few articles about
the changes in society and the
Government increasing funds to
provide psychotherapy for the general
population, I realised that there are
different ways we can see this. Some,
for example, have criticised how the
focus is on a quick fix of the individual so
he/she can return to being a functioning
member of society as soon as possible.
One can certainly argue that the
Government’s approach is primarily
intended to keep society moving and
even save money from the benefits bill,
‘Regardless of the state’s
motivation, looked at from
a di�erent perspective,
far more people are having
access to a service that will
improve their lives’
as healthy people are able to sustain
themselves.
My point is that, even if the reasons
behind the Government’s provision of
free or low-cost treatment are to save
money and facilitate a quick return
to work, ultimately it is still offering
counselling to a lot of people who
otherwise would be unable to afford
it. Regardless of the state’s motivation,
looked at from a different perspective,
far more people are having access to
a service that will improve their lives
and contribute to their own wellbeing.
One of the CBT techniques is helping
clients to shift perspective. Let us do that
ourselves, with regard to the services that
are being offered, and see that, ultimately,
we are helping the Government to create
a healthier society with people who
believe in their own values.
Amanda Romano
Diversity applies
to all of us
I read with interest William Johnston’s
letter in last month’s issue about
Nicola Codner’s article (Therapy Today,
December 2015) on mixed race identity
in counselling. I conducted the first
UK research on mixed race identity
in counselling that Codner discusses
in her article. I also teach race, culture
and difference to counselling psychology
students. My experience is that students
sometimes approach this topic with
initial trepidation if they assume that
the subject of difference or diversity
may not be relevant to them. They
discover very quickly that it is.
William Johnston highlights that he
was able to engage with the second half
of the article as it was more personal.
I would argue that this is because, on a
societal level, ‘difference’ is stereotyped
as belonging to a minority group. If they
don’t belong to one of these ‘groups’,
then it seems that people psychologically
switch off from wanting to engage with
the topic, or with any theoretical writing
on it. Johnston does, however, state that
he began to gain an understanding that
he too could belong to the ‘difference’
group when he removed the stereotype
March 2016/www.therapytoday.net/Therapy Today 35
Letters
and applied his own narrative to the
article. I felt sad that ‘helplessness’
was Johnston’s immediate reaction to
someone in his college cohort wanting
to discuss diversity. My sadness was for
the potential client who may receive a
similar reaction in the counselling room.
The main point of my research was
that counsellors cannot and should not
make assumptions based on what they
see in front of them in the counselling
room. They need to ensure that they
are competent enough to engage with
‘difference’ narratives. The first way of
doing this is by reading client research.
Surely research into the client experience
is one of the most useful ways of
understanding them? Counsellors
have an ethical duty to engage with
difference if they want to work with
any client, as all clients are ‘different’.
For some counsellors, diversity is
just a tick box subject that is studied
and then left on a proverbial shelf
somewhere. The essence of my research
was that mixed race clients wanted
their counsellor to ask them about
the ‘difference’ elephant in the room
– even if the counsellor felt that they
understood their client and didn’t
need to ask these sorts of questions.
As a Sri Lankan, female, heterosexual
and mother, do I know what it is like
for my client to be Sri Lankan, female,
heterosexual or a mother? The answer
is how could I really know? My narrative
will carry within it my own assumptions
of gender, race, sexuality and
motherhood. If counsellors do not
ask the obvious questions, then they
are not only imposing their counselling
‘model’ (because it may not be seen to
be relevant to ask these questions in
that model)- they are actively inhibiting
that client from progressing within
their therapy. This cannot be taken
too seriously.
I urge all counsellors therefore to
explore why this subject brings up
challenging feelings for them (like
William Johnston’s feelings of
helplessness), and then consider the
danger of not engaging with difference.
Difference and diversity apply
to everyone.
Angela Mooney
Counselling psychologist and lecturer,
University of Roehampton
36 Therapy Today/www.therapytoday.net/March 2016
We need a fully
informed debate
It was good to see Therapy Today
returning to the Dodo bird verdict
(February 2016) and Campbell Purton
deserves congratulations for provoking
this debate.
This is long overdue. Campbell
Purton refers to the work of both
Bruce Wampold and Jerome Frank and,
specifically, to the first edition of Bruce
Wampold’s book The Great Psychotherapy
Debate, which was published in 2001.
This is an extended review of the
research evidence in favour of the
model of counselling and psychotherapy
espoused by Jerome Frank. It
demonstrates that the evidence for this,
‘the contextual model’, far outweighs
that for ‘the medical model’, which is the
one adopted by the UK state (ie NICE
guidelines backed by randomised control
trials leading to the IAPT programme).
In his preface Bruce Wampold writes:
‘It would be difficult to imagine how a
scientist could examine these data and
come to a different conclusion.’
It is therefore remarkable that
Wampold’s work is not better known in
counselling and psychotherapy. Either he
is right – in which case his findings ought
to have been at the heart of the debate
about IAPT since its inception, or he is
wrong – in which case his book deserves
to have been subjected to a detailed
rebuttal. But I have never come across
any book review that even attempts to
evaluate his arguments. Why the silence?
Campbell Purton’s references are to
the first edition of Jerome Frank’s cross
cultural study Persuasion and Healing
(1961), not the third edition, which
Frank wrote with his daughter, Julia
Frank, some 30 years later. He also
‘Mixed race clients wanted
their counsellor to ask
them about the “di�erence”
elephant in the room – even
if the counsellor felt that
they... didn’t need to ask
these sorts of questions’
refers to the 2001 edition of The Great
Psychotherapy Debate, not the much
expanded second edition that Wampold
published last year, also with a
collaborator, Zac Imal. Since 2001 the
research has proliferated and, Wampold
argues in his preface, the evidence for
the contextual model ‘is an order of
magnitude stronger than it was in 2001’.
Unfortunately Campbell Purton builds
one of the main planks of his argument
on a misunderstanding. Bruce Wampold
and Zac Imal emphatically do not argue
that ‘the whole of psychotherapy is
analogous to a placebo effect’. Instead,
they regard placebo effects as one
element in the overall picture and
they include in the 2015 edition an
extended discussion of the complexities
involved in understanding how they
work (see pp194–209 et passim).
If our profession is to deserve the
confidence of the general public we
must move beyond both the spurious
claims of scientific objectivity that
underpin the IAPT programme and
our apparent reluctance to have proper
debate founded on what is known from
research. The subtitle of the 2015 edition
of The Great Psychotherapy Debate is ‘the
evidence for what makes psychotherapy
work’. Is it too much to expect that all
counsellors and psychotherapists should
be familiar with this evidence – and
that all discussion in Therapy Today
is informed by at least a working
knowledge of it?
Arthur Musgrave
Western Valleys, a Member Group of the
Independent Practitioners’ Network, BACP
senior accredited counsellor and supervisor
(groups and individuals)
Note
With reference to his letter on Open
Dialogue in our February issue, Dimitrios
Monochristou has asked us to make it clear
that the views expressed in the letter are
his and do not reflect the views of Tameside,
Oldham and Glossop Mind or Healthy
Minds Oldham. We are happy to do so.
Contact us
We welcome your views. Please send your
letters to the editor at therapytoday@bacp.
co.uk. We may cut or edit contributions.
Please try to keep your letters within 500
words so we can fit in as many as possible.
Reviews
Working across
cultures
Becoming a multiculturally competent
counselor
Changming Duan and Chris Brown
Sage Publications, 2016, 456pp, £48.99
isbn 978-1452234526
Reviewed by Frances Lampert
This progressive and
thought-provoking book
challenges the culturally
narrow nature of our
profession – its origins,
theories and practices.
The authors consider
the damage that can be done if we
assume a superiority of certain values
and worldviews over the culturally
influenced priorities of many of our
diverse population of clients.
It is well researched, detailed and
clear in its style, with chapters organised
around the standards identified by
CARCREP, the US accreditation body
for counselling courses. Counselling
students are facilitated to develop their
own multi-cultural identity through
reflective exercises, developmental
models and case studies. Although
written for the US market, UK readers
will still find relevance in the issues it
explores. For example, the discussion
of the damaging impact of the American
dream and the myth of meritocracy
in ignoring and perpetuating social
inequality can be applied to similar
political and media narratives in the UK.
The authors assume a limited
knowledge of, or commitment to,
issues of social injustice and inequality,
so I found the text quite repetitive
and verging on sermonising at times.
However, I have no doubt about the
fundamental importance of the central
argument: we can harm our clients
and compound social oppression if we
assume a psychological or pathological
basis for all of our clients’ difficulties
and fail to give sufficient attention to
the impact of broader cultural issues
and social injustices on their emotional
and mental wellbeing.
The suggestion that the role of the
counsellor must include advocating
38 Therapy Today/www.therapytoday.net/March 2016
for social justice, both inside and
outside the counselling room, may
be seen as controversial by some UK
readers: a sizable minority of BACP
members rejected the inclusion of
the term ‘social justice’ in the revised
BACP Ethical Framework, in contrast
to the explicit inclusion of social justice
principles in the CARCREP standards.
For me, the most valuable learning
came from the last three chapters, which
brought the theory to life by providing
some concrete explanations of social
justice counselling and advocacy skills
as well as case examples of multi-cultural
counselling in action. The main message
that has stayed with me from this
book is that ‘we the counsellors will
either be part of the solution to social
injustice or part of the problem’ (p348)
– food for thought for all of us in the
counselling profession.
Frances Lampert is a counsellor and
supervisor
Inspiring stories
of recovery
The reality of recovery in personality
disorder
Heather Castillo
Jessica Kingsley Publishers, 2015,
336pp, £17.99
isbn 978-1849056052
Reviewed by Kim Etherington
This book challenges
negative stereotypes of
a people diagnosed with
personality disorder and
offers a hopeful, creative,
and realistic alternative
view. In her previous
book, Personality Disorder:
temperament or trauma?, Heather Castillo
described how she formed a research
group of people who had received that
diagnosis with the aim of finding out
service users’ perspectives on their
needs. Some of those researchers
were inpatients and sectioned under
the Mental Health Act – a client group
considered inconsistent, undependable
and untreatable – yet their work totally
contradicted that picture, and left me
full of admiration for what they had
all achieved. So when I saw the title of
Heather Castillo’s latest book I couldn’t
wait to read it, and was not disappointed.
Rarely do we find a book that
describes research in ways that engage
us intellectually and emotionally.
This is one such book. This excellent
example of a reflexive, collaborative,
emancipatory case study builds on
the foundations laid by the earlier
innovative study, which made a
major impact on the development
of the national agenda in relation
to personality disorder. Eleven pilot
projects aimed at serving this groups’
needs were launched nationally, one
of which was The Haven.
The Haven’s birth and development
and the research that guided and fed
into that development can be found
in this book. Once again service
user research groups are at its heart,
gathering and documenting their
journeys towards recovery alongside
the feedback from families and
friends and the staff who cared for
them. Intermingled with the ‘hard data’
we hear the voices of the service user
researchers and their inspirational
and sometimes heart-breaking stories.
Heather Castillo’s reflexive voice
weaves multiple strands throughout.
This book pulls no punches,
describing the need for rules and
boundaries and the difficulties,
dilemmas and ways through them.
It contextualises the life of The Haven
against the background of organisational
and political change, while demonstrating
how research can impact society and
how we, in turn, are changed by
decisions made at a societal level.
There is a vast amount of learning
here: for practitioners working with
complex trauma; for people setting
up and evaluating community based
projects; for researchers who are
interested in collaborative action
research that changes lives; and for
service users who want to find their
own ways to recovery and healing.
This book stimulated me, informed
me and made my heart sing.
Kim Etherington is an emeritus professor
(University of Bristol), an accredited
EMDR therapist, and freelance mentor
for narrative researchers
Our bodies and
our selves
Embodied relating: the ground of
psychotherapy
Nick Totton
Karnac Books, 2015, 272pp, £26.99
isbn 978-1782202936
Reviewed by Diane Parker
How many types of
smile can you think of?
A friendly smile, a wry
smile, a malicious smile,
a seductive smile? So it is
with these and countless
other examples that
body psychotherapist
Nick Totton introduces his reader to
the concept of ‘embodied relating’ – a
smile, above all else, being relational –
that is, it happens in relation to another.
Totton sets out his stall by claiming
that the time has come for body
psychotherapy to claim its rightful
place as the ‘ground’ of psychotherapy,
meaning that on which therapy stands
(or falls), ‘the soil on which everything
grows (or fails to grow)’ (pxvii). For too
long, body psychotherapists have looked
to more traditional forms of therapy
for their evidence base, and his book,
Totton states, is an attempt to redress
that balance.
The book is organised into four parts,
each comprising three or four chapters
exploring the theory and practice of
embodied relating and its relationship
to psychotherapy. Although the writing
is sometimes dense and complex
(for which the author – also a poet –
makes no apology), at others it dances
seamlessly between various modalities,
theories and case studies. The effect on
me was to experience reading the book
almost like a therapeutic relationship
itself – at times I felt stuck or lost, at
others in flow and fully absorbed in the
material. In a valiant effort to address
the complexity of his work, Totton
helpfully provides a brief summary –
‘The story so far’ – at the end of each
section, so that readers who desire to
get to the heart (deliberate embodied
reference) of the subject can head
directly to these.
How to survive grief with a big backpack
Chris Rose unearths the all-American
allegory of personal success against
the odds in the film Wild, the story
of one woman’s attempt to expunge
grief through physical endurance
Cheryl’s life is in turmoil since the
sudden death of her mother; heroin,
promiscuity and a divorce cannot in
the end blot out her grief. She is a
woman in need of therapy who, instead
of finding someone to talk to, chooses
to walk 1,100 miles from New Mexico
to Oregon, along the Pacific Crest Trail.
The story comes from the real-life
experience of Cheryl Strayed, and
has been well adapted here in a way
that manages to combine the tedium,
repetition and physical discomfort
of long distance hiking with enough
narrative drama to engage and
entertain.
A completely inexperienced
trekker, Cheryl (Rees Witherspoon)
struggles through desert to snowfall,
encountering scenery, wildlife and
people. The physical trek is mirrored
by an internal journey through
memories and flashbacks – the
emotional landscapes that until
now she has avoided. Her oversized
backpack is an obvious metaphor
for the baggage she carries. As she
treks determinedly through changing
landscapes she is caught up in her
past, and there are moments of great
distress when she sinks to her knees
on the trail, overwhelmed by emotion
and the enormous backpack.
It should be riveting stuff for the
psychotherapist but, although it is a
highly watchable, interesting film, it
left me with nagging questions. I have
no difficulty in recognising the power
of our human relationship to the
natural world, but here Cheryl
seems to experience it as backdrop –
a continuous and undifferentiated
challenge to be overcome. The
encounters she has with people along
the way seem similarly emotionally flat
– which is, in some ways, a relief as the
threat of sexual violence haunts several
scenes. And although she uses her
own writing and that of others as guide
and support, this too felt downplayed.
This is very much a story of the lone
individual unpicking the knots and
tangles of her experience in a heroic,
isolated endeavour – conquering her
own fears, opening her own doors. I was
left thinking that the overall message
was that of the great All-American
myth: you can be who you want to
be and you can do it all by yourself.
But how much can we, in fact, do on
our own? Self-reflection is an essential,
valuable part of life, but I think it
needs to be grounded and tested in
relationship to the ‘other’ before it
can produce lasting and deep-seated
change. However much we practise
the exercises in the self-help book,
for example, it is never going to give us
the same nourishing growing medium
for development as a good therapeutic
relationship. My hope for Cheryl was
that, having completed this amazing
journey, she could now find someone
with whom to talk it all through.
Wild (115 minutes; 2014) is directed by
Jean-Marc Vallée, screenplay by Nick
Hornby based on the book Wild: lost
and found on the Pacific Crest Trail
by Cheryl Strayed. It is available on DVD.
Chris Rose is a group psychotherapist,
writer and Therapy Today Reviews Editor.
March 2016/www.therapytoday.net/Therapy Today 39
Reviews
He certainly makes no bones
(second deliberate embodied reference)
about his passion for this subject.
Whether he’s describing the limitations
of neuroscience (‘neurons don’t have
feelings; people and animals do’ (p16))
or arguing that traditional concepts of
transference, countertransference and
projection are fundamentally embodied,
Totton makes a compelling case for us
to think of our bodies and those of our
clients as more than ‘convenient meat
trees’ (p4) on which our minds perch.
I suspect those of us who are already
working in the field of body
psychotherapy may feel that he is
preaching to the converted. However,
Totton’s ability to place the concept of
embodied relating in a wider social and
political context and to draw on multiple
philosophical and theoretical sources
make this a fascinating, albeit challenging,
read for any practitioner, regardless of
the modality in which they work.
Diane Parker is a coach and dance
movement psychotherapist working in
private practice and community mental
health, and the editor of BACP Coaching’s
Coaching Today
Learning hewn
from practice
Therapist limits in person-centred
therapy
Lisbeth Sommerbeck
PCCS Books, 2015, 122pp, £14
isbn 978-1906254810
Reviewed by Mike Gallant
Sommerbeck’s latest
short offering – a little
over 100 pages, and
including some previously
published work – comes
at the end of a long career
in secondary mental
health care services in
Denmark and a significant position in
the person-centred world. Her solid gold
heritage as a classical Rogerian therapist
is demonstrated in these pages as she
uses personal case examples to illustrate
where her limits have been, and continue
to be. With a lustrous consistency of
40 Therapy Today/www.therapytoday.net/March 2016
silver-white titanium, she reflects on
the complexity and contingent qualities
of what is possible, when and where.
Grounded in a sense of certainty, and
at the same time freely revealing the
scars of personal errors in the knocks
of day-to-day practice, this is practical
jewellery to pass on to the next
generation – hard-won life experience
and a determination to deliver
humanity to people in distress.
The scope of this short book is unique
to my knowledge in encompassing
boundary setting, competence and
the interface between person-centred
‘practice’ – what Pete Sanders calls
‘contact work’ – and ‘therapy’.
Therapists working in all approaches
will have their own personal limits,
many shared across modalities no
doubt, though others perhaps more
distinctively modality specific. This
work is unashamedly and exclusively
focused on the person-centred
approach, and on the ethics of setting
limits ‘for the sake of the therapist’
and ‘for the sake of the client’– often
a blurred distinction (p26).
There are numerous provocative
gems here, sparkling at the turn of
every page, and I was struck by thoughts
of how person-centred practitioners
are constantly balancing the three
core conditions. Assuming we have
psychological contact, do we privilege
at any moment unconditional positive
regard (UPR), empathy or congruence,
and in what circumstances? In general
it seems as if Sommerbeck prefers UPR,
while Mearns and Cooper perhaps go
for congruence, and Barbara Brodley
for empathy. Food for thought indeed!
The book is divided into five sections:
Therapeutic Competence; Limit
Setting; Contextual Limits; Limits as
‘Time Out’; and Limits and Referrals.
It ends with brief closing comments
that reinforce Sommerbeck’s intention
that this book ‘is my description of
my experience and the evidence that
grew out of that experience’ (p103).
In a world echoing with the industrial
hammers of evidence-based practice,
this surely is a quarried diamond of
practice-based evidence.
Mike Gallant is a senior teaching fellow
(counselling and psychotherapy) at
Warwick University
Heart-felt plea for
emotional release
Reconnecting with the heart:
making sense of our feelings
Anne Dickson
Matador, 2015, 256pp, £9.99
isbn 978-178462551
Reviewed by Brigid Proctor
Those who grew up
reading Anne Dickson’s
A Woman in Her Own Right,
The Mirror Within and
others of her works will
know to expect wisdom
and originality. Here,
in Reconnecting with
the Heart, Dickson re-formulates the
centrality of emotion in life.
She lays out clearly and lucidly a
series of frameworks. These cover the
prime source and purpose of emotions
and the understanding of love, grief, joy,
anger, trust and fear. These are mapped
(with the assistance of simple drawings)
in relation to basic, and often conflicting,
needs of closeness/separateness, safety/
risk and engagement/containment.
Next, Dickson explores the mind–
body connection and early experiences
of cultural reactions to emotional
expression, leading to themes of
early vulnerability, the physiology
of emotional experiences and the
need for release of accumulated
tension. She writes passionately of the
way our current dominant culture fails
to acknowledge or comprehend this.
Finally, in ‘How Things Could Be
Different’ (Part 2, p131), she introduces
the DANCE: from denial of feelings
to Discernment; from rationalisation
to Acknowledgment; from evasion
to Naming, and from accumulation
to Catharsis and Evaluation. Help and
encouragement are offered to develop
the ability to take part in the DANCE
process: to discern, acknowledge, name
and release feelings safely, distinguishing
managed catharsis from dramatising or
manipulation. Suggestions and exercises
for doing this (preferably mutually, with
a safe companion) contain commentary
that I found moving and thought
provoking.
The book’s running theme is that
strong feelings are characterised
early on as either negative (‘problem’)
or positive (desirable), rather than
accepted for what they are. ‘Problems’
are often regarded as needing
professional ‘experts’ to handle them
safely but people can own and learn
the DANCE process for themselves.
Culturally, physical expression of
emotion – catharsis – is still feared and
distrusted, and often experienced as
frightening and shameful. Reconnecting
with the Heart does not advocate the
impulsive discharge of emotion but asks
us to learn to recognise it, appreciate it,
release its power and channel its energy.
I hope that we practitioners are mainly
at ease with that.
However, I still feel lurking shame
about my own ‘unacceptable’ emotions
and know it is difficult to find safe
enough places and ‘ordinary’ people
with whom I can acknowledge them,
let alone release them when supercharged. I believe emotional release
to be a human endowment for
freeing energy, and clearing vision.
I hope this book will generate
creative energy for making it
safer, day-to-day.
Brigid Proctor is a BACP Fellow and
founder member of BACP (retired)
Reviewed on TherapyToday.net
Telling time: a novel
Marie Adams
Karnac Books, 2015, 262pp, £9.99
isbn 978-1782202738
Reviewed by Michele Head
‘... the story of a psychotherapist who
is increasingly perturbed by a new
client, finding herself brought into
contact with her own repressed secrets.’
The content of psychological
distress: addressing complex
personal experience
Jack Chalkley
Palgrave Macmillan, 2015, 206pp,
£23.99
isbn 978-1137349743
Reviewed by Steve Nolan
‘An approach to assessing psychological
distress based… on the content of what
clients actually say about their concerns.’
Counselling skills for working
with shame
Christiane Sanderson
Jessica Kingsley Publishers, 2015,
262pp, £22.99
isbn 978-1849055628
Reviewed by Nathan Walker
‘It challenges the reader to re-evaluate
their own understanding of shame and
its place in counselling.’
Growing up? A journey with laughter
Patrick Casement
Karnac Books, 2015, 257pp, £19.99
isbn 978-1782203155
Reviewed by Gillian Ingram
‘… there are chilling hints at the
underlying rage and loneliness, which
are more arresting and moving than
the attempted jolliness of the incidents
he describes.’
Mentalization-based group therapy
(MBT-G): a theoretical, clinical and
research manual
Sigmund Karterud
Oxford University Press, 2015, 240pp,
£24.99
isbn 978-0198753742
Reviewed by Camilla Matthews
‘The aim is to develop a group culture
where the dialogue specifically targets
enhanced mentalization of both external
and live, here and now events.’
Kohut’s twinship across cultures:
the psychology of being human
Koichi Togashi and Amanda Kottler
Routledge, 2015, 212pp, £27.99
isbn 978-0955968365
Reviewed by Eileen Aird
‘How and in what way do individuals
come to experience themselves as
“feeling at home” relationally?’
March 2016/www.therapytoday.net/Therapy Today 41
From the
Deputy
Chair
Deputy Chair
Fiona BallantineDykes welcomes
BACP’s new ethos
of openness and
collaboration
BACP Chair Andrew Reeves
suggested that I write a ‘guest’
column for Therapy Today
to introduce myself as BACP
Deputy Chair, elected by
the Board in December 2015.
This suggestion in itself is a
strong signal of a new culture
at BACP that I welcome.
I have been a member of
BACP since I started training
as a counsellor 25 years ago,
when it was still BAC. BACP
has been in the background
of my professional life, and
always had the aura of a
benevolent but strict parent.
BACP offered me professional
identity and held me to
account, particularly through
what was then the BAC Code
of Ethics and Practice, later the
BACP Ethical Framework for
Counselling and Psychotherapy
and now the new BACP
Ethical Framework for the
Counselling Professions.
The story behind these
progressive name changes is
part of BACP’s journey, and it
reflects a wealth of meaning
for the organisation, and
also for me. As I established
my practice and moved into
training other counsellors,
BACP once again stood firmly
by my side, providing the
backbone for my teaching
and, later, my developing
supervision practice. I
watched the organisation
grow and expand and its
publications morph into
a slick professional output
with greater expertise
and presence – including
Counselling & Psychotherapy
Research (CPR) journal.
I found myself beginning
to feel a little distant from
this benevolent parental
figure and, like all teenagers,
began to question, criticise
and challenge my alma mater.
I watched with a sinking heart
as the word ‘counselling’
disappeared from the
vision and philosophy,
to be replaced by the term
‘psychological therapies’. I
went to a national conference
at a swanky hotel and felt
alienated and ill at ease. How
did this relate to my clients
and FE college students
struggling with overwhelming
social and economic
pressures and all kinds of
personal and psychological
problems? This parent
seemed to have become more
powerful but more distant.
My involvement as a
representative of the
Counselling and
Psychotherapy Central
Awarding Body (CPCAB)
on the Professional Liaison
Group during the period
of attempted statutory
regulation did nothing to
dispel these qualms. On the
contrary, I experienced BACP
as an organisation divided
and unapproachable and
at loggerheads with other
professional bodies.
On learning that BACP’s
strategic agenda included
an aspiration towards degreelevel (level 6) entry only,
my patience finally snapped
and I wrote an angry and
impassioned email to the
then chair Dr Lynne Gabriel,
questioning the evidence base
for this decision. True to her
generous and open nature,
Lynne offered to meet me and
we began a conversation that
has led by gradual degrees to
my role now as Deputy Chair.
It has not been a smooth
journey and, in truth, someone
of fainter heart might have
given up or walked away, but
I still hoped that BACP could
be the organisation I wanted
it to be.
BACP is a very different
organisation today and is
moving in a new direction. It
is re-connecting with its core
values and its membership
base, while looking to the
future. There is a new
openness and new sense of
collaboration, as evidenced
by the shared conversations
with other professional
bodies. There is an
attitude that welcomes
communication and dialogue.
There is a commitment to
inclusion and respect for all
those who, in their different
ways, contribute to providing
the much-needed help for
those in difficulty via a
range of professional roles.
I am confident that, as
BACP begins to roll out
the new strategy, the Board’s
attention to these issues
will become apparent.
The new Ethical Framework
for the Counselling Professions
signals not just a change of
scope but a change of culture.
I am honoured that the Board
has entrusted me with the
role of Deputy Chair and
will do my utmost to be
worthy of it.
Officers of the Association
President
Michael Shooter
Lynne Jones
Martin Knapp
Juliet Lyon
Glenys Parry
Julia Samuel
Pamela Stephenson Connolly
Chair
Andrew Reeves
Deputy Chair
Fiona Ballantine-Dykes
Company limited by guarantee 2175320
Registered in England & Wales
Registered Charity 298361
Chief Executive
Hadyn Williams
42 Therapy Today/www.therapytoday.net/March 2016
Vice Presidents
Sue Bailey
John Battle
Robert Burgess
Bob Grove
Kim Hollis
News
Private practice – your working lives
Patti Wallace summarises
the headline findings from
a survey of BACP members
working in private practice
The first survey of the BACP
focus group of members
working in private practice
was conducted in September
and October 2015.
Questionnaires were
emailed to 1,032 BACP
members in private practice
who had offered to be part
of an ongoing focus group,
and 427 surveys were
returned – a good return
rate of 41 per cent.
The main purpose of the
focus group survey was to
get a better picture of how
members manage their
private practice.
Location of practice
By far the largest percentage
of respondents in private
practice work in South East
England (29%) and London
(16%); the next highest
groupings are in South West
England (16%) and North
West England (11%). Some
4.8 per cent of respondents
work in Scotland, 3.3 per cent
in Wales and 1.4 per cent in
Northern Ireland.
Type and hours of work
Unsurprisingly, most
respondents’ working hours
are spent in face-to-face
client work: 154 (36%) spend
six to 10 hours per week on
direct client work, and 131
(30%) spend between one and
five hours per week. Relatively
few offer online, telephone
or group counselling, and
when they do it is only for
one to five hours per week.
When the weighted average
of time spent on each activity
was calculated, it showed that
most time (3.51 hours/week)
is spent on face-to-face work;
the next highest use of time
is administration (2.27 hours).
On average, administration
took more time per week
than supervision, training
or any of the other modalities
of clinical work (eg group
work, online counselling,
telephone counselling).
Hourly fees
Across the four nations,
most respondents (49%)
charge a usual hourly fee
of £36–£45, with 22 per cent
charging £26–£35 and 18
per cent between £46 and
£55. As expected, there is
some regional variation,
but the main difference is
between the rest of the UK
and respondents in London
and the South East; only here
do respondents (four per cent
in the South East; 17 per cent
in London) charge a usual
fee of more than £65.
Payment methods
The majority of respondents
take cash payment (94%),
cheque (81%) and bank
transfer (69%). Only 10
per cent take online credit
card payments and only
four per cent accept manual
debit or credit card payments.
However, 41 per cent say
they would take credit card
payments and 34 per cent
say they might if there was
a simple and cost-effective
system for doing so.
Contracting
Given the new BACP
Ethical Framework’s
strong recommendation
that counsellors contract
in writing with their clients,
it seemed important to find
out about current practice.
Only a very small percentage
(0.5%) of respondents have
no contract with their clients.
However, another 24 per cent
have only a verbal contract,
which is a potential risk as
there will be no written
record of contractual matters
should there be any dispute
in future. The majority (76%)
use either a written contract
they have developed or one
provided by an organisation.
Referral sources
Respondents were asked to
list all their referral sources.
By far the most frequent is
self-referral (93%), followed
by previous clients (54%),
EAPs (40%), family/friends
(33%), GPs (21%), schools/
colleges/universities (14%),
employers (11%), voluntary
sector services (9%), other
NHS services (7%) and
CMHTs (3%). This greater
numbers of referrals by
individuals (self or other)
is consistent with reports
from members.
Use of standardised
measures
Only 32 per cent of
respondents use standardised
measures. Of those who
do, 93 per cent use them
appropriately – ie in a way
that allows assessment of
change over time. Most
(72%) use them as a
therapeutic tool and discuss
the outcomes with their
clients. Another 40 per cent
use measures to monitor
their own effectiveness and
39 per cent use them because
it is a requirement of EAPs
who refer clients to them.
The main measures used
are CORE, GAD7, PHQ9,
ORS, SRS, SDQ (CYP) and
IES-R. Some 39 per cent of
respondents would use a
free toolkit of standardised
measures if BACP provided
it, and 49 per cent are unsure.
Resources from BACP
Respondents were asked
which two resources they
wanted most from BACP.
The top four answers were
CPD e-learning modules
specific to the needs of
private practitioners (65%);
an online ‘expert’ resource
where members could ask
questions and obtain advice
on how to deal with specific
concerns (57%); a moderated
online forum to support
members with difficult issues/
share best practice/business
development ideas (31%), and
‘How to’ guides on different
aspect of setting up a private
practice business (23%).
CPD
Attendance at conferences,
events and workshops (87%)
and reading journals (87%)
are the most common forms
of CPD. Others include
formal education, lectures,
seminars and courses (61%);
TV, radio, internet (55%);
network meetings (40%);
e-learning CPD modules
(28%), and committee work
(11%). Notably, 98 per cent
of respondents fund their
own CPD, with 38 per cent
budgeting over £300 per
annum towards this.
Conclusion
This is only a summary.
The full survey findings have
provided BACP with useful
information to inform future
work to support practitioners
in private practice.
Patti Wallace is BACP Lead
Advisor, Private Practice.
March 2016/www.therapytoday.net/Therapy Today 43
News/Professional conduct
Final countdown to BACP registration
Thursday 31 March 2016
marks the final stage in
the implementation of
the BACP Register.
We expect around 30,000
members to have joined
the Register by the deadline,
with more than half of these
qualifying through the
Certificate of Proficiency.
From April, MBACP,
accredited and senior
accredited members who
are currently practising will
not be able to renew their
BACP membership unless
they have signed the Register’s
terms and conditions.
Some allowance has been
made for MBACPs who still
need to pass their Certificate
of Proficiency. As long as
they have taken or booked
an assessment by their
renewal date, they will be
able to renew as an Individual
Member until they receive
their results.
Any members who are
no longer practising have
the option to transfer to the
Retired member category.
BACP Private Practice event
This year’s BACP Private
Practice conference will be
focusing on relationships.
The conference takes place
on Saturday 24 September
2016 at the Amba Hotel,
Marble Arch, London. Titled
‘Relationships: why do we
bother?’, the event is designed
specifically for therapists
working in private practice
with individuals, but will
also be of interest to those
who work with couples.
The day-long event will
include two keynote speakers
and a varied programme
of workshops exploring
the theme of relationships
from a range of perspectives.
Delegates can choose to
attend two out of seven
workshops on topics
including relationship
breakdown, communication
and conflict management,
sex and sexuality, isolation,
working with diversity,
domestic violence, and
jealousy. Details have still
to be confirmed and the
final programme will be
announced shortly.
The conference costs £105
for BACP Private Practice
members, £120 for BACP
members and £190 for nonmembers. A reduced rate of
£60 is available to students,
those in receipt of a state
benefit, and those who are
unwaged with no personal
income.
For those unable to attend
the conference in person,
we will again be providing
the opportunity to participate
online. The webcast costs
£25 for BACP members and
£50 for non-members. It
includes online access on the
day and access to recordings
for 30 days after the event.
We expect the conference to be
very popular; previous years’
events on depression, anxiety
and trauma were all sell-outs.
Booking has not yet opened but
you can register your interest
in attending by emailing jade.
[email protected]
To register interest in the
online webcast, please email
[email protected]
44 Therapy Today/www.therapytoday.net/March 2016
This offers many of the
benefits of BACP membership
and allows them to keep in
touch with the profession.
We will be sending
letters to all remaining
non-registered members
before their renewal date
explaining their options and
the steps they need to take.
‘We are sorry if members
decide to leave us, and wish
them all the best in their
future careers,’ said BACP
Chair Andrew Reeves,
‘but we see the BACP
Register as fundamental
to our vision of providing
clients with access to easily
identifiable, competent and
ethical practitioners.
‘Our goal is to safeguard
clients through high
standards of training, robust
ethics, and high quality
professional development,
in order to make sure that
“Counselling Changes Lives”.’
For more information on joining
the BACP Register, please visit
www.bacpregister.org.uk/join/
Webcast CPD events
Based on the positive
feedback from last year, we
will once again be webcasting
the conferences of both
OCTIA (Online Counselling
and Training in Action) and
UKESAD (UK and European
Symposium on Addictive
Disorders) this spring.
The OCTIA webcast,
‘Relational Depth and
Emotional Connection
in Online Therapy’, is on
16 April. Topics include
developing a therapeutic
relationship online using
text; exploring listening
skills used in both face-toface counselling and online;
working online with an
organisation; using online
therapy with clients with
a disability or illness; singlesession emotional support,
and working online with
autistic spectrum disorders.
On 2 May we will be
webcasting the UKESAD
conference on addictions.
The programme features
an exciting array of experts
from the addictions field,
including Alastair Mordey,
who will discuss ‘Addiction:
the illness with many faces’,
and Miles Adcox, who will
present on ‘Forgiveness:
the elusive and powerful
key to emotional freedom’.
We will also be hearing
from Rokelle Lerner on
‘Post-Traumatic Growth:
grieving the loss of dreams
and creating a new future’,
and Tim Leighton and Kirby
Gregory on ‘The Importance
of the Interpersonal’.
The webcasts cost £25
and are designed as an
affordable addition to
members’ CPD portfolios.
They include live streams
from the event and studio
discussions with presenters
and commentators, and can
be accessed from the comfort
of your own home, either
on the day of the event or
on demand for 30 days after
the event.
To book your place and find
out more about the speakers
and both webcast programmes,
please visit www.bacp.co.uk/
webinar
Private Practice Executive members
BACP Private Practice is
delighted to welcome two
new members onto its
Executive committee.
Lesley Ludlow retrained
as an integrative counsellor
after leaving a career in
marketing management
to start a family. A BACP
senior accredited member,
she now works with
individuals and couples
and has recently trained
as a supervisor.
Before starting in private
practice, she spent two
years working in a team of
telephone assessors, which
left her with a sense of the
importance of being part
of a team and how isolating
private practice can feel. She
co-founded, with Hatice Ocal,
the BACP Private Practice
South London regional
networking group in
Brixton, which is now a
thriving, supportive group
of counsellors in private
practice. If you would like
further information on the
group, email lesley.ludlow@
counselling-in-croydon.co.uk
Also joining the Executive
is Rachel Vint, a counsellor,
psychotherapist and
supervisor in private practice
in Edinburgh. She was
involved in setting up a BACP
Private Practice regional
networking group in the city.
After completing a degree in
psychology, she worked in the
charity sector before training
as a person-centred and
psychodynamic counsellor
and psychotherapist. She is
passionate about counselling
and has a particular interest
in the existential side of the
human condition and how
we work with this in therapy.
For more information and to
join BACP Private Practice,
go to http://bacppp.org.uk
ETHOS trial recruits school counsellors in London
ETHOS, the new £835,000
study to evaluate benefits of
school counselling, is seeking
school counsellors in London
to help deliver the three-year
randomised controlled trial.
As reported in last month’s
journal, BACP is part of the
team delivering this first ever
RCT of this size to study the
effectiveness of school-based
counselling. The project is
funded by the ESRC and
led by the University of
Roehampton. The other
partners are the universities
of Sheffield and Manchester,
the London School of
Economics, University
College London, Metanoia
Institute, BACP and the
National Children’s Bureau.
The study is being supported
by the Manchester-based
UKCRC registered Clinical
Trials Unit (MAHSC-CTU).
Approximately 20
secondary schools across
England that currently
have no school counselling
service are being recruited
to take part in the trial.
The ETHOS team is
now seeking fully qualified
counsellors with secondary
school counselling experience
to join the first wave of
schools. These will be in
London. Applicants will
need to be competent in
person-centred/humanistic
counselling and experienced
in the collaborative use of
outcome measures. Training
will take place during the
summer term and counselling
will begin in September 2016
or January 2017, for two
school years (see p53 for
full details of the posts).
Professor Mick Cooper
of Roehampton University
said: ‘There are a number
of possible ways that we
might support young people
to tackle mental health
problems. This study will
help us understand the
contribution that schoolbased counselling can make.’
BACP Professional
Conduct Hearing
Findings, decision
and sanction
Michael Worrall
Reference No: 510405
London W13
and Psychotherapy and
made a number of findings.
The Panel was unanimous
in its decision that these
findings amounted to
professional misconduct
and it was satisfied that
Mr Worrall’s ethical
conduct and behaviour
fell below the standards
that would reasonably be
expected of a member of
the profession.
The Panel found some
evidence of mitigation
and imposed a sanction.
Full details of the decision
can be found at http://www.
bacp.co.uk/prof_conduct/
notices/hearings.php
Sanction compliance
Georgios Taxidis
Reference No: 616572
London E9
The complaint against
the above individual
member was heard under
BACP’s Professional
Conduct Procedure and
the Professional Conduct
Panel considered the
alleged breaches of the
BACP Ethical Framework for
Good Practice in Counselling
Sanction compliance
Catherine Furnival-Small
Reference No: 538185
Cumbria CA20
BACP was satisfied that
the requirements of the
sanction have been met. As
such, the sanction reported
in the November 2015 edition
of the journal has been lifted.
The case is now closed.
This report is made under
clause 5.2 of the Professional
Conduct Procedure.
BACP was satisfied that
the requirements of the
sanction have been met. As
such, the sanction reported
in the September 2015 edition
of the journal has been lifted.
The case is now closed.
This report is made under
clause 5.2 of the Professional
Conduct Procedure.
To read all conduct notices, visit
www.bacp.co.uk/prof_conduct
March 2016/www.therapytoday.net/Therapy Today 45
Public affairs
Response to Mental Health Taskforce
All political parties have
welcomed the independent
Mental Health Taskforce’s
recommendations to NHS
England on how to improve
mental health service
provision.
The report recommends
an extra £1 billion funding
to provide mental health
care to over one million more
people, in particular children,
new mothers, people from
black and minority ethnic
groups and older people.
The Prime Minister
welcomed the report, saying:
‘Mental health is a major
problem in our country and
it must be properly addressed.
By providing this extra
£1 billion a year for mental
health care we will make sure
it gets the attention in the
NHS it needs.’ He announced
that, as part of the £1 billion
extra funding, thousands of
people with mental health
conditions will be supported
to find or return to work
as part of a new drive to get
the three in five people with
mental health conditions
who are out of work back
into employment.
The Labour Party’s
Shadow Minister for
Mental Health, Luciana
Berger, praised the report
but said: ‘The real challenge
will come in ensuring these
recommendations are
actually delivered. For too
long this Tory Government’s
rhetoric on mental health
has not matched the reality
on the ground.’
Former Coalition
Government Minister for
Mental Health and now
Liberal Democrat Health
Spokesman Norman Lamb
said: ‘This report lays bare
the discrimination suffered
by those with mental ill
health at the heart of the
NHS. I have made it my
mission to secure exactly
the same right to treatment
on time for those with mental
ill health. We now have the
first ever maximum waiting
time standards but this must
be made comprehensive.’
Referring to the campaign
‘Equality for Mental Health’
that he co-launched last
autumn with former
Labour Government
Communications Director
Alastair Campbell and
Conservative MP Andrew
Mitchell, he said: ‘This
report must trigger the
realisation of that ambition.
The moral and the economic
case is overwhelming.’
BACP has also
welcomed the Taskforce’s
recommendations. In a joint
statement with the UK
Council for Psychotherapy
and the British Psychoanalytic
Council, BACP said: ‘As the
report rightly emphasises,
the human cost of mental
health not being treated
with equal importance
to physical health is
unacceptable, and the
report presents an impressive
set of recommendations to
transform the support and
care of those suffering from
mental ill health.’
Andrew Reeves, BACP
Chair, added: ‘We support
the Task Force’s call for
additional capacity and
funding for psychological
therapies to help the one
in four people who suffers
from a mental health
problem. At the heart of any
reforms must be the issue
of patient choice and I hope
these recommendations
translate into meaningful
access to a range of evidencebased psychological therapies
on the NHS for those who
need them.’
Around the Parliaments: lobbying for school counselling
BACP has been hard at work
ensuring that mental health is
kept at the top of the agenda
in all four UK parliaments.
Alongside the launch of the
Mental Health Taskforce’s
findings in England,
parliamentary activity in
Wales, Scotland and Northern
Ireland has been especially
busy with the approach of
the devolved parliamentary
elections in May.
BACP has been ensuring
our members’ views and
interests are represented in
party manifesto development.
In Scotland, BACP has
recently met with Scottish
Labour’s Spokesperson for
Opportunity Iain Gray MSP
and Scottish Conservative
Party Spokesperson on
Education and Lifelong
Learning Mary Scanlon
MSP to discuss the benefits
of bringing Scotland in line
with the rest of the UK in
developing a national strategy
for school-based counselling.
As a result BACP submitted
briefings to the Scottish
Labour and Conservative
parties’ manifesto
development committees
and we hope that they will
include a pledge that all
children in Scotland will have
access to school counselling.
In addition, BACP attended
the Welsh Assembly Mental
Health Cross-Party Group.
46 Therapy Today/www.therapytoday.net/March 2016
This brought together
representatives of the Welsh
mental health charities and
service providers with key
mental health players from
across the political parties.
The group, chaired by
Welsh Labour Assembly
Member David Rees,
discussed a range of issues
affecting mental health
policy in Wales, including
a new recommendation to
ensure counsellors are able
to undertake mental health
assessments, thanks to
BACP’s continued lobbying.
Back at Westminster,
BACP continues to promote
to all national parties the
importance of having a
counsellor in every school.
We recently met with
Labour’s Shadow School
Minister Nic Dakin MP to
discuss how Labour might
hold the Government to
account and campaign for
all children and young people
in England to access school
counselling services, as they
already do in Wales and
Northern Ireland. Nic Dakin
went on from our meeting
to visit a flagship school
counselling service in Tower
Hamlets, in what we hope will
be the beginning of Labour’s
recommitment to its 2015
General Election pledge
to ensure all children can
access a school counsellor.
Research/Professional standards
Research Conference 2016
Early bird booking rates
for the 2016 BACP Annual
Research Conference will
close on 1 April, so book
your place now. Bookings
will still be taken after this
time but you will not qualify
for the early bird discount.
The conference, which will
be held in Brighton on 20–
21 May, will include keynote
presentations by Professor
Mick Cooper (University of
Roehampton) and Professor
Kenneth Levy (Pennsylvania
State University). There
will also be a pre-conference
workshop in the evening of
Professional
standards
19 May, 6–7.30pm, facilitated
by Professors Mick Cooper
and John McLeod.
For more information about
the conference and to download
a booking form, please visit
www.bacp.co.uk/events/
conference.php?eventiD=119140
Enquiry of the month: counselling supervision
This month’s enquiry of
the month considered the
question: ‘What makes
counselling supervision
effective for counselling
trainees?’ An electronic
search was conducted using
Google Scholar and our
internal abstract database,
using the search terms
‘counselling supervision’
AND ‘effectiveness’.
In 2013 Ladany and
colleagues1 interviewed
128 counselling and
psychotherapy students
to explore the effective
and ineffective factors of
counselling supervision.
Effective supervisor skills,
techniques and behaviours
included encouraging
autonomy, nurturing the
supervisory relationship, and
facilitating open discussion.
Ineffective supervision was
characterised by unfavourable
client conceptualisation
and treatment, and a weak
supervisory relationship.
Similarly, Wong and
colleagues2 interviewed
25 ethnic minority graduate
students and counselling
professionals to explore
their experiences of helpful
and hindering aspects of
counselling supervision.
Helpful aspects of counselling
supervision were a) personal
attributes of the supervisor,
b) supervision competencies,
c) mentoring, d) relationship,
and e) multicultural
supervision competencies.
Hindering aspects of
counselling supervision
included a) supervisees’
personal difficulties as a
visible minority, b) negative
personal attributes of the
supervisor, c) lack of a safe
and trusting relationship,
d) lack of multicultural
supervision competencies,
and e) lack of supervision
competencies.
These studies are
specifically concerned with
effective and ineffective
aspects of counselling
supervision as experienced
by counselling trainees
within a much larger
body of research exploring
counselling supervision.
If you have any research
queries or questions you
would like answered here,
please send them to
[email protected]
REFERENCES:
1. Ladany N, Mori Y, Mehr KE.
Effective and ineffective supervision.
The Counseling Psychologist 2013;
41(1): 28–47.
2. Wong LCJ, Wong PTP, Ishiyama
FI. What helps and what hinders
in cross-cultural clinical supervision:
a critical incident study. The
Counselling Psychologist 2013;
41(1): 66–85.
Join the CYP Practice Research Network
Do you work with children and
young people? Would you like
to connect with others working
in a similar setting? Then
join our Children and Young
People Practice Research
Network (CYP PRN) for free
at www.bacp.co.uk/schools
The network is designed
to allow practitioners to
communicate with each other
via a mailing list, keep up to
date with the latest research
and policy news in a quarterly
e-newsletter, and evaluate the
effectiveness of their service
through the COMMIT
platform, a secure web-based
platform for data collection
and storage. Members can
use the COMMIT system free
of charge. To find out how to
sign up for COMMIT, email
[email protected]
Newly accredited
counsellors/
psychotherapists
Catherine Altson
Sonja Ayres
Bina Badiani
Claire Baker
Ann Boothman
Mark Bottrill
Linda Bower
Theresa Brownlee-Blake
Janette Buchan
Vicki Champion
Yvonne Colledge
Lorna Day
Stella Goddard
Shirah Herman
Rosemary Hicks
Aziza Kapadia
Rebecca Levi
Dena Marshall
Denise McHugh
Julie Riding
Naveen Webber
Louise Wilkinson
Maria Wilson
Laura Windebank
Newly senior accredited
supervisor of individuals
Tracey Oak
Organisations with
new/renewed service
accreditations
••Arun Counselling Centre
••Network of Staff Supporters
(NOSS) Ltd
••YMCA Fairthorne Group
(YMCA-SC)
••Young Concern Trust
For a full list of current BACP
accredited services and courses,
please visit the service
accreditation webpages on the
BACP website at www.bacp.
co.uk/accreditation
This information relates to the
period 1–31 January 2016 and
was correct at time of going
to print.
March 2016/www.therapytoday.net/Therapy Today 47