Therapy Today
Therapy
Today
For counselling
and psychotherapy
professionals
March 2012
Vol. 23 / Issue 2
www.therapytoday.net
March 2012, Vol. 23 Issue 2
My therapist is a horse
Improving access to counselling for young people
Poetry and science: getting the balance right
March 2012
Volume 23
Issue 2
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Contents
Sarah Browne
Editor
Features
14 When the therapist is a horse
Nicola Banning reflects on her own,
revelatory experience of a two-day equine facilitated therapy group.
Therapy should bring the poetic and the scientific together to reflect and articulate the experience of the client, argues Sarah Van Gogh.
20 Poetry, please
Regulars
3
4
8
10
11
Editorial
News feature
What do young people want?
News
Talking point
Mèlani Halacre
Columns
Caitin Wishart
Marc Brammer
Julia Bueno
19 Questionnaire
John McLeod
BACP
felt an authentic relationship with another
being – a relationship about contact and
connection instead of manipulation and abuse.
Counsellor and BACP member Nicola
Banning enrolled in an equine facilitated
therapy group to explore power relations in her client work, in her training with groups and her work with organisations. She shares
her discoveries in this issue.
We also report on the latest developments in children and young people’s (CYP) IAPT.
The Government recently announced an extra
£22 million to broaden the range of therapies
on offer to young people and to help develop a
curriculum for counselling in schools, a project
with which BACP is closely involved. The aims
of CYP IAPT are described by one interviewee
as ‘genuinely radical’ as they will dramatically
change the culture of CAMHS. And while
acknowledging the need for pluralism – though
perhaps not extending to equine therapy just
yet – a clinical psychologist describes how
young people often like the formulation process
of CBT because it’s like detective work.
Up and down the country horses are being
used to work therapeutically with a range of conditions – addiction, depression, PTSD
and even autism. Equine assisted therapy is booming, partly perhaps because of the
increase of this therapy in the US. In 2011 the US-based Equine Assisted Growth and
Learning Association (EAGALA) trained 1500 therapists in the UK.
A quick google search reveals the popularity
of animal assisted therapy in general. I came
across several counselling services offering
therapy with guinea pigs, chickens, cats and
even pigs! The benefits of such therapy are
claimed to arise from the fact that animals are responsive, live in the here-and-now and offer unconditional acceptance. Equine
therapists say that horses also mirror back our emotions to us – they know what we are
feeling even if we don’t. Some of the best
results reported for equine assisted therapy
have been with teenagers with serious
behavioural problems; for the first time in their lives some of these young clients have 45 From the Chair
46 BACP news
47 Research
49 Professional standards
50 Professional conduct
28 Too little, too late?
People infected with hepatitis C from NHS
blood will at last get counselling. Charles Gore explains the history behind the decision.
Participants from a wide range of organisations and nations meet to explore group relations. Mannie Sher and Coreene Archer describe what happens at the Leicester Conference.
33 The Leicester Conference experience
Cover illustration by Eda Akaltun
24 Dilemmas
Disclosures in cyberspace
Maria-Alicia Ferrera-Pena
30 Day in the life
36 Letters
41 Reviews
52 Noticeboard
55 Classified
56 Mini ads
58 Recruitment
60 CPD
Readers can access articles written exclusively
for our website online at www.therapytoday.net
March 2012/www.therapytoday.net/Therapy Today 3
News
What do young people want?
The Department of Health has recently announced further investment to
improve access to talking therapies for children and young people. Catherine
Jackson talks to researchers and practitioners about what’s being o�ered
‘It can take young people a long time
to decide they need help and we need
to provide it then. If we can only provide
it several months down the line, it can be
really hard to get them to engage again.’
Julie Armytage manages the Bridgend
Child and Youth Counselling Project,
which provides a counselling service
in all secondary and special schools
and the majority of primary schools
in the borough. For much of its 10-year
life, the service has struggled to survive
on scraps of funding scraped together
by Bridgend County Borough Council.
But in 2008 the then Welsh Assembly
Government published its All Wales
Strategy, a trial programme to place
a counselling service in all secondary
schools. In 2011, following very positive
outcomes and feedback from schools,
parents and pupils,1 it announced
that it would make counselling a
statutory service in all secondary
schools. ‘Now we don’t have to worry
about our sustainability; we can offer
support to young people when they
need it, and that is key,’ Armytage says.
‘Starting well’ and ‘developing well’
are the first two stages in the journey
towards a mentally healthy adult life
outlined in the Government’s mental
health strategy for England, No Health
Without Mental Health.
There is powerful and growing
evidence of the high cost to societies,
as well as to individuals and their
families, of not attending to our
children’s mental health and wellbeing
and of failing to intervene early when
children show signs of distress.
One in 10 children aged five to 16
has a clinically diagnosable mental health
problem. That adds up to more than a
million children in the UK at any one
time. And there is good evidence that,
if they get the right treatment and early
enough, many mental health problems
4 Therapy Today/www.therapytoday.net/March 2012
can be prevented from escalating into
a lifelong disability.
Children with behavioural problems
often grow up to populate our young
offender units and adult prisons. Half
of all adult mental health problems
manifest before age 14, and three quarters
by the mid-20s. Mental health problems
that originate in childhood and early
adolescence can lead to a lifetime ‘career’
in the health and social care services –
as a user, not a worker. It is a tragic
waste of human potential.
YoungMinds, the children and young
people’s mental health charity, has been
campaigning for better access to talking
treatments for years. ‘We hear too many
stories of young people who now have
an entrenched mental health problem
that will probably be with them for the
rest of their lives. They tell us it started
with them feeling a bit depressed and
anxious and they didn’t get any help
and things just snowballed,’ Sarah
Brennan, YM chief executive, says.
Children’s IAPT
In October 2011 the Department of
Health announced that it would be
extending the Improving Access to
Psychological Therapies (IAPT) service
to children and young people with an
investment of £32 million investment
over four years. This first phase was
focused tightly on training CAMHS
and children’s services practitioners
in CBT for anxiety and depression
and on providing parenting programmes
for families of young children with
behavioural difficulties. A second phase,
with a further £22 million investment,
was announced on 29 February this
year. Details are still to be confirmed,
but it seems that this phase will broaden
the range of therapies offered within
IAPT to include talking therapies for
mental health problems with which
young people often struggle, including
eating disorders, self-harm and Attention
Deficit Hyperactivity Disorder
(ADHD). It will also fund new training
programmes to extend the skills of
professionals working with this age
group. BACP will be closely involved
in developing a curriculum for schoolbased counselling.
Unlike the adult IAPT programme,
the CYP IAPT is not a stand-alone
service. The programme is seeking to
make talking treatments more widely
available and accessible to children
and young people by working through
existing child and adolescent mental
health services. The programme is
funding three collaboratives, based in
London, Oxford and the north west (and
has invited bids to set up a fourth, with
the new funding), that are piloting CBT
and leadership training and working with
local CAMHS to change their cultures,
systems and practices to reflect the IAPT
principles. This means CAMHS will
have to start using more evidence-based
treatments, to scrupulously monitor
outcomes from treatments, to introduce
self-referral at community and primary
care level, and to actively involve children
and young people both in their own
care and treatment and also in service
planning, design and commissioning.
Sarah Brennan says the CYP IAPT aims
are genuinely radical and mark a huge
step forward: ‘CAMHS culture needs
changing. The focus on the involvement
of young people in their own care
pathways and decisions about what is and
is not helping will be a fundamental shift
towards young people gaining confidence
in themselves and their sense of self and
what is right for them, which we know
is fundamental to someone getting well.’
But, she stresses, it is important that
CYP IAPT supports a range of therapies.
‘CBT is part of the answer. It works well
March 2012/www.therapytoday.net/Therapy Today 5
© BRIAN MITCHELL/PHOTOFUSION/WWW.PHOTOFUSION.ORG
News
with particular problems, but it isn’t the
most effective treatment for all problems
and for all young people. Children and
young people say they want choice.
They don’t want to be tramlined along
any one route. They want longer than
eight or 12 sessions. They say they are
only just beginning to trust the therapist
by then. And they want the help to be
there when they need it.’
Cambridgeshire and Peterborough
NHS Foundation Trust launched a pilot
IAPT service for 14–19 year-olds in 2010,
well before this latest Department of
Health initiative. Ayla Humphrey is the
trust’s psychology lead for children’s
mental health and set up the 14–19
service. She says the service was
developed to fill a clear gap in provision.
‘Like many CAMHS, we were aware
that there was a group of young people
who were not able to access mental
health services. Typically these were
young people with anxiety and
depression who were either transitioning
between adult and children’s services
or did not meet the threshold criteria
for CAMHS community services.’
The 14–19 service had three full-time
staff: a ‘low-intensity’ worker offering
guided self-help and basic CBT-informed
techniques such as exercise to help
with mood; a CBT therapist/qualified
psychologist and a family therapist.
A local voluntary sector young people’s
service, Centre 33, was a key partner
and offered follow-up support to
clients. The team also had access
to a consultant psychiatrist.
A third of young people with mental
health needs don’t seek help, Humphrey
says, which means they may not get
any treatment until they are severely
ill. The reasons are numerous but are
likely to include stigma, not knowing
where to go for help or how to access
it, or simply a distrust of what’s on offer.
‘Research shows that one thing that
prevents young people seeking help
is they feel the people they go to don’t
understand teenagers, so it’s important
that we are able to meet them where they
feel most comfortable,’ Ayla Humphrey
says. The Cambridge team therefore
deliberately offered young people a lot
of choice about where they came for
treatment. Most clients were seen at
the 14–19 clinic in Cambridge city centre
6 Therapy Today/www.therapytoday.net/March 2012
‘Just knowing someone is
there to talk to may make
a big di�erence to some
young people, and could
be the early intervention
that means they are less
likely to develop problems
in the future’
or their GP surgery. Smaller numbers
chose to be seen at home or at school,
generally because they didn’t want their
parents involved or they didn’t want
their school friends to know they were
seeing a therapist. But the team was even
willing to meet them at Starbucks for
introductory or low-intensity sessions.
They communicated with their young
clients mainly by text and mobile phone.
Young people were offered a minimum
of six CBT sessions, with the option of
a further six if needed. If they were still
not recovered, they were referred to
CAMHS. The team had not expected so
many of their referrals to be so unwell:
most had mental health needs at levels
that would normally trigger a referral
to CAMHS, Humphrey says. But they
still achieved very good results: ‘We had
good outcomes; we made a difference.
After six to eight sessions most cases
were no longer depressed by the clinical
measures we were using. We also looked
at how things were going at home and
at school and at around 10 weeks there
was a real improvement.’ Moreover,
the number of young people needing
referral to the psychiatrist for medication
was surprisingly small. The service is
now being merged into the CYP IAPT
programme.
Humphrey is clear that CBT works
well with children and young people,
but says that its long-term outcomes
are less good. She wants to develop
‘booster sessions’ for those at risk.
‘Long-term follow up is missing in
children’s mental health services and
there is a lot of movement back into
clinical need after a year or two.’
Deborah McNally is the psychology
clinical lead at Salford Cognitive
Therapy Training Centre, which is
managing the north west CYP IAPT
collaborative. The centre is working
with the University of Manchester
and four local NHS trusts to deliver
the programme. A consultant clinical
psychologist who also works at the Royal
Manchester Children’s Hospital offering
CBT to children and young people,
McNally is (not surprisingly) a huge
advocate for the approach. The evidence
base is, she says, less robust than for
adults, but it is still strong, and growing.
She recognises that CYP IAPT has so
far been weighted towards CBT, but says
that is inevitable, given the evidence.
‘When 70 per cent of referrals to CAMHS
can be treated with either parenting
training or CBT and there is limited
funding, they are the obvious choices.’
She also says that young people respond
very well to CBT: ‘The biggest challenge
with teenagers is making the process
fun and engaging. It’s rare that a young
person knocks on your door; they are
usually brought to therapy by their family
or carers. They like the formulation
process – it’s like detective work, finding
out what is maintaining their problem,
testing out their beliefs, agreeing what
they need to do differently, and then
making plans about how to change
things. Once they get their teeth into
it, they just fly.’ But she also recognises
the need for pluralism: ‘Personally, I
think the more people in CAMHS who
are trained to a high level in all therapies,
the better it will be. CBT is excellent for
some things and some people. If there
is an evidence base for other approaches,
there’s an argument for providing them.’
Counselling in schools
BACP has been campaigning for some
time to try to persuade the Department
of Health and Department for Education
to follow the Welsh Government’s
example and fund statutory counselling
provision in all secondary schools in
England. Northern Ireland has it, and
has done so for several years. Scotland’s
previous Labour government made a
commitment to put counsellors in all
secondary schools by 2015.
BACP argues that school-based
counselling is the answer to getting
young people to access help early,
and so prevent problems escalating.
‘The evidence shows it is liked by young
people because it’s easily accessible,
it’s in a place that they are familiar with,
Mental health for all
Critics of the Government’s
education policies point to
a contradiction between
the Department of Health’s
commitment to prevention
and early intervention,
Prime Minister David
Cameron’s protestations
about building a ‘happier’
society, and the elimination
by the Department for
Education of social and
emotional learning from the
national school curriculum.
How much difference
can counsellors make if the
rest of the school is paying
scant heed to its pupils’
general mental wellbeing?
Neil Humphrey, Professor
of Psychology of Education at
the University of Manchester,
has been involved in two
evaluations of national
school-based mental health
and wellbeing programmes:
the Targeted Mental Health
in Schools (TAMHS)
programme, and SEAL
(Social and Emotional
Aspects of Learning – a
whole-school mental health
promotion programme).
He says interventions
aimed at the whole school
community are needed.
‘You have the universal
inoculation approach of,
they don’t have to go out of school and
take two buses to get to a clinic, their
parents don’t have to take time off work
to go with them – they don’t even need to
be seen with their parents, so it supports
their autonomy,’ Karen Cromarty, BACP
Senior Lead Advisor, Children and Young
People, says. ‘The waiting lists are very
short, if they have to wait at all. It’s very
flexible in how it is delivered. If they
don’t like it, they don’t have to go back,
or they can come for a few sessions and
then come back a year later. And they
can see a difference quite quickly.
‘Teaching staff don’t have the time
and expertise to do this work themselves,
they like having someone with those
specialist skills on site, and they can
see the difference in the young person’s
attendance, academic achievement
and behaviour.’
In fact, as a recent review conducted
by Manchester University and funded
by BACP shows, four out of five
secondary schools in England and
73 per cent in Scotland do offer some
kind of counselling, and the numbers
are increasing.2 Most also have a
good level of provision: up to two
counsellors offering between five
and nine counselling sessions a week.
Moreover, nine out of 10 schools give
their counselling service a ringing
endorsement: it is valued, regarded
for example, SEAL, which
gives all young people the
skills to make them resilient
to mental health difficulties.
Then there is another layer
of intervention – and
counselling would be one
such approach – where
children are able to access
more focused interventions.
The overwhelming majority
of children and young people
do not have serious mental
health needs. The message
from the projects I have been
involved in is there needs
to be a balance of universal
provision for that 90 per cent
and more targeted approaches
as an integral part of the school
community and they also say it is
very good value for money.
Cromarty says: ‘Provision is good
in England, but it’s provided in so
many different ways, by independent
counsellors, charities, local authorities
and even some teachers. We need
Government endorsement to introduce
standards for England and Scotland, and
to hold school heads to account. Even
an in principle commitment from the
Government would give us more leverage
with areas that don’t offer it,’ she argues.
The problem, historically, has been
the lack of hard evidence to rival that
accumulated for CBT. BACP is actively
involved in promoting and conducting
research into secondary school-based
counselling to establish a stronger
evidence base. Mick Cooper, Professor
of Counselling at the University of
Strathclyde, is the author of a widely
quoted 2009 audit of counselling in
UK secondary schools.3 He has been
involved in three small-scale randomised
controlled trials of school-based
counselling in Scotland and England.
These trials are comparing young people
identified as needing counselling to
see if they recover equally well with
and without it – a vital aspect of a robust
evidence base. ‘The tentative results
from these three trials so far seem to
that reach the 10 per cent of
children who do experience
mental health difficulties.’
He agrees that the
Government’s policy to
focus the curriculum on
academic subjects doesn’t
help. ‘But I think schools
recognise that their role is
not just to make sure kids
can read, write and add up
– they see the value [of
supporting pupils mental
health and wellbeing]
and will continue to do
so because they see the
benefits for kids’ learning,
particularly the very
vulnerable children.’
be showing a level of change in those
receiving school-based counselling that
isn’t happening in the control groups.
The young people on the control waiting
lists do seem to get a bit better, but less
than those getting the counselling,’ he
says. The next challenge is to find funding
for a larger study, building on these
pilot trials, and an economic evaluation
of cost-effectiveness and long-term
follow-up.
He believes school-based counselling
is one answer to meeting the needs of
the wide swathe of young people who
don’t meet the thresholds for referral
to specialist psychological or educational
services but are struggling with family
problems and other issues. ‘Just knowing
someone is there to talk to may make
a big difference to some young people,
and could be the early intervention
that means they are less likely to
develop problems in the future.’
References
1. Welsh Government. Evaluation of the Welsh
school-based counselling strategy: final report.
Cardiff: Welsh Government Social Research; 2011.
2. Hanley T, Jenkins P, Barlow A, Humphrey N,
Wigelsworth M. A scoping review of the access to
secondary school counselling. Manchester: School
of education, University of Manchester; 2012.
3. Cooper M. Counselling in UK secondary schools:
a comprehensive review of audit and evaluation
data. Counselling and Psychotherapy Research.
2009; 9(3): 137–150.
March 2012/www.therapytoday.net/Therapy Today 7
News
New funding for children’s IAPT
The Department of Health
has announced a further
£22 million in funding for
the children and young
people’s Improving Access
to Psychological Therapies
(CYP IAPT) programme.
This is on top of the existing
funding of £32 million over
four years announced last
October to improve access
to talking treatments for
children and young people.
One in 10 children aged
five to 16 have a mental
health problem and an
estimated half of all longterm mental health problems
first manifest before age 14.
Unlike the stand-alone
adult IAPT programme,
CYP IAPT will expand access
to talking treatments by
investing in existing child
and adolescent mental
health services (CAMHS)
and training CAMHS
and children's services
practitioners, and other
professionals working with
children and young people.
The programme will also
introduce the key principles
of IAPT – outcomes
measurement, involvement
of children and young people,
and improving access through
self-referral – to CAMHS.
So far CYP IAPT has
focused on CBT and
parenting programmes
for families with younger
children with behavioural
problems. The new funding
is earmarked partly to expand
the ‘collaboratives’ – based
in London, Manchester and
Oxford – currently piloting
the training programmes.
But it will also expand the
range of psychological
therapies offered within CYP
IAPT to include evidencebased treatments for mental
health problems commonly
associated with adolescence,
including eating disorders,
depression, self-harm and
ADHD-related conduct
problems. There is also new
funding for training for other
professionals, including the
development of a curriculum
for school-based counselling.
BACP flags up concerns about computerised CBT
Computerised CBT (CCBT)
should only be offered in
conjunction with face-to-face
therapy, BACP has warned.
The Association issued
a press statement raising
its concerns in response
to news that the Scottish
Government may be planning
to introduce CCBT across
Scotland as an alternative
to face-to-face counselling,
to bring down waiting lists
for talking treatments.
Health Minister Michael
Matheson MSP subsequently
told MSPs: ‘Computer-based
therapies are not intended to
replace face-to-face therapies
but to add to the options and
personal choices available
to those patients for whom
this type of intervention is
appropriate, welcomed, likely
to be effective, and safe.’
BACP says SIGN (the
Scottish Intercollegiate
Guidelines Network)
recommends CCBT only
in the context of guided
self-help, not as an alternative
to face-to-face treatment.
‘Many of the people we see
have complex psychological
needs. It is not possible to
address the underlying causes
of their distress through a
computer programme,’ Tina
Campbell, Chair of the BACP
Healthcare division, said.
© JUPITERIMAGES/PHOTOS.COM/GETTY IMAGES/THINKSTOCK
GPs may prescribe apps for managing PTSD symptoms
GPs may be able to prescribe
free apps to help patients
manage their own mental
health and wellbeing, the
Department of Health
(DH) has said.
The DH recently invited
suggestions from the public
and professionals about
how apps could be used
in NHS healthcare. Among
the most popular of the 500
ideas submitted were an
app to help people deal with
symptoms of post-traumatic
stress and apps for managing
other long-term conditions,
such as diabetes and high
blood pressure, and to support
healthy eating and exercise.
The Department of Health
is currently reviewing its
patient information strategy.
Secretary of State for Health,
Andrew Lansley, has said that
apps could help put patients
‘in the driving seat’.
Ten mental health services
have recently started using
a digital app to help patients
manage their own mental
health. The app is being given
to patients with a range of
conditions, including posttraumatic stress disorder,
depression, anxiety and
8 Therapy Today/www.therapytoday.net/March 2012
psychosis. Patients use them
like a paper diary to record
how they are feeling and
what they are doing so they
can work out what helps
or hinders their recovery.
Mental illness is ‘sixth giant’
Lord Layard, the driving force
behind the IAPT programme,
has called on the Government
to appoint a cabinet minister
specifically for mental health
and social care.
Professor Lord Layard, who
is Director of the Wellbeing
Programme at the London
School of Economic’s Centre
for Economic Performance
(CEP), was delivering a
lecture last month to mark
the 21st birthday of the CEP.
It was his report on the
economic costs of mental
illness and the benefits of
CBT that persuaded the
Government to invest in IAPT.
Lord Layard argues that
mental illness is a social ill
on a level with Beveridge’s
‘five giants’ of poverty,
unemployment, poor
education, bad housing and
physical disease. ‘Mental
health should become the
sixth pillar in the welfare
state. All the other pillars have
their own cabinet minister.
We will never get mental
health taken seriously enough
unless it has its own minister
within the Department of
Health,’ he said.
Reviewing outcomes
from IAPT to date, Professor
Layard admitted that the
In brief
programme was only
achieving a 40 per cent
recovery rate, rather than
the 50 per cent predicted,
but stressed that ‘recovery
rates are higher where
NICE guidelines are
followed and where the
staff are more experienced’.
The CEP is currently
developing a model that
would enable governments
to cost policy decisions by
their benefits for population
wellbeing. Lord Layard
said that mental wellbeing
should be ‘the ultimate
criterion by which we judge
the state of our society’.
© ISTOCKPHOTO/THINKSTOCK
More young people seek counselling
Relate counsellors are
reporting a rise in the number
of young people coming to
them for help with mental
health problems.
Relate interviewed 143
young people’s counsellors
as part of its Understanding
Teenagers’ Ups and Downs
campaign. Over two thirds
(64 per cent) said that mental
health/depression was the
most common new issue
affecting young people seeking
their help. Second most
common was family break-up
(reported by 43 per cent), and
third was dealing with parents
with mental health problems
(23 per cent). Just over one in
five counsellors (21 per cent)
said they were supporting
young people with problems
related to social media.
In a separate Relate survey
of over 1,000 young people
aged 13–18, nearly a third
(31 per cent) said they felt
stressed often or all the time
and 74 per cent said they had
felt stressed at some point
over the previous month.
The most frequently
reported pressures in the lives
of the young people seeking
counselling from Relate were
anger (58 per cent), selfesteem (44 per cent) and not
getting on with their parents
(43 per cent). The counsellors
said that factors contributing
to young clients’ feelings
of worthlessness included
being criticised by parents
(reported by 82 per cent),
not having anyone to talk to
and being bullied (45 per cent),
and not being encouraged
by teachers (41 per cent).
Relate says parents need to
talk with and listen to young
people without judging them
or telling them what to do, and
try to boost their self-worth.
‘Children look to their parents
and families to learn how to
express feelings safely,’ Relate
young people’s counsellor
Sharon Chapman said.
www.relate.org.uk
••Counsellors and therapists
need to work harder to win
the trust of looked-after
young people, the children’s
mental health charity
YoungMinds says. In a new
report, YoungMinds says
children and young people
who have experienced major
trauma are likely to have
learned that it is safer not
to trust adults and may
reject the therapist for
longer than other young
people. Art, play, drama and
music can be useful means
for counsellors and therapists
to win trust and build
relationships before the
therapeutic work can begin.
Improving the Mental Health
of Looked-After Young People.
www.youngminds.org.uk
••The Welsh Government
is to review the support
available to service men and
women with post-traumatic
stress disorder and develop
a plan to meet the increased
demand expected from
Armed Forces personnel
returning from Iraq and
Afghanistan. Welsh
Assembly Members heard
that PTSD can take 10 years
to develop, and that the
Welsh Government needed
a long-term plan to cope
with this ‘time bomb for
the future’.
••Talking treatments for
depression, anxiety and
stress are now available to
deaf people in the north west
and south central regions
of England. SignHealth,
the national deaf healthcare
charity, is piloting a service
using British Sign Language
(BSL) in these regions,
under the Governmentfunded IAPT programme.
If successful, the service
will be rolled out nationally.
March 2012/www.therapytoday.net/Therapy Today 9
Talking point
All stick
and no
carrot
Mèlani Halacre
Getting unemployed people
with disabilities off benefits
and into paid work is a hot
political topic right now.
While I agree disabled
people should work if they
can, what concerns me is
how this is being done.
Many of my disabled clients
on Incapacity Benefit (IB)
are being reassessed through
Work Capability Assessments
(WCA) and, if deemed fit for
work, moved onto Job Seekers
Allowance or Employment
Support Allowance. Both
allowances have negative
financial consequences if they
then can’t find employment.
According to the
Department for Work and
Pensions’ own estimates,
fraud and errors account
for only 2.1 per cent of the
total benefit expenditure.
This is not how the media
tells it. The current feeding
frenzy on benefit fraudsters
seems to have created a
climate of suspicion. Yet
the Citizens Advice Bureau
found significant levels
of inaccuracy in 70 per
cent of the WCAs they
investigated.1 In some
60 per cent of assessment
appeals, the assessment
decision is overturned.
Yes, there are a minority
of people who abuse the
system, but what about the
practices of the Government,
the media and the WCA itself
– are they not abusive towards
the many more thousands
of genuine applicants?
Most people with
disabilities spend much of
their time trying to convince
others about their needs
and having to wait, cap in
hand, on their judgment...
social services, occupational
therapy, NHS continuing
healthcare, Access to Work,
the list goes on.
The stress of the
assessment process has
10 Therapy Today/www.therapytoday.net/March 2012
‘The majority of
my unemployed
clients want to work.
They understand
the benefits... they
want to contribute
more to society’
an inevitable impact on
their health. Over time
these repeated experiences
lead to a kind of learned
hopelessness: resignation,
dependence, fatigue, low selfesteem and a permanent state
of anxiety and/or depression.
Clients tell me they don’t
know how to fill out the WCA
questionnaire; that assessors
are ticking boxes rather than
looking at their individual
circumstances. They feel
degraded by the process.
They feel not heard and not
believed. Assessors don’t
have access to an applicant’s
medical history and some
have misrepresented the
truth, saying, for example,
that clients can walk without
difficulty when they cannot.1
One client was told if they
watched TV they should
be able to work. Another
couldn’t even reach the
assessment centre because
it was up a flight of stairs.
People with disabilities
already feel they are a burden
on society and some have
talked to me about their
suicidal thoughts because
of this. Many are afraid to tell
anyone they are on benefits
for fear of retaliation.
The majority of my
unemployed clients want
to work. They understand
the benefits of income and
purpose. They would like to
contribute more to society.
The truth is they face
innumerable hurdles to work,
and the DWP and the WCA
are not supporting people
enough to overcome them.
There are the hurdles
created by their disability:
the extra time it takes to
get up and get ready to go
out, the pain and fatigue,
the poor concentration
caused by medication, which
can all make it hard to manage
a standard 9–5 job. There’s
the poor physical access and
endemic transport problems.
Employers are still reluctant
to take on people with
disabilities, even though they
take fewer days off sick and
have a higher retention rate
than able-bodied employees.2
If the Government
wants this push towards
employment to be a success,
it needs to do more to
recognise the structures
in our society that make
disabled people (literally)
redundant. I work with
clients to help them make
sense of what it means to be
‘disabled’ by their impairment
and society, to incorporate
the disability into their
identity and work out what
they can change, thereby
increasing their self-esteem,
sense of self-efficacy and
independence. I help them
navigate society, manage
relationships with partners,
family, carers, members of
the public, government bodies
and employers, without it
eroding their self-esteem.
This helps them to get out
there, have relationships,
socialise, lead happier lives
and yes, find jobs too.
Mèlani Halacre is a counsellor
for and Director of Spokz People,
a disability support service.
www.spokzpeople.org.uk
References
1. See www.citizensadvice.org.uk/
right_first_time.pdf
2. www.efd.org.uk/disabilitybusiness-case/resources/factsfigures/potential-employees or www.
un.org/disabilities/default.asp?id=255
In the client’s chair
Who is
this man?
Caitin Wishart
Sometimes I can’t believe
I’ve spent three years in the
company of my therapist yet
I know nothing about him.
He is a man who sits opposite
me in a chair, week in week
out, and I have no idea who
he is outside of this context.
And yet he has all of my
context. How is that fair?
Well, that’s not strictly true.
In a throwaway comment
he once told me that he had
slammed his phone down on
a table in a temper and broken
it (the phone, not the table).
At the time this comment set
me off balance. My therapist
had a temper? Enough to
break his phone? Who was
he, suddenly? Now, in this
session, I recall aloud the
throwaway comment and
ask him the questions: why
doesn’t he tell me anything
about himself? And why
don’t I ask him?
‘Sometimes,’ he replies,
carefully, ‘sometimes we
are curious about the other
when we least want to focus
on ourselves.’
This is not what I want to
hear. I don’t want a thoughtful
pause, a measured response.
I want spontaneity, something
real. I want to hear about the
man who got so angry that
he broke his phone. But this
is also something that I don’t
want to hear. I want him to be
someone he is and someone
he is not.
I am restless in the session.
I fidget. I make a comment
about the water and stand
up to get more from the jug.
I tell him the water jug’s filter
is done, that he needs to get it
replaced. I fidget with the jug.
‘Okay,’ he says. ‘Here is
something about me. When
you got up, I thought, why
does she need more water
when she has some there?
What is wrong with that
water? And then, when you
were fiddling with the jug,
a part of me was getting
anxious about you fiddling
with it, in case it breaks.’
He laughs, off-guard.
Wow, I am off balance
again now. The moment
seems to come alive in a
kind of vertigo-inducing
way. And now I have a
hundred questions in my
head. They hover between
us in this weird balancing
act. Do I want the answers?
I don’t know. The answers
feel like little earthquakes
that could irretrievably
shake this safe little container.
The comfort of not knowing
beckons.
I remember a session we
had a long time ago, early
on in our relationship,
where I had decided that
it just wasn’t working out.
I performed an Olympic
gold medal performance
in cerebral gymnastics,
justifying my decision along
the lines of ‘It’s not you, it’s
me’. But this wasn’t true really
because, in fact, it was him:
it was him and me together
that wasn’t working out.
Towards the end I said
something flippant, internally
congratulating myself on
my fait accompli. ‘That’s just
clever,’ he retorted, visibly
irritated, with not so much
as a pensive pause in sight.
Just clever? I remember
how the windows on the
moment shook. Wow, I
thought; here he is, finally.
Was he someone I could
irritate? I had an impact
on him? Out of that entire
session, those three words
were the greatest motivation
‘I want spontaneity,
something real. I
want to hear about
the man who got
so angry that he
broke his phone’
to stay. I don’t know why. It
wasn’t even the words; it was
the feeling. For the first time
I felt real contact, even if it
was fraught. It felt enlivening,
like I was suddenly interacting
with someone, not something.
I think about this in the
session and, feeling
irrepressibly mischievous,
want to start fiddling with
the water jug again. Would
he lose his temper with me
if I did? Memory fragments
of my dad losing his temper
float into my mind. The
mischief hovers, unsure, and
I look at him, wondering again,
who is this person sat in front
of me? I know that he is a man
who once broke his phone in
a temper. I know that he is my
therapist, too. I know that he
is both things at once. But this
is where the knowing ends.
The mischief has dwindled,
the water jug remains unfiddled with. ‘I once broke
my mobile phone too,’ I
confess. ‘I threw mine against
the wall in a rage. It even
took out a chunk of plaster.’
I am not sure whether I am
relaying this to reassure him
or me. Perhaps it doesn’t
matter, because I feel better
for sharing it.
I feel better for having
a shared experience with
a human being. I always
felt there was something
terribly one-sided about
therapy. If I am going to give
someone all of my context
then I want some context in
return. Perhaps some people
just like to off-load to a ‘blank
screen’, but not me. I want
an interaction, something real,
even if that something real
is vertigo-inducing and scary.
Even if it is a thoughtful pause
or spontaneous irritation.
That is the only definition
of a relationship I know.
Details have been changed to
protect identities.
March 2012/www.therapytoday.net/Therapy Today 11
In training
Back in
the client’s
chair
Marc Brammer
Something that has really
struck me since I started
my training is the distance
I’ve come from my own first
session with a counsellor
to where I am today, working
with clients on placement as
part of my diploma studies.
I am currently based in
a busy GP surgery in a large
market town, where I am
working with a wide range
of clients from many
backgrounds and across
the age spectrum.
I recently attended a
BACP Making Connections
event. These are regional
gatherings organised by
BACP for members to
meet others working in
the profession and discuss
issues of interest and
concern. It was an
enlightening experience.
We were seated in small
groups around tables. One
of the afternoon speakers
led an exercise. He asked
us each to write down on a
piece of paper a particularly
embarrassing confession
– something we wouldn’t
feel comfortable about other
people knowing – and then
to fold up the paper, write
our name on the front and
keep it in our sweaty hand.
He then chose one person
from each table to come up
to the front and hand in their
piece of paper. He would, he
said, read one of them out.
The stress and discomfort
were written across each
of their faces as they stared
out at us, and every one
of the rest of us was right
there with them, feeling
their terror too.
The speaker then told
us he wouldn’t be reading
out any of the confessions
and asked the individuals
to go back to their places.
However, he then chose
a volunteer from the room
and asked them to pick
12 Therapy Today/www.therapytoday.net/March 2012
‘How can clients
be expected to trust
in the counselling
process and lay
out their secrets
if their therapist
isn’t prepared to
do the same?’
three people and announced
that one of their secrets
would definitely be revealed.
The atmosphere in the
room again became distinctly
uneasy as we all tried to
avoid the eye of the person
choosing the victims. One
person who was picked said
he wasn’t comfortable with
this exercise and that he
regarded it as psychological
abuse. I admired him for
having the courage to refuse
to do something with which
he felt uncomfortable. It
made me wonder if I would
be able to take myself out of
the situation, or would I bite
the bullet and go up onto
the stage? I’m still not sure.
Three people did end up
on the stage and once again
the tension in the room was
palpable. Then, as before,
the speaker said no one’s
secrets were to be revealed.
This was, he explained, an
exercise to help us think
from the point of view of
the client: to remember
how it feels to be holding
something you are not sure
you want to reveal and being
confronted in a situation
where it may come out.
I found the whole
experience terrifying. My
palms were sweaty, I was sick
to my stomach and I could
feel the blood pounding in
my ears. It took me right back
to the waiting room where I
sat waiting for my first session
with a counsellor, the feelings
bubbling away inside me and
my unease at what was to
come. You could have cut
the air with a knife when
we were all awaiting the
fate of those up on the stage.
There was an audible gasp
of released tension when
they were let off the hook.
Their reactions were very
telling, ranging from ‘I’m
very nervous’ to ‘I’m OK;
I’ve made peace with it’.
I had been deeply and
totally honest in what I
wrote on my slip of paper.
Some of my colleagues
around the table later said
they had only written down
trivial things or had left the
paper blank. They thought
I’d been too honest if I’d
written down something
genuinely embarrassing.
But I had seen this as a
genuine opportunity to push
myself, to lay myself bare
and risk the consequences.
I’m not passing judgment
on the others – an element
of self-preservation is
healthy – but I did ask
myself: ‘How can clients
be expected to trust in
the counselling process
and lay out their secrets
if their therapist isn’t
prepared to do the same?’
This was such a marvellous
learning experience for me.
Knowing the theory is
obviously of the utmost
importance in counselling.
But, sitting in your nice
warm classroom or hunched
over your books, it can be
easy to lose touch with
what it feels like to let
someone in and trust
them with your deepest,
and sometimes darkest,
thoughts and feelings.
The Making Connections
exercise was a visceral
reminder of how much the
process of counselling affects
the client, and that I must
never forget what it’s like
to be sitting in their chair.
In practice
Friend or
therapist?
Julia Bueno
A dear friend of mine has
been going through hell in
her increasingly desperate
attempts to work out if she
should leave her partner.
The relationship has been
breaking down, slowly but
surely, over a number of
years – ever since the birth
of their first child. I’ve been
on the wings, doing my best
to be a good friend. I try to
be there for her when she
needs me, in person or by ear;
I try to cheer her up with my
hackneyed humour and give
her hugs too. I may even tell
her what I think she should do
when she can’t think straight.
But a few years ago I
strayed out of our wellworn dynamic and attempted
to convey what I felt was
really going on behind her
melancholic frustrations. I
probably did this badly as I
was fairly new to therapeutic
skills then, and it certainly
didn’t land well. ‘Oh don’t
be such a bloody therapist,’
she sniped. I still remember
the look of vague contempt on
her face. But the other day she
wanted something different
from me: ‘What would you
say if I was your client?’
There have been times
when I would have welcomed
this invitation to strip away
our lengthy shared history
– if only to help my own
navigation through her
bind. I can also feel muddled
about whether she should
leave her relationship. I’m
especially fond of her two
kids; I’ve watched them
grow from small bumps and
I can vacillate in my opinion
on how OK they will be if
their parents part. So perhaps
shelving all that I know and
all that I feel, which is further
entwined with legions of
shared memories, would
help carve a space for a new
perspective on her seemingly
intractable position. Intimate
friends can see a hell of a
lot up close, and see it in a
different way to any therapist.
But responding to my
friend ‘as a client’ proves
impossible for me. While
I could indeed mirror back
what I have heard repeatedly
said, and what I’ve felt has
been repeatedly felt –
including the feelings that
she may not be so conscious
of – this would be too
enmeshed in our established
way of being with each other.
My guts may wrench in
response to her own fear of
her imagined future, but I also
know her daughter too well to
bear the idea of her little heart
in pain. These fine details will
always get in the way.
And if I were able, by magic,
to carve a therapeutic niche
that was detached from our
friendship, I would still have
to return to what we have
between us. I have realistic
hopes that our friendship
will last another 40 years
in its intimately fuzzy way.
Discussing this with a
friend and colleague, he tells
me of a recent wrangle with
his son. The boy pushes
boundaries in the way eight
year olds are supposed to, and
can express a healthy rage at
the many inevitable demands
on him. Getting dressed and
eating are never as important
as Beast Quest cards or
Premier League tables. So,
when the probability of being
late for school became a near
certainty, tempers frayed and
escalated fast. Then came the
‘A dirty nappy was
not enough... I
worried that my
son would develop
a false self if I made
him smile too often
for my own delight’
words: ‘I need you to help me
with my feelings here, Dad.
You are a psychotherapist.’
‘This was really difficult to
hear,’ said my friend, ‘and
I was tempted to be stalled
by it, but I remembered in
the nick of time that, first
off, I’m his father.’
I know there have been
times when I’ve stalled and
slipped away from being a
mother. Like many colleagues,
I combined training as a
psychotherapist with
becoming a mother for
the first time. The shades
of Winnicott, Klein, Stern
and the rest would manifest
before my eyes after a
gruelling day of theory and
experiential work. A dirty
nappy was not enough; my
son was clearly writhing in
the anxiety of the paranoid
schizoid position. I worried
that he would develop a
false self if I made him smile
too often for my own delight.
I had my very own baby
observation on tap, although
being a very inexperienced
observer and mother
simultaneously didn’t lend
itself well to useful feedback.
Knowing when to be a
psychotherapist feels so
much easier when I’m with
my clients. It’s just always.
There may be times when,
from the outside, I seem
to be something different –
when I consciously choose to
share a glimpse of me if I feel
confident enough in its value
for my client. And sometimes
I can be pulled well out of
shape without even realising,
and I then have to think long
and hard about why I leaked
something about myself.
But, in doing so, I return to
the safety of knowing what
I should not be. Not a friend
or a parent or anyone else.
Details have been changed to
protect identities.
March 2012/www.therapytoday.net/Therapy Today 13
Ways of working
When the
therapist
is a horse
Equine facilitated
therapy is about entering
the horse’s environment
and using their presence
to reflect back a sense
of self. Nicola Banning
describes her own,
revelatory experience
on a two-day workshop
Illustration by Eda
Akaltun
14 Therapy Today/www.therapytoday.net/March 2012
It’s a cold winter morning. A frost covers
the ground and clear skies spread out
across the Severn Estuary. I’m in the
Forest of Dean to take part in an equine
facilitated therapy (EFT) group run
by equine facilitated psychotherapist
Miranda Carey.
Day one
The group is already gathering in
Miranda’s kitchen, making tea and
signing the contracts for working safely
with horses. The two-day group therapy
takes place on the horses’ turf: out in
the fields, with the herd.
Miranda, who has over 15 years’
experience as a humanistic and
integrative counsellor, first explains
a bit about equine facilitated therapy
(EFT – not to be confused with
emotional freedom technique): ‘The way
I work with the horses is that they are
free. The horses choose if and when they
engage with the work. I work with the
horse’s process and the client’s process.
The horse is not used as a tool and nor
is the client given exercises to do.’
It’s a case of we humans entering
the horses’ environment, a wild space,
where they are without a head collar
or a lead and they have the freedom to
be with us – or not, as the case may be.
Opportunities to debrief and warm
up are woven into the day and take
place in a yurt, erected in a hollow in
the landscape and heated by a woodburning stove. It’s like a fairytale. I find
a cushion and a blanket and we settle
in a circle. I tune in and make a note
of what I’m feeling. Apprehensive.
Stirred. Vulnerable. I know I’m going
to learn a lot this weekend.
March 2012/www.therapytoday.net/Therapy Today 15
Ways of working
‘There is a vague and illusive quality
to the whole equine experience, which
is unsurprising as it takes place in the
feeling, intuitive right side of the brain’
You don’t need a background with
horses to do this work, and it’s not
about horse riding. In our group of eight
or so women, some are experienced
horsewomen, and others have no
experience or admit to a fear of horses.
So what brings me here? Repeatedly
I take to supervision the issue of power
relations: in my client work, in training
or facilitation work with groups and
when working with organisations. I know
horses make congruent teachers and I
want to learn from them about holding
my power, taking power, being directive
or stepping back and how this might
inform my work with clients, groups
and organisations.
Miranda starts by explaining some
safety issues integral to EFT. Horses
are prey animals and are easily startled
into fight or flight mode. We humans
are their predators. These factors are
both significant. Because they are prey,
horses need to be really present for
survival. An untrained human eye may
struggle to read a horse’s emotional
state, but the horse will have no problem
picking up ours. Miranda says that many
people ask whether you can do this work
with dogs. The answer is no. Unlike
horses, dogs have a tendency towards
obedience and express their emotions
easily with a wagging tail, jumping up,
growling or licking. Horses are harder
to read. They are also much bigger,
more powerful and not instinctively
compliant. Because of this, they
command our respect.
The horse’s prey status distinguishes
them as particularly congruent
therapists, it seems. In The Tao of Equus,
Kohanov writes: ‘The common human
16 Therapy Today/www.therapytoday.net/March 2012
habit of suppressing negative or socially
unacceptable feelings is notoriously
unsettling to a species that survives
by being able to gauge a predator’s
presence and intentions at a distance.’1
Before meeting the herd, Miranda
gives us a central message. ‘You need
to get into your bodies. Our bodies
tell the truth. When we are real, the
horses know. If you’re in your head,
they’ll know.’ More than that, the
horses are constant mirrors and will
reflect if a client is in or out of his/her
body. I ask Miranda to explain further.
‘Well, Maud is a mare who picks up
when people are not in their bodies.
Maud will sometimes fall over with
clients who have experienced abuse.
I will check out with the client: “Can
you feel your feet?” And they’ll say
things like: “I’ve never felt my feet”
and “I can’t feel my legs”. But what
helps them come into their bodies is
that they are with an animal that they
can touch and can be close to, and
touch is very important in this work.’
To help us get into our bodies, Miranda
gathers us outside and asks us to form
a circle for a body scan. I close my eyes
and notice what I’m feeling in my body.
Miranda asks a series of questions:
‘How grounded are you? Are you leaning
more on one foot than the other?’ And:
‘Could a horse knock you over?’ What
a revealing question. Yes is my answer:
I’m not remotely grounded. I try out
some rooting poses, squats, a nice deep
bend at the knees, palms of the hands
facing outwards. And then I feel strong.
I remind myself of the New Zealand
rugby team doing the Hakka. I breathe
deeply into my solar plexus.
The horses are in three fields. Miranda
invites us to go and meet them – if, that
is, the horses want to meet us. Watched
by an observer, in case there is a need to
intervene (whether for human or horse),
we set off. I’m not at ease as we head
out. I’m feeling awkward and I’ve already
gone into my head. After a while, the
inner critic starts: ‘What if the horses
don’t like you? May be you can’t do
this…’ I feel vulnerable and a bit daft.
I take three deep breaths. I see some
horses ahead and trudge towards them.
I notice some of the group approaching
the horses with apparent confidence.
I’m not feeling confident.
One young woman, who earlier had
appeared shy and defensive, is sitting
down in the field in among three grazing
horses; she seems completely at ease.
A horse approaches her, sniffs at her
and stands over her. I watch as the
horse nuzzles her hair and face while
the young woman strokes it and talks
to it in whispers. I can’t hear what’s said,
but there is a gentleness now between
them. It moves me to tears and I look
away. Healing is happening here. I feel
envy: I’d like some of that. A couple
of horses walk towards me, sniff me,
then walk off, uninterested, to graze.
I’m feeling rather dull, and they know
it. The inner critic starts up again. Then
I remember Miranda’s words: ‘Horses
hate all that self-talk.’ I know that inner
critic needs silencing. I tune into my
body. I’m unsure, lonely and feeling a
bit left out: that’s what’s going on inside.
I’m aware that this is familiar territory.
I stay with the uncomfortable feelings.
After some minutes, a pretty Palomino
looks up and slowly approaches me.
‘You need to get into your bodies.
Our bodies tell the truth. When we
are real, the horses know. If you’re
in your head, they’ll know’
Ah, the relief. I’ve been chosen. I’m
unbelievably grateful. She stops and
nuzzles me gently. For the briefest of
moments I stand and breathe her in.
Her big brown eyes are looking right
into me. I sense acceptance. She blows
through her nostrils, close to my heart.
Then she turns, does a little buck and
canters off. Blinking through tears, I
head back to the warmth of the yurt.
I’m unsure quite what happened but
I’m equally sure that something did.
Looking back, it’s still hard to say
what took place. There is a vague and
illusive quality to the whole equine
experience, which is unsurprising as
it takes place in the feeling, intuitive,
right side of the brain that is associated
with the ‘feminine’. Miranda had
suggested we bring journals to note
down our experience as close to the
moment as possible, to help the left
brain, the logical, rational side associated
with the ‘masculine’, make sense of it.
Debriefing, Miranda explains that
our communications with horses can
be very short: ‘Horses don’t need a
therapeutic hour,’ she says. Miranda
tells me more about the Palomino horse
I met. Nutlett has touched something
deep in me. I learn that Nutlett struggles
to find and display her active masculine
power in the herd. Growing up in a
male dominated family, I empathise.
This particular power dynamic is
acutely familiar to me and I’m stunned
by the horse’s insight. But I find her
compassion healing. Strange, but true.
Stories and connections unfold.
The horses demonstrate a depth of
knowing and wisdom that I find inspiring
but not surprising. For example, two
women form a bond with the same horse.
But the same horse is very different
with each woman. With one she calmly
nuzzles and accepts her attention
quietly. With the other, she is more
agitated, scratching and vigorously
rubbing her rear on the gate. Then,
turning back to the first woman, she
resumes her calm. It transpires that the
second woman has a skin condition and
is feeling very itchy and uncomfortable
around her back. The horse repeatedly
reflects this discomfort in her behaviour.
This behaviour continues in our second
day together: whenever the horse is near
these two women, she’s calm with one
and itchy and scratchy with the other.
We approach the end of day one.
The experiences of the group reverberate
around the yurt. I’m tired, but in a
good way. It’s warm and I could sleep.
I’m struck by the powerful aspects
of working therapeutically in nature.
I’ve attended a good number of
therapy, groupwork and professional
development events, but I have never
worked outdoors. Connecting and
networking is valuable, but so too is
being able to be fully here for myself.
I feel no need to make small talk or
do anything other than listen to myself
and be aware of the horses and our
environment.
Day two
I sleep soundly and wake with a sense
of the horses. There’s a light drizzle as
we gather to check in. Everyone seems
more alive today. We leave the yurt to
begin the body scan but today the horses
have come to join us. Instead of being
out of sight, they’re grazing close by.
Miranda had planned to ask us to stand
with our eyes closed but appreciates
we might feel safer if four large horses
weren’t walking among us. She suggests
instead that we do this work inside the
round pen, so we can close the gate and
keep the horses outside. The horses have
other ideas. We walk into the round pen
and they follow us, refusing to be shut
out. They find us interesting today –
a reflection of where we are in our
consciousness and in our bodies.
The horses, it’s clear, like us this way.
We gather and Miranda asks us to
work in pairs: one half is asked to think
of a negative script – for example, ‘I’m
no good at this…’ – and then the other
pushes her or him gently. Each time
I’m pushed, I feel unrooted, as though
I could be pushed over, literally. Then
she asks us to breathe deeply into our
solar plexuses and to replace the negative
script with a positive thought. This time,
when my colleague pushes my chest,
my feet stay firmly rooted: I’m not a
pushover. It’s a quick exercise but it
demonstrates powerfully the direct
impact of our thought processes on
our bodies. Horses can read us and,
quite simply, they know whether I
(or we) can be pushed over or not.
Holding this awareness, I make my
way towards a big, dark horse standing
at the top of a slope. He’s eyeing me as
I approach, looking majestic up close,
powerful. I walk towards him, barely
registering the other horses grazing
around. I stop below him and say ‘Hello’.
I’m aware of him above me and that I
am standing under his head, small but
not intimidated. I take time to connect.
I breathe deeply and exhale. So does the
March 2012/www.therapytoday.net/Therapy Today 17
Ways of working
‘At a time when horses are no longer
required to work in our fields and
carry us to war, they can do something
arguably more important – work on us’
horse. And then he opens his mouth
wide, wiggling his jaws; his huge, long
tongue comes out and he shows me
his teeth. He stays with me, yawning,
opening and closing his jaws and
blowing through his nose. He nibbles
my hand a little and I feel his teeth,
but gently. He nuzzles my hair and
his soft nostrils and whiskers tickle me.
Drawing close to my face, he blows warm
breath around my mouth and nose. I
bask in his warmth and we stand for a
while. I lose track of time. I’ve no fear.
Tears pour down my face as we stand
together in this silent communication.
Big Horse seems to like my tears.
‘When we cry, horses release.’ That’s
what Miranda has told us, and that’s
what he’s showing me, by yawning,
stretching his tongue and licking. The
smell of the horse surrounds me, my
nostrils, hands and face. It’s wonderful.
Time passes and I sense that it’s time
to leave. It’s a little like saying ‘Goodbye’
to an irresistible lover, but without any
sadness or longing. I make my way back
to the group. Miranda notices me and
asks if I’m OK. I assure her I am. I don’t
need to say anymore. She offers a quality
of holding that makes this potentially
volatile work with horses feel very safe.
Later there’s an opportunity to do
an active piece of work with a horse in
the round pen. Buoyed by my experience
with Big Horse, I seize the chance.
Supportively observed by the group,
I step into the round pen with a horse
called Maud. The idea is to engage
with my masculine energy, which is
what you need to do to direct a horse.
It looks effortless, but it isn’t. To make
a horse move is to engage with your own
18 Therapy Today/www.therapytoday.net/March 2012
power, to be directive, to get the horse
to do something that you want it to do.
I befriend Maud first. And then I start
to make her move, gently encouraging
her to walk with me. There’s no head
collar or lead, but she’s now walking
with me because she wants to. As I feel
more confident, I start to feel lightness
in my step. I become playful, getting
her to trot with me. Maud’s actions
reflect mine: if I want her to increase
her energy, I have to show her mine.
Reflecting now, I can see a parallel
with facilitating groups, being directive,
and taking people with me but, in the
round pen with Maud, I lose track of
time and all sense of being watched.
We come to a stop and I stroke Maud
and thank her. I come out of the round
pen, blinking and happy. Miranda asks
me if I want feedback from the group.
Having lost all sense of being observed,
I’m curious to know what others saw.
One woman is crying as she describes
the quality of communication between
Maud and me. Something about the way I
directed Maud without being controlling
moves her greatly. Later, while writing
this article, I call Miranda to ask her
what she saw; I’m struggling to express
it. ‘That’s interesting,’ she says, ‘because
what I saw between you appeared so easy
and effortless. I saw a lovely connection
between you and Maud. You were in
sync with one another. You just went
in and you moved together. Maud won’t
do anything unless she’s being respected.
You were very much collaborating. You
didn’t have to pick up a stick and use it.
And you didn’t have to be dominant.’
We return to the yurt to draw the
weekend’s work to a close. Miranda
asks us how we’ll take away our
experience with the horses. I hold an
image of me standing under Big Horse
on a slope, with him towering above
me. I’m small underneath him and
he’s majestic and powerful. But I hold
my space, facing him. I leave with the
memory, in my body, of what it felt like
to be really present with the horses, to
hold my ground, to be directive and to
feel nourished by their spirited presence.2
After so many years of working
therapeutically as a counsellor, and of my
own therapy, professional development
and yoga practice, I thought I knew about
being present. But, through EFT, the
horses are teaching me how much more
I have still to learn. If we listen, horses
can teach us so much about how we
relate to the world and how we’re
experienced by others. Perhaps, as Linda
Kohanov so eloquently puts it: ‘At a time
when horses are no longer required to
work in our fields and carry us to war,
they can do something arguably more
important – work on us.’3
Nicola Banning is an independent counsellor.
She has a specialist interest in promoting
wellbeing in the workplace and is a member
of the BACP Workplace executive committee.
[email protected]
Details of Miranda Carey’s EFT workshops
can be found at www.ehwaz.co.uk
References
1. Kohanov L. The tao of equus. California:
New World Library; 2001, p32.
2. Kohanov L. Riding between the worlds.
California: New World Library; 2003, p129.
3. Kohanov L. The tao of equus. California:
New World Library; 2001, pxxii.
Questionnaire
John McLeod
Counsellor, research
consultant and
former academic,
John McLeod believes
in the power of
art-making as a
fundamental human
activity that can help
change the world
What do you feel guilty
about?
When did you become
interested in counselling/
psychotherapy?
I see myself as a counsellor
rather than a psychotherapist.
As I grew up, and particularly
in my teenage years, I
struggled with a lot of
personal issues around
relating to other people
and to parts of myself. I had
various kinds of therapy to try
to work through these issues.
In my early 30s I realised
that I was finally in a position
to offer something back.
What gives your life purpose?
In my own small way, I am
trying to make the world
a better place.
What is your earliest
memory?
At around three or four
years, diving into the pool
on a bright, humid afternoon
in India, then swimming
into my father’s arms.
What are you passionate
about?
The possibility of an
independent Scotland
that does the right
things. The struggle to
prevent the destruction
of the environment. In
my professional life, I am
passionate about clients
getting what they want
and what they know is
right for them.
Do you always tell the truth?
Definitely not. I am deeply
familiar with all shades of
self- and other-deception.
What has been the lowest
point in your life?
A day in 1985, driving
north on the M5, alone.
How do you relax?
Snuggled up on the sofa
with my wife Julia, working
our way through a DVD
box set, eating pineapple.
What keeps you awake
at night?
Worrying about things I
haven’t done and deadlines
that have been missed.
Letting other people down.
What makes you laugh?
Early Garrison Keiller.
Ben from the BBC series
Outnumbered. The News
Quiz on Radio 4.
Where will your next
holiday be and why?
What makes you angry?
Right wing politics.
Which person has been
the greatest influence
on you professionally?
Dave Mearns, who has
been a source of support
and inspiration over many
decades. Henry Murray,
whose ideas about how
to do meaningful research
are only now finding
expression, 80 years on.
How do keep yourself
grounded?
Walking the dog, meditating,
digging the garden, cooking,
ironing, stacking logs,
experiential focusing,
remembering my mother’s
voice.
What are you reading
for pleasure right now?
A Scandinavian crime novel.
Do you fear dying?
Absolutely. It is the end of
the story, and the shift from
being to nothingness. What
is there not to fear about that?
What would you have written
on your tombstone?
‘He did his best to work as
if he lived in the early days
of a better nation.’ It’s an
adaptation of a quote from
the Scottish writer and artist
Alasdair Gray.
‘I would want
to change the
fundamental
premises around
which contemporary
society seems to
be organised’
Somewhere hot in the
Mediterranean, with the
whole family. Anyone who
survives winter up a hill
in rural Perthshire needs
as much sunshine as they
can get over the summer.
What would you change
about society if you could?
I would want to change
the fundamental premises
around which contemporary
society seems to be organised
– military solutions to
international conflict,
dehumanising forms of
work, the illusion of material
success, alienation from
nature, pseudo-democracy,
and so much more. One
thread that runs through
all of these areas is the
importance of art-making as
a fundamental human activity.
What is your idea of perfect
happiness?
A day looking after a baby.
Do you believe in God?
No.
What’s your most
treasured possession?
I don’t have any.
What do you consider your
greatest achievement?
At a personal level, my
three daughters, who are
wonderful human beings. At
a professional level, a paper
titled ‘Counselling as a social
process’, which was published
in this journal in 1999.
John McLeod recently retired
from his post as Professor of
Counselling at the University of
Abertay, Dundee. He continues
to work as a counsellor, author
and research consultant.
March 2012/www.therapytoday.net/Therapy Today 19
Viewpoint
Poetry, please
Therapy should use the poetic and the scientific together
to reflect and articulate the experience of the client, argues
Sarah Van Gogh. Illustration by Eda Akaltun
I am a counsellor, a tutor on a counselling
diploma course and I love poetry. This
makes me, as far as I can tell, completely
unexceptional.
All the therapy practitioners I have
ever encountered love poetry. They read it
or write it or do both. They can remember
a wide range of favourite snippets and
quote them to colleagues, trainees and
sometimes even clients. Whenever
counsellors and therapists get together
for­any kind of CPD event – workshops,
seminars, conferences, residentials,
lectures – someone, at some point,
will use some lines by TS Eliot or Maya
Angelou or Keats or Goethe or Carol
Ann Duffy or Rumi or… the list goes on.
And when the lines are spoken, there
is always a small but palpable change
in the room’s atmosphere. A kind of
collective expansion seems to occur
as the words sink in. For a brief period
people’s shoulders seem to loosen a
fraction, their facial expressions soften
subtly as the poetry makes connections
within them and between them.
William Carlos Williams wrote:
‘It is difficult/ to get the news from
poems/ yet men die miserably every
day/ for lack/ of what is found there.’1
I am struck by how often the words
‘poetry’ (or ‘poems’, as in the William
Carlos Williams quote above) and
‘therapy’ could take each other’s place
and wonder about the deep affinity
that poetry and therapy seem to have.
What might this affinity be about, and
what might it mean for the therapy
profession if we made it more explicit?
20 Therapy Today/www.therapytoday.net/March 2012
Coleridge described poetry as ‘the best
words in the best order’.2 He maintained
that true poetry is that which cannot be
translated into another tongue without
losing something essential. In this he
was writing about the quality of precision.
His comment points to the way in which
a poem can, in far less space and time
than most other forms of language, put
its finger exactly on an inner place and
give us words to perfectly express that
which, until we read or heard the poem,
seemed inexpressible. And it does so
in a way that retains the mystery and
complexity of that inner place. It is
not technical exactitude that a poem
offers; rather, it is a soulful precision.
Just like therapy.
The relatively recent neurobiological
research that has opened up new worlds
of insight to therapists has helped us
understand the biology of what is so
potent and so healing about articulating
our feelings in a safe and accepting
environment. When we do so, we are
allowing the parts of the brain that are
chiefly connected with our cognitive
functions and those that are chiefly
to do with affect regulation to
communicate with each other.
Poetry seems to play the same sort
of role: it simultaneously stimulates
the cognitive and the emotional, healing
the split between thinking and feeling,
bridging the divide and restoring a sense
of wholeness. We could even argue
that it helps to regulate the autonomic
nervous system, just as the sensitive
response of the caregiver helps regulate
the autonomic nervous system of the
infant. For poetry is paradoxical and
can both stimulate and soothe and thus
help us return to a state of equilibrium.
As Dr Johnson argued: ‘The purpose
of literature is to help mankind enjoy
life a little more, or endure it a little
better.’3 Just like therapy.
If we regard Freud as the founder
of therapy as it is practised in western
Europe, we can see how profoundly
a poetic sensibility has been part of
its fabric from its birth. The poetic was
always a part of Freud’s thinking, his
writing, his practice. It is a fitting irony
that the ambitious doctor who fought
so hard to gain scientific respectability
and status for his ‘talking cure’ was
the same deeply cultured man who
wrote so lyrically, using language that
dripped metaphor, simile and imagery.
I remember a time when I offered
a depressed client what I thought was
quite a helpful, clear reflection of how
she continually repressed her strong
feelings, and how this fed her sense
of stuckness and depression. My
comment fell on stony ground; she
looked unimpressed and distant. In the
silence that followed Freud’s famous
image came to me, and I offered it: the
room full of neglected, imprisoned dogs;
the longer they are shut away, the more
urgently they press for attention and
release.4 The mood between us changed.
Her face became animated; her voice
sounded excited. She leaned forward
in her seat: ‘That’s it! That’s what it is!
The more I try to shut them up, the more
Viewpoint
‘How strange and dispiriting it is to find
the technical and clinical being given ever
more importance at the expense of the
relational, the creative and expressive’
my dogs keep barking. I keep hoping if I
lock them away my dogs will calm down,
but they never do!’ Freud’s metaphor
had done it – allowed for both a cognitive
grasp and an emotional charge, all in one.
Poetic v scientific
There have been many other key figures
since who have championed the need for
an explicitly soulful and poetic approach
in the work – Robert Bly, for example,
and Marion Woodman. I am willing
to bet that the therapy texts you most
enjoyed and that have stayed with you
from your training or your continuing
professional development have been
those with a touch of the poetic in
them. In the persona of our founding
grandfather, and in the work of other
therapy ‘elders’, we can see the twin
strands in the craft woven together:
the clinical strand and the poetic,
imaginative, soulful strand. Both
are essential for therapy and should
be allowed to influence each other.
Yet one of them is increasingly given
less space within the professional arena,
and seems to be considered of everless value, less worthy of attention and
interest, despite the place that poetry
seems to have in so many therapists’
hearts. I recently gave a talk on therapy
and poetry to a group of practitioners
in the south west of England, and asked
them how they would see their work
if there was no place for the poetic in it.
I was expecting a few people to express
a mild regret, and for the majority to
say that, on the whole, a lack of the
References
1. Williams WC. Extract from
‘Asphodel, that greeny flower…’
In: Williams WC. Journey to love.
New York: Random House; 1955.
poetic would not make much difference.
In fact there was an almost unanimous
expression of how dry, empty, even
pointless the whole enterprise of
therapy would seem without the
juice of something poetic in the mix.
‘How weary, stale, flat and unprofitable
seem to me all the uses of this world.’5
So, how strange and dispiriting it is,
as a counsellor, to look through much
of the current writing that our profession
generates and find the technical and
clinical being given ever more
importance at the expense of the
heartfelt, the relational, the creative
and expressive. Naturally, there would
be a different set of problems if there
was a swing of the pendulum the other
way. The answer is not poetic precision
at the expense of clinical competence.
It’s a case, rather, of recognising how
the two can be seen as interdependent
and ensuring that the poetic and soulful
is rescued from its second class citizenry
in the therapy profession.
The late James Hillman, Jungian
thinker, writer and analyst, took us all
to task as a profession for our increasing
tendency to attempt to collapse the
clinical and non-clinical into one
kind of language, in a spurious attempt
to make what is not clinical have a
technical-sounding authority and weight.
He referred to this mushy, pseudoscientific language as the equivalent
of bland, sliced white bread.6 It creeps
into much of what counsellors write and
speak to each other and to those outside
the profession. Why can therapy-speak
2. Coleridge ST. Specimens of
the table talk of Samuel Taylor
Coleridge. London: John Murray;
1835.
22 Therapy Today/www.therapytoday.net/March 2012
seem so dry and lifeless – so dreary
to read and banal to listen to? George
Orwell argued that the sure sign of a
cliché is when a phrase does not require
the person using it, or hearing it, to really
think about it or emotionally engage with
it, which in turn allows it to be hopelessly
imprecise while sounding as if it isn’t.
‘You can shirk it [the effort of using
fresh language] by simply... letting the
ready-made phrases come crowding in.
They will construct your sentences for
you – even think your thoughts for you
– to a certain extent – and at need they
will provide the important service of
partially concealing your meaning even
from yourself.’7
Therapy is a profession with the vast
potential to be equally scientific and
poetic. It is where the clinical and the
soulful can legitimately get into bed
with each other; their kinship is in
therapy’s very DNA as we have inherited
it, not only from Freud but from our
other therapy ancestors who wrote
and thought poetically: Jung, Perls,
Klein. Winnicott, especially, often
sounds more poet than paediatrician:
‘We are poor indeed if we are only sane.’8
The scientific and the poetic are
both brilliant at articulating important
things about being alive: about the
world around us, and the worlds within
and beyond. They can both provide
an absolute clarity about certain things
that were not clear before. When I read
a wonderfully clear explanation of the
consequences of continuous cortisol
release on the infant nervous system,9
3. Johnson S. Review of A Free
Enquiry into the Nature and Origin
of Evil. In: Johnson S. The works
of Samuel Johnson in nine volumes.
Volume 6: Reviews, political tracts
and lives of eminent persons.
London: W. Pickering; 1825, p47–75.
4. Freud S. New introductory
lectures on psychoanalysis.
London: Penguin Books; 1991.
5. Shakespeare W. Hamlet. Oxford:
Oxford University Press; 2009.
‘Just as surely as our clients need us to
know what we’re doing clinically speaking,
they need us to be able to work from
and therefore speak from the heart’
I experience an enrichment of my inner
world and a charged enlightenment
that is similar to how I feel when I read
a poem that touches and moves me.
It is subtly different in each case, as the
first is chiefly feeding my ability to make
cognitive sense of my experiences and
the second is chiefly feeding my ability
to make emotional sense of the same.
But they are interwoven; each has an
element of the other. The two ways of
writing are kissing cousins; they both
awaken, enlighten and invite us to
connect deeply to our own experiences
and thereby to the experiences of others
and to make meaning from that.
From the heart
So why, as therapy practitioners, are
we increasingly pulled to privilege the
scientific, (or, worse, the blandly pseudoscientific) over the poetic? One example
is the increasing expectation to be
‘evidence based’ in a very particular
way. Our quantitative research may
offer valuable clinical insight, but it
tends not to include any passion, selfawareness, humour or panache. To be
taken seriously, in certain arenas, it
seems that research has to be written
up in characterless, functional language,
sprinkled with research jargon and
counsellor-speak. Does it have to be so?
Of course our clients need us to know
what we’re doing. As clinicians, we need
a sound training, and to practise ethically.
We should make ourselves aware of
important relevant developments,
such as those in neuroscience and
6. Hillman J, Ventura M. We’ve had
a hundred years of psychotherapy
and the world’s getting worse.
New York: Harper Collins; 1993.
the treatment of trauma. We need to be
open to new ways of thinking, and be able
to reflect on issues such as gender, class,
sexual orientation, ethnicity – issues
that therapists have often been justifiably
accused of ignoring. We have to be able
to express clearly what we do and why we
do it, and to be able to devise meaningful
ways to monitor and evaluate our work.
What responsible, mature practitioner
would argue against any of that?
But, just as surely as our clients need
us to know what we’re doing clinically
speaking, they need us to be able to work
from and therefore speak from the heart.
They need to tell their stories to people
who can hear and reflect them back in
fitting language – language that enables
us to talk about love and death; about
breaking down or through; about falling
into a sick despair after watching events
on the evening news, or grieving for a
lost mother; about the joy we feel when
we walk in an autumnal park with a dog,
or the hatred that chokes us when we
face a bullying boss, or how it is to lie
awake, longing for a lover even though
that lover has betrayed us.
We best support our clients when,
in writing or speaking about our work
to others, we are free to use language
that does justice to the depth of their
experiences: when we can offer words
that aren’t clichéd and on autopilot.
Our colleagues can be stimulated by,
and the wider community can be more
aware of, what happens in our work
when the telling of it can come to life
in language that is vivid and expressive.
7. Orwell G. Politics and the
English language. In: S Orwell,
I Angus (eds). Collected essays,
journalism and letters of George
Orwell: volume 4. Harmondsworth:
Penguin Books; 1970, p165.
The Neo-Expressionist artist Joseph
Beuys stressed the importance of making
a space for what is ‘other’: for what is
not purely rational, conscious and
logical. He explained his reason for
dressing up in strange costumes as
part of his art: ‘When I appear as a
kind of shamanistic figure, or allude to
this, I do it to stress the need for other
priorities... different plans... For instance,
in places like universities where everyone
speaks so rationally, it is necessary, I
think, for a kind of enchanter to appear.’10
Perhaps therapy, like education and
medicine (and many other areas of life
that have become the preserve of logos
and technology and the enlightenment
that comes from the intellect), needs
a space to be preserved within it for
such shamanism and enchantment
and the ‘heart’-perspective that they
offer. The poetic does this.
‘These songs are about forgetting,
dying and loss.
They rise above both coming in
and going out.’11
Sarah Van Gogh is a BACP accredited
counsellor in private practice in south
east London and works as a counsellor for
Survivors UK, a charity offering support
to men who have experienced sexual abuse.
She is also a tutor at the Revision Centre
for Integrative Psychosynthesis in north
west London. [email protected]
Visit www.therapytoday.net for an
exclusive interview with Sarah Van Gogh.
8. Winnicott DW. The family and
individual development. London:
Tavistock Publications; 1965.
9. Gerhardt S. Why love matters:
how affection shapes a baby’s brain.
Hove: Brunner-Routledge; 2004.
10. Perry G. The tomb of the
unknown craftsman. London:
British Museum Press; 2011.
11. Kabir. Extract from The Boat.
In: N Astley, P Robertson-Pierce
(eds). Soul food: nourishing poems
for starved minds. Highgreen:
Bloodaxe Books; 2007.
March 2012/www.therapytoday.net/Therapy Today 23
Dilemmas
Disclosures
in cyberspace
A gay counsellor advertises for casual sex on the internet. Is this a potential
personal disclosure too far? Illustration by Eda Akaltun
This month’s dilemma
Dominic Davies
Marco has been counselling James,
a gay single man, for some time.
James is struggling with his sexuality
as he has only recently discovered
that he is gay.
The question of Marco’s sexuality
has not been raised in therapy by
James, and Marco has not brought
it up himself. James believes that
Marco is gay, partly because he
found his details in a directory
that is specifically aimed at lesbian,
gay, bisexual and transgender
(LGBT) potential clients (although
the directory states that the
therapists who advertise in it are
not necessarily themselves LGBT).
As part of his self-exploration,
James logs onto a gay website that
lists gay men looking for casual sex
in particular geographical areas.
He discovers that Marco has posted
a profile there, looking for occasional
sex. James is upset by this and
wonders what to do.
Are there ethical issues in
counsellors (of any sexuality)
posting their profiles on websites
looking for casual sex?
Director, Pink Therapy
www.pinktherapy.com
24 Therapy Today/www.therapytoday.net/March 2012
Gay men may have fewer opportunities
to meet than heterosexuals, especially
in rural areas, so the internet is a common
dating resource. It also allows the
therapist to meet people more discreetly
than in local clubs and bars, if these
exist, where they might run into clients.
James should be encouraged to raise
the issue with Marco, who will hopefully
be skilful enough to help him explore
his own concerns about meeting people
for casual sex in a non-defensive way.
Marco’s private life should not be the
focus of sessions but therapists working
with clients who might feel shame about
their sexuality can be useful role models
in helping clients find ways to integrate
their sexuality with other parts of their
lives. If Marco has a supervisor well
trained in Gender and Sexual Diversity
Therapy (GSDT) issues, they will
agree what is ethically sound, given
the therapeutic model they work to.
Therapists like Marco who are gender
and sexual diversity-aware will explore
with clients in initial consultations how
they will manage living and working
within the same communities and how
to deal with any out-of-session contacts
and disclosures, which are more likely
within smaller communities.
I am wondering if there is a
heteronormative assumption in the
last question of the dilemma. Is looking
for ‘casual’ sex worse than looking
for a boyfriend? It could imply that
counsellors should not enjoy
consensual, no-strings sex or that
only sex in the context of on-going
relationships is acceptable.
It would be wise for therapists
constructing website profiles to bear in
mind that clients or colleagues may see
them, and to consider the information
they give in this light, especially if they
are including their picture in the profile.
It is not obligatory to tick all the boxes
when invited to give details. Omitting
a face picture, or making it available
only to private view, is another way
of maintaining some discretion over
who knows what about you.
Training and supervision in managing
these situations is vital when working
within gender and sexually diverse
communities.
John Daniel
Psychosynthesis counsellor and
editor of Private Practice
Therapists are entitled to a private
life and we have to be realistic and
acknowledge that it is never possible
to rule out the possibility that our paths
might cross with those of our clients
outside the therapy room. This potential
is arguably greater for therapists from
sexual minorities who work with LGBT
clients. If Marco is out on the scene as
a gay man, his chances of crossing paths
with his gay male clients are considerably
greater than for straight therapists.
Consequently, he would be wise to
consider the impacts for his clients
should boundaries be inadvertently
compromised. That is not to suggest
that Marco should feel ethically bound
to inhibit his freedom to express his
sexuality in whatever and whichever
way he chooses. I would argue that he
would be wise to consider the potential
impact that his behaviour may have
on clients, should they encounter him
March 2012/www.therapytoday.net/Therapy Today 25
Dilemmas
outside the therapy room, as James has
done by stumbling on his online profile,
and take action to minimise the potential
risk of damage to his clients should such
an encounter occur.
This raises a much larger question
about the choices therapists make
about managing boundaries in light
of the myriad ways in which technology
allows us to communicate our existence
to the world. I think therapists have an
ethical responsibility to share online
only information that they would feel
comfortable to share with a client in
the therapy room, should the client
ask. By advertising his services in an
LGBT counselling directory, you could
argue that Marco is tacitly disclosing
his sexuality to his clients (although
therapists advertising on such sites are
not all necessarily LGBT). However,
by posting an online profile looking for
casual sex, he should be mindful that
he may be inadvertently sharing with
those same clients the ways in which
he chooses to express his sexuality,
which I would argue is inappropriate.
To refer back to the dilemma in
question, I think Marco would be wise
to obscure his identity on online sex
sites so that clients will not be able to
recognise him from his profile. I would
offer the same advice to therapists of any
sexuality using the internet to look for
sex. What might then be avoided is this
unfortunate situation of clients finding
out sensitive, private details about
their therapists, which they might not
then have the confidence or courage to
address in the therapy room. The danger,
as may already be the case in Marco’s
work with James, is that the integrity and
safety of the therapeutic alliance may be
compromised because the therapist has
not taken due care to limit the access
their clients have to intimate personal
details about them via the internet.
Lisa Whitehead
Person-centred counsellor in
private practice
I wonder what has upset James about
seeing Marco’s profile on the website?
There are many possibilities and,
whatever James’ feelings are, it seems
important to his current exploration
of his sexuality that he is able to look
at them in therapy. The fact that he
wonders what to do next suggests that
he is unsure whether or not to do so.
When contracting with new clients
we have an ethical obligation to ensure
there are no dual relationships that
could contaminate the counselling
26 Therapy Today/www.therapytoday.net/March 2012
relationship. This not only protects
the counselling relationship but also
the counsellor. I feel this is particularly
important for LGBT therapists when
working with LGBT clients, as our
social circles can be small and interrelated and the possibility of our
worlds colliding therefore more likely.
Using the internet, whether for
social networking or when looking
for casual sex, further diminishes the
distance and the boundaries that would
otherwise protect us and our clients. It
is impossible to know who is looking at
your online profile, or even to know who
you are talking to, as it is so easy to use
an alias or change identity. We also have
much less control over the information
we provide about us: we have to assume
that a profile posted anywhere online
is completely public and available to
everyone to see. This raises considerable
ethical dilemmas for counsellors.
Discovering more about his therapist’s
sexuality may be particularly difficult
for James at this time, but there are other
potentially controversial issues that a
client could find out about a therapist
if they were posted online – such as
their political views or religious beliefs.
By publishing any personal information
online we are effectively disclosing this
to our clients, and we need to consider
if it is appropriate to do so. As
counsellors, we are entitled to a private
life but it is important to remember
that the internet is a public sphere.
If Marco has an online presence,
should he, perhaps, discuss with clients
what to do if they were to ‘see’ each
other online, in the same way that we
discuss with our clients how we would
handle it if we bumped into them in a
supermarket?
Social networking online is an
increasingly important part of many
people’s lives and I think it would be
restrictive to suggest that Marco (or any
counsellor) should not use these sites at
all. However, if we do choose to disclose
information about ourselves online we
need to be aware that it could affect our
clients and the counselling relationship.
William Johnston
Person-centred therapist in
private practice
Reading this month’s dilemma I am
reminded of those people who have
loud conversations in the street on
their mobile phones. There is a range
of views among counsellors as to how
much of themselves they should reveal
to clients. I don’t make any particular
efforts to hide my private life from clients.
Would I, however, wish my clients to
see me having sex in a public space? No.
If I advertise for casual sex on a website
available for view by millions, then I see
little difference between this, having
sex in public or having one of those
‘private’ conversations in the street.
There is an entire discussion to be
had here about my rights to a private
life and what I present as a counsellor.
Maybe advertising for sex anonymously,
with no photo and with disguised
personal details, could be OK. I would
still be concerned about ways in which
a client might spot vital signs that identify
me. What matters here, I think, is that
I have let go control over extremely
personal details of my life. I can no
longer know what my clients know about
me. On the other hand, it is one thing
for a client to spot me pushing a shopping
trolley in Sainsbury’s; quite another to
obtain details about my sex life. As a
client, I know that I would find the
possession of this sort of secret about my
counsellor almost impossible to handle.
If one of the principal aims of
counselling is to deprive secrets of
their power by bringing them into the
light, then the creation of new secrets
cannot properly serve the work I do.
Maybe another way to look at this is
that, as a counsellor, and somewhat like
a politician, my private life is no longer
entirely my own affair, and I need to
recognise that as a responsibility.
Alex Drummond
MBACP (Snr Accred), GSDT (Accred)
The problem here, as I see it, is that
we are being invited to apply
heteronormative cultural values of
disapproval to the idea that a gay male
counsellor engages in casual sex. This
would of course be folly since, as Eric
Anderson so clearly illustrates in his
research,1 heterosexual men are just as
likely to have sex outside a committed
relationship, and casual sex (as an
adjunct to or instead of a committed
relationship) is merely a different
type of relationship style.
In considering the dilemma, it is
important to note that we have very
little detail and the mistake would
be to jump to an assumption. Caution
is warranted. The ethical principle
of trustworthiness may be challenged,
but only if there is incongruence
between the images promoted by the
therapist and the reality. Clearly, if the
website was in a more extreme arena
(such as sadomasochism), then some
aspects of that might prove unsettling,
despite remaining within the law.
In terms of beneficence, we might
acknowledge that the therapist is in an
ideal position to help the client become
more aware of cultural norms within the
gay community – particularly with regard
to the higher incidence of contracted
open relationships. James may have met
partners who were non-monogamous
and been unsettled through lack of
familiarity with this relationship option.
By the same token, a heterosexual
counsellor who lacks training in LGBT/
GSDT issues may unwittingly harm a
client by showing disapproval of a
pattern of relating that is perfectly
acceptable within gay culture.
We need to note that the counsellor
is unaware of what has happened and
herein lies the potential ethical risk.
If James were to suddenly drop out of
therapy as a result of what he saw, he
might leave with a negative impression of
Marco or possibly of the profession, and
Marco will not have been able to address
this. Although some counsellors may be
unfamiliar with open relationships, there
are others who successfully manage the
balance between public information and
private lives. It may be that Marco has
held such a profile and worked effectively
for many years with clients, and it has
not been a problem.
If James suddenly drops out of this
work (and given that it is an established
relationship), Marco may be justified
in contacting him to explore his sudden
exit from otherwise engaged therapy
and offer the opportunity to work with
any rupture. This would be in service
of the fidelity of the profession and
beneficence towards the client. There
are many aspects of our lives that may
impact on our clients – we are real
people having real lives and I suggest
the greatest value comes from remaining
congruent in all our relationships.
REFERENCE:
1. Anderson E. The monogamy gap. Oxford:
Oxford University Press; 2012.
Keith Silvester
Psychotherapist, counsellor and
supervisor in private practice
In the internet age, it is well beyond the
control of any counsellor or therapist
to know what clients may find out about
us. I have found that most clients have
already googled me ahead of a first
session. Sexual orientation is no
exception. But the question here is
the degree to which this practitioner
would knowingly volunteer something
that might compromise his professional
role with a potentially vulnerable client.
There are, however, some traps in
the way the question is formulated.
First, is there an assumption that
therapists should not be real human
beings with ordinary needs, or that it
would be damaging to a client to find this
was so? At some point the idealisation of
the therapist by the client needs to ‘break’
for a real meeting to take place – so the
question, perhaps, is simply ‘when?’.
Second, is the scenario implying
that casual sex outside a committed
relationship is shameful and not a
legitimate thing to be seeking? This
is insidious and its shadow has been
put onto gay men for generations.
The potential benefit of James finding
out that Marco’s needs are human
and little different from his own might
well be very releasing and outweigh
the deflation of the idealisation bubble.
The fact that such a discovery gets
made in cyberspace rather than in
the therapy room itself might be a red
herring. After all, a client could run into
their therapist in a gay club or a sauna.
The situations are comparable because
the client has not put himself into any
of these settings casually or accidentally.
Connected with this shame is the
issue of collusion in secrecy about being
gay, which just feeds low self-esteem.
There is a valid ethical argument that
it is more harmful for gay therapists to
withhold information about their sexual
orientation than to be open and explicit
about it, given the history of social taboo.
Having said this, I think Marco has a
responsibility as professional to present
himself, even in cyberspace, in a way
that is least likely to compromise his
relationship with a vulnerable or
impressionable client. Marco can use
a pseudonym. If he is using a photo he
can use a head-and-shoulders rather
than, say, a full body or semi-naked
picture. My reason for saying this is that
it is not helpful to encourage a client to
fixate on the actual body of the therapist.
Ordinary, ‘in the room’ projections and
fantasies are hard enough to contend
with. Last, and following on from this,
he can choose to avoid being 100 per
cent explicit about what his sexual
practice preferences might be.
Taking the broader, long-term
perspective, the benefits of mutual
disclosure in the therapy space far
outweigh the worries or the risks of
the therapist being ‘outed’, as the client
would then have the opportunity, in a
safe enough space, to work through his
coming out issues in a relational way.
Next month’s dilemma
Janet, a psychotherapist in private
practice, has become friendly with
Alma, whom she met through a social
club. Alma has been in and out of
therapy over the years and is currently
looking for a new counsellor.
She asks Janet if she could suggest
someone, explaining that she needs
a counsellor with skills and knowledge
in a particular area. As it happens,
these are exactly the areas in which
Janet’s supervisor specialises, and
so she suggests her.
However, Janet and Alma have a
falling out and their friendship ends.
Janet is left feeling very uncomfortable
about the situation. She believes that
her former friend will be discussing
her in therapy and she is anxious that
this might have an impact on her own
work in supervision. She knows that,
for reasons of confidentiality, her
supervisor could not tell her anything
Alma has said and wonders what she
should do.
Please email your responses
(500 words maximum) by 28 March
to Heather Dale at [email protected].
Outline how you would manage the
dilemma and make your thinking
as transparent as possible. A small
selection of answers will be published
in the April issue of Therapy Today.
Others will be published on our
website at www.therapytoday.net.
Readers are also welcome to send
in their own ethical dilemmas, but
these will not be answered personally.
March 2012/www.therapytoday.net/Therapy Today 27
Viewpoint
Too little, too late?
The Government has recently agreed to fund counselling for
the thousands of people infected with hepatitis C and/or HIV
from infected NHS blood. Charles Gore tells the sorry tale
Frequently referred to as ‘the worst
treatment disaster in the history of
the NHS’, thousands of people in the
UK were infected with hepatitis C
and/or HIV through NHS blood and
blood products in the 1970s and 1980s.
Successive governments have
refused to accept liability for the
tragedy. However, following a review
last year, the Coalition Government
increased payments to those affected
and also decided to offer them free
counselling. Given that the infections
took place more than 20 years ago
and many of those affected – certainly
all those with haemophilia – have
known about their diagnosis for years,
this was perhaps an unusual decision.
Why has the Government made this
offer? No rationale has been given. To
understand what may be intended, and
what counselling is likely to achieve, it is
necessary to look at the tangled history
of this major public health disaster.
In the 1970s it became apparent that
people were developing inflammation
of the liver (hepatitis) after receiving
blood. The condition became known
as ‘transfusion hepatitis’. It was
speculated that a virus was involved
and, when it became clear that neither
the hepatitis A virus nor the hepatitis
B virus was responsible, it was referred
to as ‘non-A non-B hepatitis’. The virus
involved was only isolated in 1989,
when it was called hepatitis C. In the
meantime HIV also emerged as a major
blood-borne infection, and again a
test was not available immediately.
As a result, thousands of people in
the UK were infected with one or both
28 Therapy Today/www.therapytoday.net/March 2012
viruses. Those who received whole blood
were at some, but fairly low, risk because
each unit would have come from just one
donor. So someone like the late Anita
Roddick, who had a transfusion following
the birth of her youngest daughter in
1971, was unlucky to contract hepatitis C.
However those who received blood
products, such as clotting factors, were
at very high risk because these products
were made from the pooled blood of
hundreds of donors. It only needed
one of those donors to be infected to
make the product unsafe. Added to
that, whereas whole blood in the UK
was collected from volunteer donors,
much of the blood used to make blood
products was sourced from commercial
companies and these were mainly in
the US, where donors were paid for
blood and were often prisoners or
intravenous drug users, among whom
hepatitis C was very prevalent.
Most at risk were haemophiliacs
who required multiple treatments with
clotting factor. Almost all – about 5,000
of them – were infected with hepatitis
C, and about a quarter were also infected
with HIV. Inevitably, many of them
died. Could more have been done to
prevent this? Certainly the risk of blood
sourced from paid donors in the US was
recognised at the time; the Secretary
of State for Health also promised to
make the UK self-sufficient in the blood
needed for transfusions and treatments,
but this was never implemented.
Moreover, it wasn’t just haemophiliacs
who received clotting factor or other
blood products, and similar numbers
were infected by whole blood because
more people received blood transfusions,
even though the risk was smaller.
The haemophilia community was
the worst affected group, however,
and led the campaign for compensation.
The Government did set up a payments
scheme, for HIV from 1989 and for
hepatitis C in 2003. However, no liability
was accepted and the payments were
made ‘ex-gratia’. The payments for
hepatitis C were not nearly as generous
as those for HIV.
The haemophilia community also
campaigned for a public enquiry into
how the whole tragedy had been allowed
to happen and to decide who might have
been at fault. Successive governments
refused to hold an enquiry. Finally, in
2007, a privately funded enquiry was
established under Lord Archer. It was
hampered by inadequate funding and
its unofficial status but it heard a lot
of evidence and reported in 2009.
One of its principal recommendations
was that payments should be at least
as generous as those in Ireland, where
people similarly infected have received
payments averaging nearly €400,000.
Then, as the Archer report was being
finished, the Scottish Government
announced it would set up a public
enquiry under Lord Penrose. That
enquiry has still to report.
Payments review
It was against this background that,
in 2010, the Coalition Government
announced a review of payments to
those affected. The Public Health
Minister Anne Milton said she hoped
the review would draw a line under
the whole affair and bring closure. The
infected community were consulted;
they said what they needed for closure
was the implementation of Lord Archer’s
recommendations. This was wishful
thinking. Payment of several hundred
thousand pounds to thousands of
people was never going to happen
when the Government is trying to
cut costs everywhere.
What the Government did do, as
a result of the review, was increase
the payments to those with advanced
hepatitis C so they get the same amount
as people infected with HIV. It also index
linked the annual payments (currently
£13,200) for both. A charity, the Caxton
Foundation, was set up to manage the
payments for those with less advanced
hepatitis C – payments that are likely
to be restricted to those in need,
because it has limited resources.
In addition, £100,000 a year was
set aside to fund counselling for all
those affected by the infected NHS
blood products in England – an
estimated 2,500 people. The Welsh
Government has now joined the scheme
and is funding counselling for people
in Wales. What Scotland or Northern
Ireland will do is still not known.
It is assumed that the majority of those
seeking counselling will be those affected
by hepatitis C rather than HIV. This is
partly because there are many more of
them but also because the Macfarlane
Trust has been offering counselling to
those affected by HIV-infected blood
products for years and will continue
to do so under the new scheme, using
its existing network of counsellors.
The counselling scheme for those
affected by the hepatitis C infected blood
is being administered by The Hepatitis
C Trust. The Trust is therefore looking
to extend its UK-wide network of
counsellors. People will be allowed to
choose their own counsellors, as long
as they are BACP accredited, but the
Trust wants also to be able to offer a
list of practitioners who can offer this
service. People can then either ask their
GP to refer them to a counsellor of their
choice, or contact The Hepatitis C Trust.
These are just some of the issues that
clients may bring to the counselling:
• some will undoubtedly feel very
angry that the Government is refusing
to accept responsibility for what
happened and also that payments
have been far less than they want
• others will have lost a partner to
hepatitis C and want help coming
to terms with the bereavement
• some may still need help to cope
with living with a chronic, potentially
life-threatening disease, even though
they have had it for more than 20 years
• some may find the stigma attached
to hepatitis C a real problem
‘Some people will
undoubtedly feel very
angry that the Government
is refusing to accept
responsibility for what
happened and also that
payments have been far
less than they want’
• some may be struggling to cope with the
treatment for hepatitis C, which can have
severe side-effects, including depression
• some may have been exposed to other
viruses, such as Variant CreutzfeldtJakob Disease (vCJD).
The counselling can be about any issue
in the person’s life; the circumstances
of the infection simply qualifies them
to access the scheme.
Will counselling help those affected
come to terms with ‘the worst treatment
disaster in the history of the NHS’?
Will it help bring closure? Will it help
them move on? That will depend on
many things, not least the quality of
the counselling they receive. Will
counselling stop the campaigning
for bigger pay-outs? That is unlikely.
Many of those campaigning have been
doing so for more than a decade and
still feel adamant that government
must admit responsibility and offer
proper compensation. It is likely they
will now be looking to Scotland and
the outcome of the Penrose Enquiry.
If you are interested in putting your name
forward to The Hepatitis C Trust’s list
of suggested counsellors, please email
[email protected]
Charles Gore founded The Hepatitis C
Trust (see www.hepctrust.org.uk) in 2000,
having been diagnosed with hepatitis C in
1995 and cirrhosis in 1998. He was closely
involved in the creation of the European
Liver Patients Association and was elected
its first President in 2004. He is President
of the World Hepatitis Alliance, which he
was instrumental in establishing.
March 2012/www.therapytoday.net/Therapy Today 29
Day in the life
A space
for sadness
Dr Maria-Alicia FerreraPena is a volunteer
bereavement counsellor
in a category B prison
for male o�enders
Interview by John Daniel
Photographs by Jacky
Chapman
30 Therapy Today/www.therapytoday.net/March 2012
I have been in private practice since
2000 and have my own consulting room
at home in Hassocks, West Sussex. I was
born in Chile and I have lived in England
for 36 years. I originally came to do a
PhD in social inequality at the University
of Sussex. I was already qualified as a
sociologist and I was working for an
international organisation that
supported me with a scholarship.
Augusto Pinochet had a lot to do
with me coming to England. The
first democratically elected socialist
government of Salvador Allende came
to power in Chile in 1970. It was
overthrown by Pinochet in a coup on 11
September 1973. Suddenly, Chile became
a dictatorship. The army was in the
streets; I had friends who disappeared;
a great part of the population was in a
state of shock. So, when I was offered
a scholarship to study in the UK, I
thought it was a chance to breathe for
a couple of years. I never expected to
stay but then I met my former husband,
finished my PhD and joined the BBC
as a producer for the World Service for
16 years. I did my counselling training
at the Psychosynthesis and Education
Trust while I was working for the BBC.
On an average day I see my first client
at 10am and my last at six. Ideally I see
no more than four clients a day. I have
never booked clients back to back and
like to have at least an hour between
sessions. Most of my work is one-toone but I also work with couples and
with bereavement issues. My caseload
varies: in the last year I have had fewer
referrals and I think the economic crisis
has something to do with it. I didn’t go
into counselling to make money and if
my practice grinds to a halt I will just
have to accept it. I have been extremely
fortunate in not having needed to
depend on my income from counselling
to survive. I am aware that this is a
very comfortable position to be in
and one that other people don’t share.
Throughout my life I’ve been
involved in volunteering. I believe in
the importance of giving something
back. I became a bereavement volunteer
for Cruse in Brighton and Hove in 1983.
The year before, my then brother-inlaw killed himself, having attempted
suicide several times before. My former
husband’s family didn’t discuss feelings,
so when his brother died no one talked
about it. I come from a culture where
people take time to grieve. In Chile
people are not so afraid to talk about
feelings, and friends and family play a
part in the grieving process. The death
of my brother-in-law inspired me to
volunteer for Cruse and I’ve had a long
journey with the organisation since.
For the last 10 years I have been a
volunteer bereavement counsellor at
HMP Lewes. I’m taking a break at the
moment because a close friend died
recently after a long and painful illness
and I felt I needed some time off to
reflect. I plan to go back, although
I’m not sure when. I relax by reading,
meditating – I’ve been practising
transcendental meditation for over
30 years – and painting. I have a tiny
studio in my house where I paint.
My colours are very vibrant, in
contrast to the greyness of the prison.
HMP Lewes is a category B prison
in East Sussex for remanded and
convicted male offenders. It has an
operational capacity for 742 individuals.
When I’m there, I see two clients in a
morning, twice a week. I do the work
as a volunteer with the Carat team
March 2012/www.therapytoday.net/Therapy Today 31
Day in the life
‘There have been
days when I think,
how can I instil a
sense of hope when
the environment
is so hopeless?’
32 Therapy Today/www.therapytoday.net/March 2012
(Counselling, Assessment, Referrals,
Advice, Throughcare). Carat is part
of the national government strategy
to address substance and alcohol
misuse in the prison population.
It’s very challenging work. I remember
one client who had one of his legs
amputated because of drug abuse.
His living conditions when not in
prison were appalling. A significant
number of the people I see are clearly
institutionalised. Going back into the
community means that they have to
be able to support themselves, and
there isn’t a framework for that. There
have been days when I arrive home and
think, how can I instil a sense of hope
when the environment is so hopeless?
A client once said to me: ‘If, by the
time for my release, I still haven’t got
anywhere to live, I’m going to commit
another crime because I’m not going to
spend the winter living outdoors.’ Prison
does very little to tackle the reasons why
a person has offended. Would you blame
someone who’s never had anything if,
for a period, they have food, a roof over
their head, access to a library, and perhaps
some counselling? All governments have
to administer justice and it’s not up to
me to tell them what to do, but you have
to understand why people have offended
in the first place. Most of the clients I see
in Lewes have been in care at some point
in their lives and their personal histories
are harrowing.
The practical challenges of working
in a prison are innumerable. I book
sessions from week to week but a client
can be moved to another prison the
day before I’m due to see him and I am
the last person to know. I then cannot
have a proper ending with that client.
I see clients in the Hall of Legal Visits.
When I first started 10 years ago the
cubicles weren’t sound-insulated and
sometimes you could hear what was
going on in the cubicle next door.
They are completely insulated now,
so confidentiality isn’t compromised.
The world of prisoners is clearly
divided between ‘us’ and ‘them’.
‘Them’ is the establishment that is
there to control and punish. I’ve had
sessions where clients arrive in a clear
state of anger because some kind of
injustice has been committed against
them, or they see it that way, and they
see me as part of the world that is
committing the injustice. I say to
them: ‘I’m not representing the prison.
I’m here to offer you a space where
you can look at your sadness and grief.’
Prisoners inhabit a very violent world.
There are drugs and alcohol in prison.
I don’t know how they get the stuff in.
When they use alcohol, they call it
‘making a brew’. One client, who’d been
in and out of prison all his life, said to
me: ‘You know that I’ve got ways of
making a brew.’ I said: ‘I’d appreciate it
if, while we’re working together, you don’t
do it.’ At the last session he said: ‘I can’t
tell you that I’m not going to go back to
it when I come out. But I promised you
that I wasn’t going to do another brew
while we were working together and I
never did.’ I was very moved by that.
When my mother was alive, I used
to go back to Chile every year. I may
move back there one day. I haven’t got
children of my own and there is a whole
generation of younger relatives in Chile
who could keep an eye on me when I
grow old, should I make it that far. I love
England; I have so much to thank this
country for. But in my old age I need
to go where there will be sunshine.
Training
We are all members of different groups
every minute of the day – even if we
are sitting alone on top of a mountain.
We have pictures in our minds of the
groups to which we do and don’t belong:
my family group and the family I don’t
talk to; my church and the church I don’t
pray at; my vocational or professional
group, which is so dispersed that its
members are mostly a concept in my
mind; my gender and race groups;
those that ‘are me’ and many others
that ‘are not me’. The groups we are
part of and those to which we don’t
belong all have an influence on our
thoughts, values, feelings and behaviour.
We may feel proud of our faith or sports
group; we may feel ashamed of the way
our government acts on our behalf.
We all have feelings about the groups
that purport to represent us or do
things for us. Sometimes these feelings
are very strong – positively or negatively
– and can lead to demonstrations or
riots. Sometimes we are indifferent.
Groups play important roles in our
lives. Often we don’t understand them,
or our relationships with them are
confused. We can take a stand or we
can bob along like corks on a sea. We
may be frightened of them because they
make us lose our sense of individuality
and we are carried along through group
pressure to think or behave in ways we
would never dream of doing normally.
Groups need members to achieve
what groups want to do. People can feel
‘used’ by their group, which may make
them resistant to the group’s purposes.
The pull to join and the opposite pull to
step back and retain one’s individuality
tend to make groups unstable. They are
a source of tension and conflict for us:
we want to be part of the group, to be
useful, accepted and approved of, but
we also want to retain our uniqueness
and independence.
These forces are called dynamics –
the interweaving, overarching ebb and
flow of the currents, movements and
forces within the group and those
outside the group that affect it. Some
people enjoy participating in these
dynamic pools of energy; others loathe
them and refuse, consciously anyway,
to be part of groups. But so many things
in society can only be achieved through
joint efforts in groups; for most of us,
the quiet life of the recluse is not
possible. To be a loner these days is to
be thought of as odd. We don’t respect
hermits as much as we once did.
We educate the next generation in
the art of group membership from a
young age. People learn how to survive
in groups and, with some exceptions,
most of us get by. But the less socially
skilful can miss out on the opportunities
presented by groups, or they may move
away from their groups, which can
lead to social exclusion. There is much
concern about the socially excluded
and yet no one seems to know how to
integrate these people in a better way.
Will caring do it? Or persuasion? Or
cajoling? Or reward or punishment?
Or force? Dialogue, debate and
negotiation, in groups, may be the
means to resolve these group issues
and differences. The way we live, our
relationships with others and how we
engage with each other, individually
and collectively, ultimately determines
the kind of society we want to see evolve.
The Tavistock Institute
The Tavistock Institute of Human
Relations was established in 1947,
immediately after the Second World
War, as the country was beginning to
get back on its feet. The war and its
aftermath forced the pace of change,
providing an opportunity and spur for
individuals, organisations and society
as a whole to take a fresh view of social
structures and relationships.
A group of social scientists and
psychiatrists wanted to contribute to this
change: to assist the leaders, managers
and others who were responsible for
creating and leading a civil society as
it emerged from the ruins. They did
this through research, consultation
and professional development
programmes. The Tavistock Institute
was one of these initiatives.
The early pioneers of the Tavistock
Institute were convinced that new
methods of research and training were
needed to support people in their roles
as societies recovered, new technologies
were developed and the pace of change
quickened. They saw the need to work
with all human faculties – cognitive,
rational, emotional and unconscious –
to produce long-lasting learning and
lessons that people could translate
into new situations as they came along.
New concepts and structures were
needed to develop understanding of the
group and the individual’s role within it.
The Tavistock’s clients clamoured
for more opportunities to learn about
The Leicester
Conference experience
The annual Leicester Conference o�ers participants the opportunity
to analyse and experience what makes groups work. Mannie Sher
and Coreene Archer describe a potentially transformative process
March 2012/www.therapytoday.net/Therapy Today 33
Training
‘dynamics’ – the inner and outer forces
that influence human behaviour at
all levels – the individual, the group,
the system and the environment.
Any aspiring professional, technical
specialist, leader or entrepreneur would
need to be equipped with this knowledge.
The Leicester Conference
The first Leicester Conference (so
named because it has always been held
at the University of Leicester) took
place in 1957, organised by Tavistock
staff: notably, Ken Rice, Wilfred Bion,
Harold Bridger, Isobel Menzies and
Pierre Turquet, among others. Its initial
aim was simply to ‘provide opportunities
to learn about leadership’.1 This was
later expanded to ‘provide opportunities
to learn about the nature of authority
and the interpersonal and inter-group
problems encountered in its exercise’.2
The underpinning philosophy is
that the strategic and structural interrelationships of individuals, groups
and organisations can be studied and
understood. The conference programme
is designed to include opportunities
for participants to apply the learning to
their own institutions and organisations.
The conference emphasises
experiential learning, on the grounds
that learning is more substantial and
lasts longer if all the senses and faculties
are involved. It draws on intellectual
study and also the emotional
engagement that comes through
participation in group activities.
The Leicester Conference is
residential and runs annually, for
two weeks, although the model has
been developed by the Tavistock
team to offer shorter (one to five-day),
in-house and non-residential events
for organisations. The work of the
conference takes place in large and
small study groups and whole system
and inter-group events.
The conference is described by
the Tavistock as a ‘real time’ learning
laboratory. Participants are enabled
to understand in greater depth the
factors behind the exercise of effective
leadership and to develop further
their own leadership capacities and
the leadership potential of others,
as well as recognise, understand
and work with their own and their
organisation’s resistance to change.
A participant’s experience
For participants, the Leicester
Conference has a certain mystique
that comes from bringing together
psychodynamic principles, open
systems theory and critical psychological
processes. Its experiential emphasis
may provoke anxiety among potential
participants, fearful of exposure of
their unconscious thoughts and feelings
and that the staff will see more than
they want to reveal. In an experiential
conference, such anxieties often come
from a fear of loss of control. It is
easier to hide yourself in lectures and
in books; active participation in the
group process cannot be easily avoided.
My (CA) own attendance as a
participant at the last Leicester
Conference resulted from four years
thinking about it and attendance at
other group relations events. I was,
I thought, clear in my mind that the
Leicester Conference would be a
significant experience. I was in a state
of excitement, not fear. I was relaxed,
in the sense that I thought I knew what
was going to happen during the two
weeks. I didn’t.
The problem with working
experientially with unconscious
resistance is that one is not sure where,
when or how that resistance will manifest.
My problem, and the problem for many,
was that I – an otherwise chatty person
– could not find my voice.
How is one heard? Which aspects
of myself are privileged in a group
discussion? Is it age? Race? Personal
or work relationships? Or some other,
unidentified part of me? How am I
being used and in what ways?
One of the strengths of the conference
is that the tasks are reflective and meant
to allow the space to think about these
questions and to find answers to them.
In the words of one participant,
describing this experience: ‘I have
found myself taking on roles that I was
previously unaware of – eg my tendency
to lead from behind. I found myself in
roles that I was amazed I was taking.’
For another, a clinical psychologist
and organisational consultant, the
conference brought insight and clarity:
‘I feel new clarity in roles every day.’
A key focus of the conference is
authority. Emphasis is given to
developing your own sense of personal
(inner) authority and making sense
of the personal authority of others.
An example of authority is the way
time is managed. ‘Leicester time’
‘The group relations conference is intended to
provide an experiential space in which the participant
is helped to reflect on the life of the organisation
and the roles of the individuals within it’
34 Therapy Today/www.therapytoday.net/March 2012
means that sessions start and end
promptly, as scheduled, even if someone
is still speaking. Although this may seem
strange, or even anti-social, it is seen as
important to establish clear boundaries
around when work is happening and
when it is not. This is meant to create
a sense of safety so that participants
can engage with other aspects of the
conference that provoke anxiety. The
programme structures provide another
dimension through which ‘boundaries’
can be challenged. How do we think
about boundaries? How easily do we
breach the boundaries of others? Do
we notice our own boundaries and when
they are crossed and by whom and why?
I found it difficult to negotiate my
relationships with the other participants,
some of whom I knew already, and with
the conference staff, many of whom were
colleagues. I felt observed, and worried
that I might be found wanting. Of course,
it is not possible to get it ‘wrong’ in this
type of event, but fear is not always
logical and it is this fear that the
conference seeks to expose and provide
opportunities for testing. Another
participant has commented: ‘The bottom
line is that there has to be a shared will
to change and a willingness to take risks
in order to develop relatedness.’
Participants of a Leicester Conference
are drawn from all sections of society,
all streams of working life and all parts
of the world. The conference offers
opportunities for exploring identity
in new ways. Interactions with fellow
participants, many of whom come from
other countries and cultures, provoke
reflection. Issues of authority, seniority,
leadership, and internal and external
connections become increasingly
relevant, leading to discussions of
what ‘difference’ really means, how
it manifests and its shifting nature.
Isolating oneself from one’s groups
becomes increasingly difficult. In an
experiential conference, tension and
challenge occur on the boundaries
between person and group, between
group and group and between group and
organisation, leading to learning about
the shades of difference between self
and others. As a participant commented
in feedback: ‘I learned that tensions are
inevitable in organisations and certain
group behaviours, eg the tendency to
form silos seems to exacerbate these
tensions. Encouragement… to reach
out across boundaries and be curious
about what was happening in other
silos was a useful way of improving
understanding and relationships.’
For me, the conference was
transformational. It is inspiring to
see what emerges from the myriad
connections between person, role,
group, organisation and environment
and their inner psychological and
systemic dynamic processes. It is
in these spaces between ‘inner’ and
‘outer’ that decisions are often made.
Participants often comment on the
‘slow release’ quality of the Leicester
Conference: that the learning continues
long after the event has ended. As one
recent participant put it, succinctly:
‘Once I start thinking about the
conference, I realise that there is a
fine web from this conference which
has been layered into my life.’
And, in the words of another:
‘I feel like I have found a place in the
world, in this work, that not only offers
a way in which seeing and being seen,
hearing and being heard is possible,
but also sustainable.’
Participant comments are taken from
conference feedback. For a history of
the Leicester Conference, see Miller EJ.
Experiential learning in groups I: the
development of the ‘Leicester’ model.
In: E Trist, H Murray (eds). The social
engagement of social science: a Tavistock
anthology. London: Free Association
Books; 1990.
Mannie Sher is Director of the Group
Relations Programme and Principal
Consultant, Organisational Development
and Change, at the Tavistock Institute.
Mannie will be co-directing the Leicester
Conference this year, which will focus
on Coalition, Cooperation and
Sustainable Society.
Coreene Archer is Group Relations
Consultant at the Tavistock Institute.
She is developing a number of leadership
and development offers, including
programmes for young people and
working with victims of domestic violence.
Details of the Leicester Conference 2012
can be found at www.tavinstitute.org
References
1. Rice AK. Learning for leadership: interpersonal
and intergroup relations. London: Karnac Books;
1965.
2. Rice AK. Individual, group and intergroup
processes. Human Relations. 1969; 22(6): 565–584.
‘For participants, the Leicester Conference has
a certain mystique that comes from bringing
together psychodynamic principles, open systems
theory and critical psychological processes’
March 2012/www.therapytoday.net/Therapy Today 35
Letters
Beware
the back
to work
industry
Contact us
We welcome your letters.
Letters not published in
Therapy Today may be
published on TherapyToday.net
subject to editorial discretion.
Email your letter to the Editor
at [email protected] or
post it to the address on page 2.
What an interesting
juxtaposition of articles in
the February 2012 Therapy
Today. We have the exposition
on how counsellors can get
involved in offering their
services to get the jobless
back to work by Catherine
Jackson and, in Talking
Point, Andy Rogers reflects
on his experiences working
with students now in austerity
Britain. One looks for
business opportunities for
the professional counsellor/
agency; the other highlights
the dismay, despair and
confusion of so many people
today and its echoes with
the tough times of the 1980s.
I am constantly aware, in
the agency in which I work,
of the huge increase in the
numbers of those presenting
as depressed and anxious,
and also aware that we are
seeing more severe cases of
both. We seem to be creating
a structural ‘emotional
depression’ alongside
our economic one.
My feelings are that
counsellors would do well to
think carefully before getting
caught up in the Department
for Work and Pensions-based
industry of trying to get
people back to work. To see
lack of jobs as an indication
of some pathology on the
individual’s part seems to me
to ignore the role of politicians
and societal structure in what
is going on here and, if we
see their plight as business
opportunity, then we are part
of the problem. Politicians
of all three parties seem
happy to make unemployment
seem a character flaw, rather
than a failure of the political
and financial systems.
Of course counsellors
may have a role in helping
a client make sense of their
depression, lack of self-worth
and so on, and may be able
to help an individual move
36 Therapy Today/www.therapytoday.net/March 2012
forward in terms of
employment, but to nail
our colours to the ideological
driver and mechanisms that
see individuals as purely
responsible for their own
lack of employment is to
me a complete travesty of
what we should be about.
When you ally this to the
increasingly stigmatising
and punitive regimes towards
the jobless and disabled that
we are seeing currently, then
we should be reacting as Andy
Rogers describes – we bear
witness to many of society’s
ills as we hear the narratives
of despair which so many
of the people with whom
we work bring to therapy.
To coin an old phrase from
feminist history: ‘The
personal is the political.’
We must not find ourselves on
the wrong side of the debate.
Diane Collingwood
What about
the workless?
The October 2009 issue of
Therapy Today published an
article called ‘Work is good
for you’.1 It was illustrated
by a picture of a god-like
figure – the counsellor –
holding a key with which he
winds up tiny broken people
on one side of him and, on
the other side, sends them on
their happy, straight-backed,
employed way. The article
was based on government
policy and mentioned ‘...
growing evidence that work
is good for your health’, but
offered not one reference
to research at all.
This was repeated in
February 2012 Therapy Today
article ‘Counselling the
jobless back to work’. Again,
assertions are made about
the ‘research evidence’ of the
harmful effects of being
unemployed, with not one
reference to that research.
This piece was, like the October
2009 article, concerned with
‘opportunities for counsellors’.
All three pieces were
ludicrously unbalanced,
with no reference to serious
criticisms. There was no
exploration of how complex
external influences, such
as the demonisation of the
unemployed and the rhetoric
around ‘hard-working
taxpayers’ vs ‘benefit
scroungers’, contribute to
the distress of people whose
identity is fundamentally
altered the day they become
unemployed or claim benefits.
There was no recognition
that unemployment rates
are at their highest in 17
years2 or how failure to find
employment after being
processed through various
‘Back to Work’ schemes might
affect a person’s wellbeing.
Nor was there mention of
dissent to the Welfare Reform
Bill (WRB) from respected
organisations like the Joseph
Rowntree Trust, Disability
Alliance, Mind, National
Housing Federation and
Citizens Advice Bureau,
among a great many others;
no mention of the Royal
College of Psychiatrists’
concerns about ‘the capacity
of relevant members of staff
in Jobcentre Plus and Work
Programme providers to
make appropriate decisions
about what type of workrelated activity is suitable for
claimants with mental health
problems’, or the fact that the
College will not support the
Health and Social Care Bill.3
There is no discussion of the
WRB being demolished, crossparty, in the House of Lords, or
that the Government is forcing
these reforms into law despite
its Lords defeat. There is no
mention of the Department
for Work and Pensions’ sixpoint guidance to Jobcentre
staff around increases in
self-harm and suicide.4
There is no recognition
of, let alone reflection on,
the essential shift in the
purpose of counselling
summed up in the article
by Kevin Friery, past Chair
of BACP Workplace: ‘The
prime contractor doesn’t
want to pay you to have a
nice chat and help the person
cope with being unemployed;
they want you to increase
their employability so that
they can get work, and help
keep them at work.’
The October 2009
Therapy Today led with
the news that ‘One in six
therapists still sees fit to
offer gay clients treatments
that aim to make them
straight’.5 That article resulted
in shock and outrage that
so many counsellors should
be abusing clients by telling
them what they should be and
purposefully aiming to change
them to suit the counsellor’s
world view. There hasn’t been
a similar reaction to the same
and recurrent message when
it involves people who are
unemployed. Instead, there
seems to be consensus that
counselling should be one
thing for people who can
afford private practice but
should be the polar opposite
when the counsellor is
working as part of the
Work Programme or, indeed,
when meeting with any
person who is unemployed.
The abuse of politically
vulnerable groups by mental
health professionals has a
long and shameful history.
Whether it’s single mothers
being subjected to electroconvulsive therapy, ‘protest
psychosis’, the incarceration
of political dissenters or
the Martha Mitchell Effect,
each individual professional
involved in this scapegoating
is ultimately paid by and
works for the government
of their time. BACP professes
to be concerned with an
ethical approach to practice
but that doesn’t seem to hold
true when ‘opportunities
for counsellors’ are at stake.
Clare Slaney
REFERENCES:
1. Brown K. Work is good for you.
Therapy Today. 2009; 20(8): 16–19.
2. Office for National Statistics.
Labour market statistics: February
2012. London: ONS; 2012. http://
www.ons.gov.uk/ons/rel/lms/
labour-market-statistics/february2012/statistical-bulletin.html
3. Royal College of Psychiatrists,
Centre for Mental Health, Mind
et al. Work experience for ESA
claimants. London: Royal College
of Psychiatrists; 2011. http://www.
rcpsych.ac.uk/PDF/2011-11-03%
20Work%20Experience%20for%
20ESA%20Claimants.pdf
4. Taylor R. Freedom of Information
Request. May 2011. http://www.
whatdotheyknow.com/request/
job_centre_staff_guidance_on_
sui#incoming-174789
5. Daniel J. The gay cure? Therapy
Today. 2009; 20(8): 10–14.
Editor’s response
The views expressed in the
article, as with all views
expressed in Therapy Today,
are not those of the BACP, unless
expressly described as such.
Kevin Friery was commenting
in an individual capacity. There
is a considerable body of research
into the mental health benefits
of employment. One that is
often cited is: Waddell G, Burton
AK. Is work good for your
health and wellbeing? Norwich:
the Stationery Office; 2006.
Unethical
opportunities?
I hardly know where to start
with the unspoken ethical
dilemmas surrounding the
news of ‘huge opportunities’
for therapists reported in
‘Counselling the jobless
back to work’ (Therapy
Today, February 2012).
Of the many questions of
morality and politics barely
touched on in the article, it
was particularly telling that,
despite the early mention
of the legitimate claim that
‘mental health and wellbeing’
is best supported by
‘rewarding and healthy’ work,
not just any work, neither
the rest of the article nor the
various quoted protagonists
made any further mention
of this core issue.
As we well know, not
all employment enhances
‘wellbeing’ – some will even
be detrimental. This raises
pretty tough questions for
counsellors choosing to
adopt an explicit, financially
incentivised agenda to
‘help’ people find any
job they can stick at long
enough for the contractors
(and their counsellors)
to pick up cheques from
the Department for Work
and Pensions.
And, as evidenced by the
current scandals engulfing
the Government’s policy of
pushing people into unpaid
and unrewarding work with
little hope of a real job at the
end,1 the Minister for Welfare
Reform’s statement in the
article that ‘we want that
person back in work… we
don’t mind how you get that
outcome’ is frighteningly
truthful and should ring
alarm bells for all those
tempted by this ‘potentially
new and burgeoning
market for their skills’.
Do counsellors and
psychotherapists really
want a part in all this?
Andy Rogers
REFERENCE:
1. http://www.guardian.co.uk/
commentisfree/2012/feb/16/workfree-tesco-job-advert?intcmp=239
Stop this
undignified
scramble
It must be 30 years ago that
I heard the trade unionist,
Clive Jenkins, express the
view that a return to full
employment was a myth that
would never materialise, and
that what mattered now was
to educate people into leisure.
There are those who have a
vested interest in maintaining
the myth, together with the
corollary that income is the
only real measure of worth,
so that those on lower incomes
are less important than those
on higher incomes, and those
not in paid employment at
all are effectively worthless.
Such vested interests were
predictably unimpressed
by Clive Jenkins’s views,
and the destructive – indeed,
disastrous – consequences
of this worldview continue
unabated.
I find it, therefore,
particularly depressing to
see (‘Counselling the jobless
back to work’, Therapy
Today, February 2012)
BACP apparently
subscribing, unthinkingly,
to this same agenda, and
promoting an undignified
scramble on to the latest
government bandwagon,
the Work Programme.
Step back for a moment,
and consider what is
being promoted here.
My first duty is to my client.
Maybe a client comes to see
me because of depression
from being out of work. That
is the presenting problem. In
my experience, the presenting
problem is rarely the core
issue. My client’s agenda
is likely to change, and a
satisfactory outcome may
include – although probably
March 2012/www.therapytoday.net/Therapy Today 37
Letters
as a side issue – getting a
job, or changing job; or even
abandoning regular or paid
employment as desirable
at all. The point is that I
cannot know what will be
best for my client.
Every course I have ever
been on; every halfway
decent book on counselling
emphasises the importance
of being OK with not knowing.
The minute I have an agenda
– political, organisational
or financial – then I am no
longer OK with not knowing.
If I need to know that my
client will get a job, otherwise
I don’t get paid, then at this
point I have abandoned my
duty to my client.
How refreshing, therefore,
to turn to the ‘From the Chair’
column in the same issue
and to realise that nothing
that comes from central
Government need in any
case be taken too seriously.
There cannot be anything
that wrong with a world
that contains an office
called ‘The Department of
Health and Comic Relief’.
William Johnston
If I could
work I would
Here is a brief synopsis of
who I am and what’s currently
occurring, causing me to
actually ‘get things out there’
about the Welfare Reform
Bill. I had a road traffic
accident in 1988, occasioning
a severe head injury and
necessitating my having
to re-learn absolutely
everything. In 2001 I
became a volunteer at
HAD (Hertfordshire Action
on Disability) as a student
counsellor, qualifying in
2003. I am still seeing clients
for HAD and continue to try
to encourage people to be
‘more’ and live easier in their
own skins. Let me further
explain: I believe that what
the Government gives me
to live on I, in turn, pay back
into society by doing what I do.
I hasten to add here that my
counselling work amounts to
far less than 16 hours per week
and is all dependent on my
physical capabilities, which are
not at all predictable. I am also
Senior Counsellor at Resolve,
based in Welwyn Garden
City. I have never, in the
whole time since the accident,
been knocked to my hands
and knees, so to speak. Until
now. This is all brought about
by the present Government
attempting to save all it can
– finance-wise. Regardless
of your own political leanings,
I am merely venting my own
frustration at the situation.
In October 2011, I received
a lengthy questionnaire
about the benefits I receive,
being Incapacity Benefit and
Income Support. I was sent
to a Medical Assessment,
some 18 miles away and six
floors up, on 19 December.
At this assessment, although
the doctor was only doing
her job, I was given the
impression that because I try,
will not lie and am not what
I term ‘depressed’, then I am
able to work for eight hours
a day, five days a week. A
week ago I received a letter
informing me that I am to
receive Employment Support
Allowance, with the proviso
that I attend interviews at
the Jobcentre. So, it would
appear that I was right and the
Government deems it all good
and proper that I go out and
find work. This is, of course,
irrespective of the fact that
there is not sufficient work
for the workforce in any event.
Please believe me, if I
could work then I would.
Not everybody claiming
38 Therapy Today/www.therapytoday.net/March 2012
benefit is a cheat. Regardless,
also, that I will be appealing
the decision, I am not
sleeping at all well because
of the stress it has caused; it is
having a physiological impact
and this is after just a week.
I ask myself: is this all
training for when Disability
Living Allowance changes
next year into Personal
Independence Payment, when
every person claiming will
have to attend an assessment
interview? How much more?
Denice Reeves
Dip Couns, MBACP
Damaging
pragmatism
I read ‘Counselling for
depression’ (Therapy Today,
February 2012) with mixed
feelings. While it’s good to
see BACP at the NHS/IAPT
‘top table’, helping to ensure
the provision of counselling
within IAPT services, it comes
at a cost that does not seem
to have been recognised.
The summary dismissal of
concerns about the evidencebased paradigm, leading to
the need to be ‘pragmatic’,
makes me wonder whether
principles have been
forgotten.
Although I understand
the conflict for BACP
(damned if they do and
damned if they don’t), this
kind of pragmatism could
result in damaging collusion
with the target-driven culture,
long-term outcomes of
which are unclear especially
given the ‘revolving door’
syndrome. I find the attempt
to align counselling for
depression (CfD) with
accreditation unconvincing:
these programmes could
devalue and render irrelevant
BACP accreditation as an
indicator of competent and
ethical practice, since CfD,
dynamic interpersonal therapy
(DIT) and interpersonal
therapy (IPT) all ‘require’
additional, no doubt expensive
and time-consuming, training
to prove that applicants are
fit for NHS purpose. They
are also restricted to certain
professional orientations and
perhaps those already working
in the NHS, since the cost
may well prove prohibitive
to others. Besides producing
a kind of professional
exclusion, exacerbated by
one organisation having
the monopoly on training
in the case of CfD and DIT,
the message seems to be
that our diplomas, MScs,
MAs and accreditation, not
to mention many hours of
clinical experience, achieved
at considerable personal cost
in many cases, are somehow
deficient. It sounds as if
‘mapping existing practice
onto the CfD competency
framework’ is code for
eliminating individuality.
It’s understood that
language is a tool conveying
powerful messages about
intentions and attitudes.
A worrying aspect is the
use throughout of
reductive language such as
‘mechanisms’, ‘adherence’,
‘formulation’ and the need
to ‘bring into line idiosyncratic
ways of working based on
experience and personal
philosophy’, all of which
convey a homogenising,
one-size-fits-all intention.
All of this is contrary to the
values on which counselling
and therapy are predicated:
eg recognising, nurturing and
celebrating difference and
promoting plurality of choice.
At least one spurious
conclusion seems to have
been drawn from the first
training programmes.
There was concern that
some participants showed
gaps and misunderstandings
in their knowledge of the
person-centred/experiential
(PCE) approach, this
programme guarding
against the ‘complacency
of experience’. Yes, in every
situation there will be people
who demonstrate poor grasp
of theory or have forgotten
some while still describing
their practice as humanistic,
integrative or whatever.
But another possibility is
surely set out in the stated
aims of accreditation: ie to
demonstrate how we have
developed since qualification.
This development, if one is
committed to continuing
professional development
(CPD) and personal growth,
inevitably means moving away
from or at least questioning
various aspects of our original
trainings, perhaps through
learning other approaches,
CPD, experiencing
different supervisors and
co-supervisees, leading to
honing our own professional
practice. If we stick rigidly and
indiscriminately to the original
offering, how much have we
then developed? But it doesn’t
follow that our practice may
not be primarily the one we
started with. Far from
‘complacency of experience’,
although of course this exists,
many of us will be continually
reassessing and monitoring
ourselves along the lines of
Patrick Casement’s ‘internal
supervisor’, together with
supervision and personal
therapy. Individuality can
therefore result just as easily
from considered reflection
as it can from complacency.
It also needs to be borne in
mind that the CfD assessors
will not themselves be free
of bias and idiosyncrasies.
Several months ago a letter
pointing out the weaknesses
in the accreditation system,
citing frequently encountered
examples of unprofessional
practice, suggested that
accreditation is not difficult
enough and that something
more challenging, a kind
of annual MOT, is needed.
I don’t believe these
programmes are it.
Roslyn Byfield
MSc, MBACP (Accred)
counsellor in private practice
Hidden
costs of data
collection
where the therapy is not being
helpful can be useful when
the client has 12–16 sessions,
which is what they receive in
our area with high intensity
CBT. I question their value in
the more typical eight sessions
offered by counsellors.
Anonymous
What about
the lesbians?
I read David Richards’ article
‘Working with older LGBT
people’ (Therapy Today,
December 2011) with interest.
However, there are some
issues that I would like to
Nic Streatfield (Therapy
raise in the interests of older
Today, February 2012) makes
lesbians. I speak as a lesbian
an interesting case for routine
growing older, a client, a
collection of outcome
healthcare professional
measures. I wonder, however,
and a researcher.
if his situation is typical.
First, to address LGBT as
Where he works, clients
one general group I believe
are able to input the data
is incorrect. Even taking out
themselves thereby both
the bisexual and transgender,
saving the therapist time
one is still left with two
and involving the client more
deeply in the process. Further, hugely diverse groups.
he is apparently equipped with Political, sociological and
economic influences over
a computer programme that
provides a helpful chart. Where the years, combined with
the biology of being a woman,
I work, in a London borough,
will inevitably make older
we don’t have these facilities.
lesbians’ experiences markedly
Moreover, Streatfield uses
different from those of gay
CORE. The IAPTUS system
men of a similar age.
has 27 separate measures.
Women who today are
Inputting all these inevitably
over 65 (born pre-1947)
takes a lot of time. In my
and identify as lesbians are
surgery, counsellors will lose
acknowledged by health and
about 25 per cent of face-toface time with clients, resulting social care researchers to
be a difficult group to reach;
in longer waiting times.
‘convenience’ samples may
I am all in favour of
not always be representative
measuring outcomes and,
of the wide group. But there
indeed, instituted a system
are findings from pertinent
in the Department of
Psychological Medicine where research studies, including
I once worked. But the IAPTUS my own,1 which may have
system is too cumbersome
relevance for the therapist.
and time-consuming and has
Traditional female roles
too much redundant data.
meant that many women
One further point – using
married and had children
outcome measures to identify despite knowing they were
lesbian. These women may
have ‘come out’ later in life
and avoided earlier stigma
attached to being lesbian.
Certainly in my work I found
this group of women more
‘celebratory’ about ‘coming
out’ than those who had
always identified as lesbian.
Heterosexual ‘privilege’
(husband’s profession/salary/
pension/insurance) may have
meant married women were
better set up financially than
women who had always been
lesbian, particularly if they
divorced after the change
in divorce law (1969).
Conversely, being in an
unsatisfactory marriage
may have put them at risk
of various forms of abuse,
not being able to work due to
childcare responsibilities and
the accompanying stress that
goes along with these factors.
‘Lifelong’ lesbians often
described the hard work of
developing self-preservation
strategies to protect
themselves from prejudice.
Their stories convey how
they continued to feel outside
the norm even as societal
attitudes towards same-sex
partnerships relaxed. In
general this did not prevent
them from having careers or
a social life, but it made them
cautious. Discrimination may
not be as blatant as it once
was but it can take on subtle
forms. Some of my research
participants were scarred
by homophobic experiences
early in life and were still
scared many years later to
be ‘out’ in any situation.
While male homosexuality
was decriminalised (above
21, the age of consent) in
1967, being lesbian was never
recognised in any way, legally,
politically or socially. This
may have had some benefits
but it served to trivialise
lesbian relationships and put
them on a different footing
March 2012/www.therapytoday.net/Therapy Today 39
Letters
to heterosexual and gay
relationships. Even today
it is not uncommon to come
across comments that two
women cannot have a ‘real’
relationship.
Research participants
described the care they
had to take to conceal their
sexuality, particularly in the
workplace, for fear of ridicule,
discrimination and losing
jobs. Job and pay equality
may have improved over
previous decades but women
have traditionally been paid
less and have often found
themselves juggling part-time
work with family life and not
being able to build up savings/
pensions. The effects of this
will be having an impact
now and costs of therapy
may well prevent some older
lesbians from seeking it out.
The heterosexist
assumptions in health and
social care settings that David
Richards mentions are borne
out in many older lesbians’
stories. But most participants
in my work seemed to accept
that this was easier to cope
with than ‘coming out’ and
that disclosing sexuality
was not relevant in many
healthcare interactions.
My research participants
all highlighted difficulties
in meeting other older
lesbians. While most
described rewarding social
networks, they wanted to
meet lesbians their own
age. Most had contact with
younger lesbians but, apart
from their sexuality, had little
in common with them, which
is unsurprising. It would be
interesting to find out what
impact the internet may
be having in this area.
The research study I
carried out was small but
rich in content, with people
sharing information often
disclosed for the first time.
Inevitably it is impossible
to generalise about the lives
of older lesbians. I fully
support David Richards’
comment about the ‘need to
understand the histories of
older LGBT people in order to
offer appropriately developed
and sensitive services’.
Price2 estimated that the
number of gay men and
lesbians aged over 65 in the
UK was between 545,000 and
872,000. With an increasingly
ageing population and with
women living on average
longer than men, there will
be more older lesbians than
ever before, yet we remain
largely invisible. As a
number of authors highlight,
older lesbians are triply
disadvantaged by gender,
age and sexuality.3- 5
Carly Hall
BSc (Hons), RN, PhD
REFERENCES:
1. Hall C.B. Wellbeing in later
life: a qualitative exploration of
lesbian and heterosexual women’s
experiences. Unpublished PhD
thesis. Bristol: University of the
West of England; 2006.
2. Price E. All but invisible: older
gay men and lesbians. Nursing
Older People. 2005; 17(4): 16–18.
3. Kehoe M. Lesbians over 60
speak for themselves. New York:
Harrington Park Press; 1989.
4. Jensen K.L. Lesbian epiphanies:
women coming out in later life.
Binghamton: Haworth Press; 1999.
5. Claassen C. Whistling women:
a study of the lives of older lesbians.
Binghampton: Haworth Press; 2005.
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40 Therapy Today/www.therapytoday.net/March 2012
Reviews
In search
of self
Why be happy when
you could be normal?
Jeanette Winterson
Jonathan Cape 2011, £14.99
ISBN 978-0224093453
Reviewed by Angela Cooper
This story of Jeanette
Winterson’s early life will
resonate with many people
with attachment and/or
adoption issues. Winterson
is a well-known novelist.
Her first published book,
Oranges are not the only fruit,
described her adoption
and upbringing by the
evangelical Mrs Winterson
in relatively light-hearted
tones. This much later
version of the same story
is an altogether darker tale.
Winterson explores
complex areas that even
an experienced therapist
would find challenging.
Attachment and
abandonment issues,
rejection and collusion,
projection, denial, splitting,
Transactional Analysis
(TA) roles and triangles
are all explored through
the various personalities
and relationships she
encountered in her early
life. Mrs Winterson is the
main focus of the book,
but characters such as
Mr Winterson and the
author’s biological mother
also come into the spotlight.
Most of the characters
she describes are less than
benign. Those who show
kindness do so mostly in a
brusque, no-nonsense way.
More sinister figures, often
religious, collude with Mrs
Winterson in her attempts
to exorcise the demon she
believes possesses Jeanette.
Even characters who never
appear, like the perfect Paul,
exert a powerful influence.
Most striking of all is that
the author – despite growing
up in this environment –
has managed to keep her
distinct voice, and one that
has such evident vigour. It
is hard to tell what she really
felt as a child. As an adult
searching for her mother,
her feelings are clearer.
However, humour – albeit
often bleak and cynical –
runs through it, providing
much-needed relief.
The book also goes
beyond Winterson’s own
story to describe the social
context to those years.
From the plight of the
single mother in the 50s
to the disappearance of
the public library in recent
times, Winterson writes with
insight about the less literate
in society and the effects
of political decisions on
the lives of working people.
This is an excellent book.
Therapists who work with
attachment and complex
loss will benefit from reading
it as much as their clients.
Angela Cooper is a senior
accredited supervisor
(groups and individuals)
Facing up
to life
Skills in existential
counselling and
psychotherapy
Emmy van Deurzen
and Martin Adams
Sage 2011, £19.99
ISBN 978-1412947800
Reviewed by Els van Ooijen
This book presents the
UK model of existential
therapy, which has its
roots in continental
philosophy and is based
on the phenomenological
method. The authors
make it clear that their
approach is not the same
as phenomenologicalexistential therapy, which
they see as similar to
person-centred or
integrative therapy.
As this book explains,
working in this way means
that therapists help clients
face up to life’s difficulties
through an array of listening,
clarifying and challenging
skills, as well as their own
understanding and
experience of life.
Practitioners should,
however, remain openminded and curious, and
not assume that they know
what is going on for clients.
Importantly, existential
therapy aims to help people
come to terms with the
non-negotiable givens of
our existence. We cannot
escape death, although
many of us try to ignore
this fact, or challenge it
through reckless behaviour.
However, we are reminded
of our mortality through
accidents, physical illness
or bereavement. When this
happens, people may feel
that life has lost its meaning
and may need help to
make sense of their lives.
The authors stress the
importance of engaging
with these essential
existential issues, as they
are behind everything
clients bring to therapy.
I found this helpful and in
line with my own experience.
Other ways of working
include the practice of
agreeing the problem with
the client, reformulating it as
a dilemma, and then helping
the client to find a solution
through dialectical thinking.
This is an introductory
text for those unfamiliar
with existential therapy.
It is written in an accessible
style, is attractively laid
out and contains many
synopses, reflective
exercises and case examples
to illustrate the theory.
March 2012/www.therapytoday.net/Therapy Today 41
Reviews
As someone whose training
includes the existential
therapeutic approach, and
who has ongoing experience
of supervising existential
therapists, I found this a
useful guide for students
and teachers alike, as well
as those seeking to integrate
the approach into their
practice. Although some
of the skills-based sections
may appear rather basic to
the experienced practitioner,
it certainly deserves a place
on the library shelf of every
training organisation.
Els van Ooijen is a
psychotherapist at the
Nepenthe Consultancy, Bristol
Staying
together
Let’s stay together: your
guide to lasting relationships
Jane Butterworth
Sheldon 2011, £8.99
ISBN 978-18470915505
Reviewed by Julia Greer
This is a self-help book
in a Sheldon series called
Overcoming Common
Problems. Written by Jane
Butterworth, former agony
aunt at the News of the World,
it is a straightforward, easy
read, giving advice for specific
situations and problems much
in the style of a newspaper
or magazine column.
Its attitude to relationships
is positive: all relationships
will encounter difficult
times; they can be worked
through. Butterworth seeks
to normalise the struggles
most couples will have at
some point, and argues that
many relationships can be
saved if couples recognise
and heed the early warning
signs that their relationship
is in trouble.
The book covers the key
developmental stages in the
course of a relationship, such
as birth of children, midlife
crises, children leaving home,
stepfamilies, retirement and
bereavement. Also covered
are financial problems,
infertility, affairs, cybersex,
redundancy and illness.
The chapter on sex is
particularly useful. It outlines
the most common sexual
problems encountered by
couples over the lifetime
of a long-term relationship,
with explanations and
suggested solutions. There is
also some brief information
about sex therapy and when
that might be appropriate.
The book emphasises
the need for honest
communication and gives
tips on how to manage anger
and conflict in a healthy way,
using examples from the
author’s agony aunt mailbag
to illustrate techniques.
Short quizzes throughout
the book allow readers to
test the viability of their own
relationship, again in the
style of women’s magazines.
The book doesn’t cover
theory or look at underlying
dynamics in relationships.
It refers only briefly to
abusive and co-dependent
relationships. However,
it is a useful title to
recommend to clients
who want some guidance
on repairing or rebuilding
their relationships, and is
helpful, if basic, reading
for counsellors who are
not trained in couple work
but are working with clients’
relationship issues.
Julia Greer is a psychoanalytic
psychotherapist
42 Therapy Today/www.therapytoday.net/March 2012
Ed, me and
recovery
Letting go of Ed: a guide
to recovering from your
eating disorder
Pippa Wilson
O-Books 2011, £9.99
ISBN 978-1846946981
Reviewed by Cicely Gill
This very clearly written,
accessible self-help book
is one for practitioners to
recommend to clients. Pippa
Wilson, herself a survivor
of an eating disorder, takes
great pains to treat her
readers as equals. She believes
eating disorders are ‘all about
feelings’ and her guide to
recovery is presented from
this perspective.
Wilson explains that
personifying the eating
disorder can be a helpful
strategy. She refers to it as
‘Ed’ throughout. She explains
how to recognise ‘Ed’ and
describes the inner resources
needed to achieve change.
‘Don’t even try to change
until you can accept “Ed”.
Once you accept that “Ed”
was a necessary coping
mechanism, you can begin
to explore what lies beneath,’
she writes. She lists possible
causes and discusses factors
such as self-punishment,
control and perfectionism.
She emphasises the
importance of allowing
both good and bad feelings
and of paying attention
to black and white thoughts
and ‘shoulds’.
At this point, the reader
is asked to ‘find herself ’ –
to make a list of negative
and positive characteristics
and try to accept them.
Next Wilson asks the reader
if s/he can envisage life
without ‘Ed’. Can s/he
connect with her/his body
and appreciate it? We are
now in recovery mode: the
focus shifts to food, finding
sources of support, avoiding
triggers. Wilson highlights
and discusses ways to deal
with common pitfalls –
how to behave at work,
in a restaurant, or eating
with your children.
She emphasises the
importance of actively
choosing a therapist and
discusses the advantages
of medication,
complementary therapies
and spiritual help. She
finishes with a few words
about what is ‘normal’ and
the possibility of relapse.
The style might not suit
everyone. At times it is overchatty: faith, for example,
is described as ‘a slippery
bugger’, and at times the
tone becomes almost
religious –‘the darkest
gloom’, the ‘weary bowed
head’ – although this lessens
after the first few chapters.
There were for me two
weaknesses. One, I felt
that Wilson might have
emphasised more the
difficulty of recovering
without a therapist’s support.
Two, she neglects to point
out that people in the grip of
a sugar craving, for instance,
need to do the equivalent
of drying out alongside
sorting out the feelings.
On balance, however,
this is a very helpful book
for the person seeking to
recover from an eating
disorder. Wilson’s
confidence in the success
of her methods is infectious.
Cicely Gill is an eating
disorders practitioner
Ab/users and
c/harmers
And no birds sing:
exploring the landscapes
of personality disorder
Liv Adams
Emic Press 2010, £8.99
ISBN 978-0956731609
Reviewed by Trudi Dargan
The eloquence of this
beguiling book’s narrative
style by no means detracts
from the import of its
subject matter and overall
academic rigour. Its subject
is the perplexing domain
and dynamics of personality
disorders and narcissistic
personality disorder in
particular.
It describes the ‘Quixotic
Quest’, the intrepid personal
journey of exploration and
discovery undertaken by the
protagonists Jenny and Alex
– friends and survivors of
their markedly dysfunctional
relationships with narcissistic
male partners. Their journey
to North Wales is a searching
attempt to make sense of
these actively ‘nonreciprocal’, self-absorbed
individuals who exhibit
‘a stultified pattern of
interaction’ and employ
stealth, deceit, charm
and manipulation in their
‘consistently exploitative
interactions’.
Through the adept
interweaving of four women’s
personal stories with current
theory and research into
the development of the self,
the author presents us with
a comprehensive account
of the potential roots,
aetiology, manifestation
and interpersonal impact of
narcissistic individuals. These
are people who present with
a ‘fixed inability to empathise
with others’ – ‘ab/users’ and
‘c/harmers’ who seek out
unwitting suppliers, tenders,
rescuers and maintainers
in their determined,
idealised, romanticised
pursuit. Initially awed and
gripped, the ‘suppliers’ end
up as shells of their former
selves, like shocked survivors
cast into a desolate land.
While principally
concerned with narcissists,
the book recognises that
other personality disorders
display similar behavioural
patterns: shallowness of
feeling, extreme emotionality
and unhealthy interpersonal
relationships. Adams is
looking more broadly at
individuals who aim to be
‘in subversive control of
significant others’ (p80)
and who ‘will do in the head
of the people in closest
relationship with them’
(p81). By acknowledging
the complexity of her
subject matter and its
many grey areas, Adams
carefully avoids tagging her
characters with fixed labels.
The dialogue occasionally
verges on the saccharine,
but the book still offers a
commanding perspective
on narcissistic pathology.
Cleverly, it manages to be
simultaneously soothing and
powerfully incisive. I would
recommend it to anyone
interested in the development
of the self and where it can
go awry. And No Birds Sing
sits well alongside Lowen’s
renowned book Narcissism1
and Gilles Delisle’s excellent
Personality Pathology.2
Trudi Dargan is an integrative
counsellor practising in
Devon and Cornwall
REFERENCES:
1. Loen A. Narcissism: denial
of the true self. London: Simon
& Schuster; 2004.
2. Delisle G. Personality pathology:
developmental perspectives.
London: Karnac Books; 2011.
Pressure
points
Under pressure:
understanding and
managing the pressure
and stress of work
Denis Sartain and
Maria Katsarou
Marshall Cavendish
Business 2011, £9.99
ISBN 978-9814302630
Reviewed by Veronica
Howard-Jones
I find it ironic to be reviewing
this book at a time when
continuing change in
Higher Education means
we incrementally have less
time to do more. The current
political environment, both
nationally and internationally,
is making our lives busier, less
secure and more challenging.
There is a vast number of
books imploring us to take
heed of our stress levels,
understand how the mind
and body react to change
and be aware of the
consequences of prolonged
stress on our physical and
emotional health. This book
seeks to give us practical
tools to do this.
Sartain and Katsarou
start by identifying the
main stressors in our lives
and their inherent dangers.
Their argument is that, if
we already understand our
strengths and vulnerabilities
under pressure, we will be
forewarned and therefore
forearmed to ward off the
damaging effects.
To this end, they go on to
introduce the Myers-Briggs
Type Indicator (MBTI) as
a means for assessing how
we will react in stressful
situations, depending on
our personality type.
From this, authors explain
the concepts of ‘Uptime’ and
‘Downtime’. These appear
to be based on an integration
of mindfulness with CBT
techniques. ‘Downtime’
refers to rumination about
past events, which engenders
negative emotional and
physiological responses.
Uptime is the opposite
and involves the person
maintaining themselves
in the here and now, and
deliberately not making
evaluative responses
beyond being aware of
sensory information as
it is experienced.
The most powerful tool
for me was the self-contract
titled ‘My commitment to
myself ’, which the authors
urge us to complete and
act on. It reminded me
how difficult it can be to
keep the promises we make
to ourselves and the very
real costs to our health and
wellbeing if we fail to do so.
The book also helpfully
includes case studies, which
provide a context and
comparisons for the reader’s
own situation. The conclusion
includes a very useful
checklist of guidelines, which
is helpfully cross-referenced
to the relevant chapter.
Overall, the clear message
is that we are ultimately
responsible for ourselves.
Veronica Howard-Jones is
a lecturer at the University
of Salford and HJ Heinz
staff counsellor
March 2012/www.therapytoday.net/Therapy Today 43
Reviews
Nurturing
self-regard
Building clients’ self-esteem
Paul Grantham
www.psychotherapydvds.com
2011, £59.90
ASIN B0064P66JE
Reviewed by Adrian Pepper
This is a set of four DVDs,
each an hour long and worth
a total of three CPD hours,
featuring consultant clinical
psychologist Paul Grantham
leading a skills workshop on
building clients’ self-esteem.
They show him interacting
with his audience, talking
to his slides and analysing
a video of several short
work sessions.
The first DVD explores
the nature of self-esteem
and draws out the dual
contributions of worthiness
and competence in how a
client regards him or herself.
This leads into defining
the healthy behaviours that
a client can use to develop
their self-esteem.
The second DVD identifies
five sources from which a
client can gain self-esteem:
self-efficacy, positive
cognitions, self-nurturing,
support and help, and
usable feedback. It goes on
to address how to generate
and measure self-efficacy,
with recommendations for
the use of problem solving
to manage life challenges
and the value of goal setting.
The third DVD focuses on
positive cognitions: helping
the client to become aware of
their thoughts, beliefs, values
and images; connecting their
feelings and behaviour to their
thoughts and beliefs; helping
clients to change their beliefs,
and encouraging them to weed
out their unhelpful thoughts.
The final DVD addresses
self-nurturing, and how
support and relevant feedback
can be used to build the
client’s self-esteem. A range of
research findings is presented
to underpin the approaches,
showing how specific groups
of clients have benefited
from these interventions.
Watching these DVDs is
like being in the workshop
(without, of course, being
able to ask questions). It is
at times difficult to read the
OHP slides but the key learning
points are repeated at regular
intervals in a form suitable for
copying and printing from the
screen shots. The workshop
proceeds at a good pace and
Paul Grantham’s presentation
is consistently interesting.
Overall these DVDs give a
solid, evidence-based approach
to working with clients to
improve their self-esteem.
Watching this workshop is
certainly worth the three
hours CPD suggested.
Adrian Pepper is in private
practice as a counsellor,
psychotherapist and supervisor
Survivors
of suicide
After the suicide: helping
the bereaved to find a path
from grief to recovery
Kari Dyregrov, Einar Plyhn
and Gudrun Dieserud
Jessica Kingsley Publishers
2011, £17.99
ISBN 978-1849052115
Reviewed by Sarah Lewis
The number of people
affected by one suicide is
surprisingly high. The stigma
of suicide is still huge in many
societies, making it difficult
for the bereaved to find an
outlet for their grief and a
means to understand why
the person took their own life.
This translation of a book
written by Norwegian
researchers and psychologists
seeks to guide those offering
bereavement support.
Although the statistics
and examples given are
Norwegian, the themes
it addresses are universal
and the book will be relevant
to anyone affected by suicide.
It deals with the most
common questions and
reactions to suicide. We
are told that guilt and selfreproach are much stronger
than in other sudden death
bereavements, even if a
suicide note has been left.
I particularly liked the use
of personal quotes from
those bereaved by suicide,
which I found made the
book’s contents much more
real and serve to dispel some
of the taboo.
In relation to children
losing a loved one to suicide,
I found these guidelines
to be especially helpful:
‘Everything that one says
should be true – but one
need not say everything that
is true,’ and ‘Speak so that
the children listen, and listen
so the children speak’ (p76).
Other chapters explore the
professional help and support
that may be available to those
bereaved by suicide, as well
as ways of growing through
the grief process.
Layout, style and contents
are clear, enabling the reader
to select the most relevant
chapter to their own
situation, and the book is
well referenced. It will, I think,
be of help to those working
in counselling and other
professions where suicide
is encountered, as well as
to those directly affected.
Sarah Lewis is a person-centred
counsellor in private practice
Visit www.bacp.co.uk/shop for great books at great prices!
Browse the BACP online bookshop for the full range of BACP
publications including: training & legal resources, directories, research
reviews, information sheets and more.
Now available: Legal issues across counselling and psychotherapy
settings: a guide to practice – by Barbara Mitchels & Tim Bond.
44 Therapy Today/www.therapytoday.net/March 2012
From the Chair
The long
route to
registration
The new, voluntary
register for
counsellors and
psychotherapists
will shortly come
into e�ect. It has
been a long and
difficult journey, but
new opportunities
now beckon
By Amanda Hawkins
Our route to regulation
has certainly been long
and arduous, full of twists
and turns and seemingly
as though there was no end
in sight. I have at times felt
frustrated, despairing, excited
and, quite frankly, bored.
But I think we are nearly
at the end of our journey.
BACP has been working
long and hard along the
way. At first there were
the sometimes painful
negotiations with the
Health Professions Council
(HPC) via the Professional
Liaison Group (PLG) that
tried to pull the professions
of counselling and
psychotherapy together
into a coherent register.
The process flushed out the
difficulties around definitions
that lurk in the respective
professions, yet was never
able to resolve them.
Then came the general
election and everything
changed, virtually overnight.
The new Government decided
we were not a huge risk to
the public and indicated
that a ‘light touch’ regulation
was needed for us and the
other professions that were
queuing for take-off on
the regulation runway.
The Council for Healthcare
Regulatory Excellence
(CHRE) appeared on our
landscape and we started
a dialogue around a brand
new concept of registration/
regulation – the voluntary
assured register.
Lynne Gabriel (BACP’s
immediate past Chair) has
given readers a fair bit of
detail over the last year
about the new registration
scheme (see Therapy Today,
June and July 2011). But,
in brief, the scheme will
be a voluntary register held
by BACP and audited by
the Professional Standards
Authority (PSA), currently
known as the CHRE. BACP
hopes to be an early adopter of
this new form of registration
and is working hard to finalise
pathways onto the register
for all those of our members
who want to be included.
What we as a profession
have consistently wanted
from a regulation/registration
scheme is something that is
fit for purpose – something
that recognises the
complexity of our field
and provides a means
to demonstrate our
commitment to public safety.
I believe this is what we have
in this scheme. What we
won’t get is a protected title.
So what will be the
advantage of the register?
The PSA assures us that, as
the regulator, it will be its job
to publicise the scheme and
ensure that both the public
and employers will recognise
the ‘kitemark’ it represents.
Our collective aim is that,
when choosing a counsellor
or psychotherapist,
employers and clients will
consult with the register,
confident that there are
processes embedded within
it that will give them a voice
and support if something
goes wrong.
We are now in the final
stages of negotiating this
scheme and are waiting for
the legislation (in the Health
and Social Care Bill) to be
passed. When it is finalised,
there will be much to do.
‘What we as a
profession have
consistently wanted
from a registration
scheme is something
that provides a means
to demonstrate our
commitment to
public safety’
All members will be contacted
and asked if they want to
move onto the register (and
I want to highlight here the
consultation aspect – no one
will be made to go onto the
register). The entry criteria
are currently being written
and agreed, and routes to
registration decided. So watch
this space (and by ‘this space’
I mean the journal and the
BACP website), as there
will be a lot of information
coming your way over the
next few months and maybe
a few things for you to do.
We will also be writing to
all our members individually
when the register opens.
Winning the recognition
that we should have the
support of some form of
regulation has been an
important part of our
professional journey, and
we have spent a long time
moving into that ‘adult space’.
So what lies beyond? My
hope is that we will be able
to focus on what I feel are
crucial issues on our horizon
at this time: increasing
access to counselling and
psychotherapy for people
who need it, our status
and relevance in the field
of mental health and
emotional wellbeing, jobs,
standards and training.
Indeed, as Therapy Today
went to press we got the
welcome news that the
Department of Health
is expanding the IAPT
programme for children and
young people (CYP IAPT).
Extra funding has been
earmarked specifically to
help build a curriculum for
school-based counselling
that will start to build a
bridge between CYP IAPT
and school-based counselling.
It seems the Government
has listened to us when we
say young people want more
than CBT.
March 2012/www.therapytoday.net/Therapy Today 45
News/Research
Policy and public affairs
BACP continues to promote
the importance of access
to school-based counselling
with parliamentarians across
all four home nations and this
month wrote to Chris Ruane,
Labour MP for the Vale of
Clwyd, and Labour Assembly
Member Rebecca Evans
about the issue, following
questions asked in the UK
and Welsh Parliaments.
Responding to Rebecca
Evans’ question, the Welsh
Government Minister
for Education and Skills
Leighton Andrews said:
‘An independent evaluation
report from the British
Association for Counselling
and Psychotherapy (BACP),
published in November 2011,
evaluated the success of
the strategy and the longer
term effect of the service
on children and young
people.’ He also pointed
to the evidence that ‘young
people, teaching staff, local
authorities and counsellors
all express high overall
levels of satisfaction with
school-based counselling
and the role it plays in
helping young people
achieve their potential.’
Secretary of State for
Health Andrew Lansley
has announced the
Coalition Government’s
new Public Health
Outcomes Framework.
The new Framework uses
a set of 66 health measures
and will for the first time
enable councils in England
to identify where
improvements are needed
in local public health. Local
authorities will receive a
share of the £5.2 billion ringfenced public health fund to
pay for measures to address
local identified needs.
A large proportion of the
66 health measures are aimed
at improving the public’s
mental health and wellbeing,
and include employment
rates among people with
mental health conditions,
premature mortality rates
for people with severe mental
illness and numbers of people
with mental illnesses in
settled accommodation.
Responding to the
Framework, Centre for
Mental Health chief
executive Sean Duggan
said: ‘We are delighted that
the framework recognises
the stark health inequalities
faced by people with
mental health problems
and look forward to the
further development of
the indicators to improve
the wider determinants
of health to include people
in prison with a mental
illness and “school readiness”
among young children.’
BACP has been busy
responding to a number of
external consultations. These
include the recent response
to the Centre for Healthcare
Regulatory Excellence’s
(CHRE) consultation on its
Cost Efficiency and Effectiveness
Review of Health Professional
Regulators. BACP supports
the CHRE’s proposals to
improve the cost-efficiency
and effectiveness of the
healthcare regulators that
it oversees. These include
the proposals to reduce
the size of the regulators’
governing bodies and ensure
a minimum 50 per cent lay
membership. This will help
to minimise governance
costs and reduce the
likelihood of professional
concerns dominating
regulatory functions.
46 Therapy Today/www.therapytoday.net/March 2012
BACP responded to
the Welsh Government’s
consultation on The Mental
Health (Primary Care Referrals
and Eligibility to Conduct
Primary Mental Health
Assessments) (Wales)
Regulations 2012. BACP
strongly recommended
that counsellors and
psychotherapists with the
required skills and training
should be regarded as eligible
to conduct primary mental
health assessments.
Representatives of nine
national mental health
organisations, including
BACP, responded to the
National Institute for Health
and Clinical Excellence’s
(NICE) consultation on
Potential New Indicators
for the 2013/14 Quality and
Outcomes Framework (QOF).
The response warmly
welcomed the proposal
to offer a biopsychosocial
assessment to those who
respond in the affirmative to
either or both of the screening
questions recommended by
NICE. For the future, BACP
has also suggested how the
framework could better
measure the effectiveness
of the support general
practices are able to offer
to patients with depression.
In response to the Scottish
Government consultation
on its Mental Health Strategy,
BACP has suggested that
the strategy should be
broadened to include the
wider landscape of mental
health services in Scotland.
Full copies of all of BACP’s
previous consultation responses,
as well as information on
how members can contribute
to on-going consultations, can
be found on the BACP Policy
and Public Affairs web pages.
Chair of BACP
Coaching
resigns
Linda Aspey has resigned
as Chair of the BACP
Coaching division. Linda’s
long voluntary contribution
to BACP, including seven
years on the BACP Board
of Governors and two as
the inaugural Chair of
BACP Coaching, BACP’s
newest division, has been
immensely valued.
Jo Birch, who was recently
elected Deputy Chair, will
step up to lead the division.
She said: ‘I have been very
proud to work and learn
alongside Linda. We will
very much miss her energy
and commitment.’
The next issue of Coaching
Today, the journal of BACP
Coaching, will be published
in April, with a new research
column. Julie Hay, writer,
trainer, practitioner and
consultant, will be the
first interviewee in the
new On the Coach series.
Julie Hay is founder and
inaugural Chair of the
Institute of Developmental
Transactional Analysis and
a past president of both the
European and International
TA Associations.
Local coaching
networking groups will be
held in East London, York
and Central London in
March. The meetings are
free to all BACP Coaching
members. Other BACP
members are also very
welcome to attend free
as guests for a taster
session prior to joining
the coaching division.
For more information visit
www.bacpcoaching.co.uk/
localgroups.php or email
Jo Birch at [email protected]
Around the Parliaments
The Health and Social Care
Bill returned to the House
of Lords on Wednesday 8
February, to begin the report
stage of its passage through
Parliament. Peers immediately
voted to support an
amendment that called for
parity of treatment between
mental and physical health
in the health service.
Introducing the
amendment, Crossbench
peer Lord Patel said that the
amendment would explicitly
require the health secretary
to ‘promote parity of esteem
between mental and physical
health services’ and introduce
a duty to promote a health
service ‘designed to secure
improvements in the
prevention, diagnosis and
treatment’ of both types
of illness. Despite the
Government Minister’s
reassurances that any
references to ‘illness’ in
the Bill referred to both
physical and mental illness,
the amendment was passed
by only four votes.
In his first major speech
as Shadow Secretary of State
for Health, Andy Burnham MP
set out the Opposition’s vision
for mental health policy.
With reference to counselling
and psychotherapy, he called
for continued investment
in IAPT and for greater
awareness of mental health
issues in primary care:
‘We need to get to the
point where, when people
go to their GP, it would be
as normal for them to expect
questions about mental as
well as physical health and
for social or psychological
support to be offered as
routinely as medication,
perhaps more so. That means
nurturing embryonic IAPT
services and preventing them
falling victim to the salamislicing cuts across the NHS.’
There is, he said, a social
justice case and an economic
one for continued investment
in IAPT: ‘It makes no sense
to disinvest right now in a
service that saves us money in
the longer term, by reducing
demand for GP consultations
and hospital admissions,
but unfortunately, there
are already signs that these
vital services are in danger.
We need strong advocates
for IAPT amidst the current
chaos in the NHS.’
BACP Ethical Helpdesk
The BACP Ethical Helpdesk
has been transferred to
the Customer Services
department. This may
temporarily result in a
slower than usual response
to ethical enquiries while
the service is re-evaluated.
The Helpdesk team will
try to return calls as soon
as possible. However, we
suggest that members
contact their supervisor
in the first instance if they
have an ethical dilemma.
If a response is needed
from the Helpdesk team,
we recommend that
members check the BACP
Information Sheets first.
These can be found in the
members’ area of the BACP
website at www.bacp.co.uk.
The Ethical Helpdesk is open
Monday–Friday, 11am–4pm.
Please call 01455 883300
or email your enquiry to
[email protected]
BACP supports workplace
counselling study
An evaluation of the staff
counselling service at the
University of Cambridge has
found clear evidence of its
benefits for clients. The study
was supported by BACP
Workplace, who awarded
the team a seed corn grant
to pay for expert data analysis.
The practice-based research
took place in 2009–10 and
aimed to examine the normal
working of an in-house
workplace counselling service.
Over a 12-month period all
new clients were invited to
participate. Measures were
taken of each client’s
wellbeing at the beginning
and end of the counselling
sessions, and then at three
and six months afterwards,
using the Warwick–Edinburgh
Wellbeing Scale.
The results are very
encouraging. They show that,
on average, clients’ wellbeing
improved after an average of
seven sessions and that this
improvement was maintained
at the six-month follow-up.
The Cambridge University
staff counselling service was
awarded a BACP Excellence
Award 2011 for this work,
and will be presenting the
results at the 2012 BACP
Research Conference in
Edinburgh in May.
The research paper and
results are available, free for
a limited time, at http://www.
tandfonline.com/doi/abs/10.
1080/14733145.2011.638080
The BACP Workplace
division is the home for
practitioners in organisational
settings. With cuts and
closures threatened in
many counselling services,
the division is actively
campaigning to evidence
the value and effectiveness
of its members’ work, so that
organisations understand
that maintaining a workplace
service is even more vital in
today’s economic climate.
BACP members can join
BACP Workplace by contacting
the Membership department
on 01455 883300.
School-based counselling
review sets a benchmark
Preliminary results from
a survey of all secondary
schools in England and
Scotland (n=3,499) will
be presented at the 18th
BACP Annual Research
Conference in Edinburgh
from 11-12 May.
The survey was
commissioned by BACP
from a research team at
University of Manchester
led by Dr Terry Hanley.
The survey explores the
provision of and attitudes
towards school-based
counselling services and how
services are funded. Teaching
staff were also asked to rate
their satisfaction with the
school counselling service.
The results will provide
an up-to-date benchmark
for the provision of schoolbased counselling in England
and Scotland. It will also
demonstrate the value that
schools themselves place
on in-school counselling
services.
March 2012/www.therapytoday.net/Therapy Today 47
Research/Professional standards
BACP Annual Research Conference
A record number of
presentations are on the
programme for this year’s
BACP Annual Research
Conference.
The conference, entitled
‘Understanding counselling
and psychotherapy:
preferences, process and
outcomes’, takes place 11–12
May at The Roxburghe Hotel,
Edinburgh, and is co-hosted
with the University of
Edinburgh.
This is the conference’s
18th year. Over the years it
has established a reputation
as a central event in the
counselling and
psychotherapy research
calendar, where students,
researchers, practitioners,
commissioners and service
providers come together
to share knowledge, report
research findings and
exchange ideas across a
wide range of theoretical
modalities, research
methodologies and practice
settings. It is a unique
opportunity to learn about
new and upcoming research
and engage in open discussion
and critical debate about
research that can really
have an impact on practice.
This year the conference
is truly an international
research event, with
presenters from Denmark,
Malaysia, New Zealand,
Norway, the United Arab
Emirates and the United
States, as well as from all
four UK nations.
The packed 2012
programme covers a breadth
of traditions in a record
number of presentations.
These include over 50
individual research
presentations, 16 poster
presentations and two
workshops.
The nine symposia cover
a further 44 individual papers
on themes that include
spirituality, counsellor
training, school-based
counselling, case study
research and reflexivity.
Highlights of the conference
include the evaluation of
the first phase of the new
Counselling for Depression
(CfD) training and a
symposium on the PCEPS
Study on NICE guidelines
A study to be published in the
latest issue of Psychodynamic
Practice explores the key
assumptions underpinning the
National Institute for Health
and Clinical Excellence’s
(NICE) approach to guideline
development. The authors
suggest the assumptions have
led to the current reductions
in the range of therapies
available to patients in
primary care. It is argued
that NICE ought to move
away from strict diagnostic
categories and follow the lead
of the American Psychological
Association (APA) in adopting
a pluralistic approach to
psychotherapeutic and
counselling research evidence.
REFERENCE:
Guy A, Loewenthal D, Thomas R,
Stephenson S. Scrutinising NICE:
the impact of the National Institute
for Health and Clinical Excellence
guidelines on the provision of
counselling and psychotherapy
in primary care in the UK.
Psychodynamic Practice. 2012;
18(1): 25–50.
48 Therapy Today/www.therapytoday.net/March 2012
scale, which measures
adherence to the personcentred CfD competence
framework. BACP
Outstanding Research Awardwinner Jill Collins will be
there to share her research on
counselling in the workplace.
A pre-conference workshop
on 10 May on ‘Practice
Research Networks: Promises,
Pitfalls and Potential’, will be
facilitated by Joe Armstrong
from the University of
Strathclyde, Amanda
Hawkins, Senior Manager,
RNIB and Chair of the VINCE
Research Committee, and
Mhairi Thurston, also from
the University of Strathclyde.
The workshop runs from
6–7.30pm and is open to
all conference delegates.
Professor John Cape will
open the conference on 11
May with a presentation
titled ‘What makes a good
counselling and psychological
therapy service?’ Professor
Cape will report findings
from recent research on
the quality of counselling
and psychological therapy
services, drawing on
unpublished analyses
from the National Audit
of Psychological Therapies
for Anxiety and Depression
and recent analyses of
differences between IAPT
services. On Saturday,
keynote speaker Professor
Else Guthrie will present
‘Understanding counselling
and psychotherapy for clients
with physical symptoms
and medical conditions’.
Professor Guthrie will
explore how counselling
and psychotherapy can help
people with physical health
problems that are exacerbated
by emotional difficulties or
relationship issues.
So join us in Edinburgh
to share in this abundant
selection and meet leaders
in the field of counselling
and psychotherapy research
and practitioners from across
the world. The Friday evening
entertainment will be a
traditional Céilidh. We look
forward to seeing you there.
For further information and
details of the draft programme,
visit www.bacp.co.uk/research/
events/index.php
PhD bursary applications
The deadline for applications
for the next round of BACP
PhD bursaries is 5pm on
Friday 30 March.
BACP offers grants to
members who are studying
for a doctorate in
counselling and
psychotherapy. The
bursaries cover the full
cost of a year’s BACP
subscription for up to
three years. The award
does not include
Accreditation application
fees. Applicants must be
current members of BACP
and must already have
started their PhD course.
The next round of
bursaries will be available
from April. Incomplete or
late submissions will not
be considered. Successful
applicants will be notified
by email during the first
week of April.
For further details please
contact Stella Nichols at
[email protected]
CPR portal to research
Counselling and Psychotherapy
Research (CPR) is an
international peer-reviewed
journal, disseminating high
quality, peer-reviewed
research into counselling
and psychotherapy. CPR
has its own website at
www.cprjournal.com.
The website has information
on the current issue, previews
of articles scheduled for
forthcoming issues and a
Focus on Research section.
It also features information
about the editorial board,
how to write and review
articles for CPR, and a glossary
of key research terms to help
make articles more accessible
and relevant to readers.
The hope is that the CPR
website will provide a way for
counsellor and psychotherapy
practitioners and academics
to reflect on, and contribute to,
developments in counselling
and psychotherapy research.
Subscribers can also sign
up to be notified by e-bulletin
when a new issue of CPR is
published. The e-bulletins
summarise the content of
each issue and are sent free
to BACP members and nonmembers alike. Just go to
www.cprjournal.com and
follow the link to the e-bulletin.
Research
surgery
The website gives BACP
members unlimited access
to all papers that have
appeared in CPR since volume
one through to the current
issue. To access papers online,
log in to the members’ area
of the BACP website using
your username and password,
then click on the CPR Online
link on the left-hand page
menu. This will take you to
a contents list showing all
the issues of CPR that have
been published. To access the
full paper, simply click on the
paper title and select either
‘download full PDF version’
or the ‘HTML version’.
ScoPReNet membership grows
Nearly 200 members have
already signed up to the
new BACP School-based
Counselling Practice Research
Network (ScoPReNet).
The aim of the network is
to bring together practitioners,
researchers and trainers to
research and evaluate schoolbased counselling services.
Members of ScoPReNet can
access regularly updated
information on recent
research studies in schoolbased counselling and new
study findings, outcome
measures and guidance on
how to score and analyse data.
Network members will also
be able to share information
about research projects in
which they are involved.
Newly accredited
Debra Cooper
counsellors/psychotherapists Monica Cooper
We would like to congratulate
the following on achieving
their BACP accredited status:
Katharine Allen
Rosanna Amadeo
Amanda Ashman-Wymbs
Ella Bouwmeester
Helen Braithwaite
Gemma Brammeld
Dinah Brown
Mary Carnell
Wendy Carty
Brian Clark
Frances Coad
Ian Collier
Esther Cox
Phillip Cox
Deirdre Claire Coyle
Denise Craig
Sonya Cranmer
Cathy Curran
Ruby Deeman
Naomi Del Strother
Sharon Doherty
Maria Dougal
Jacqueline Doust
Linda Dowey
Louise Edwards
Linda Gardner
Giles Godwin
The BACP research surgery
supports members who do
not have access to research
supervision and have a
research dilemma, question
or problem. Research phone
surgeries are run by Andy Hill
(Head of Research) and Jo
Pybis (Research Facilitator).
If you would like to book
a 30-minute session please
contact the Research
Department on 01455 883300.
Research surgery dates are:
••Wednesday 28 March
••Wednesday 25 April
••Wednesday 23 May
••Thursday 26 June.
CPR on
Twitter
A discussion forum also
allows SCoPReNet members
to network with each other
to share research ideas,
collaborate or ask for help
from colleagues working
in this field.
To join SCoPReNet, visit http://
bacp.co.uk/schools/index.php.
For further information please
contact [email protected]
Counselling and Psychotherapy
Research (CPR) now has
its own Twitter account
@cprjournal. Follow CPR
on Twitter to get the very
latest news about counselling
and psychotherapy research,
forthcoming papers and the
current issue.
Janet Greenwood
Tracy Guilfoyle
Brian Hawthorne
Louise Heelas
Erika Holloway
Pauline Hopkinson
Amanda Jones
Jane Keenan
Ciara Kennedy
Helen Kerr
Bernadette Khan
Karen King
Joan La’Bassiere
Carolyn Langdon
Debbie Lapthorn
Caroline Laurie
Ann Lawler
France Le Garnec
Clarissa Maidment
Susan Marr
Cynthia McAdoo
Paula McClean
Malachy McGuone
Helen McLoughlin
Noel McQuaid
Elizabeth Nicholas
Barbara Noonoo
Denise O’Connell
Jan Oldham
Linda Oliver
Melanie Oulton
Janine Piccirella
Alison Platt
Debbie Rigby
March 2012/www.therapytoday.net/Therapy Today 49
Professional standards/Professional conduct
Toni Rodgers
Nicola Ross
Christine Schneider
Mo Sharpe
Fiona Shiells
Georgina Smith
Amanda Stevenson
Rachel Taylor
Alison Thomas
Angela West
Lucinda Whitmarsh
Coreen Williams
Rosita Wrigley
Newly senior accredited
supervisors of individuals
Lesley Shrapnell
Norma Williams
BACP Professional
Conduct Hearing
Findings, decision
and sanction
Paula Collins
Reference No 564973
Maidstone ME15
The complaint against the
above individual member
was taken to Adjudication
in line with the Professional
Conduct Procedure.
The complaint was heard
under BACP Professional
Conduct Procedure 2010
and the Panel considered
the alleged breaches of the
BACP Ethical Framework for
Good Practice in Counselling
and Psychotherapy.
The focus of the complaint,
as summarised by the PreHearing Assessment Panel,
is that the complainant has
questioned Ms Collins’ fitness
to practise during the time
she was on the management
committee of organisation
X, performing the role of
Finance Officer within the
organisation and working as
a counsellor covering a period
commencing September
2008. Further, it is alleged
that there were times when
organisation X would not refer
clients to Ms Collins because
Whether it is through
retirement, illness or
perhaps moving on to a
different career, we would
like to thank the following
members for their
contribution, to offer
our good wishes for the
future, and to confirm
that they may no longer
describe or advertise
themselves as BACP
accredited members:
Joy Abel
Maria Albertsen
Adam Bolland
Rachel Butler
Ruth Clark
Ann-Marie Flynn
William Hallidie-Smith
Joy Kay
Barbara Mackenzie
David McLellan
Priscilla Meyer
Aggie Moorman
Tracy Morefield
Brenda Newland
Teresa Pacchiega
Jackie Petrie
Michael Ryan
Pamela Scott
Leslie Shepperd
Nicola Slade
Mary Taylor
Dilys Thomas
Elizabeth Wood
of concerns about her fitness
to practise.
The complainant alleges
that Ms Collins was distressed
as a result of a complex
relationship with her
supervisor. The complainant
also states that Ms Collins
had been in a supervisory
relationship with E, the
previous manager of
organisation X, and that she
claimed she was a counsellor
to E’s daughter and that E
had supervised the work.
It is also alleged that
Ms Collins continued the
counselling sessions with
clients outside the counselling
room, where the conversation
could be overheard, and
allowed children to play
noisily outside the
counselling room, which
disturbed other therapists.
The complainant states
that, without prior agreement,
Ms Collins set up a website
advertising a separate service,
service B at support centre
A, which allegedly involved
the unauthorised use of rooms
allocated to organisation X.
At the Christmas party
2010 held by organisation X,
it is alleged that Ms Collins
laughed about taking illegal
drugs and allegedly
commented to the effect that
this was not a good idea when
having to get up to see clients
the next morning.
Ms Collins was allegedly
asked to attend a meeting on
1 March 2011 to discuss her
role. The complainant alleges
that, on arrival, she found
all the furniture in the room
used by Ms Collins had been
removed. The complainant
states that support centre A
advised her that Ms Collins’
security fob had been used at
the weekend. It was found that
there had been a withdrawal
of £1400 from organisation
X’s bank account, referenced
as ‘Paula Collins’ wages’. The
complainant states that this
sum was intended to cover
the room rentals and that
this caused the organisation
considerable stress because
organisation X was unable
to meet its direct debits
and financial commitments.
The Pre-Hearing
Assessment Panel, in
accepting this complaint, was
concerned with the allegations
made within the complaint
suggesting contravention
of the Ethical Framework for
Good Practice in Counselling
and Psychotherapy, and those
in particular as follows.
••In allegedly having been
Newly accredited
counselling/psychotherapy
service
Relate Bournemouth,
Poole & Christchurch
Members not renewing
accreditation
50 Therapy Today/www.therapytoday.net/March 2012
Members whose
accreditation has
been reinstated
Michael Beck
Janice Plum Taylor
Andrea Walton
All details listed are correct
at the time of going to print.
in a supervisory relationship
with E who was the previous
manager of organisation X
and also in counselling E’s
daughter and E having
supervised that work, Ms
Collins was part of a series
of dual relationships that
might have had unforeseen
and detrimental consequences
for all parties.
••Ms Collins allegedly failed at
times to monitor and maintain
her fitness to practise at a level
that enabled organisation X
to refer clients to her.
••In allegedly allowing the
counselling sessions with
clients to spill over into public
spaces where they could be
overheard or potentially
overheard, Ms Collins
allegedly risked compromising
client confidentiality.
••In allegedly advertising
a separate service without
agreement and which involved
the use of rooms reserved for
organisation X, Ms Collins
allegedly risked creating a
conflict of interest with
organisation X and for their
clients about the services
that were potentially on offer.
••In allegedly removing all
furniture and other items
from the room Ms Collins
had used without agreement
or prior notice, she allegedly
undermined working
relationships with organisation
X and their services to clients
and did not conduct her
professional relationships
with organisation X in a
spirit of mutual respect.
••In allegedly taking the sum
of £1400 from organisation
X’s bank, Ms Collins allegedly
did not behave in an honest,
straightforward and
accountable way.
••Ms Collins’ alleged
behaviour, as experienced
by the complainant, suggests
a lack of the personal moral
qualities of integrity, respect,
competence and wisdom
to which practitioners are
strongly encouraged to aspire,
as outlined in the Ethical
Framework for Good Practice
in Counselling and Psychotherapy
2007/2009 and 2010. It also
suggests a contravention
of the Ethical Framework for
Good Practice in Counselling
and Psychotherapy 2007/2009
and in particular paragraphs
4, 7, 8, 16, 26, 32, 43 and 57,
and the ethical principles
of fidelity, non-maleficence
and self-respect as outlined
in the Ethical Framework for
Good Practice in Counselling
and Psychotherapy 2010 and
in particular paragraphs 4,
7, 8, 20, 33, 35, 40, 51, 62 and
65, and the ethical principles
of being trustworthy, nonmaleficence and self-respect.
Findings
On balance, having fully
considered the above, the
Panel made the following
findings.
••There was no evidence
brought to demonstrate
that Ms Collins’ work with
E’s daughter had been
directly supervised by E.
••It was clear from Ms Collins’
evidence before the Panel
that she had considered some
aspects of dual relationships
before she accepted E’s
daughter as a client. However
the Panel found that it was
unwise of Ms Collins not to
have discussed the implications
of dual relationships with an
independent advisor.
••There was insufficient
evidence brought to
demonstrate that Ms Collins
failed to monitor and maintain
her fitness to practise at a
level that made her unfit for
organisation X to refer clients
to her.
••There was insufficient
evidence brought to show
that Ms Collins had
demonstrated a lack of the
ethical principle of self-respect.
••The Panel found that Ms
Collins was unwise to work
with a child in a room that
she had concluded was ‘not
satisfactory’ for the purpose
of play therapy. While the
Panel accepted that she had
taken some precautions to
minimise the potential risk
of compromising client
confidentiality, these were
not sufficient to justify
her decision to work in the
corridors with the child.
••The Panel found that, in
advertising a service for service
B and intending to use a room
reserved for organisation X,
Ms Collins did create a conflict
of interest with organisation
X and its clients about the
services being offered.
••Ms Collins fully admitted
that she was wrong in
removing the furniture from
Room 104. She accepted that
she had failed to realise the
impact on other people’s
clients, and on her colleagues
in organisation X.
••Ms Collins fully admitted
that she was wrong to take
money from the organisation
X bank account and said,
with hindsight, that this
had been ‘a terrible mistake’.
••In both removing the
furniture and in taking the
money from the bank account,
Ms Collins demonstrated a
lack of the personal moral
qualities of wisdom, respect
and integrity. In addition
her actions demonstrated a
lack of the ethical principles
of fidelity, non-maleficence
and being trustworthy.
••There was insufficient
evidence brought to
demonstrate that Ms Collins
had been incompetent.
••The Panel questioned
both parties about the
conversations at the
Christmas party in which
Ms Collins was alleged to
have laughed about taking
illegal drugs. However, there
were conflicting accounts, and
the Panel found that there was
insufficient evidence brought
to prove the allegations.
••In light of the above findings,
the Panel was satisfied that
paragraphs 4, 16, 26, 43 and 57
of the Ethical Framework for
Good Practice in Counselling and
Psychotherapy 2007/2009 and
paragraphs 4, 20, 33, 35, 51, 62
and 65 of the Ethical Framework
2010 had been breached.
Decision
Accordingly, the Panel was
unanimous in its decision
that these findings amounted
to professional misconduct
on the grounds that Ms Collins
contravened the ethical and
behavioural standards that
should be reasonably expected
of a member of this profession.
Mitigation
Ms Collins apologised
profusely both for removing
the furniture from a shared
counselling room and for
taking money from the
organisation X account
without prior consultation.
She said that ‘there was no
justification’ for her actions
and that she was ‘truly sorry’.
The Panel noted that there
was evidence given that
there had been a breakdown
in the relationship between
Ms Collins and the
complainant, and accepted
that Ms Collins gave some
evidence of having learned
from these events when she
said that with hindsight she
would have sought mediation.
Sanction
Within one month from the
date of imposition of this
sanction, which will run
from the expiration of the
appeal deadline, Ms Collins
is required to provide a
written report detailing
her learning from the events
leading to this complaint.
In particular, Ms Collins
should include written
reflections on her increased
understanding of the
importance of seeking
advice and guidance from
independent sources before
taking decisions that may
involve potential boundary
or ethical violations.
Within not less than nine
months and not more than
18 months from the date of
imposition of this sanction,
Ms Collins should provide
written evidence that she
has read widely and
discussed issues relating
to dual relationships and
client confidentiality. She
should provide evidence
of an informed and in-depth
understanding of these
issues, linked to her client
work. This evidence should
be countersigned by a
supervisor outside of her
current network and who
has supervised Ms Collins
for at least six months.
These written submissions
must be sent to the Head
of Professional Ethics and
Legal Services by the given
deadlines, and will be
independently considered
by a Sanction Panel.
March 2012/www.therapytoday.net/Therapy Today 51