BACP
Children &
Young People
For counsellors and psychotherapists working with young people
04
Challenging the CBT
verdict on depression in
young people
20
Cybertrauma
25
How do
I look?
39
Evaluating
a service
December 2014
02
BACP Children & Young People
is the quarterly professional
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psychotherapists working with
children and young people.
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BACP Children & Young People | December 2014 | Welcome | 03
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© BACP 2014
ISSN 2050-1897
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CONTENTS
Features
Issues
04 | What prize for curing
Alice’s tears?
Pieter Nel reviews the quality of
the evidence for using CBT for
depression in young people
09 | Priming the pump
in supervision
Ged King on group
supervision of groupwork
20 | Trauma in cyberspace
Cath Knibbs explains
possible online sources of
presenting issues
14 | Children adapted
to adversity
Sarah Sutton writes about
children who feel ‘taken in’
and tricked
25 | How do I look?
How important is a counsellor’s
physical appearance?
Nick Luxmoore writes
32 | New framework for
supervisor training
Helen Coles introduces the
BACP training curriculum
In practice
34 | Working with families
Judith Sonnenberg describes
her work
18 | Online jottings
Emma Yates offers help for
working via chat
Regulars
28 | Founding a service:
the nuts and bolts
Pauline Culliney paves the way
12 | Reflecting on…
Operation Yewtree
Jeanine Connor
39 | Young people
evaluating…
…their service. Sarah Perry
and Simon Carpenter report
on a BACP-funded pilot
12 | Thinking about…
being new to supervision
Anna Jacobs
13 | Considering…
talking about sex
Nick Luxmoore
43 | Reviews
50 | From the Chair
WELCOME
M
ost of us are confronted daily with the
misery endured by children as they try to
negotiate the world we adults have set up.
A not particularly good metaphor might
be the slug as it slowly circles the sharp,
broken gravel around a plant to get at the nourishment
it wants and needs. Mike Shooter, President of BACP
and a seasoned child and adolescent professional,
writes of needing ‘the most eclectic of approaches’
to deal with the problem: ‘Children ... rarely
compartmentalise their lives. What misery they face
in one bit spreads throughout. To tackle it, we must
offer a package of approaches, tailored to the child’s
needs, not cram the child into what “ism” suits us best.’
And that package, he states, ‘should be set within a
holistic, multidisciplinary context that tackles the
problems from every angle – home, school, peer
group and community.’1
This is the reason I try to commission a wide variety
of articles for this journal – to address issues and inspire
ideas from several different angles, in the hopes that
some of us will find some of the thinking the very thing
we needed to become aware of. I do find in life in
general that the specific piece of information I need
tends to turn up in my mind from somewhere else at
the moment I need it. And so we range in this issue
from challenging the supremacy of CBT to setting up
and managing a service ourselves so that we can run
it in the way we believe necessary; from sharing
group supervision of groupwork with a social worker
colleague to allowing young people to work out how
to evaluate the service they have been offered; from
realising again how (often uninhibited) cyberspace
activities may lie behind seemingly unconnected
presenting issues in our therapy rooms to asking
ourselves whether how we dress and appear in front
of our clients actually matters. Can we bring families
together for face-to-face experiential groupwork in
schools? Can we – at the opposite end of the spectrum
– work synchronously with invisible clients online?
Our nine book reviews this time also represent a
broad spectrum of areas that may well feed into our
work with children and young people. I do ask
reviewers not to specifically critique the book in
comparison to other similar books that are available
but rather to give us sufficient information and personal
opinion that we can consider whether we might want
to buy it when funds permit. Our reading of such book
reviews (and articles, of course) is not intended to add
to the misery we experience vicariously each day, but
rather increase our awareness of the eclectic
approaches for dealing with it that Mike Shooter
recommends. As a result, I hope we may enrich our
own practice by seeing more clearly how we might
help young clients surmount the gravel in their world
with the least further injury possible.
Eleanor Patrick
Editor
References
1 Pattison S, Robson M, Beynon A (eds).
The handbook of counselling children and
young people. BACP/Sage; 2014.
Upcoming Professional Development Days
How to ethically
set up, market and
develop a successful
private practice
Martin Hogg
12 December 2014
Newcastle
Legal issues in
therapeutic work
with children and
young people
Peter Jenkins
9 March 2015
Exeter
Working with
children facing loss
and bereavement
Sally Flatteau Taylor
23 January 2015
Edinburgh
Skills, dilemmas
and challenges
for experienced
supervisors
Sally Despenser
12 March 2015
London
04 | The CBT question | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | The CBT question | 05
WHAT PRIZE
FOR CURING
ALICE’S TEARS?
Pieter Nel asks what we should make of the claim that CBT is more
effective than other recognised psychological therapies in the treatment of depression
in young people. Having recently reviewed the quality of the evidence and its
interpretation, he offers us his thoughts
T
here is a captivating story in Alice’s Adventures
in Wonderland1 where the young Alice is
confronted by sudden and unexpected
changes in her appearance. She sits down and
begins to cry. Her best efforts to talk herself out
of her distress come to nothing. Instead, frightened
and distraught, she goes on to shed gallons of tears,
until there is a large pool all round her. Her sadness
is quite overwhelming and eventually she exclaims:
‘Who in the world am I?’ followed by ‘I am so very
tired of being all alone here!’
Alice soon becomes worried that she might be
punished for crying too much, and tries to find her way
out of her pool of tears. When she comes across a
mouse, Alice asks it for help. The mouse looks at her
rather inquisitively, but initially says nothing. When
Alice inadvertently starts talking fondly about her cat,
Dinah, the mouse is startled and forbids her to mention
her name again. Alice agrees, ‘We won’t talk about her
any more if you’d rather not,’ and tries to change the
subject by talking about a nice little dog near her
house. This time, the mouse has had enough and
swims away as fast as it can go. Alice quickly promises
not to talk about cats and dogs anymore, and the
mouse returns slowly to her.
By this time the pool (of tears) is getting quite
crowded with birds, animals and other ‘curious
creatures’ that have fallen into it. Eventually, the
whole party swims to the shore. Upon arrival, they
are dripping wet, cross and uncomfortable.
Nevertheless, the most pressing issue is how to get dry
from swimming in the pool of tears. The group starts to
quarrel about the best way to do this. Initially, the Lory
bird argues that it is older and must therefore know
better than the others. But soon the mouse stamps its
authority on the group, exclaiming: ‘Sit down, all of you,
and listen to me! I’ll soon make you dry enough!’ The
mouse delivers his remedy with aplomb, not allowing
any interruptions or questions.
When, as psychotherapists, we encounter a child
or a young person who is sad and depressed like Alice,
we can hear the advocates of different psychological
therapy models telling us what is best to do. It could be
an advocate of an older model, appealing to our sense
of respect for the wisdom of our elders. Or it could be
an advocate of a newer model, speaking with the
confidence of the young.
At present, one model – CBT – is heavily promoted
to dry children and young people from swimming in
their pools of tears.
What works for a child in tears?
When asked why CBT should be used rather than any
other recognised form of psychological therapy, its
advocates regularly point to its ‘superior evidence base’.
It is claimed that empirical studies using randomised
controlled trials (RCTs) show that CBT is more effective
06 | The CBT question | BACP Children & Young People | December 2014
than other recognised psychological therapies for
treating children and young people who have been
diagnosed with depression. What should we make of
these claims? Do these studies really provide the
unequivocal ‘evidence’ that CBT advocates like to claim?
I recently published a paper based on my own
efforts to review the quality of the evidence and its
interpretation.2 I looked specifically at the 2005
National Institute for Health and Care Excellence
(NICE) guideline on Depression in Children and Young
People,3 as this document continues to form the basis
of what treatments should be available on the NHS in
England and Wales. Since the guideline was published,
a dominant narrative has developed that individual CBT
is superior to other psychological therapies and that it
should be provided to all children and young people in
CAMHS who have been diagnosed with depression. As
in Alice’s story, we are often told to accept this narrative
without questioning or interrupting.
The NICE guideline references four RCTs where
individual CBT was compared to another psychological
therapy intervention, a non-specific control
intervention and/or wait-list.4–7 I considered these trials
separately before looking at the overall evidence that
they provide when the findings are considered as a
whole. A trial comparing individual CBT to a nonpsychological intervention (medication) was also cited
by NICE, and I considered this trial separately from
the other four.8
The interpretation of statistical data as evidence
is a crucial issue in experimental research. In the full
guideline, NICE concluded that the overall evidence for
the effectiveness of individual CBT was ‘inconclusive’.
This is an acknowledgement that the evidence base
that underpins the guideline is limited, and what
evidence there is, is weak. To get around the problem
of the lack of significant evidence for individual CBT
in the four RCTs, NICE chooses to talk of ‘clinically
important improvement’ rather than ‘statistically
significant improvement’. The problem here is not so
much the use of the concept ‘clinically important
improvement’. However, if you want to base the
superiority of your evidence claims on the fact that you
employ ‘gold standard’ RCTs, then you also have to
accept if this method of inquiry does not yield the
results that you might want.
There are numerous other problems with these four
trials and how their results were interpreted. None of
the trials included a single child under the age of eight
years, with the majority of participants at least 13 years
old. Although the full NICE guideline cautions readers
against assuming that their conclusions apply to
younger children, this advice is clearly not heeded by
those responsible for the initial CYP-IAPT training
curriculum.9 The first training manual states that
CYP-IAPT workers will be trained in the NICE guidance
to deliver CBT for children and young people, and that
they will learn to adapt a CBT approach to younger
children presenting with depression.
All four trials had small sample sizes. While this is not
unusual for these sorts of trials, they nevertheless
suffered from a lack of power. Although all four studies
used the DSM-III-R to decide who could be included in
their trials, what qualified as ‘depression’ and how it
could be determined varied from study to study.
Similarly, all four studies used different exclusion criteria
and, perhaps more importantly, excluded children and
young people with other co-morbid problems. This
matters, because in all the years that I have worked as
a clinician, I have rarely come across a child or young
person who presents with a single, uncomplicated
problem. The four studies all purport to have used
individual CBT as the intervention for which efficacy was
being evaluated. However, a closer look reveals that the
‘CBT’ that was used varied from study to study. Each
version of CBT had its own unique protocol. Also, there
was no consistency across the four studies regarding
the instruments and protocols used to measure the
effectiveness of the individual CBT that was provided.
Finally, two of the four trials were conducted outside
the UK, raising some issues relating to the ecological
validity of the findings for a UK context.
The Treatment for Adolescents with Depression
Study (TADS)8 is an altogether more robust piece of
research with a large trial and a sound design. However,
there are a number of problems with this study as well.
For example, a significant number of participants (56%)
were volunteers recruited through advertisements
rather than from actual clinical settings. There was a
large dropout rate (28%) from the CBT group in the
trial. No child under the age of 12 was included.
Most strikingly, when CBT on its own was compared
to a blinded pill-placebo at a 12-week interval, no
statistically significant difference was found.
Nevertheless, the authors conclude that CBT should be
the treatment of choice for adolescents who have been
As we can see from taking a closer
look, the clinical effectiveness of
individual CBT for children and
adolescents who have been diagnosed
with depression is clearly overstated
BACP Children & Young People | December 2014 | The CBT question | 07
diagnosed with depression. This is in stark contrast
to a comprehensive recent Cochrane review which
concluded that, based on the available evidence, the
effectiveness of interventions for treating ‘depressive
disorders’ in children and adolescents (including
individual CBT) cannot be established.10
The wisdom of the Dodo bird
Let’s return to Alice’s pool of tears. After the mouse
confidently delivered his remedy, he asked Alice how
she was now getting on, to which she replied in a
melancholy tone: ‘As wet as ever, it doesn’t seem to
dry me at all.’ At this point, the Dodo proposed that
they immediately adopt more energetic remedies. He
proposed that the best thing to get them dry would
be for everyone to participate in a ‘Caucus-race’. He
marked out a racecourse, with everyone placed here
and there along the course. However, it was a curious
race: ‘There was no “One, two, three, and away”, but
they began running when they liked, and left off when
they liked, so that it was not easy to know when the race
was over.’ Nevertheless, after a while everybody was
quite dry again and the Dodo declared that the race
was over. But who had won? The Dodo thought about
it carefully for a long time, and at last declared:
‘Everybody has won, and all must have prizes.’
In 1936 the psychologist Saul Rosenzweig, a
friend and classmate of the behaviourist BF Skinner,
published a paper discussing ‘common factors’
underlying a range of popular and competing
approaches to psychotherapy. He argued that all
forms of psychotherapy, when competently employed,
could be equally effective.11 This idea, that positive
psychotherapy outcomes are likely to be due to
competent therapists sharing common factors,
rather than specific techniques, became known
as the Dodo bird hypothesis.
Three decades later another psychologist, Lester
Luborsky, led a team using modern statistical methods
to test the validity of the Dodo bird hypothesis. They
determined that most of the positive effect that is
gained from psychotherapy is due to factors that
different approaches have in common, namely the
therapeutic effect of having a relationship with a
therapist who is warm, respectful and friendly.12 This
conclusion became known as the Dodo bird effect.
Luborsky et al13 showed that the effect size that can be
attributed to specific therapy techniques is only 0.20
(Cohen’s d). This small and non-significant effect size,
based on 17 meta-analyses, shrank even further when
corrected for the therapeutic allegiance of the
researchers involved in comparing the different
psychological therapies.12 Their findings are in line with
another large-scale review of treatment comparisons
of active treatments that found a similar effect size:
(Pearson’s r=0.19).14 Based on these findings, one might
conclude that all bona fide psychological therapies can
be equally effective and therefore ‘all must have prizes’.
It is claimed that empirical studies
using randomised controlled trials
show that CBT is more effective
than other recognised psychological
therapies for treating children and
young people who have been
diagnosed with depression. What
should we make of these claims?
Making tears pay
So why are so many CBT therapists not content with
their prizes, but work so hard to position CBT as the
most-prized psychological therapy? There is no single
answer to this question, but it is worth briefly looking
at the wider context. Much has been written about the
medicalisation of misery through the production of
psychiatric diagnoses (for example, see Moncrieff et
al).15 However, the production of psychiatric diagnoses
is not only a medical activity – it has also become a
lucrative commercial activity, a marketplace if you like.
Treating psychiatric ‘disorders’ has developed into a
big business, and the monetary prizes are equally big.
IMS Health, a market research company, estimated
that by 2006 antidepressants had become the most
commonly prescribed class of drugs in the US,
accounting for $13.6 billion of sales in the US alone
and $19.7 billion globally. By 2007 three of the 10
best-selling medications worldwide were psychiatric
medicines. According to IMS Health,16 the combined
global sales of antidepressants and antipsychotics in
2011 were $48.4 billion, roughly £30.1 billion in today’s
rates. To put this in some perspective: according to the
Office of Health Economics,17 the total UK NHS spend
on medicines (GP and hospital) in 2011 was £13.6 billion
(at list prices), so £30.1 billion would have funded all
medical drugs in the NHS for more than two years.
To compete for a share in this lucrative market, it is
essential to convince buyers and consumers not only of
the superior efficacy of your product (through effective
marketing campaigns), but also its cost effectiveness
compared to other rival products. And this is CBT’s
pitch when it comes to the treatment of children
and young people who have been diagnosed with
depression: ‘Our treatment is superior to other
(psychological) interventions, and is more cost effective
(than medication).’ But as we can see from taking a
closer look, the clinical effectiveness of individual CBT
08 | The CBT question | BACP Children & Young People | December 2014
for children and adolescents who have been diagnosed
with depression is clearly overstated.2 Is it more cost
effective? I don’t know, but in this commercialised
context of mental distress, it helps, of course, if you can
recruit an eminent economist as your main cheerleader.
Lord Richard Layard makes a passionate case for the
use of evidence-based psychological therapy (rather
than psychiatric drugs) to reduce the economic costs
of child, adolescent and adult mental health problems.
And he likes to refer to the NICE guidelines when
proposing which psychological therapy has won the
evidence race and should be awarded all the prizes.
Of course, he would not take the advice of a fictional
Dodo bird seriously, but perhaps he should take the
evidence, or lack thereof, more seriously.
Pieter W Nel is Reader in Clinical
Psychology Training at the
University of Hertfordshire, UK,
and also practises as a consultant
clinical psychologist in CAMHS.
He has a broad interest in
alternatives to more orthodox
approaches to clinical psychology
education and practice, including
non-pathologising models of
working with children and families
in psychological distress.
BACP Children & Young People | December 2014 | Group supervision | 09
Will it all end in tears?
I agree with those who point to the tenacious veracity
of the Dodo bird verdict. We should invest less effort
in trying to prove that one specific psychological
therapy model wins every time, and more effort in
systematically applying the common factors inherent
in a relational model of therapist competence. This, in
my view, is also true in relation to the treatment of
children and adolescents who have been diagnosed
with depression. Finally, the Dodo bird cautions us to
beware ambition, hubris and greed around one model
of psychotherapy getting all the prizes. It may yet end
in tears, a pool of tears, regardless of our preferred
models. And who would dry these tears?
References
1 Carrol L. Alice’s adventures
in wonderland. London:
Macmillan; 1908.
2 Nel PW. The NICE guideline
on the treatment of child and
adolescent depression: a
meta-review of the evidence for
individual CBT. European Journal
of Psychotherapy & Counselling
2014; 16(3): 267–287.
3 National Institute for Health
and Clinical Excellence (NICE).
Depression in children and young
people: identification and
management in primary,
community and secondary care.
Clinical Practice Guideline No. 28.
London: British Psychological
Society and Royal College of
Psychiatrists; 2005.
4 Brent DA, Holder D, Kolko D et al.
A clinical psychotherapy trial for
adolescent depression comparing
cognitive, family, and supportive
therapy. Archives of General
Psychiatry 1997; 54: 877–885.
5 Rossellό J, Bernal G. The efficacy
of cognitive-behavioural and
interpersonal treatments for
depression in Puerto Rican
adolescents. Journal of Consulting
and Clinical Psychology 1999; 67:
734–745.
6 Vostanis P, Feehan C, Grattan E et
al. A randomised controlled trial of
cognitive-behavioural treatment
for children and adolescents with
depression: 9-month follow-up.
Journal of Affective Disorders
1996; 40: 105–116.
7 Wood A, Harrington R, Moore A.
Controlled trial of a brief cognitivebehavioural intervention in
adolescent patients with
depressive disorders. Journal of
Child Psychology and Psychiatry
1996; 37: 737–746.
8 Treatment for adolescents with
depression study team (TADS).
Fluoxetine, cognitive-behavioural
therapy, and their combination
for adolescents with depression:
treatment for adolescents with
depression study (TADS)
randomized controlled trial.
JAMA 2004; 292(7): 807–820.
9 www.cypiapt.org/docs/CYP_
Curriculum_December_2013.pdf
(p35) (accessed 18 November
2014).
10 Cox GR, Callahan P, Churchill R
et al. Psychological therapies
versus antidepressant medication,
alone and in combination for
depression in children and
adolescents. The Cochrane Library
2012; Issue 11.
11 Rosenzweig S. Some implicit
common factors in diverse
methods of psychotherapy.
American Journal of
Orthopsychiatry 1936; 6(3):
412–415.
12 Luborsky L, Singer B, Luborsky
L. Comparative studies of
psychotherapies: is it true that
‘Everyone has won and all must
have prizes’? Archives of General
Psychology 1975; 32: 995–1008.
13 Luborsky L, Rosenthal R, Diguer
L et al. The Dodo bird verdict is
alive and well – mostly. Clinical
Psychology: Science and Practice
2002; 9(1): 2–12.
14 Wampold BE, Mondin GW,
Moody M et al. A meta-analysis of
outcome studies comparing bona
fide psychotherapies: empirically,
‘all must have prizes’. Psychological
Bulletin 1997; 122: 203–225.
15 Moncrieff J, Rapley M, Dillon J.
De-medicalizing misery: psychiatry,
psychology and the human
condition. Basingstoke, Hampshire:
Palgrave Macmillan; 2011.
16 www.imshealth.com/
deployedfiles/ims/Global/Content/
Corporate/Press%20Room/
Top-Line%20Market%20Data%20
&%20Trends/2011%20Top-line%20
Market%20Data/Top_20_Global_
Therapeutic_Classes.pdf (accessed
13 October 2014).
17 www.abpi.org.uk/our-work/
library/industry/Documents/
OHE%20ABPI%20Medicines%20
Bill%20Forecast.pdf (accessed 13
October 2014).
Priming the pump
in supervision
Ged King undergoes supervision of her young
people’s therapeutic groupwork alongside her
co-facilitator – a social worker – and explains
how her organisation uses joint supervision of
groupworkers to enhance both the particular
group’s process and their own personal and
professional development
T
herapists are accustomed to the concept of
individual clinical supervision – something many
other professionals in complex roles view with
envy. I am currently working as a therapist at
the Young Person’s Advisory Service (YPAS) in
Liverpool, where we have also introduced group
supervision for groupwork projects. This evolved in
connection with the anger awareness project I cofacilitate, but has also been used for the facilitators of
the self-injury groupwork and a communication group
(the Talk Don’t Walk project).
The ethos behind our group supervision is to
enable the group facilitators to explore their working
relationship in the context of each group they deliver,
so as to enhance their own professional development
and encourage the continual evolution of the
groupwork. The counsellor role is an individual one,
but the group co-facilitator role is a public one and as
such is more exposing. Thus group supervision allows
us to process some of the difficulties that a public role
can produce. In theory, this sounds like a very tidy
process, but due to the fact that practitioners are
human beings working with human young people,
it is much messier in practice.
This article is a joint attempt by our group supervisor
and me to share some of the learning we have
experienced over the years.
How our group supervision is organised
Each group’s facilitators will organise their own
supervision, and there is obviously a certain amount of
flexibility around the practitioners’ availability. But the
guidelines suggest that supervision should be planned
to happen within two weeks of the end of a group. This
enables the facilitators to recall the individual group
participants and any issues that may have occurred.
The sessions last two hours to give sufficient time
for the facilitators to process and explore their feelings
around the group and any issues that may have arisen
with each other. The group supervisor is selected by
the facilitators rather than by the organisation, which
has an impact on how we see her – as an independent
person rather than part of the organisation. However,
one of the interesting features of the groupwork at
YPAS is that group facilitators are not necessarily
trained therapists. Both the anger awareness groups
and the Talk Don’t Walk groups have been cofacilitated by both a qualified therapist and a trained
social worker. As a result of these professional
differences in both practice and theoretical outlook,
it has been important, in the early sessions of
supervision, that the facilitators agree on the style/
model of supervision they feel would be of most
benefit to them. Social workers often have a different
view to therapists about the use of supervision,
so some exploration and discussion is supported by
the supervisor to establish what facilitators want to
use the supervision sessions for – whether this is for
processing issues that have arisen with group
members, or whether it has more of a personal
development aspect to it, to explore the dynamics of
the relationship between the facilitators. In practice,
it has often become a mixture of both elements, as
issues in the group often highlight the dynamics
between the facilitators.
The reality of working within an organisational
context means that wider issues from outside the
groupwork can be explored in supervision, in terms
of their impact on the facilitators. Funding cuts, job
insecurities and workplace dynamics have all been
explored with the supervisor, and it is this freedom and
flexibility that YPAS allows us as an organisation, that
enables us to grow and develop as professionals.
10 | Group supervision | BACP Children & Young People | December 2014
The reality of working within an
organisational context means that wider
issues from outside the groupwork can be
explored in supervision, in terms of their
impact on the facilitators
Types of issues explored in
groupwork supervision
Groupwork supervision has been embedded in YPAS
for more than seven years, involving many different
groups and individual young people. As a result, every
issue that we can think of has probably been covered.
Group supervision allows us the time and space to
explore issues that may have impacted on us
individually or as co-facilitators, enhancing our
awareness of them and how they affect our work.
During one of our anger awareness groups, we had
a young person attending who was consistently
sabotaging the group through disruptive and
challenging behaviour. Due to their initial referral and
one-to-one assessment for the group, I was aware
of their complex and difficult background, so was
prepared to extend some flexibility around their
involvement in the group. However, this culminated
in the group behaviour becoming increasingly
challenging, and led to us asking this young person to
permanently leave the group. At our group supervision
session, I was able to explore my reasons for allowing
this person to become involved in the group, despite
my previous experiences telling me that they were not
a suitable participant. Through the supervision
process, I was able to identify and understand my own
‘rescuer’ syndrome – not unusual for many therapists,
I think – which enabled us to tighten up our assessment
process and gently steer potentially disruptive
participants towards individual work rather than trying
to rescue them in a group setting. This event also
highlighted the need to establish and maintain
boundaries, and the importance of containment,
to keep the group and the facilitators safe.
Nurturing the groupwork through supervision
All groupwork programmes that we run at YPAS
have evolved into organic processes, in which we as
facilitators try to structure the programmes around the
needs of the individual young people. This is obviously
restricted to some extent by the constraints of the
funding and the outcomes expected, but we do try
to reflect the young people’s needs in each group.
So group supervision will often involve an exploration
of which parts of the programme worked for the young
people and which parts were difficult. The Talk Don’t
Walk project, for example, involved a Lifeline exercise,
in which the group members were invited to plot some
of the challenging events of their life, and some of the
positive ones, sharing these with the other group
members. We had found that this helped the group
to bond – through sharing their stories, they quickly
became a closer group and more supportive of each
other. However, we are also aware that this sharing can
encourage young people to reveal very difficult and
complex issues that the groupwork is not intended for,
and not funded to do. At groupwork supervision, we
were able to explore the reasoning behind the Lifeline
exercise, discuss its relevance to our intended work,
and as co-facilitators evaluate its impact on the young
people we were working with.
Training for groupwork
The experience and training of the facilitators in the
groupwork projects varies. Some have been trained in
specific groupwork techniques such as CBT, and some
have had more generalised training in how to create
a safe nurturing group, such as the Family Links
BACP Children & Young People | December 2014 | Group supervision | 11
Nurturing Programme.1 The facilitators are either
qualified social workers or qualified therapists, but
much of our learning is done on the job, which is where
groupwork supervision is really useful. The group
supervisor is an experienced group facilitator who has
been involved with personal development groups in
a university setting for many years. As a result of her
experience and input, we have been able to develop
and refine the group programmes within YPAS,
incorporating techniques and activities that we have
discussed in supervision.
For example, our anger awareness group needed to
involve some aspect of future planning, in order for the
young people to take forward and remember the parts of
the group programme that had resonated with them.
We discussed this in supervision and decided that at the
end of the group programme we would set the members
a task of writing a letter, in which they would remind
themselves of what they had felt was important to them
from the two-day programme. The letters would then be
sealed up and put away until the young people revisited
us for the catch-up group six weeks later, when we would
return the letters to them and they could revisit their
personal statements. This aspect of the programme was
particularly important for group members, and might not
have been developed without the reflective space and
input of the groupwork supervision.
Personal development as well as
professional development
When I began working with groups, I was a newly
qualified counsellor fresh out of university and feeling
very unsure about my ability to co-facilitate groups
of young people in any sort of meaningful way.
Fortunately, YPAS trusted me to learn and grow into
this role, and invested in the groupwork supervision
to support and develop my practice. I was initially
co-facilitating with a more experienced practitioner,
who was remarkably patient and ‘giving’ with me
and was a big part of my professional development.
The group supervision, however, also enabled me
to explore with my co-facilitator some of my feelings
about being the ‘new girl’, about feeling inexperienced
and occasionally useless, and helped me to recognise
my own abilities and strengths. As I currently cofacilitate groups with other professionals who are
now the ‘new girl’ or ‘new boy’, I am able in our group
supervision sessions to help them, too, to recognise
their own unique strengths and abilities – continuing
the cycle of personal and professional development
that started in our first supervision sessions all those
years ago.
Tips for group supervision of groupwork
Our supervisor, Caro Marsh, came up with these
tips that reflect what we have learnt from our past
experiences. My hope is that they will help inspire more
groupwork projects that can grow and develop under
good supervision.
• Remember that with good groupwork supervision
in place, groupwork can become a valuable
alternative to individual one-to-one work, especially
but not exclusively in cash-strapped times.
• Choose a supervisor with experience of group
dynamics and not just one-to-one clinical practice.
• Make sure your funding bids include provision
of professional supervision/support.
• Have a warm, pleasant place for groupwork
supervision – in-house is good and cuts down
on travel time.
• Prepare to be surprised at how challenging
groupwork and co-facilitation can be in practice –
but also how rewarding it is if there is a reflective
and accepting place for the team to consider the
group process and content.
Ged King completed her PG
diploma in person-centred
counselling and psychotherapy in
2006 at Liverpool John Moores
University, and has been a
counsellor and group facilitator in
the Young Person’s Advisory
Service since then. She completed
a graduate diploma in child and
adolescent mental health at the
University of Central Lancashire.
Email [email protected]
Reference
1 www.familylinks.org.uk/
The-Nurturing-Programme
12 | Opinion | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | Opinion | 13
OPINION
JEANINE CONNOR
ANNA JACOBS
Reflecting on...
Thinking about...
OPERATION
YEWTREE
Jimmy Savile, Rolf Harris, Gary Glitter –
household names of a 1980s childhood.
Men who found notoriety on the roll-call of
Operation Yewtree. Publicity surrounding
police investigations has led to terms such
as grooming, paedophilia and child
pornography entering the vernacular, often
inaccurately. It has also led to widespread
mistrust and mislabelling, and it’s time to
set the record straight.
‘Paedophilic disorder’ is a paraphilia
characterised by sexual fantasies and urges
towards prepubescent children (DSM-5).¹
Diagnostic criteria require that symptoms are
present for at least six months and include:
the presence of sexually arousing urges,
fantasies or behaviour towards prepubescent
children in individuals aged 16+, and that
the fantasised children are at least five
years younger than the perpetrator. Not
all individuals who molest children are
psychiatrically unwell paedophiles. Nor are
older adolescents who engage in sexual
activity with younger adolescents. Psychiatric
classification systems exempt them, and
rightly so.
Grooming is a criminal offence whereby
an adult with sexual intentions towards a
child elicits a meeting. The objective is
sexual contact, trafficking, prostitution or
the production of explicit images. So called
‘stranger danger’ has been drummed so
vehemently into so many children that every
adult is viewed with suspicion. This is a terrible
shame. The act of befriending a child does
not equate to grooming and the majority of
adults have benign intentions towards them.
Child pornography is a misnomer. Images
labelled as such are representations of child
sexual abuse. Furthermore, research suggests
that an extensive collection of such images
is a strong indicator of sexual fantasy and
intent. The creation, storage and circulation
of sexually explicit images of children is a
crime. The growing trend of sharing sexually
explicit ‘selfies’ with same-aged peers is
imprudent and ill advised, but it isn’t criminal
and nor is it paedophilic.
Operation Yewtree has highlighted
historical and truly heinous sexual crimes and
this has led to the conviction of guilty men.
But there have also been a number of highand low-profile investigations that have not
resulted in convictions. Some say there is no
smoke without fire. What I say is, let’s educate
ourselves and others so that we are at least
speaking the same language. Let’s equip
young people with the capacity for safe
decision making with regard to their sexual
behaviour. Let’s continue to implement
professional curiosity. But please let’s not
forget to exercise our common sense.
Jeanine Connor MBACP works as a child
and adolescent psychodynamic psychotherapist
in private practice and in specialist Tier 3
CAMHS, and is also a writer.
www.seapsychotherapy.co.uk
Reference
1 DSM-5. Diagnostic and statistical manual
of mental disorders. Fifth edition. American
Psychiatric Association; 2013.
BEING NEW TO
SUPERVISION
When I meet a new supervisee for the
first time, whether new to the profession
or a seasoned traveller, I hold a few key
things in mind.
I like to hear about their needs; their
theoretical stance; how open they are to
more personal insights; if they need
therapeutic goals; if they love a vibrant
discussion; whether they’re willing to play
with my creative tools; need support for
work situations; have ethical dilemmas; or
indeed are looking for a challenge. And if
they prepare.
They need to hear about me too. After
all, supervision is a key relationship, the
backbone of counselling, especially when
working with children and young people.
When we meet for the first time, we do
our first dance of engagement and sense
each other’s awarenesses and needs – much
as the first session between client and
therapist is that same dance of heightened
awareness. Ours is a mutual dance, I believe.
When meeting Barbara for the first time, I
heard her need for clear support, especially
for her complex young clients in care. I also
heard both fear and intrigue concerning my
tools of play. Our first two sessions were
spent talking – but then she touched on an
issue related to boundaries and I felt an
opening of opportunity, as the sandtray
can be perfect for this with its very physical
boundary of the edges.
NICK LUXMOORE
Barbara felt the sand’s substance and
texture and tentatively placed two items
in the sandtray, carefully choosing where
they went. ‘Aha,’ she said. ‘I know this from
my childhood.’
Wonderful, I thought. That recognition
of familiarity is the beginning of safety.
She proceeded to explore safety and
containment metaphorically, her
movements mirroring the over-familiarity
her abused client had shown her.
Afterwards, we made sense of her dilemmas
verbally, making space also to practise
new responses. Our trust had begun.
From these gentle beginnings, our
supervisory relationship meandered in
and out of creativity, discussion, insights,
systems issues and other challenges for
more than two years. Barbara gained an
ease in how to use supervision for her own
needs. She knew when to ask for a creative
tool, when to simply talk, and she trusted my
insights (as I trusted hers) to guide and ask.
She became empowered to use supervision
for her differing needs. Ours was a vibrant
relationship, based on respect, exploration,
some challenge and much growth. From
tentative beginnings, our dance became
truly a tango of transformation.
Anna Jacobs is a counsellor, creative arts/play
therapist, supervisor and author based in the
South West.
Considering...
Like other subjects that we instinctively
avoid, we usually avoid the subject of sex
because of our own anxiety, including –
probably – our paedophilic anxiety. Does
asking about sex mean that I’m being weird?
Or prurient? Or nosey? Am I over-reaching
myself? On the one hand, we’re deterred by
the spectre of Jimmy Savile, but on the other
hand, we’re aware of the collusive secrecy of
sexual exploitation in Rotherham, Oxford
It’s not the only issue and, for many young
people, may not be the most urgent issue. But and who knows where else.
Most young people won’t initiate
sex is always one of the important issues for
conversations about sex any more than
young people, regardless of whether or not
they’ll initiate conversations about other
they’re in sexual relationships or on the cusp
difficult subjects. Instead, they rely on us to
of sexual relationships. They’re surrounded
anticipate and understand their unspoken
by sexual images, by talk of sex, by other
need. They rely on us to do the asking.
people’s sex lives. Their bodies are changing
We have to find ways of initiating the
in readiness for sex. Other people, including
conversation, and to do that, we probably
their parents, are increasingly reacting to
have to think carefully and rehearse our
them according to all this and yet… and yet
questions in supervision. There’s huge
I suspect that we don’t talk about sex much
pressure to leave the subject alone, to leave
in counselling with young people.
it to someone else. But when we do that,
Of course, it depends on what we mean
whose need are we really serving?
by ‘sex’. We certainly do talk a lot about
romantic relationships and we might talk a
bit about sexual orientation. But what about
the sex bit itself? What will sex by like? Will I Nick Luxmoore is a school counsellor,
psychotherapist and author.
be any good at it? What will people expect
See www.nickluxmoore.com
of me? What about the things I don’t know
or don’t understand? What if I don’t like sex?
Who can young people talk with about
these things? Their parents? Unlikely. Their
friends? Possibly, but friends can be
unreliable witnesses. What if young people
want to talk about sex with their counsellors
but sense that it’s somehow off-limits? What
if they sense an unease in their counsellor?
Who do they talk with then? Or are they
obliged to muddle through, learning that
this most intimate, personal and confidenceaffecting part of their lives is to be
negotiated alone?
TALKING
ABOUT SEX
14 | Deprived children | BACP Children & Young People | December 2014
Being
taken in
Sarah Sutton explains how we make
meaning of what we perceive as truth – and the
challenge of working with children adapted to
adversity, who display a deeply embedded sense
of being taken in by some horrible trick, despite
wanting to find a ‘home’ with the therapist
T
he trouble with a disturbed start in life is that
you bring it with you. Detention centres and
prisons are full of children who had disturbing
early experience, and couldn’t leave it behind
as they grew up. How many of us working with
such children have been puzzled and frustrated at
their apparent refusal to ‘know a good thing when
they see it’?
Recent neuroscience explains the predicament.
Research demonstrates that what we think we see is
what we get. Even at an everyday level, we see what
we expect to see – witness the invisible gorilla
experiment, a selective attention test.1 A powerful
truth is expressed in the old saying, seeing is believing.
However, if we look even briefly at perception and
‘the evidence of our eyes’, it turns out to be much
less straightforward than it sounds.
What you see is what you get
You may well have seen Shepard’s so-called
impossible elephant, officially the L’egs-istential
Quandary,2 where the elephant’s legs seem to be the
background and vice versa. Or how about the McGurk
effect?3 Type www.youtube.com/watch?v=G-
lN8vWm3m0 into a search engine, watch and listen,
and then close your eyes and listen again.
What we take in from the world around us, what is
presented to our senses, is not so much a presentation
as a re-presentation. We are unconsciously working
out what we could be hearing in the context of what
we are seeing. This itself is influenced by what we have
known in the past. In the McGurk effect, we know that
the shape of the mouth cannot be making the baba
sound, and so we do not hear it, but hear what would
fit with the evidence of our eyes. This is central to the
problem for children with adverse early experience.
The mind’s task is to find out what could be
happening, on the basis of past experience.
Meaning is not a given, even in things we see
with our own eyes; it’s what we make of it that matters.
This depends entirely on context. In our earliest days,
we use the mind of our mother for cues about
meaning, through the emotional responses we read
in her face and body. We continue to develop our
own context – specific ways of understanding what
happens to us – even, as we have seen, the ‘evidence’
of our own eyes. The mind is excellent at filling in the
gaps – for example, take peripheral vision. We have
no perceptual cone cells for colour in our peripheral
vision; instead we have rod cells there, which are
good at picking up movement but unable to
distinguish colour, and so what we should see is
grayscale at the edges of our visual field. We don’t.
We see the colours we expect. Furthermore, we
actively exclude contradictory evidence – like the
actual sound of the baba clip, or the actual shape
of the impossible elephant.
The basis for this is the neuronal plasticity of the
brain, which adapts to our own particular environment.
This way, we learn how to fit in and belong, and so get
protection and improve our chances of growing and
flourishing. As we know from our own personal and
clinical experience, past experiences are essential in
shaping our perception of the world and our relation to
it. In the psychoanalytic world, it is called transference.
Siegel,4 among others, gives us the neurobiology
of transference. He explains how we actually seek
particular kinds of relationships to match our
expectations. The cues about how to relate in our early
world set us up in later life to notice and respond to
particular situations and not to others. This bias leads
us to perceive, process and act in a particular way, laid
down in neural connections from our earliest years.
These pathways are repeatedly reinforced, and the
bias of our system gets stronger and stronger as we
grow. No wonder it’s so hard to change. We are
continually seeking out confirming evidence and
mentally deleting any evidence to the contrary.
Studies5 have shown that a type of cognitive
coherence – we might just call it recognition – is
necessary for the brain to process all the daily sensory
input, to prevent overload. But this recognition
actually gets in the way of really noticing. Looking at
BACP Children & Young People | December 2014 | Deprived children | 15
Shepard’s impossible elephant, the brain sees a
roughly elephant-shaped object, and recognises it as
an elephant, rather than bothering to work out why
the legs are weird. The longer we’ve been doing
something, the more likely we are to feel we know
what we’re doing – although this is likely to make us
miss things we are not expecting.
So although we can be all too sure of what we
see, we cannot be sure what this very certainty may
disguise – like the impossible elephant. Certainty
blinds us to new possibilities. This makes evolutionary
sense: see an elephant and move quickly – better
wrong than dead.
This has huge implications for therapy with children
who have had a troubled start in life. They see what
they know, just as we all do, but what they know is to
be on guard for danger.
The framing relationship
Over the past two decades, neuroscience has moved
us some way towards a fuller grasp of how early
experience shapes our brain6 and our emotional
responses.7 Balbernie explains that a baby’s emotional
environment influences the neurobiology that is the
basis of mind: ‘From the infant’s point of view, the most
vital part of the surrounding world is the emotional
connection with his caregiver. It is this that he is
genetically pre-programmed to immediately seek
out, register and exuberantly respond to.8
Children’s first relationships set a frame of
reference, a way of understanding the world. In my
book, Being Taken In, I have called this a framing
relationship9 to emphasise the set-up. Some things feel
possible, and others not; they are outside the frame of
awareness. Deprived, abused and neglected children
are aware of a depriving, abusing, neglectful world,
and, if things have been really bad, are not aware of
other possibilities. It makes sense, given what we
now know about perception, that this is how they
will experience relationships in general, even when
something different might be on offer.10 They simply
will not see it that way, just as what we saw distorted
what we heard in the McGurk effect.
For neglected, abused and deprived children, the
early worldview is unconsciously transferred to the
world of the therapy relationship, which is experienced
by the child in just the same way as people related to
them in their early world. It might feel unpredictable,
conflicting, confusing, depriving, neglectful or
abusive, and also at times exciting, and even perhaps
pleasurable. Much of this worldview is not conscious,
not available to think and talk about, having been laid
down in body memory in the earliest years of life.
This makes for a significant challenge in work with
children whose early experience has been disturbing.
The question is, how can a child take in something
new? The problem is how to build new ways of relating,
when the very process of relating is itself often
frightening. It would make sense for the child not to
take the risk, and to act a part, perhaps, while the
real fears are kept hidden from view.
The task of the therapist, like that of the new
mother, is to offer a world into which the child can be
truly taken, with all his or her impulses and force of
feeling – paradoxically including the child’s fear of
being taken in by the therapist. The challenge is how
to do this without triggering panic and flight/fright/
fight reactions and thus reinforcing the wired-in
connections. Ideas from child development studies
and neuroscience about emotional regulation4 and
attunement11 are critically important here, as are
psychoanalytic ideas about temperature, distance12
and levels of work.13
Children who have had a troubled
start in life see what they know, just
as we all do, but what they know is
to be on guard for danger
16 | Deprived children | BACP Children & Young People | December 2014
Central, too, is the feeling of being taken in, which for
disturbed children seems to involve the feeling of a
horrible trick, as well as the hope of finding some kind
of home, and being taken in in a good way. These
contradictory, puzzling feelings seem to link to the
confusion and fear felt by children with a disorganised
attachment, where the caregiver can be unpredictably
a source of fear as well as good feelings.
Learning the body language
How to address this clinically? In Being Taken In, I
describe work with a boy whom I have called Dan, in
which these difficulties were central. Dan’s start in life
was very disturbing, and it was clear as we worked
together that the complicated and conflicted feelings
of his early world were communicated chiefly through
body language. He couldn’t tell me about them. He
needed me to tune into these wordless feelings, so that
I could first begin to understand them in myself. In a
game of hide and seek we often played, he would say,
‘Don’t look – just feel!’ Finding him through feeling was
the way it had to be done. He needed me to first feel
and then slowly begin to put words to unthinkable
feelings of despair of ever having something good to
hold onto, and of fear that this whole thing might be
some horrible trick, in which I might pretend to care,
make him dependent on me and then laugh at his
need and leave him.
Putting words to these painful states of mind was
inflammatory, and needed to be done very cautiously.
It was a delicate business. I needed to try and take
account of what he could bear, while not allowing those
feelings to be altogether denied and suppressed, nor
to trample over the good feelings that were emerging.
Any talking I did, and he wanted very little, had to be
attuned to his state of mind/body, chiefly through
reflecting on mine. That was how he communicated. I
would ‘get the feeling’ of something frightening and
panicky in the room, or of something oppressive and
domineering and hostile, and eventually, of something
very very sad. I had to ask myself what he was making
me feel, and what that might be about.
Over the three years we worked together, we did,
very gradually and with lots of setbacks, begin to
establish a new way of relating, in which he had a hope
that he could be cared for and could begin to trust that
someone could be alongside him, interested in how it
felt for him. I do not think the process of therapy
removed the old template, but our relationship did
perhaps wire in the possibility of something new,
alongside the old. The therapy relationship acted, I
think, as a kind of bridge. He could experience some
of the old fears and confusion in relation to me so that
I could resonate with them, feel them in myself and
then help begin to make sense of them.
If this sounds touchy-feely, even woolly, it’s not. It’s
hard science. It has emerged in recent years that the
emotional connection with another person has a home
Central is the feeling of being taken
in, which for disturbed children
seems to involve the feeling of a
horrible trick, as well as the hope
of finding some kind of home, and
being taken in in a good way
in our right brains. The ‘right mind’,14 which leads the way
in the first three years, is dominant for the perception
and expression of nonverbal communications.15 Schore16
tells us that the process of emotional regulation happens
between right brains in the mother-infant pair, as they
pick up on each other’s emotional states micro-second
by micro-second. This same process plays an essential
role in the communication of emotional experience in
later life, too.
Changing minds: what works
When we are able to be sensitive to the child’s
emotional state, how things happen feels different
for the child. This relates to procedural memory, laid
down in the body. We remember in our bodies not just
what happened, but how it felt. In thinking about how
memory works, we have to picture it not as taking a
document out of a mental filing cabinet, but rather
drawing an artist’s impression at speed. Pally17 tells us
that memory ‘is constructed on the spot’, together
with all the sensory and emotional impressions of what
it feels like now, as we remember the past. It is not an
exact replica of what happened then. The new
impressions include the emotional qualities of the
present relationship. For example, the fact that
someone has asked gently, when the time is right,
‘I wonder if it feels frightening for you in here
sometimes?’ becomes associated with the feeling
of danger, softening it, though not removing it.
Likewise, suggesting ‘I think you feel very alone
sometimes’, in itself can mean that someone might
now be alongside you, understanding the loneliness.
Provided our timing is right, and our tone and body
language conveys empathy, we are doing something
scientifically sound; this process opens new neural
pathways alongside old connections.
The therapy relationship, then, can be a reframing
relationship, using the very process that wired our
minds in the first place as a mechanism for change.
BACP Children & Young People | December 2014 | Deprived children | 17
With careful attunement, constellations of new
mind-brain connections can be made, and a new world
of possible ways of relating is built between us and the
child. The early framing relationship is brought into the
world of the therapy relationship, chiefly through body
language. The therapist feels his or her way into it.
I had to gradually get to know what it was like for Dan
when he was little, by asking, What is he making me
feel? and taking this as a communication about how
it felt for him then. Supervision is a vital part of this
process, helping to sort out the tangle of feelings and
what they might mean.
There is then the question of how to convey this
new understanding. The dangerous feeling of the old
connections for abused and deprived children in therapy
Sarah Sutton is a director
of the Learning Studio, has an
independent practice as a
psychotherapist, and teaches on
the Tavistock’s Psychoanalytic
Studies and Infant Mental Health
programmes. Her book Being
Taken In: the framing relationship
is published by Karnac. She is
currently working on her next
book, Missing People.
sarahsutton@
understandingchildren.org
References
1 Simons DJ, Chabris CF. Gorillas in
our midst: sustained inattentional
blindness for dynamic events.
Perception 1999; 28(9): 1059–1074.
[Also online.] http://www.
theinvisiblegorilla.com (accessed
21 August 2014).
2 Shepard R. Mind sights: original
visual illusions, ambiguities, and
other anomalies. NY: Freeman;
1990. [Also online.] http://www.
anopticalillusion.com/2012/03/
impossible-elephant/#sthash.
T6ATf1GA.dpuf (accessed 14
October 2014).
3 McGurk H, MacDonald J. Hearing
lips and seeing voices. Nature 1976;
264(5588): 746–748.
4 Siegel DJ. The developing mind:
toward a neurobiology of
interpersonal experience. NY:
Guilford Press; 1999.
5 Brochet F. Tasting: chemical
object representation in the field of
consciousness. Application
presented for the grand prix of the
Académie Amorim following work
carried out towards a doctorate
from the University of Bordeaux.
[Online.] http://web.archive.org/
web/20070928231853/http://www.
academie-amorim.com/us/
laureat_2001/brochet.pdf
(accessed 21 August 2014).
has to be crept up to gently. In my work with Dan,
I had to find a way to bring this feeling of danger into
awareness, without destroying the simultaneous
experience of new emotional qualities. Talking too soon
about his experience did not help; in fact it triggered him
into panic. He taught me that it is not about the words
themselves – certainly to begin with; it is about the way
things are said, the timing, tone, pitch and intensity of
the way we talk. We might call it the music of emotional
connection. It is this process that in itself helps make
a new road so that we can begin to draw a new map,
which can help children, if not to leave their pasts
behind, at least to see them in a new light, alongside
new possibilities, and set off in a new direction.
© Sarah Sutton
6 Schore AN. Affect regulation
and the origin of the self. NJ:
Erlbaum; 1994.
7 Perry BD, Pollard R, Blakley T et
al. Childhood trauma, the
neurobiology of adaptation and
use-dependent development of
the brain: how ‘states’ become
‘traits’. Infant Mental Health Journal
1995; 16(4): 271–291.
8 Balbernie R. Circuits and
circumstances. Journal of Child
Psychotherapy 2001; 27(3):
237–255.
9 Sutton S. Being taken in: the
framing relationship. London:
Karnac; 2014.
10 [Both these papers develop this
idea from a psychoanalytic point of
view] Williams G. Double
deprivation. Internal landscapes
and foreign bodies: eating
disorders and other pathologies.
London: Duckworth/Tavistock
Clinic Series; 1997. Emanuel L.
Deprivation x 3. The contribution
of organizational dynamics to the
‘triple deprivation’ of looked-after
children. Journal of Child
Psychotherapy 2002; 28(2):
163–179.
11 Schore AN. Affect regulation
and the repair of the self. NY:
Norton; 2003.
12 Meltzer D. Temperature and
distance as technical dimensions of
interpretation. In: Hahn A (ed).
Sincerity and other works: collected
papers of Donald Meltzer. London:
Karnac; 1997 (pp374–86).
13 Alvarez A. The thinking heart:
three levels of psychoanalytic
therapy with disturbed children.
London: Routledge; 2012.
14 Ornstein R. The right mind:
making sense of the hemispheres.
Florida: Harcourt Brace; 1997.
15 Blonder L et al. The role of the
right hemisphere in emotional
communication. Brain 1991; 114:
1115–1127.
16 Schore AN. The right brain as
the neurobiological substratum of
Freud’s dynamic unconscious. In:
Scharff D. The psychoanalytic
century: Freud’s legacy for the
future. NY: Other Press; 2001
(pp61–88).
17 Pally R. Memory: brain systems
that link past, present and future.
International Journal of PsychoAnalysis 1997; 78: 1223.
18 | Online synchronous work | BACP Children & Young People | December 2014
Online
jottings
Following from her first article about how she
set up working via live chat,1 Emma Yates
offers tips and hints to help others who wish to
take this route
T
his article should not be read as a how-to guide
to online working; it should be approached
cautiously, just as you would a marathon runner
extolling the benefits and joys of completing
their first race. What you have to remember
is that behind the evangelical joy of success is the
unseen sweat, mistakes, cursing and self-doubt.
I shall not really touch on technical/systems issues
or recommendations, nor discuss the even more
challenging issue of data protection – all of which
require separate articles. And I have not covered email
counselling for the same reason. But I had the privilege
of managing a committed and experienced team of
counsellors while implementing the introduction of an
online counselling service for young people, so, while
I will not regale you with all the nightmare scenarios
narrowly avoided, the moments of ‘what are we doing?’
and the frantic calls for tech support, what I will try to
do is draw your attention to a number of areas that will
enable you to avoid some of the potential difficulties of
online chat work. In addition, I will also include some of
my ‘advice to self’ that I use when counselling young
people online.
Setting up an online service
There is as much involved in setting up online working
as there is in actually doing it, and if that isn’t done well
enough, in my experience it backfires upon both you
and the client.
I’m addressing here the relational elements that I
believe set the foundations for the service. Of course,
much of what I think is important is inherent in
establishing any service, so I will focus only on the
issues that especially pertain to online working.
One of the most important areas to attend to is the
preparation with the referrer. Whoever is enabling the
young person to access therapy online needs to have
a good understanding of how it will work, as it will not
be suitable for some young people. You need to be
able to ‘sell’ online counselling in the same way you
may sell face-to-face counselling. As I was never
present in a venue to do this (such as a school or
youth centre), I had to rely solely on the referrer
understanding both counselling and the online
version of it. A big ask.
I would therefore recommend the following
be considered:
• Demonstrate the system to referrers so that they can
see how it works, ask questions and work through
their own doubts and fears about online working.
• Demonstrate the system to potential clients if in
an organisation – consider a drop-in, or a ‘chat to
a counsellor’ type of session.
• Ensure referrers know what counselling is like with
you, and that they know how to pass on the key
points of that to the young person.
• Be clear about the requirements of the room where
the young person will be online at their end. If
possible check it out.
• How will you explain to those at the client’s end
why the client should still be in a room on their own
despite working online? And why they shouldn’t
share the transcript with others? Or will you even
mention that this is possible?
• Be realistic about the snags and difficulties that
may occur with technology, and plan for this.
• Think about contracting – how will you do this
when you are not face to face?
• How will you receive referrals securely and
confidentially if you are not physically present?
• What will you do with the transcripts, and how will
they be stored securely? When and why might
you print them out? What are the potential
consequences of printing them?
• Revisit your safeguarding procedures – how will they
still work if you are not present, and how will you
communicate with the client if they are not present?
So, having addressed the key organisational issues,
it then comes down to you and your computer. Here,
I’m considering synchronous working, which is often
called live chat.
Pre-session preparation
• What will you do if there are connection problems
for you or your client? Do you have a plan B in case
this happens – which it will!
• You may want to consider a quick test run a couple
of days before, just to ensure that the client’s
computer can access whatever system you may be
using. (Some schools will need their IT people to
BACP Children & Young People | December 2014 | Online synchronous work | 19
sort this out, as unauthorised sites, and particularly
ones involving live chat, are sometimes blocked.)
• I used to offer a brief ‘come online and chat to see if
you like it’ meeting, which allowed the young person
to try out the system and see if they felt it might work
for them.
• I put notices up on my front door to ask visitors not to
knock or disturb.
• I take time to consider my work space. After all, I will
be sitting there for an hour. Do I need a table? Can I
sit in an armchair and type? Am I warm enough? Do I
need a brew?
•S
et up and connect early. At first, I used to set up an
hour before the session to ensure all my connections
worked and that I could get online with plenty of time
to sort out any technical problems.
• If you have a choice of typeface, which will you use?
What size font will you use? Can you use colour?
Consider seeking guidance with regard to dyslexia and
colour blindness (you can easily check this out online).
Once the client is online
• Ensure that you can type reasonably quickly. If you
can’t, this may not be the medium for you.
• Don’t worry about spelling – it can be reassuring
for the client to see you make errors too.
• Try to hit the return key fairly frequently (this sends
your message) or clients can be waiting for what may
seem like ages for your reply.
• If you are pausing to think or read, tell them that.
I sometimes type (thinking) or (hang on… I’m just
reading this). In my experience, young people tend
to write reams and then hit return.
• You may have smileys and pictures on your system,
and some young people use them regularly, so it’s
fairly accepted to use these. But I usually wait for the
young person to start using them first.
• Remember silences do not work.
• Remember, simple reflection of their comment just
looks stupid. I had a young person once who told me
that the last counsellor she had worked with online
just typed back what she had written. She was furious
with the counsellor – and so would I have been.
Revisit your safeguarding
procedures – how will they still
work if you are not present, and
how will you communicate with
the client if they are not present?
• It helps to be familiar enough with your own
technology that if the client mentions a song or lyrics
or similar, you can open another window and check it
out there and then.
• Use cut and paste. I use it for stock phrases that I use
in most sessions, for web links and for recommending
other organisations such as ChildLine or rd4u.1 This
may be possible on your system or you may need to
create a document that you can access instantly.
• Be as real as you can online. The best online
counsellors we’ve had have been people whose
online presence was really visible and tangible. Their
humanity shone through.
Probably the most valuable aspect of my learning has
been the training and practice sessions I had with
colleagues. This allowed me to experiment with many of
the aspects discussed above, it enabled me to become
familiar and at ease with the system, and it allowed me
to develop my online presence. I would recommend
that any counsellor who wishes to work online with
clients should practise with a colleague or any willing
volunteer who can give genuinely honest and
constructive feedback. Receiving feedback not only
about the therapeutic elements but also about how you
present yourself online is crucial. After all, if it turns out
that we have the online persona of a dead leaf, then
maybe we need not inflict that upon our clients!
Emma Yates is a dry stone waller,
a motorcyclist and an adventurer in
the world of counselling. Having
counselled for 14 years, she has
developed special interests in
working with children and young
people and the LGBT community.
Currently working in private
practice, offering counselling
supervision and training, she is
particularly interested in using the
outdoors in her practice.
References
1 Yates E. Ready to enter the
online world? BACP Children &
Young People 2014; September:
35–37.
2 www.rd4u.org.uk
20 | Cybertrauma | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | Cybertrauma | 21
CYBERTRAUMA
What does cybertrauma look like when it enters the therapy room?
Cath Knibbs offers practical examples and pointers to help us think about
how cyberspace can be the unnamed source behind presentations of trauma,
acute anxiety and developmental issues
Cyberbullying
Chloe is in high school and ‘knows for sure’ that
people are writing negative things about her on the
internet, which means for her that ‘everyone will see
it!’ She stresses the everyone – and she is correct to
some extent, as technically anyone can see what has
been written about her if they know how to use social
media. This is cyberbullying. Cyberbullying is rife on
the internet and via mobile phone, and most young
people will experience it at some time.
It is a huge and traumatic issue for Chloe and not
at all a grandiose view to take when you consider the
scenario. I myself cannot comprehend fully what this
is like for Chloe or anyone else. I’m sure Chloe is
struggling too. Anyone that you care to think of is
capable of seeing this information. How would that
be for us to have some information about us in a space
that is infinite by definition and a place we have no
control over? Currently, in the UK, cyberbullying is a
crime, but one that is not easily prosecuted. Police are
often called into school to warn perpetrators – the
best they can do. Chloe is lost for words about how to
describe this. This space that we cannot see, touch or
hear, feels as big as the universe to Chloe and other
young people. She is traumatised by what has
happened.
Chloe works in the sand tray and shows me the
space that surrounds her. The sand tray isn’t big
enough to accommodate all of the people who see this
information. It’s not big enough to contain her worry
about what people think of her. People in the sand tray
can shout to people outside of the sand tray about ‘the
things they’ve read about me’. She is upset, saddened,
and despises this. She tells me she is not ‘a drama
queen’ (one of the things written about her). She uses
the word ‘numb’ to describe this large space that’s both
empty and full (of people) at the same time. This space
follows her around and is in her head. It’s large and
heavy. She doesn’t like herself and feels ‘they must be
right’. She is angry, ashamed and overwhelmed and
feels as if she cannot express this to an adult: ‘They
don’t understand what it’s like. They say just ignore it,
and it’s like, you know, not as easy as that.’
This space that we cannot see,
touch or hear, feels as big as the
universe to Chloe and other young
people. She is traumatised by what
has happened
For illustration purposes: posed by model
I
have been researching cybertrauma. This covers
various aspects of trauma-based referrals that are
connected to the use of, and interaction in,
cyberspace. Cybertrauma is a large area
encompassing extreme, violent and graphic
material, sexual content, bullying, stalking, grooming
and exploitation. I will describe only a small number
of examples in this article due to space constraints,
but hope to help us think more about what might be
going on for our young clients. (All the vignettes are
a mixture of clients both real and fictitious to protect
confidentiality and identities.)
22 | Cybertrauma | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | Cybertrauma | 23
It is obviously horrifying for a five
year old to see and hear a zombie
being shot in half and still crawling
towards the camera
where I heard the noise – 10 years ago on a
PlayStation game. Sam says that he’s watched his dad
play this game and he doesn’t like it, although he only
saw glimpses of the animal on the screen. He tells me
that when he goes to bed he can hear his dad playing
the game and he can hear the noise the animal makes.
Sam cannot and does not understand that this animal
is fictional. Moreover, as we spend more time in the
room, Sam draws other fictional game and horror
movie characters. All from 18-rated material.
Useful pointers to identifying where
background cybertrauma may be an issue
Whenever she is alone she thinks about what has
been written. It intrudes into her brain. She feels numb
again. She takes a blade (the most commonly used one
is from a pencil sharpener, freely available in schools)
and she cuts her skin. She knows where to cut and how
deep to go because she’s searched online and read
up on aftercare. This is the very space that causes her
anguish but is the space that provides a solution to it.
However, now she feels something, and this is her way
to express herself. When someone sees the visible
scars in school, negative virtual comments and gossip
start the cycle again.
Chloe is a victim of cyberbullying and is also part of
recent statistics: 12 per cent of bullying is carried out
online rather than face to face. Even though this is a
fairly small percentage in terms of an actual figure, it is
on average one in every 10 clients and this figure has
increased since last year.1 In other research, the figure
is put at 21 per cent.2
The important thing here is that the vignette of
Chloe is based on referrals for self-harm that were
not initially linked to cyberbullying. Only after some
time in the room, and an exploration of the client’s
reasons for self-harming behaviour, has it emerged
that cyberbullying seems to be the cause. Are we, as
therapists, missing this by not initially asking questions
about cyberspace or cyberbullying? It strikes me as
a form of bullying that has increased in occurrence
over the last few years and is not yet fully understood
by some of us working with children. The concept of
the bullying being permanently in print, recyclable
and accessible to any and all other bullies means
that it is a longer-lasting form of intrusion, terror
and hurt for these young people, and I feel that we
need to provide a space that holds our clients and
contains this. Metaphorically, our therapy walls
need to be ‘cyberproof’.
Gaming, cognitive development and night terrors
Eddie is five years old. He presents with bereavement
issues and seems very sad. He makes a town in the
sand. There are zombies – ‘loads of zombies get cut in
half and then they get you’, ‘the zombies are baddies
that you shoot’, ‘sometimes these zombies are in my
dreams and they are scary’. Eddie introduces a few toy
cars to the story and explains: ‘These are stolen off a
mister that I just shot.’ He tells me this car is one he
designed at home on his Xbox. He tells me it’s a
Bugatti and that when he stole it, he drove over some
people to get away. Eddie has used his sand tray story
to tell me about two games that I instantly recognise
– a parallel with the storyline of Call Of Duty: Nazi
Zombies and Grand Theft Auto. These games are
rated PEGI 18. In our next session, Eddie draws a
picture. It is orange and green, and words like ‘scream’
and ‘scary’ and ‘die zombie’ are scribbled on it. He
tells me this is what his dreams are like. He doesn’t like
the zombies and they make scary noises.
Sam, nine, has a different story to tell. He is really
good at drawing. He presents with family issues and
as we work together, he draws me his favourite
cartoon character. This character is a ‘Digimon’
(similar to a Pokémon) and it’s called ‘slice and dice’.
It holds a hammer and knife in its hand. Sam explains
that this is to protect him from the animal that has a
forked tongue coming out of its mouth and makes
a sound like this… (he makes the most horrific and
terrifying noise). I am genuinely shocked, and yet I
know that I have heard this somewhere before; I just
can’t place it as we work together. I say that I think the
noise is scary and that I feel scared like he does. As
we explore the noise and what this ‘animal’ might be
doing, Sam says, ‘It looks like this,’ and draws the
animal so accurately for me that I instantly recognise
1 Ask parents/clients about the client’s use of
cyberspace at assessment, whatever the presenting
issues, but especially where trauma with a small or big
T seems present in order to learn about a client’s
relationship with cyberspace. Is it daily? Is it into the
night? Which applications does the client use and
how (eg Xbox, Facebook etc on a computer/phone/
tablet)? This is important because Facebook on a
phone will automatically play videos in the newsfeed
unless settings are changed.
2 Ask parents how many ‘friends’ the client has on
social media and if they know which sites/apps the
friends use. Friends are about popularity, but ignore
safety. This can be very important for client
safeguarding because children add unknown
people to increase their so-called popularity.
3 Ask the parents/carers about whether the privacy
filters/settings on the house computer/tablets are
set to block adult content – again, for safeguarding
reasons and access to underage material.
4 In general conversations about cyberspace, ask
clients about the kinds of thing they see or the
games they play. It can create rapport between you
and the client, but also provides knowledge about
what they do in this space.
5 Research these games yourself so that you are able
to chat intelligently with the client about the content.
6 Research ‘text speak’ and trends in order to better
understand the client’s world and what they might
be referring to. Some acronyms and words are
common at certain ages and nuances of their
external world. Words like ‘sick’ do not mean ill in
the 9+ world, and acronyms change regularly
(try www.netlingo.com/acronyms.php).
7 Use social media and/or the apps for yourself so
that you can learn what they are like and do. Learn
about their privacy settings too.
8 Do not get a child to show you how to use these
in a therapy setting – for ethical and safeguarding
reasons.
Sam and Eddie are both traumatised and terrified to go
to sleep at night, and their worries and anxieties are
linked to material they have seen in inappropriate and
age-restricted games. This does not come as a surprise
to me. In both of these cases, I am left with ethical
questions about the use and viewing of these games
and the clients’ ages. However, society seems to have
made this an acceptable situation, with many parents
claiming that this is normal and keeps their children
quiet. Or perhaps the truth is that pester power has
overcome their common sense or they wish only to
silence the nagging. Furthermore, it seems these
games and consoles are used as rewards for good
behaviour or doing chores. This means that I have to go
against the grain of society’s seemingly entrenched
belief that it’s just a game, they know it’s not real, what
harm can it do? I have had to speak with the parents
about the use of this material in the home and offer
some education around the possibly traumatic impact
this is having on their children – these games are not
suitable for the children, nor is it OK for them to be
bystanders or distant listeners. These clients are
cognitively and developmentally unable to tell what is
real or fantasy, and, due to the increasing technical
skills of the gaming industry and enhanced computergenerated images (CGI), I will also suggest that this is
going to be visually harder for even adults to
distinguish from reality in future.
What is really interesting about these two boys is
how a normal element of child development for both
ages, ie becoming scared of, and resolving, scary
thoughts and feelings at night, has seemingly evolved
into a new level of terror that includes disturbed sleep
patterns and anxiety about the games’ content – it is
obviously horrifying for a five year old to see and hear a
zombie being shot in half and still crawling towards the
camera. Our job as therapists is somewhat terrifying
too, helping to sort out a type of trauma and damage
that never used to occur from picture book reading.
I have had to speak with the
parents about the use of this
material in the home and offer
some education around the possibly
traumatic impact this is having on
their children – these games are not
suitable for the children, nor is it
OK for them to be bystanders or
distant listeners
I now wonder if the fear and stress response may have
changed for these children who are witnessing these
images in today’s virtual reality – and how this
compares to what older people witnessed before the
development of the games console. What is it like to
be a four, five or six year old seeing these images?
What is it like for a slightly older child, cognitively more
aware, with a well-developed imagination and possibly
a greater understanding of death, to watch or play
these games? And worse, in many of these games,
death itself is not the end, as there is the ability to
‘respawn’ (come back to life elsewhere in the game)
or ‘glitch’ (cheat death in some way). Many of my clients
have said that their understanding of life and death
is that ‘you respawn’ or ‘find a glitch to help’.
Child sexual exploitation (CSE)
The rise of social media use by young people,
especially synchronous applications that offer instant
responses such as Snapchat, Kik (17+) and Omegle
(18+), has meant that the level to which they are
exposed to sexual material can be very high, unless
restrictions are put in place. Many adults – parents,
teachers and other professionals – are not as aware
or as tech-savvy as young people, and many do not
know how to do this. Young people use these apps
and behave as they normally would among friends.
They take risks, and react very quickly instead of
waiting and then responding. This is quite normal
behaviour for adolescents, but in a world that is not
inhabited solely by other adolescents, the worrying
aspect about these apps is that the technology can
be misused by hebephiles and paedophiles to exploit
young people sexually. In turn, this is leading to a
rise in clients who are being referred to us for the
Cath Knibbs is a
psychotherapeutic counsellor
(MBACP registered, awaiting
accreditation) and supervisor,
working with children and adults.
She has a PG diploma in
integrative child psychotherapy
and is currently studying for an
MSc related to providing therapy
for victims of cybertrauma. She
owns PEER Support Yorkshire
CIC and is a consultant in
cybertrauma, running workshops
on cybertrauma for professionals
and parents.
BACP Children & Young People | December 2014 | Counsellor appearance | 25
aftermath of sexual exploitation. Clients can be
reluctant to disclose about this, due to the shame,
blackmail and safeguarding issues that are attached
to it. Recent media coverage of Operation Yewtree
and the Rotherham scandal highlights the ‘taboo
and distanced’ approach of professionals to this
subject matter. CSE via cyberspace is a new area of
investigation and as such there is limited information
that we as therapists can share at this stage.
Jane and John are both primary school children
and have been exploited in and via cyberspace. Their
work in the therapy room mirrors that of the process
of grooming: they expect that soon they will have to
‘do something’ for an adult – perhaps there will be
blackmail and a threat to those they love. They expect
that their story will be shared, and I suppose I am
indeed doing that very thing as I write this article,
except that they are disguised and unrecognisable
composite clients. Sexual abuse that occurs via a
webcam, phone camera or any other method, eg
explicit videos and images being shared, is abusive
and intrusive in a different way to that of the physically
abusive touch. This makes it difficult for a child or
parent to comprehend what has actually happened.
Some professionals involved have appeared to take
an attitude of ‘Well, what was actually done to this
child?’ In the therapy room, I wonder how this feels
for the child. The act of child sexual abuse is one that
brings about its own transference in the therapy room
and I ask myself at what level this changes when it’s
happened via a space that can be considered real,
virtual (generated by a computer or hypothetical) and
not real all at the same time. But nonetheless, when
CSE enters the therapy room, even hidden behind
another presenting issue, we need to remember that
it is equally traumatic for the child.
References
1 Livingstone S, Haddon L,
Vincent J et al. Net children go
mobile: the UK report. London:
London School of Economics
and Political Science; 2014.
2 www.ditchthelabel.org/
downloads/Annual-BullyingSurvey-2013b.pdf
For illustration purposes: posed by model
24 | Cybertrauma | BACP Children & Young People | December 2014
How do I look?
Nick Luxmoore explores the importance of a counsellor’s physical appearance.
Can the erotic transference become idealised or demonised and thus unavailable for discussion?
26 | Counsellor appearance | BACP Children & Young People | December 2014
L
ucas and I were together in our supervision
meeting, trying to understand what made
15-year-old Jade decide to end her counselling
meetings with him. She’d recently split up with her
much older boyfriend, which may have had some
bearing on things, but she’d been reluctant to meet with
Lucas long before that, needing to be fetched from
classrooms and, finally, sending messages through
teachers to say that she no longer wanted to see him.
Lucas was a good counsellor, a thoughtful and
honest counsellor. He was also a counsellor with
straggly dreadlocks and a wild, blond beard he never
bothered to trim. Despite wearing conventional clothes
for work, he still managed to look like a hippie. I
imagined Jade’s friends saying to her, ‘Are you going to
see that bloke? The weird one?’ and I imagined her
feeling embarrassed because, however much she may
have felt appreciated by Lucas, he probably did look
weird to her, and his appearance probably was hard
to see past.
Struggling to understand and not quite sure of
the implications of my question, I asked, ‘Was it
sexual, Lucas?’
Immediately, he asked what I meant. But explaining
was difficult. I was embarrassed, afraid of hurting
someone whose dreadlocks and beard probably meant
a lot to him. Commenting on my supervisee’s physical
appearance seemed entirely unfair, but I ploughed on,
hoping that he’d cope with what I was trying to say,
but worrying all the while in case I was saying more
about myself and about my own response to his
appearance than about Jade and whatever might
have been going on between the two of them.
‘There are girls who have a strong sense of how men
look,’ I said, clumsily. ‘They’re keen on men with slick
haircuts, on fashionable townie-boys. By “sexual”,
I don’t mean “Did Jade want to have sex with you?”,
but I was wondering how comfortable she might have
felt with you, physically?’
I squirmed.
‘Are you saying that I’m different from what she’s
used to?’
That’s it, I thought, on stronger ground now, happy
to argue that, in homogenous schools, it’s important
to promote difference but that if a counsellor is too
different, it potentially jeopardises the relationship.
I knew that some young people in school jokingly
referred to Lucas as ‘Gandalf’ and I’d heard him called
ruder names behind his back. But still I was on shaky
ground. If Lucas was black and Jade was white, would
he be too different? Of course not! If he was gay and
she was straight, would that be too different? Certainly
not! So what exactly was I saying?
I once supervised a counsellor who wore black all the
time. He was well built and wore his black clothes very
tightly, with shirt buttons undone at the top so that his
chest hair was visible. There were tattoos on his arms
and, typically, he sat with his legs apart, the outline of
his balls visible inside extremely tight black trousers.
Commenting on my supervisee’s
physical appearance seemed
entirely unfair, but I ploughed on,
hoping that he’d cope with what
I was trying to say
I remember saying to him that it might be hard for a
13-year-old girl to relax, alone in a room with him and
obliged to sit opposite such a frightening sight! I said
that he needed to think about his appearance because
appearances do matter in counselling and he’d lose
young people if they couldn’t relax with him.
He could have said that appearances shouldn’t
matter, that he was being himself and was entitled to
wear whatever he wanted. He could have said that
unless I was prepared to ask his clients what they
thought, I was probably only voicing some prejudice of
my own about black clothes and expressing my own
jealousy of his physique (I was jealous!). Fortunately, he
didn’t say any of these things and we were able to talk
more interestingly.
Stepping back to consider
I think there’s a level at which all relationships – including
counselling relationships – are sexual in the broadest
sense. We can’t help noticing and reacting to the
physical appearance of the other person. We sit there
with all of the person: not only with her words and
internal life, about which we’ll talk a lot, but also with
her clothes, colours, hairstyle, smell, the sound of her
voice, the way her body shifts in the chair.
In counselling with young people, difficulties arise
when the erotic transference between client and
counsellor becomes idealised or demonised, when
we fancy the other person or find the other person
repugnant. Our reaction will be informed by earlier
relationships in our lives and by all sorts of unconscious
processes, which is why erotic transference needs to be
a regular topic of conversation in supervision. But our
reaction to the person will also be informed by our
objective as well as subjective experience and that’s
why Lucas’s appearance seemed worth discussing.
In my experience, counselling with young people
requires a benign attraction to the other person and
that attraction can take many forms. We might find the
other person intellectually or emotionally attractive.
We might enjoy their humour. We might find them
physically attractive in a way that’s unthreatening,
unarousing and yet enjoyable – in the way that a parent
finds his or her child physically attractive. Schwartz
writes that ‘in cases where strong erotic feelings are
BACP Children & Young People | December 2014 | Counsellor appearance | 27
present in the consulting room, it is essential to be
able to enjoy erotic feelings in the countertransference
without conflict or need’.1 If the erotic transference and
countertransference are idealised (we fancy the other
person) or demonised (we find them repugnant), it’ll
be too dangerous for sexuality to become part of the
conversation for fear that these feelings will be acted
out in some way. The subject of sexuality will be
sublimated, avoided at all costs by the two people
in the room. Yet it’ll always be there.
And that was the issue for Lucas. Jade had just
split up from her much older boyfriend with whom
she was probably having a sexual relationship. It might
have been her first sexual relationship. It would be
hard for a 15-year-old girl to talk with her counsellor
about this at the best of times (assuming she wanted
to), but impossible if there was a sexual uneasiness
between them.
Young people only talk about the things and only talk
at the level that they think their counsellor can bear. If
they sense a physical or sexual unease in the counsellor,
they’ll avoid the topic of sex and sexuality. I imagine that
for Jade, as for most 15-year-old young people, how she
looked and whether or not she felt sexually attractive
was a hugely important part of her life. But it would have
felt impossible to talk to Lucas about this if she felt that
he looked strange or seemed uneasy in his own body.
And he did look uneasy, his conventional shirt and tie
at odds with his straggly dreadlocks and wild, blond
beard. He was younger than his old man’s beard made
him look, tugging at a stray lock and tucking it behind
his ear as if anxious, uncertain about something.
Looking for a good fit
In choosing a counsellor, we look for people who
are like ourselves in some way, imagining – rightly or
wrongly – that we’ll be able to attach to these people,
that they’ll keep us safe and understand us. Staunton2
identifies a ‘somatic’ kind of transference and
countertransference in therapy, while Holmes3 proposes
the notion of ‘hedonic intersubjectivity… a playful,
self-affirming, interactive sensuality’ between the two
people in the room. Of course, a counsellor’s physical
appearance isn’t the only thing that we take into
account in making our choice. We look for other
identifications as well, for a rapport that can become
Nick Luxmoore is a school
counsellor, psychotherapist and
author. See www.nickluxmoore.
com His latest book, Essential
Listening Skills for Busy School
Staff: what to say when you don’t
know what to say, has just been
published (Jessica Kingsley, 2014).
a therapeutic alliance. But how the counsellor looks is
certainly one of the factors that we take into account.
And if the counsellor looks odd in some way, then that’s
not necessarily the end of the relationship because, so
long as the counsellor seems comfortable in his or her
oddness, we can relax. A counsellor might be sporting a
bright green Mohican haircut: that in itself matters less
than our sense of the counsellor’s ease or unease with
the haircut. A Mohican haircut exuding anger is likely
to disconcert. A Mohican somehow expressing a
counsellor’s need to be noticed is likely to leave clients
feeling anxious.
Would Jade have felt better able to talk about sex
and sexuality with a female counsellor? Possibly, but
gender is only one of many factors when it comes to
choosing a counsellor, and female counsellors are just
as capable of disconcerting girls with their appearance.
I’ve supervised excellent female counsellors who have
lost girl clients because something made the girl
uneasy: the counsellor’s vocabulary perhaps, or
reticence, or low-cut top, or choice of middle-class
clothes. Inevitably, there will be unconscious factors at
play: a female counsellor might look more like a mother
than a father and Jade might have all sorts of reasons
to mistrust mothers. But appearances will also be
important. An obese counsellor might find herself
working with an anorexic girl. A pregnant counsellor
might find herself working with a girl who’s had an
abortion. Another counsellor’s wedding ring might
be significant, or her piercings, or her sudden change
of hairstyle. None of these things mean that the
relationship is necessarily doomed, but they’ll almost
certainly need to be acknowledged and thought about.
They’ll matter.
‘How do I look?’ isn’t a question that we ask our
supervisors. But perhaps we should. Robust, honest
feedback might tell us important things about ourselves
and our likely effect on clients. It was precisely this
robust kind of feedback that I avoided giving Lucas. I
could have said, ‘Lucas, you look a mess! You look like
someone pretending to be a counsellor. Your hair and
beard are at odds with your conventional clothes and
that makes you look confusing.’ He might have hated
me for saying this but could have taken it to his own
therapy and thought about why someone might say
these things. I think I’d have been doing Lucas a favour
if I’d had the courage to say what I was thinking.
References
1 Schwartz J. Attachment and
sexuality. In: White K, Schwartz J
(eds). Sexuality and attachment in
clinical practice. London: Karnac
Books; 2007 (pp49–56).
2 Staunton T. Sexuality and body
psychotherapy. In: Staunton T (ed).
Body psychotherapy. Hove:
Routledge; 2002 (pp56–77).
3 Holmes J. Exploring in security:
towards an attachment-informed
psychoanalytic psychotherapy.
Hove: Routledge; 2010.
28 | Service provision | BACP Children & Young People | December 2014
Founding a
service: the nuts
and bolts
BACP Children & Young People | December 2014 | Service provision | 29
It has always been, and continues to be, an aim of ours
to pay all qualified counsellors, and we continue to
work towards that.
Brainstorming first, acting second – don’t rush
The all-important ‘to do’ list – some might call it a
business plan – was critical for us as we sifted through
a raft of ideas, needs and actions. We spent a
considerable amount of time talking and planning
before we were in a position to act on anything.
Jane and I seemed to fall into roles – perhaps
because we each felt they were the least scary for us.
Jane is great at networking and ‘asking’, whereas my
comfort zone is researching and writing.
Building our structure with a mantra:
‘What is the purpose?’
What is the reality of founding a local counselling
service? What do you need to consider before
going that route? Pauline Culliney shares
the story of setting up Community Counselling
HP16 – with the intention of offering practical
value to anyone thinking about starting such a
service or who is in the process of doing so
B
efore I recount the journey, some wise words
from hindsight: if you decide to undertake
such a project, you will need energy, patience
and courage – lots of courage in these difficult
financial times – plus a dose of humour. I’m not
sure I started out with all these but I acquired them
pretty quickly.
I’d taken a break from counselling during 2010
following a personal tragedy and some consequent
therapy, so I was delighted to be asked by my
colleague, Jane, to join her in her vision of setting
up a local, affordable counselling service. However,
I felt I needed to consult with someone who really
knew me, my strengths and my weaknesses and that
was my very first supervisor – who had nurtured me
through my training. My biggest question for her was
‘Am I OK to do this?’ followed by ‘Should I do this?’
This opportunity highlighted the importance of
having a good supervisor/supervisee relationship in
which I was able to be open and honest, disclosing
both the good and the bad. My supervisor and
therapist have been pivotal in building my courage
and self-belief, along with a dear friend who has
stayed with me throughout.
Jane had already begun the process of bringing her
thoughts about the service into reality with two other
counsellors. I came on board at the point where:
• f unding from a charitable trust had been established
• t he name chosen
•a
logo created and
•m
arketing cards and posters begun.
I was initially asked if I would offer three hours of
counselling a week, which seemed a gentle way for me
to get back into the counselling world. But at the same
time the other two founders discontinued their
involvement due to other commitments and I ended up
in the position of working with Jane to set up the service.
As we already had significant funding established from
a charitable trust, we secured accountancy services
for advice, and ultimately registered as a Company
Limited by Guarantee. This was the best option at the
time and also protected us financially. We did look into
becoming a charity and felt that this was something to
establish further down the line – so we are now at that
point and are exploring how best to move forward with
charitable status.
Of all the ‘setting up’ processes, what felt the most
responsible and valuable task was putting together
our own policies and good practice (P&GP) document
– how we work. It provides us, and our clients, with
a stable foundation to work from.
Creating P&GP took time and focus – it certainly
tests what you know versus what you think you know,
but also what you clearly don’t. Although I did the
research and put the wording together for our P&GP, it
was very much a collaborative effort – important when
developing such a pivotal framework for a service.
We mulled over meanings, legislation and guidance
for many days, making an early decision to avoid
jargon. We wanted to understand exactly what we were
writing, in the belief that those who then read it would
also find it clear. For us, it was important that there
was no doubt about the meaning of, for example,
confidentiality, significant harm or competence.
Everything had to be clear, concise and backed up
with sound reasoning.
Our mantra thus became ‘What is the purpose?’ –
a mantra we still follow closely today.
Our P&GP document encompasses the BACP
Ethical Framework together with law and government
guidance – the latter two researched and checked
thoroughly. Part of my work is to keep us up to date
with legislative and/or guidance change that could
affect our service, particularly with regard to
safeguarding and child protection. Good sources
for this are:
•C
ASPAR – an update service run by the NSPCC1
• Coram Children’s Legal Centre2
• The local authority in the appropriate area.
From a practical perspective, we were fortunate in
finding a supportive local pharmacy whose owners
are extremely active and forward thinking in what they
provide to the local community. We rent a room at
a low, negotiated rate and we have been allowed to
furnish it ourselves – turning a very clinical room into
a welcoming space for our clients. We also have a
working arrangement whereby we don’t pay for
cancelled or non-attended appointments – a set-up
we truly appreciate. For evening appointments, we
have a separate venue and also offer the facility to see
clients in their homes if they are unable to travel for
health and/or mobility reasons.
Community Counselling HP16
So, here I am in 2014, Deputy Director of CCHP16 and
responsible for children and young people who use
our service, as well as for safeguarding issues and a
multitude of other jobs.
We are at present offering an average of 38
counselling hours each month, but have the potential
to provide 156 hours as we gradually recruit more
counsellors. In the three years we have been up and
running, we have seen clients from age 11 to 80+ years
and feel proud we have reached so many generations.
To maintain our affordable counselling vision, we have
a fee scale that offers clients guidance in deciding what
to pay, based on household income and circumstances
(they may not have access to household income). We
also offer free counselling to those unable to pay,
allocating two free places at any one time. Our intention
is to turn no one away, whatever their circumstances.
The foundation we painstakingly built
over many months is what has created
the stability and care we enjoy for
ourselves and our clients today
30 | Service provision | BACP Children & Young People | December 2014
Marketing – beyond word of mouth
We began by putting up posters, distributing
information cards about us and networking with
anyone and everyone who cared to listen. Networking
has been an extremely valuable way of both promoting
ourselves by word of mouth and becoming part of the
community. We were invited by the local food bank to
become one of the care professionals who can identify
people in crisis.
Early on, we placed an advertorial – a written piece
about counselling – in a local paper. From this, we
gained several client enquiries.
We began with a very simple website that was
created without charge by an acquaintance; this was a
good place to start and one less thing for us to do. But
we soon realised we wanted to change certain words,
expressions… well, actually the entire thing! We now
use a web service through which we are able to create
what we want and have full control at all times over
changes we might need to make. It took some time to
take the leap into this, as it was another job added to
our ongoing list. But it was one we knew was critical
to getting our message out there and creating an
accessible platform for clients – especially young
people who research online by default. This transition
has brought with it an increased number of client
enquiries, particularly from young adults aged 18 to 25.
We continue to think about where we can generate
interest and how we can get our message to potential
clients. With that in mind, we have joined Twitter and
are working on a Facebook page to connect in a
relaxed and personable way. While it remains early
days, our vision is to create a mix of informative and
supportive content for clients, counsellors or anyone
interested in what our service has to offer. We are
learning to keep up with the times.
It is said that it takes a business around two years to
really become established. That certainly rings true
with our experience. Although the idea of the service
was very well verbally supported by local GP practices,
the support initially stopped there. We had, perhaps
Creating a policies and good
practice document took time and
focus – it certainly tests what
you know versus what you think
you know, but also what you
clearly don’t
naively, thought that GPs would refer some of their
patients to us, as Healthy Minds3 always had a long
waiting list. This was not to be the case. We did,
however, manage to get an advert on one of the
surgery’s rolling information boards, together with their
agreement to have our information cards in reception.
With regular reminders that ‘we are here’, over the last
year we have not only begun to receive GP referrals but
also referrals from Healthy Minds – we can’t help but
feel accepted and valued at long last as professionals.
The lesson is to never give up promoting.
Where do our clients come from and
what can we offer that is different?
Policies written, venue secured, insurance sorted,
marketing printed – we were ready to roll, but with
a ‘chicken or egg’ question – do we need more
counsellors on board for all the clients that might ring?
What if no clients ring?
We referred back to our mantra ‘What is the
purpose?’ which threw up the answer that we needed
sufficient counsellors on board to offer counselling
support to vulnerable people in need. It would be
unethical to begin the service and not be able to
accommodate clients. So we recruited two counsellors
who were in their final months of training. At the same
time we welcomed on board a supervisor willing
to provide monthly group supervision and support
for them. What transpired was a service with four
counsellors, a group supervisor and no clients for
several months.
From now on, however, we’ll expand recruitment as
the client portfolio increases, although we’re under no
illusion that the plan might have to change at some
point. We have become very accustomed to change.
Being aware, through GP referrals, of generally long
waiting lists and short-term therapy as the default
model, we wanted to offer clients a choice – short- or
long-term therapy at the moment someone wanted or
needed it. Being able to offer open-ended counselling
at weekly or other intervals where necessary feels like
truly giving the client choices to suit them. At present
we have the luxury of being able to give as much time
as is wanted, needed or useful – facilitating a journey
for our clients that can clean emotional wounds far
beyond the surface.
What we also offer is a ‘beyond school’ service – for
holidays and those clients who feel safer seeking help
outside of the school environment. School counselling
is vital, but with many schools only having one parttime counsellor (with a waiting list) and a common
concern (of both teachers and pupils) about missing
lessons, it can only be a good thing for young people
to have the option of another place to go. We were
fortunate, early on, to have been signposted from two
local secondary schools as a service for children on
their waiting list. It is an area of work we wish to expand,
as we feel we can be of particular use to those young
BACP Children & Young People | December 2014 | Service provision | 31
people whose parents are involved in them accessing
counselling. However, it remains imperative that school
counselling continues to grow for those young people
who do not want any parental involvement.
How involved should parents/carers be?
It became clear quite early on that parental inclusion
to some extent would be beneficial for the child –
particularly as there is usually a fairly lengthy telephone
conversation with that parent or carer expressing
concerns about their child.
Where a parent or carer contacts us about their
child, we ask them to attend for part of the first free
session – the main aim being to establish clarity about
confidentiality and the independence of the child in the
counselling room. We strongly believe this shouldn’t be
left to the child to explain to a questioning parent after
the session, nor is it enough to explain to a parent over
the telephone. We back this conversation up with
leaflets for both young clients and their parents.
Our set-up appears to help the parent or carer feel
connected and supported rather than excluded – and it
makes sense that they would want to meet the person
to whom they are entrusting the wellbeing of their child.
Where appropriate, we offer an alternative counsellor
for the parent, which has been taken up on occasion.
While we do not offer family therapy, working with
parents or carers when needed is important. We have
not ruled out offering family therapy in the future, as we
have had adult clients whose issues have been around
serious breakdown in relationships with their teenage
child, but at present, we can only hope that the children
of these adults have also benefitted in some way from
the changes in their parents.
Our young clients have come with issues around
bereavement, domestic violence and extreme anxiety,
all of which have had a huge effect on their happiness
or attendance at school – often due to the addition
of either their anger in school, being bullied or nonattendance. It became clear that, for these clients,
counselling out of school was helpful – talking about
their difficulties away from the school environment
seemed to separate the problems of school (often the
parental concern) from their actual emotional difficulties
of bereavement, domestic violence or anxiety. Some of
these young people have expressed the opinion that
counselling outside of school has felt more confidential
and contained.
My journey has been mentally challenging, fulfilling
and educational all at once. It is something I remain
proud of and that has been, and continues to be, a
thorough CPD experience.
There have been times when the organisational
needs have felt overwhelming, and Jane and I have
both said ‘we just want to be counselling clients’. But
what I have come to appreciate is that the foundation
we painstakingly built over many months is what has
created the stability and care we enjoy for ourselves
and our clients today.
One other thing I’ve come to appreciate is that the
process of counsellors ‘pooling together’ – whether
you wish to call that a ‘service’ or otherwise – creates a
supportive experience for counsellors, makes it easier
to raise a profile among other professionals, and
ultimately gives prospective clients a real choice.
Strength in numbers springs to mind. In this climate
of cuts in services, perhaps this is a way forward?
If you’re about to head down a similar path, I’d like
to leave you with a few thoughts:
• Give yourself a good 9-12 months just to set the
service up.
• Build a solid, well-researched foundation that will
carry you through the growing service, and have
the courage of your convictions.
• Our mantra – ‘What is the purpose?’ – may be helpful
in clarifying the ‘why’ behind thoughts and/or
decisions.
• If you are already managing an established service,
be sure that the requirements on you don’t conflict
with the law or your own ethics and way of working.
If they do, challenge them.
Pauline Culliney is a personcentred counsellor, Deputy
Director of CCHP16, and a
sessional lecturer at Amersham
and Wycombe College, where
she co-delivers a course in
counselling children and young
people, developed by herself and
a colleague. She provides
workshops/training for local
organisations working with CYP
and has previously worked as a
counsellor in a youth agency,
local primary and secondary
schools and Place2Be.
References
1 The NSPCC Information
Service’s weekly CASPAR email
alert can be subscribed to via
[email protected]
2 www.childrenslegalcentre.com
3 Healthy Minds is an NHS
primary care psychological
therapies service.
32 | Supervision | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | Supervision | 33
New framework
for supervisor
training
To provide consistent standards for supervisor
training and link training to evidence-based
practice, BACP has launched a new
supervision training curriculum.
Helen Coles reports
B
ACP has launched a new Counselling
Supervision Training Curriculum, which
offers training providers a framework for
the delivery of supervisor training. The new
curriculum can be taught at certificate and
diploma level to post-qualified counsellors and the
suggested minimum assessment standards can be
adapted to be taught in higher/further education
and by private training providers.
The curriculum is based upon A Competence
Framework for the Supervision of Psychological
Therapies, which was developed through a
comprehensive research review overseen by an Expert
Reference Group led by Professor Tony Roth. Building
on this, BACP commissioned a research report from the
University of Leicester in 2011 on the applicability of
the supervision competences to practice. The report
confirmed that the competences are representative
of supervision practice in the field and made some
recommendations for additional competences. To
ensure best practice, the new BACP curriculum has
incorporated those recommendations, including input
on the role of independent consultancy supervision.
Consultancy supervision, also known as ‘supervision
of supervision’ is a requirement of the BACP Ethical
Framework and provides a developmental and
supportive function to supervisors.
Purpose of the curriculum
A recent internet search for information on counselling
supervision courses in the UK returned 464,000
results, with courses being taught by a range of
providers across the education and private training
sectors, at varying academic levels, for different
durations and across a range of modalities. There are
many different awards and qualifications used for
supervision training and these can be confusing for
the trainee. A BACP internal report, Counselling and
Psychotherapy Supervision Training in the United
Kingdom 2008, confirms the problems of making an
informed choice about training to be a supervisor.
According to the report, the most common awards
are at certificate and diploma level in supervision. The
majority of supervision trainings take place within the
private training sector, with the diploma in supervision
being the most popular. In higher education, the
postgraduate certificate in supervision is the most
common training. However, distinguishing what the
awards and levels of qualification mean is further
complicated, as some of the courses in the private
sector do not link in with the Qualifications and
Curriculum Authority’s National Qualifications
Framework or the Quality Assurance Agency for
Higher Education, and as many as 40 per cent of
private providers who participated in the study at
that time did not respond to the question about
external validation, or stated that they had no external
validation. Some of the shorter courses did not offer
an award.
Methods of study
Supervision courses vary widely in duration of training
and tutor contact hours, which can range from 12 to
500 hours. Almost all supervision training is done on
a part-time basis with the most popular option being
modular courses delivered over weekends. In 2008
only one course had a formal distance-learning
component. It would be interesting to revisit the r
eport today to see if advances in technology and the
increasing availability of online training and e-learning
have enabled a more blended approach to learning.
For example, the recently launched Counselling
MindEd e-portal (http://counsellingminded.com),
developed by Health Education England in
collaboration with BACP, provides access free of charge
to e-learning sessions for counsellors who wish to
develop their skills to work with children, young people
and young adults (CYPYA). There are also specific
sessions for supervisors who wish to develop their
skills to work with counsellors of CYPYA. Counselling
MindEd is not only aimed at individual learners but
also at counselling training providers, who can use
the resources to supplement existing training.
What does it mean for training providers?
To date the feedback from training providers on the
BACP curriculum has been very positive. Some training
providers may have concerns about adapting their
current format or fear losing their autonomy or
creativity. The curriculum is not, however, intended to
be prescriptive but is designed to be flexible and can
be taught to students with differing abilities at different
academic levels. Its purpose is to provide consistent
standards of supervisor training and to link training
to the evidence base for supervision practice. The
curriculum covers the range of topics needed for
comprehensive supervision training and consists of
nine units or sessions and a session-by-session guide
that connects the session to A Competence Framework
for the Supervision of Psychological Therapies.
The curriculum suggests pathways for both
post-qualification certificate and diploma level and is
consistent with the National Qualifications Framework.
Training providers can also adapt it to meet the needs
of their particular awarding body. Trainers can choose
to select and teach the units in the order that best
suits them and the needs of their students and they
can also elect to omit one or more of the sessions
on theoretical models to match the approach to the
primary model of their institution or their students.
Trainers are encouraged to use their creativity in the
development and delivery of the practice sessions
that accompany each unit, bringing theory to life by
connecting it to practice.
Training providers who use the curriculum and want
to have their supervision training courses recognised
by BACP can currently apply to do this through the
BACP Continued Professional Development (CPD)
Endorsement Scheme. BACP accreditation is however
currently under review as we recognise the need to
develop the means to recognise specialist postqualification training, like supervision training that
exceeds the current 60-hour limit of the CPD
Endorsement Scheme.
In future, aspiring supervisors will be reassured
that a course teaching the BACP curriculum is
comprehensive and contains the elements required
for competent supervision practice. The curriculum
can be used to meet the knowledge requirements of
BACP Senior Accreditation (Supervisor). The current
revision of the BACP Ethical Framework may in time
impact upon the role of supervision and members are
encouraged to keep up to date with the progress of
the revision.
Helen Coles is Head of
Professional Standards at BACP.
FIND OUT MORE
The new BACP Counselling
Supervision Training
Curriculum is available for
members to download free
of charge from www.bacp.
co.uk/research/resources/
index.php. For further
information or to give
feedback on the
curriculum, email:
[email protected]
34 | Families | BACP Children & Young People | December 2014
BACP Children & Young People | December 2014 | Families | 35
B
Working with families
efore becoming a child and young person’s
counsellor, I was a mainstream teacher.
What convinced me to change direction was
OFSTED’s assumption that all children should
follow the same curriculum and structure
in the hope that a universal standard of excellence
would be reached. I began to wonder if I was the only
one who thought the idea preposterous. Children are
not factory products to be moulded and processed
until fit for purpose. Many fall off the educational
conveyor belt along the way or remain close to the
edge, desperately clinging on. Even those who pass
through the system with credit can arrive at the other
end and still be unemployable.
So I took it upon myself to step in and listen to the
children along the way. I wanted to give them space to
learn about themselves and think about their feelings
and actions in order that they might survive and find a
measure of success.
Since then, however, I have found counselling work
to be valuable and rewarding. But I have kept realising
that my focus has needed to shift from working in
isolation with the child to embracing the context of
the whole family. Like Mones, in his book Transforming
Troubled Children, Teens and their Families,1 I realised
that the family is better considered as a whole
organism than the sum of its parts.
Working one to one with children is useful, if not
vital, for exploring their internal world. Yet it is also
rather tantalising in that I can only ever link their
revelations to their subjective view of the outside
world. Not only that, but I find myself drawn in,
becoming prejudiced and biased towards their
interpretations and agreeing or, even worse, feeling
indignant on their behalf about all the injustices and
slights that they report to me. I have ended up
suspicious of teachers and parents or carers. They
have sometimes become monstrous in my mind.
Usually, however, after a few sessions of getting to
know the child, I have always contacted the parents
or carers to meet with them, and most often ended
up feeling ashamed.
How can parents be involved in their child’s therapy so that feelings are shared where
they need to be heard? Judith Sonnenberg describes her groupwork with families
© Oleg Golovnev / Shutterstock.com
Balancing various truths
Leshai* complains that her mother loads her with too
much responsibility for her younger siblings, who, she
claims, are wild. She feels that her mother ignores her
needs and is preoccupied with her own life. Mother is
invited in and I already feel angry. Yet there before me
sits a slightly built, timid woman, at her wits’ end. She
is a single mother of four children. Her husband has
been diagnosed with a mental illness and lives in
sheltered accommodation. Her children have become
tyrants. In his absence, she battles constantly with
them, which is why they see her as an ogre. She thinks
she is being a good disciplinarian by shouting at
them until they do as they are told or run away. She
attempts to be both caring mother and firm father, but
she cannot see that she is gradually alienating them
from her.
Anthony* claims that his father never speaks to him.
Always on his computer, Dad even works in computers,
which monopolises his time. The only time Dad spends
with Anthony is when he takes him to a fast-food outlet.
Even then, neither of them speaks to the other. But
when Dad arrives at the session, he does not stop
talking. It is as though a tap has been turned on. I sit
there in disbelief. I have been expecting awkward
silences and passive aggression. He tells me how his
first wife, the boy’s mother, is living in another country.
He feels guilty because he is responsible for the split
and the boy misses her terribly. The silence between
Anthony and his father is made up of unspoken
accusations and resentment on both sides.
Clearly there is a lack of direct communication of
feelings between the generations as parents and
children move ever further apart. Both parties feel
misunderstood and not safe enough to express how
they are feeling. Parents bring their baggage from
their own traumatic pasts, which they cannot bear to
unleash, while children try to work out what is going on
and why they feel the way they do. This observation
was again clarified for me by Mones,1 who states that
‘children are immersed in the present family drama’
whereas ‘parents suffer from the residue of their past
childhood suffering’. Often, the parents of those
who act out cannot face the needs of their children.
The children remind them too painfully of their own
unresolved losses and traumas. So they avoid them
and attempt to compensate with material objects,
money or food. They cannot then understand why
their children break their toys, fritter the money or
develop anorexia.
Children thrive on a loving emotional attachment to
their parents or caregivers. According to Bowlby,2 they
develop an ‘internal working model of predictable and
loving behaviour’ and interact with the outside world
accordingly. How can children attach to a parent who is
cut off from feelings? This does not make the parent a
baddie, just a parent who, according to Winnicott,3 is
not able to be ‘good enough’ and unconscious of it. It
creates havoc, and the problems compound as the
children work their way through school.
I began to wonder what I
could do to bring parents
and children together in a
sympathetic atmosphere of
mutual appreciation and safety
36 | Families | BACP Children & Young People | December 2014
The way I was tempted to react to parents at first is
apparently not unusual, according to Shemmings and
Shemmings in their book Assessing Disorganised
Attachment Behaviour in Children.4 There, they
demonstrate an empathic model of working with
parents to combat these feelings of disapproval that
might emerge. It was formulated to help child
protection practitioners keep a level head when
dealing with parents of disturbed children. When
interviewing parents, they are reminded to stand back
and think beforehand in order to remain neutral, and to
employ ‘non-directive curiosity’ rather than being
tempted to burst in with direct judgments.
BACP Children & Young People | December 2014 | Families | 37
The whole six-week scheme has a theme such as
‘Feelings’, which is then broken down into different
topics. As an example, in one session we examine
famous portraits such as the Mona Lisa to talk about
how she might be thinking or feeling (see figure 1).
We ask children and parents to comment on the
picture. We ask open questions such as ‘How do you
think she is feeling and why?’ ‘Do you think she is rich or
poor?’ ‘Do you think she has any children?’ ‘What job
does she do?’ ‘Where was she born?’ and ‘Does she
have any brothers or sisters?’ Many of the children think
she is wealthy. Some think she looks sad because she
has left her children behind.
Taking things forward in a practical way
As a counsellor, I seriously considered this approach. I
began to wonder what I could do to bring parents and
children together in a sympathetic atmosphere without it
being too obvious. I wanted to create a climate of mutual
appreciation and safety. I wanted to break down the
barriers of communication using my own skills,
knowledge and experience, determined that if I was
comfortable and enthusiastic, my group would be too.
As a teacher, I had encouraged the children to
express themselves through creative media. I insisted
that there was no such thing as right or wrong when it
came to self-expression. This seemed to unleash a
torrent of creativity in my pupils. It was also fascinating
to discover what children could tell me through their
creative work.
For example, Caroline* was an exemplary student
– sweet and mild mannered, kind to everyone. For her
coursework, she designed a moving tiger in minute
detail. Its jaws snapped shut when the tail moved. She
laughed heartily at this dangerous creature. Caroline’s
father was overprotective. He loved his teenage
daughter and thought he showed it by keeping her
in at night even though her friends were allowed more
freedom. As an eminent member of the local
community, he also had an image to uphold. Caroline
had to stay in and complete her schoolwork to gain the
results that would reflect well on him. He imposed strict
limitations, making her feel stifled and extremely angry.
Her tiger’s sharp teeth snapped away as she
demonstrated to me just how cross she was with the
situation.
Thinking about all these aspects, I have formulated
a six-week project in school for parents, carers and
children, which I call ‘Talking Through Art’. There are
funds in schools for work such as this, but head
teachers and special educational needs co-ordinators
(SENCOs) have to attach sufficient importance to it.
The SENCO selects the children. Usually, there is a
specific issue, such as children who are too quiet or
children from chaotic backgrounds, and children are
gradually selected throughout the term rather than
being plucked immediately from the middle of a crisis,
which could prove counter-productive.
Figure 1
Mona Lisa
© Oleg Golovnev / Shutterstock.com
Mones1 uses a model of direct questioning to ascertain
a child’s ‘strategies for survival’ and ‘attitude to family’.
He brings out children’s feelings by making them feel
safe and complimenting them when they speak at
length. He feels that creative activity can be too openended, making it too vague. However, I find that by
referring to feelings through a third person, such as the
subject of the portrait, the process can be focused yet
not too personal or intimidating. The child is naturally
less defensive, in most cases eager to speak about the
subject, and indirectly revealing information about how
they or others in their family might be feeling.
When a child comments that the lady in the portrait
is feeling very sad, it triggers a response in her mother
about her own sadness. We explore in front of the
group why she is feeling that way. In turn, the child feels
free to release her feelings of resentment about her
mother’s preoccupation with her depression. Both
sides communicate and become sympathetic towards
each other. Reparation takes place between them.
To further explore relationships, parents and
children paint each other’s portrait by observing each
other. In the large group, we come back and discuss
the paintings. Children paint their parents’ faces in
colour. One mother is given a blue face and looks as
though she is having apoplexy. This is a mother of
particularly hyperactive children. Often, children paint
pictures of their mothers with smiles on their faces
because that is their wish. Janey* paints her mother
with a hint of a smile on her face, like the Mona Lisa,
but tears are rolling down her cheeks (see figure 2).
Ryan* refuses to paint his mother at all. He just sits
there crying. Ryan was fostered by his grandmother at
birth, as his mother’s partner abandoned her. When his
mother remarried, she promised her son that she would
take him back. That was the plan but it did not come to
fruition and the boy is furious. We invited his mother to
the session and he was able to show her just how hurt
he was feeling.
Another topic I use is ‘Bedtime’. The children paint
monsters under the bed or peeping from behind
moonlit curtains. We discover as a group that
unresolved issues from the day culminate in frightening
feelings and phantasies at bedtime. Unless time is
spent unravelling these before sleep, problems arise.
Gemma* never gives way to sleep at night. In the
session, she is able to appreciate the effect this is
having on her father. He paints a picture of his daughter
crying on the stairs and himself crying at the bottom of
the stairs. She feels safe enough in the room to discuss
her fears at bedtime, and both she and her father agree
to spend more time listening to each other before bed.
We discuss just about everything in the group,
reinforcing the code of confidentiality at all times.
Children become brave enough to tell mothers to
spend less time on their phones. They tell us that
parents don’t play with them or take them to the park.
In the safe environment of the room, parents are able to
take these criticisms and think about their actions. This
way of working is a much more powerful and resonating
tool than any counsellor or teacher informing the
parents of their children’s needs.
On the other hand, children are privy to sides of their
parents never witnessed before. Simon* feels
undermined by his father’s strict rules and discipline.
He is withdrawn and cowed. In the session, his father
tells us that he was a general in the army and was very
proud of his rank and achievements. Simon listens in
wonder as his father regales us with stories of army life.
A new respect evolves on both sides after that and
father becomes more forgiving as he realises the effect
his training has been having on his son. Pushing his son
away from him was the last thing he intended.
These are sample topics. Every time we set up the
project we have a different emphasis to keep it alive
and current. We might refer to the latest computer
game characters and create scenarios with plasticine.
This is a method promoted by George Enfield5 in the
book Engaging Boys in Treatment, in which he says that
‘less powerful boys can transcend their limitations’ by
referring to their super-heroes.
As a facilitator, I often become the forgiving female
figure and the SENCO takes the more direct male
approach. This works for us in the role of a supportive
parental couple. It proves to be supportive especially
as we are able to recognise when the other might be
reverting to becoming judgmental and biased. It keeps
the group safe.
Rather than using a form of negative
persuasion, we have to work hard to
convince those parents that they are
needed to contribute to the mix in a
positive and inclusive way
38 | Families | BACP Children & Young People | December 2014
Groups as creative, non-judgmental containers
I have chosen this method to work with families as I am
from a creative background. Another method used by
the school is called ‘Talking Together’. This is based on
an informative lecture to parents by a psychotherapist,
followed by the parents talking with their children
using the strategies learned. This makes parents feel
worthwhile and brings them into school without making
them feel judged. Children appreciate that we can
relate to their need to keep their ‘good object’ safe –
as described by Melanie Klein6 – and they will open up
far more without fear of destroying it. Any future sessions
with the child then become deeper and more rewarding.
I think that groups can offer a containing structure so
that families don’t feel so singled out. Nevertheless,
some parents feel that simply being selected implies
criticism. Rather than using a form of negative
persuasion, we have to work hard to convince those
parents that they are needed to contribute to the mix
in a positive and inclusive way.
In the words of Bion: ‘The neurosis displayed as a
problem of the individual, in treatment of a group it
must be displayed as a problem of the group.’7 I feel
that this is particularly so for the family as a group, and
furthermore I apply this philosophy to groups of families.
Thinking in this way prevents the problem being the sole
responsibility of the child. Once the child is relieved of
that burden, thinking can take place. The child has room
to breathe and consider what is going on for them.
According to Freud,8 traumatic events are repressed
into the unconscious in the individual. Thinking of the
family as a whole organism, I believe the family also
represses painful feelings from the past, obliterating
them from the collective consciousness. Any attempt
to retrieve them is met with fierce resistance. Mones1
calls these powers of resistance the ‘fire fighters’. By
BACP Children & Young People | December 2014 | Research project | 39
sharing feelings in the group, resistant defences break
down. Quite often, tears emerge. As facilitators we
allow and respect the tears while the family member
explains to all of us what is on their mind. When we
listen and show that we empathise, they realise they
are not alone and healing begins.
*The above cases are based on an amalgam of cases,
and any identifiable details have been carefully removed.
Permission has been granted for the publication of the
portrait of ‘The tears behind the smile’.
Evaluating
a service
Figure 2
The Tears Behind the Smile*
Sarah Perry and Simon Carpenter
introduce a pilot project that received BACP
seed-corn funding to support the young people
themselves in evaluating a counselling service
for children and young people who have
experienced abusive relationships
W
e would like to provide an overview of
a pilot project that encouraged young
people to consider how they would
evaluate the effectiveness of a counselling
service. We will explain why we wanted to
do this project, the practicalities of carrying out such a
research project and what we learned from the process.
We hope this overview will provide a good insight into
what is entailed in doing research with rather than on
young people and service users.
Measuring outcomes
Judith Sonnenberg was a senior
teacher for 25 years and trained
as a counsellor for children in
educational settings at the
Tavistock Clinic. She now practises
in schools in Ealing and Harrow
at both primary and secondary
level specialising in working
with families. As an accredited
counsellor, she has developed
her private practice to include
young people in Harrow with
autism. judithsonnenberg@
googlemail.com
References
1 Mones AG. Transforming
troubled children, teens and
their families. New York:
Routledge; 2014.
2 Bowlby J. Cited in: Silberg J.
The child survivor. London:
Routledge; 2013 (p17).
3 Winnicott DW. Theory of the
parent-infant relationship.
International Journal of
Psychoanalysis 1960; 41: 585–595.
4 Shemmings D, Shemmings Y.
Assessing disorganised
attachment behaviour in children.
London: Jessica Kingsley; 2014.
5 Enfield G. From virtual to real.
In: Haen C (ed). Engaging boys in
treatment. London: Routledge;
2014 (pp135–151).
6 Klein M. The psychoanalysis
of children. New York: Free
Press; 1932.
7 Bion WR. Experiences in groups.
London: Tavistock Publications;
1961.
8 Freud S. Five lectures on
psychoanalysis. London:
Hogarth Press; 1910.
It is hard to imagine working in mental health services
without some awareness of evidence-based practice
(eg guidelines from the National Institute for Health
and Care Excellence – NICE) and practice-based
evidence (eg guidelines from IAPT). As professionals,
we are encouraged to refer to the evidence base to
inform our practice and what we deliver, and in turn
collect our own evidence to demonstrate the
effectiveness of our own services. In addition,
commissioners of services have become more
interested in outcomes as well as outputs. However,
there is a substantial gap between research and
practice, particularly in terms of how to best measure
outcomes, wellbeing and the effectiveness of a service.
Consequently there is much cynicism around
measuring outcomes. We can all feel manipulated by
statistics and personal accounts. Personal accounts
provide a snapshot of an unfolding story, and statistics
raise awareness rather than explain complex
interactions between personal, social and cultural
factors in an individual’s life. The extent to which
service evaluation and research projects raise
questions and encourage reflection or are reductive
and involve some deception, or perhaps a mixture
of the two, is open to debate.1
Participation research
As professionals working in both statutory and
voluntary sectors and in private practice, we have
increasingly become aware of the importance of
evaluating our practice and being able to demonstrate
that what we do makes an important difference to
people. However, we have also felt constrained by
how we gather evidence for our practice, which is very
much determined by scientific models for acquiring
knowledge and set ways of carrying out research.
We both worked for a charity (CLEAR – see
www.clearsupport.net) that provided counselling
and therapy to children and young people who have
experienced abusive relationships, and this charity
regarded itself first and foremost as a service for
children and young people. We began to wonder what
children and young people would consider important
if they had more input into the evaluation process,
beyond completing standardised questionnaires and
feedback forms.
The Department of Health’s report Quality Criteria
for Young People Friendly Health Services, commonly
referred to as ‘You’re welcome’2 refers specifically to
‘young people’s involvement in monitoring and
evaluation of patient experience’. Again the focus is
on capturing young people’s experiences and
collecting their views of the services they have
received. However, professionals and services tend
to remain in charge of the evaluation process and there
is less attention paid to whether the evaluation process
itself needs evaluating.
We were aware that therapists who worked within
CLEAR were not always very positive about the
outcome measures used, and they, too, had reasonable
40 | Research project | BACP Children & Young People | December 2014
We considered what the alternatives
might be, particularly if young people
were involved in the selection and
development of measures and more
involved in the evaluation process
reservations about outcome measures and their
strengths and limitations. This resulted in us
considering what the alternatives might be, particularly
if young people were involved in the selection and
development of measures and more involved in the
evaluation process.
There are a number of useful guidelines produced
by charities that deal with how best to involve young
people in research, development and evaluation.3-5
Distinctions are made between involving young people
as active partners or participants and seeing them as
mere subjects of research. There are different levels
of involvement in research, from consultation to
collaboration to user-control or ownership of the
research, with the former being the most frequently
applied and easily arranged and the latter the least
frequently applied and most challenging.
These guidelines raise important questions, not only
about asking an organisation how committed they are
to user empowerment, but also about how best to
train young people so that they are able to carry out
good-quality research themselves and complete
a project within time and resource restraints. It is
recognised that involving service users and the public
in research can improve the quality of the research itself
in terms of making research more relevant and robust,
but there are power, development and resource issues
that frequently hinder such involvement.6
This project entailed a collaboration between young
people and therapists who were involved with CLEAR,
and a clinical psychologist who worked independently
of the organisation and was involved in the evaluation
of the service as a whole. The project invited therapists
and young people representing CLEAR to reach a
consensus on in-house evaluation procedures, with
the aim of testing these out in the next phase of the
project. It was also hoped that the participatory aspect
of this project would help to empower children and
young people and further develop their confidence,
knowledge and skills.
Overview of the project
The young people who took part in the project were
part of CLEAR IDEAS, a consultation group made up
of members aged between 10 and 18 years. These
members were young people who had experienced
therapy with CLEAR or who had a family member with
connections to the service. Membership for this group
varied but generally involved between six and 12
young people between the ages of 11 and 16 years.
Initially we anticipated that participation in the
project would involve attending two-hour meetings on
a monthly basis. However, arranging regular meetings
of this frequency proved problematic. Consequently,
meetings tended to be bi-monthly, during school
holidays or on Saturdays during term time, and either
lasted two hours or a whole day (10am to 3pm).
Participants received vouchers of their choice for
attendance at each of the workshops (£20-£30
equivalent) as an acknowledgement that they were
making a valuable contribution to the running of the
organisation and its development.
During the course of the project, we trained young
people in research methods, involved them in
evaluating a number of standardised measures
routinely used in children’s and young people’s mental
health services, including those used by CLEAR, and
encouraged them to think what outcome measures
they would use themselves to demonstrate the
effectiveness of therapy.
BACP Children & Young People | December 2014 | Research project | 41
The development of a new questionnaire
The young people compared their preferred
questionnaires with those used by CLEAR in order to
consider current practices and how they might be
improved. We then encouraged them to think about
the strengths and limitations of these questionnaires.
Although the young people were aware that each of
the questionnaires captured a different aspect of
wellbeing and experience of services, they felt that all
the standardised questionnaires were limited in terms
of measuring the direct benefits and drawbacks of
counselling and therapy, which they had explored at
the beginning of the research project. The measure
that best captured this aspect of effectiveness within
CLEAR was the feedback form, which consisted of
three open-ended questions asking clients to comment
on what had been helpful about counselling and how
it could be made better.
We all decided that it would be useful to look at the
confidential comments that children and young people
had written on the feedback form over the last three
years. The young people cut out each of the comments
and then arranged them under themes in order to
capture the main ways in which clients felt counselling
had helped – as recorded at the end of counselling.
There were a number of recurring themes, indicating
improvements in several areas:
• Feelings (eg happier, calmer, more relaxed)
• Self-confidence (eg feel better about myself, talking
about things and what I do)
• Understanding (eg of self, others and situations)
• Communication skills (eg better at expressing myself
and managing difficult feelings)
• Relationships (eg can connect with others, share
experiences, confidentiality).
The young people selected the comments that they felt
best reflected these themes. They decided that they
did not want to lose the young people’s voice and thus
developed a questionnaire that included 16 verbatim
statements alongside a rating scale in which young
people could indicate how much they agreed with these
comments, based on their own experience of
counselling. Examples of these statements are as follows:
Therapy makes me feel like I’m not alone.
I was able to express myself more than usual.
It has helped me to forget all the stuff that’s happened
and kept it from the front of my mind.
It helped me to open up more about my past and feel
more confident when speaking about it.
They decided that they would also like to include three
open-ended questions to ensure that children and
young people were still able to feed back in their own
words what their experience of therapy had been.
They gave this questionnaire a name, It’s Hard to Put
Into Words, based on a comment made by a client,
which they felt captured how young people often felt
when talking about difficult experiences. They felt that
the questionnaire would be suitable for young people
aged between 11 and 16 years. The young people were
also responsible for designing how the questionnaire
would look in print. They felt it was different from many
other questionnaires because it was based on young
people’s views and experiences and focused explicitly
on how therapy might help.
The questionnaire was then shared with CLEAR’s
counsellors and therapists, some minor amendments
were made, and everyone agreed that it would be
piloted for four months. To date, 25 young people have
completed the questionnaire and the responses to it
have been encouraging. The next phase of this project
will entail further amendments to the questionnaire,
taking into account the quality of data collected.
Young people’s feedback on being
involved in the project
The young people were positive about the research
project as a whole, and the comments below are typical
of those made during the final session of the project:
‘This project helped me to view therapy in an unbiased
way. Looking through feedback of children’s views of
therapy, we were able to notice how therapy helped
and which elements helped the children the most. It
was nice to see the progress of the project at our
monthly meetings and how everybody’s input had
come together to produce the final questionnaire.’
‘Being part of this project has been really interesting, as
it has helped me to understand how therapy can help a
child/young person. The sorting of all the feedback and
comments gave me an insight into how young people
feel after therapy. The questionnaire we have made is
quite easy to understand and to complete for the age
range we have chosen, and the method of answering
(smiley faces) makes it accessible to everyone.’
Professionals’ reflection on being
involved in the project
We wanted to involve young people in service
evaluation as active participants in the research
process. Although the focus on the project was to
improve on service evaluation and practice-based
evidence procedures within CLEAR, we hope that the
lessons learnt will be of wider interest and encourage
other services to consider how children and young
people may be more involved in the research process
rather than simply being consulted and asked to
rate more aspects of their wellbeing and levels of
satisfaction. In this way, service evaluation models
may become more relevant and sensitive to children’s
and young people’s experiences of therapy.
There were difficulties and limitations with doing
participatory research, primarily in terms of resources
42 | Research project | BACP Children & Young People | December 2014
(time and funding) to carry out such projects and to
respectfully consider young people’s own priorities,
commitments, abilities and goals. For example,
attendance over the course of the project changed
from workshop to workshop. It was important to build
on learning from previous workshops as well as have
the flexibility to adapt to changing interests and goals
without losing sight of the focus of the project.
The different uses of young people’s ‘voices’
in action research (ie authoritative, critical and
therapeutic) have been identified7 and these were
explored by the young people and therapists within
CLEAR. The young people who were part of the
CLEAR IDEAS consultation group were generally very
supportive of the organisation and may therefore be
regarded as having less of a critical or objective voice.
Their motivation to be a part of the research project
was often altruistic and based on wanting to give
something back to an organisation they valued and
trusted. Indeed, at the outset, the group wanted to
know how this project would help children and young
people. They also wanted to know how they would
benefit from the project themselves, and reiterated
the importance of learning new skills, being more
knowledgeable and meeting new people.
As stated, it is often difficult to do justice to the
principles of action and participatory research when
References
1 Duncan BL, Miller SD, Wampold
BE et al. The heart and soul of
change: delivering what works in
therapy. 2nd edition. Washington
DC: American Psychological
Association; 2010.
2 Department of Health.
Quality criteria for young people
friendly health services. London:
Crown; 2011.
3 Save the Children. Young people
as researchers. London: Save the
Children; 2000.
4 Kirby P. A guide to actively
involving young people in
research: for researchers, research
commissioners and managers.
Eastleigh: INVOLVE; 2004.
BACP Children & Young People | December 2014 | Reviews | 43
there are constraints (eg resources and commissioning
or funding arrangements) that both support and
discourage creative practices. For example, the authors
of this report took a lead in both instigating and writing
up the project. In hindsight, more consideration could
have been given to making this a more ‘young person
owned’ project than a collaborative enquiry from
conception to presentation of findings.
For CLEAR IDEAS, then, reciprocity appeared to
be an important motivator, whereby there was an
opportunity to both give and receive something in
return, ensuring everyone benefitted from the project.
These sorts of arrangements can make the development
of evaluation procedures even more complex as the
ownership of procedures, limits around making changes
and making compromises are explored (eg recognising
the sometimes competing needs of service users,
therapists, trustees and funders). There was general
appreciation, however, that this project encouraged a
dialogue between therapists and young people about
how to best evaluate a counselling service, and this will
need to be continually reviewed to ensure the voices of
young people remain central to the organisation. The
development of a new questionnaire was just one option
for ensuring that the experiences of young people were
not lost and that the chosen project was achievable
within the resources available.
5 Shaw C, Brady L-M, Davey C.
Guidelines for research with
children and young people.
London: NCB Research Centre;
2011.
6 Stayley K. Exploring impact:
public involvement in NHS, public
health and social care research.
Eastleigh: INVOLVE; 2009.
7 Hadfield M, Haw K. ‘Voice’,
young people and action research.
Educational Action Research 2001;
9: 485–499.
Sarah Perry is a chartered clinical
psychologist who works in private
practice and for statutory
services. She has a particular
interest in mental health,
service-user experiences,
research and evaluation.
Simon Carpenter is CEO and
founder of CLEAR and a member
of BACP. He has considerable
experience working as a therapist
with children and young people
and in particular where they have
witnessed or experienced abusive
relationships.
REVIEWS
The handbook of counselling
children and young people
Sue Pattison, Maggie Robson,
Ann Beynon (eds)
BACP/Sage Publications 2014
ISBN 978-1446252994 £29.99
There are books on special issues, books
on skills and books on theory devoted to
counselling children and young people.
Occasionally even one book on aspects of
all that. I am unaware of any, however, that
cover all that ground in such detail and with
such interlinking between the chapters as
this one. Considering the number of
contributors, this is an achievement. Each
chapter (and there are many) tends towards
a holistic approach. For instance, ethical
issues are brought in by many authors, as
are risk considerations, modality issues,
different work contexts and age of client.
The result is two things: the sense of being
able to grasp worthwhile learning without
having to assemble all the considerations
oneself, and the feeling that this tome
represents an excellent way of revising one’s
whole work stance – for, perhaps, CPD or
discussion in supervision. For trainers and
trainees, it is the complete works.
The range and reach is excellent,
although I do have a reservation here. The
references are pleasingly up to date, but it
saddens me that online resources listed at
the end of chapters are mostly limited to
BACP CYP and MindEd. There are many
good online resources that could have been
included, and their frequent omission is a
missed opportunity.
However, there are many things I do like
about this volume. First and foremost is
that, although I half expected the book to
be all guidelines, policies, procedures,
strategies and thresholds, the child’s voice
is championed and heard throughout and
the art of good therapy is uppermost – while
still grounded both in official research
and sensible, from-the-therapy-room
knowledge.
Chapters that stand out for me include
the one on preparation for therapy and its
seven collaborative assessment tasks to
prepare the map; the very valuable chapter
on groupwork, which highlights many
appropriate methods and ethical
considerations and offers a run-down on
what further research is needed in this area;
and the chapter on endings, with its
recognition of so many different types,
along with an emphasis on endings for
different ages, development levels and
issues. But every chapter in the book
offers rich insight and commentary that
is invaluable to both new and seasoned
professionals working with children.
And this brings me to my other slight
gripe. There are both reflective exercises
and learning activities after each chapter
summary. Whereas the learning activities
allow us to think and apply from our own
experience and from what we have just read,
nearly all the reflective questions supply
the answers right there. This prevented me
thinking for myself. Such a layout implies
that trainers will have the manual and its
prompts, and that students won’t. Qualified
readers will just read on from question to
answer as if this content were simply part
of the preceding sections. This is another
missed opportunity that a change of order
would resolve. In addition, some of the
reflective questions are simply too dense
and would benefit from being in chart or
bullet form. Perhaps in the final book (this
is a pre-publication copy) this will have
been spotted. The questions themselves,
however, are excellent and real enough
for us to bother doing them for our own
self-development as practitioners.
Overall, there is no question but that I
recommend this volume to all of us in the
field. It is articulate, real, down-to-earth
and complete in its coverage of theory and
practical approaches, counselling practices
and processes, practice issues and practice
settings. The price seems justified within the
norms for counselling books, although it still
represents a serious outlay even for this
number of quality pages.
Eleanor Patrick is a counsellor of children and
young people, a coach-therapist and editor of
this journal.
Sage is offering a 25 per cent saving on this
book to BACP CYP journal readers. Just add
code UK14AF80 at checkout on Sage’s
website: www.sagepub.co.uk
44 | Reviews | BACP Children & Young People | December 2014
that parents seem to know that there is
‘something wrong’ with their child but
struggle to make sense of the unique way
in which their child’s brain is wired. The
author advises on how to help parents and
professionals to accommodate the child’s
diagnosis. It draws in the community around
the child and emphasises the need for a
group approach to helping the child to
achieve their potential, alongside a
reduction in distress. There is good advice
here, too, on understanding the child’s
mindset, combined with suggestions for
beginning to change their behaviour,
attending to problem-solving skills and
dealing with angry and frustrated children.
In further chapters, the book describes
and clarifies ADHD, specific learning
disorders, autism spectrum disorder,
Martin L Kutscher,
anxiety and obsessive compulsive disorders,
Jessica Kingsley 2014
sensory integration dysfunction, tics and
ISBN 978-1849059671 £13.99
Tourette’s, depression, bipolar disorder,
oppositional defiant disorder and
I have been waiting for this book. Subtitled
intermittent explosive disorder, and central
The one stop guide for parents, teachers
auditory processing disorders. The last
and other professionals, it finally gave me
chapter looks at medication for these
the chance to define and conceptualise
autistic spectrum tendencies and clarify the conditions. It is like a mini DSM for disorders
in children – and therefore useful as a
child’s mindset with advice from an expert
reference book.
in the field. I think it is an excellent book for
It is inevitable that if you are working
both trainees and seasoned professionals
in any setting with children, you will come
who want to take the time to hone their
across these disorders. You will help parents
thinking on this range of disorders now
and children to save time, struggle and
so prevalent in our work with children.
distress if, as a practitioner, you are able to
Parents with children whose behaviours are
identify these disorders and direct parents
associated with these disorders really need
on management as well as refer on for
the solid advice of professionals when they
come for counselling and therapy – they are professional assessment. All trainings for
counselling and psychotherapy with children
so often frustrated and bewildered by their
should include this book on their book list.
child’s behaviour. A consequence of this is
It gives straightforward and helpful
that children suffer unnecessarily and feel
lost and misunderstood. This book will help information and is also a great reference
book once you have read and digested the
professionals provide that advice so that
first two chapters. I recommend it highly
parents get help more quickly.
The book outlines in the first two chapters as a contribution to improving mental
health services for children.
‘General Principles of Diagnosis’ and
‘General Principles of Treatment’. So often,
children on the spectrum get described in
Joanna North is a BACP accredited
negative terms such as ‘lazy, lacking in
motivation and lacking in interest’. The book psychotherapist, a chartered psychologist and an
observes these common pitfalls and the way expert witness. She runs an Ofsted Registered
Kids in the syndrome mix
of ADHD, LD, autism
spectrum, Tourette’s,
anxiety, and more!
Adoption Support Agency.
BACP Children & Young People | December 2014 | Reviews | 45
Being taken in:
the framing relationship
Sarah Sutton
Karnac Books 2014
ISBN 978-1782200710 £17.79
Being Taken In is based on the science
of intersubjectivity and combines
psychoanalytical theory with the latest
thinking in the field of neuroscience. The
book details the author’s psychotherapy
with a neglected child and relates theory
to practice, providing the reader with an
interesting insight into psychoanalytic
therapy with children.
I found the first two chapters of this
book quite heavy going and not at all what
I was expecting having read the reviews
on the back cover. Maybe my difficulty was
because my training is not psychoanalytical
and the author begins with an overview
of psychoanalytic theory, linking it to
modern neurobiology. Initially, I thought
that there was nothing new here because
Sutton explores the impact of the
baby’s early experience of the parents,
considering the work of, for example, Bion,
Winnicott and Stern – also focusing on
research into intersubjectivity in the 1990s.
While I found the revision interesting
and well written, I had to read slowly and
thoroughly in order to fully understand
what the author was saying.
The book really came to life for me in
Chapter 3 where Sutton details her work
with a child called Dan. While this has real
similarities with Winnicott’s The Piggle and
Axline’s Dibs in Search of Self, I always find
these detailed accounts of therapeutic
work interesting and informative. I usually
find myself comparing what I might have
done or said in the same situation.
The final chapter then puts the theory
into practice and I found this much easier
to read and digest.
What I really liked about this book was
the author’s challenging of the status quo.
She considers that the NICE guidelines seek
to ‘objectify excellent clinical practice in
order to spread it more widely, and possibly
speed it up. In the attempt, it may be that
the effort to be, and be seen as, “scientific”
means that the relational and the emotional
are overlooked.’ (p31) In the final chapter,
Sutton states: ‘The naughty step approach
is likewise unhelpful for children who have
suffered adversity. It leaves them without
another body and mind to help process the
strong emotions […] and so deskills them
further… These measures are thus more
likely to reinforce than to ameliorate wired-in
responses that are adapted to previous
circumstances.’ (p105)
Lynn Martin is a certified integrative
psychotherapist and certified transactional
analyst working in private practice in Devon.
Much of her work is with children and
young people.
Skills in counselling and
psychotherapy with children
and young people
Lorraine Sherman
Sage Publications 2014
ISBN 978-1446260173 £22.76
Parts of Lorraine Sherman’s background are
similar to my own, in that she has extensive
knowledge and many years’ experience of
working therapeutically with children and
young people and providing supervision to
counsellors working with young people. My
reason for mentioning my background is to
give you an idea of where I am coming from
when reviewing this book.
The book covers a wide range of learning,
from how to engage and develop empathy
with the young person through to overcoming
ethical and professional dilemmas that
emerge along the way. The sections are
well arranged and easy to read and Sherman
avoids using long blocks of text, which, in
my opinion, makes the information clearer
and easier to absorb. What I find particularly
refreshing here is that I get a feel for the
author’s passion and belief in the words she
is writing, as though she is sharing herself.
There are some skills books that I have read
that are very informative but lack this feeling
of personal passion.
The contents of the book have emerged,
in part, from conversations and dialogues with
young people, and I consider this an organic
approach to engaging and working with
young people. The author has a genuine
empathy with how the young person might
be feeling during the counselling process with
an adult – for example the power dynamics,
vulnerability, powerlessness and fear. She
puts across just how important the therapeutic
alliance is to the success of the work with
young people.
I particularly warmed to the section on
self-care as a practitioner. Working with young
people can be a lonely and mentally draining
place at times, and it is important to maintain
awareness of this. The book gives suggestions
about how to look after ourselves. For
example, by accessing supervision and
attending to physical health, exercise,
good food and sleep.
Sherman highlights the importance of
being professionally qualified to work with
children and young people, which is a view
I strongly share. She also offers suggestions
about how to liaise with parents, carers
and teachers of the young people we are
counselling. This part is where I gained most
of my learning from in the book. At times, in
my own practice, I find myself reflecting on
how I am going to match up the parental
views with the needs of the young person.
I found some useful learning when
reading the case studies and considering
the solutions offered for the challenges that
a young person and the counsellor face
within the therapeutic process.
Altogether, I found the book brilliant. It
resonated with my own thoughts and feelings
about the minds of young people and
therefore engaged and excited me, making
me want to read on and learn more and
continue to develop my own practice. If I had
to make any suggestions, they would be to
include more about how to involve/not involve
parents/carers in the process of healing for
their young person, and perhaps also to learn
more about how the author would consider
working with some of the cases she describes.
Nevertheless, the book is ideal as an aid for
trainee counsellors and for other professionals
working therapeutically with young people.
Julie Griffin MA MBACP
Counselling/psychotherapy for young people in
Lincolnshire, Leicestershire and Rutland
Email [email protected]
46 | Reviews | BACP Children & Young People | December 2014
wonderful experience of self-discovery’.
(p30) They advocate the use of art, board
games, cartoons and superheroes when
working therapeutically with children, as all
are easily accessible and translate readily
into therapeutic metaphor. The book is full
of case studies and children’s drawings that
illustrate how the principles of therapeutic
metaphor have been used effectively in
practice. I welcomed the refreshing
approach of emphasising the positive with
a de-emphasis on diagnostic labelling. In
many examples, children are asked to draw/
describe/illustrate the ‘problem’ as well as
the ‘problem all better’. The child can be
encouraged to create the bridge between
‘problem’ and ‘problem all better’ by
thinking about their favourite superhero or
Joyce C Mills and Richard J Crowley
remembering/imagining a time when things
Routledge 2014
were/will be better. We can see how, by
ISBN 978-0415708104 £26.99
utilising these techniques, children can be
offered the opportunity to heal themselves.
Coincidentally, I began reading this book
Chapter 5 – ‘Learning the Language
for review when I was also reading Philip
of the Child’ – outlines rather more
Pullman’s Grimm Tales. The two
sophisticated techniques for interpreting
complement each other nicely and have
much in common. All three authors are great children’s presenting symptoms as out-ofstorytellers with an easy ability to enthral the conscious communication (psychodynamic
therapists might call it unconscious
reader. The stories told aren’t necessarily
communication). Examples are provided
new: Pullman retells the fairy stories told
according to three domains: out-ofto the Brothers Grimm, and Mills and
conscious visual ie lack of co-ordination,
Crowley recount narratives collected from
or psychosomatic complaints such as
therapeutic encounters and/or literature.
excessive blinking; out-of-conscious
But that matters little. The authors invite
auditory ie not hearing instructions, or
us to engage with their stories and,
psychosomatic complaints such as tinnitus;
implicitly, to re-engage with childhood.
and out-of-conscious kinaesthetic ie lack of
Mills and Crowley make a link between
bodily sensations to do with bladder control
metaphor and literature in general and
or hunger, or psychosomatic complaints
fairy tales in particular, but they highlight a
difference between literary and therapeutic such as pain and sensitivity. The chapter
also illustrates how a child’s verbal
metaphor. They propose that the function
communication can provide literal cues
of literary metaphor is purely descriptive,
about out-of-conscious sensory systems
whereas the function of therapeutic
such as ‘I can’t see myself doing that’ or
metaphor is to reframe, reinterpret and
‘I never hear what I’m told’ or ‘I can’t feel
alter. I grappled with this distinction but
anything since it happened’. Remaining
I do agree that for metaphor to mean
attuned to the child’s out-of-conscious
anything, it has to be personally resonant,
systems allows the therapist to facilitate
and I think that children are very good at
metaphors that emphasise those systems
creating metaphor.
The authors posit that children possess a that are blocked, and thus aid healing.
The authors make a distinction between
‘natural ability to use whatever is available
directive, non-directive and indirective
– an image, a sound, a texture – to create a
Therapeutic metaphors
for children and the
child within
BACP Children & Young People | December 2014 | Reviews | 47
approaches and advocate the latter. They
suggest that, rather than directing the
child (directive) or reflecting back what
they are doing or saying (non-directive),
the therapist who uses an indirective
model communicates at an unconscious
level to facilitate treatment. We might say
something like ‘it’s interesting that you
know how you want it to look when it’s all
together’. (p210) I can see the benefits of
this subtle change in how therapeutic
observations are communicated indirectly.
The use of metaphor in the authors’
work has evolved into StoryPlay Therapy®
(chapter 10). Techniques are rooted in the
principles of Milton H Erikson with healthy
doses of play and art therapy, stories from
real life and fantasy, the natural world and
cross-cultural philosophies, all of which are
woven together throughout this wonderful
book from which I have learnt plenty.
Jeanine Connor MBACP works as a specialist
child and adolescent psychodynamic
psychotherapist in private practice and
specialist Tier 3 CAMHS, and is also a writer.
Working therapeutically
with families
Tonia Caselman and Kimberly Hill
Jessica Kingsley 2014
ISBN 978-1849059626 £19.99
This is a book written by practitioners for
practitioners – indeed, the subtitle is
Creative activities for diverse family
structures. Tonia Caselman is experienced
at working with families as both clinical
social worker and counsellor, and is
Associate Professor in Social Work at the
University of Oklahoma, US. Kimberly Hill
has experience working therapeutically
with families as a qualified social worker,
and is Assistant County Office
Administrator at Grand Lake Mental
Health Centre in Oklahoma, US.
The publishers have put a lot of effort
into the design and layout of this book.
Almost A4 in size, it is not dense but easy
to read, with large text giving it the feel of
a practical manual, which appeals to me.
The first two chapters – ‘Introduction’
and ‘Family Assessment’ – are followed by
10 chapters, each covering one type of
family issue: single-parent families with
an absent parent, divorced/separated/
unmarried families with both parents
available, blended families, and a chapter
each on families with grandparents as
caregivers, with an incarcerated loved one,
a substance-abusing child, a substanceabusing parent, a mentally ill parent, a
chronically ill child or in grief.
Ten photocopiable appendices support
some of the therapeutic activities detailed
in the book and there is a subject index.
Every chapter is self-contained and laid
out in the same way, including, among
other things, possible challenges, possible
strengths, questions to help thinking,
empirical support for treatment, suggested
homework and suitable activities. In this
way, the chapters are designed to increase
knowledge of the subject area, prepare
you for unique issues that particular client
groups/families present with and equip
counsellors with plenty of ideas to work
with families.
Anyone from parents and young people
through to teachers and therapists could
read portions of the book and find
something useful. I am a qualified counsellor
with experience of working therapeutically
with children and young people, and
although I recognise many of the issues
highlighted in this book, I have found myself
both informed and resourced by it.
The book’s strength is its readability and
its repetition of layout, which makes it easy
to use when finding subjects, resources or
information within it. I particularly like the
evidence-based theory and practices
covered in the book, and the demonstration
of how theory is linked with practice. I really
like the way the authors recognise that they
do not hold all the answers, nor can they
present an exhaustive coverage of a
particular issue, and that research and
statistics change continually. So their
inclusion of other resources is appreciated.
I love the way each therapeutic activity –
there are nine or 10 per chapter – is laid out
to include which family members they are
aimed at, the purpose of the activity, the
materials you will need and the description
of how to carry out the intervention.
I would have liked to have seen a chapter
on looked after children (non-family), and
on young carers, but I realise not all
subjects can be covered. And although the
statistics were enlightening, I found them
less useful as they are from the US. I
understand that issues are universal and
circumstances affect families in similar ways
in spite of their cultural differences, but
statistics may not be so transferable. That
said, they are true for one country and
therefore valid as examples.
All in all, I would recommend this book
to anyone working with children, and in
particular to counsellors and therapists. I
will certainly be using it and will promote
the book to my colleagues.
Rachel Eastop
MBACP (Accred)
48 | Reviews | BACP Children & Young People | December 2014
further into ‘What do we know?’ and ‘What
does this mean for counselling?’
Each ‘What do we know’ section focuses
on the scientific facts, and the biological and
physiological reasoning. And while these
can be substantial, they are written in an
accessible way, with the neuroscience being
further demystified by their application in
the ‘What does this mean for counselling?’
section that follows immediately afterwards.
Initially, I found difficulty in the oscillation
between detailed neuroscience and the (for
me) less intense implications for practical
application, but this soon settled down
Rachal Zara Wilson
once new concepts and neuroscientific
Jessica Kingsley 2014
language became more familiar to me. I
ISBN 978-1849054881 £24.99
also feel that the author’s use of metaphor
throughout the book served to make this
This book is structured in seven main
learning easier to integrate.
sections: Introduction, Plasticity and How
As a counsellor and supervisor, I found
the Brain Works (plasticity, neuron activity,
the chapters dedicated to specific disorders
gene transcription, left/right brain and
to be the most intriguing, tempting me to
myelination); Learning and Memory
bypass the others and go straight to them.
(learning and attention, memory, false
memory, memory and self); Other Workings However, it is the initial chapters that provide
the foundations from which to build
of the Brain (mirror neurons, emotion,
knowledge, and this is invaluable. It can
attachment, addiction, stress); Specific
sometimes seem that information is being
Dysfunctions (PTSD, dissociation,
repeated from some of these earlier chapters
depression, bi-polar disorder, anxiety,
attention-deficit disorders, autism spectrum and while this would usually be a frustration
disorders, obsessive compulsive disorders, for me, I found on this occasion that it was
useful for reinforcing the salient points.
personality disorders, psychosis and
In considering the practical application
schizophrenia, and eating disorders);
of the book, I feel that it offers not only a
What Can We Recommend? (exercise,
way of creating new perspectives in case
sleep, relaxation and healthy eating);
conceptualisation and hypothesising, but
and Conclusion (future uses of what
also an alternative view when considering
we now know). There is also a useful and
the neuroscientific base for cognitive
comprehensive glossary of the most
behavioural, narrative and solution-focused
frequently used scientific terms.
therapy, with all of which it concurs strongly.
As its subtitle title suggests, this is
This is a book that I shall no doubt refer to
a practical book aimed at those working
again, but it is already a book that I hold in
with people in a therapeutic or helping
mind both when working with my clients
capacity, namely counsellors, therapists
and when reflecting upon clinical work,
and mental health practitioners – although
and is also one that I would recommend to
it would likely be a useful resource for
qualified practitioners and students alike.
those studying biological and counselling
psychology.
At first glance, some of the contents can
Alison Smyth (MBACP Accred)
give the impression that the read will be
Counsellor and clinical supervisor
weighty and arduous. However, each
chapter within the sections, and indeed
each chapter subsection itself, is divided
Neuroscience for counsellors
BACP Children & Young People | December 2014 | Reviews | 49
The good life
Graham Music
Routledge 2014
ISBN 978-1848722279 £16.99
Have you ever wondered if people are
getting more selfish or does it just feel that
way? This well-written, interesting and
thoroughly researched book looks at this
question and why this might be the case.
Music asks the questions in his
introduction: ‘What predisposes us to act
kindly? Have we evolved to be selfish or
co-operative? How do our moral senses
form? What undermines this? How do
parenting and family life shape how moral we
are? What is the role of our biology or genes?
What is the influence of the particular culture
that we are born into? Is contemporary
Western society with its individualistic values
leading us to become less moral, impulsive
and selfish? In the chapters that follow, he
goes on to answer these questions using
examples from his own practice as a
consultant child and adolescent
psychotherapist at the Tavistock and Portman
Clinic, and up-to-the-minute research.
Music’s premise is that we are primed to
help others and are rewarded by improved
health and prolonged life, but that poor
attachment and parenting in early years can
affect this priming, preventing the growth
of empathy and altruism. He suggests that
to be good to each other in a caring and
supportive way, we need plenty of love
and caring support in childhood. Without
this, can we care about others?
Music argues that stress, especially in
childhood, affects the nervous system. Even
in small doses, stress makes us less caring
of others, but he suggests that it is not just
inadequate upbringing that causes this,
but that social trends such as insecurity in
employment and financial worries can also
make us less caring. Of interest to those of
us working with young people, linked to this
is impulsiveness – possibly, the author
suggests, a learned reaction caused by,
among other things, poor parenting. No
point in waiting if nothing good is coming.
The chapter titled ‘A Battle Between
Emotion and Reason’ is fascinating. Is our
society, which places such a high value on
rationality, causing a decline in our capacity
for empathy?
Music also investigates the effect of
hormones on co-operation and competition.
There appears to be a connection between
the amount of certain hormones in our body
and our levels of empathy and altruism, and
vice versa. This is a relatively new area
of study that will in future give us more
understanding of the complex effects
of upbringing and environment on our
hormones and thus our behaviours.
Those of us working with young people
cannot be unaware of their frequent
obsession with consumerism. Music points
out that young people with less nurturing in
their past tend to place a higher value on
consumerism, and, perhaps worryingly, he
quotes studies that suggest that sellers have
a vested interest in keeping things this way. It
is possible that, although we evolved to be
co-operative, our modern market economy
may prefer a more individualistic approach.
In his conclusion, Music stresses the
importance both to society and to the
individual of having high levels of altruism
and empathy. Studies show that this results in
living longer, happier lives. However, he says
that perhaps our present capitalist society is
working against this, begging the question
‘Is poor mental health good for profit?’
A really fascinating, evocative and
readable book – highly recommended.
Caroline Anstiss
School counsellor
Essential listening skills
for busy school staff
Nick Luxmoore
Jessica Kingsley 2014
ISBN 978-1849055659 £10.99
Nick Luxmoore subtitles his book What to
say when you don’t know what to say, and
highlights the fact that everyone in school,
no matter what their role, has an obligation
to listen. He states: ‘This book is about
becoming more confident and effective
in that daily work of listening, listening,
listening. It’s a book about the different
kinds of listening you’re obliged to do and
about what exactly it is that you’re listening
for. It’s about what to say when you don’t
know what to say and about how to listen
when there’s never enough time.’ (p12)
The premise of this book is as follows:
‘Good listening isn’t about how much time
you’ve got. What matters is the quality
rather than the quantity of your time.’ (p17)
Luxmoore gives some useful tips for
managing conversations when there is very
little time, such as not asking how someone
is if you haven’t time to listen to their
response, and being very clear with people
by stating how long you have before you
need to be somewhere else: ‘I’ve got four
minutes…’ (p18)
At the heart of this short book is a
practitioner and writer with a wealth of
experience of working in schools with young
people. I, too, have spent many years working
in a variety of roles within education and I was
filled with anticipation when I received this
book. Chapter 2, ‘Yes, but’, promises answers
or commentary on questions that I have heard
on many occasions, such as ‘What if I don’t
know what to say?’ and ‘Should I talk about
my own experiences?’ Similarly, Chapter 3,
‘Helping people …who are angry …who are
stubborn …who self-harm’, brought to mind
several conversations I have had with
colleagues over the years and numerous
questions I have been asked during training
courses. Unfortunately, however, I did not
find the answers Luxmoore offers to be of
sufficient depth for the target audience.
There appears to be some ambiguity that
concerns me. For example, in the sections
relating to people who talk of suicide (p55)
and people who self-harm (p61), he invites
the reader to make judgments about a
situation – which may assume a degree of
knowledge and/or experience the reader
does not have. He suggests that ‘some cuts
are so light that to tell other people would be
to overreact’. (p64) This sentence is wide open
to individual interpretation and could result
in people making potentially harmful
autonomous decisions.
This book promises a lot, but unfortunately
does not deliver for me. It is short and
succinct, but it tries to cover too many
subjects, resulting in it being superficial and
leaving more questions unanswered than
answered. I also did not enjoy the tone of
the book, which at times felt patronising.
For example, I found myself wincing when
I read Luxmoore’s description of attachment,
making references to ‘lucky babies’ and
‘unlucky babies’. (p57) This may be because
the author was attempting to condense
complex ideas into one or two sentences,
but for me, this did not do justice to the
theories he was trying to convey.
Overall, I would not recommend this
book to fellow counsellors, and I would
hesitate to recommend it to colleagues in
school – which is a very difficult statement
to write because I really wanted to like the
book. I read it three times.
Emma Pilling
Counsellor, teacher and tutor
50 | From the Chair | BACP Children & Young People | December 2014
FROM THE
CHAIR
I
often find myself thinking of lyrics from various types
of songs. If I’m on my own, I will belt out the words.
The one buzzing in my head over these last days
and weeks has been What a diff’rence a day makes.
Perhaps some of you know it? It was originally
written in Spanish by María Grever in 1934 and has
been translated and popularised by many singers.
As a therapist, I know only too well how events in
our lives can have a major influence, sometimes for
the good but sometimes for the ‘not so good’, causing
uncertainty and bewilderment. The reality for me,
since I last wrote in this journal, has been that in the
space of four different 24-hour periods I have known
the bewilderment that arises from death and loss.
I spent time with a dear uncle, listening in awe as he
spoke of the journeys he wanted to embark on with my
aunt in retirement and the jobs he was going to tackle.
I left them in the early hours of a Saturday morning,
and within 24 hours he was dead. What a diff’rence
a day makes.
In the days that followed, two members of my
extended family also passed away. What a diff’rence
a day makes.
I then found all my plans for the summer months
disappearing into the ether as my doctor signed me
off from work due to the flare-up of a long-term
condition. Reports due to be written and muchlonged-for holiday plans had to be postponed.
Everything had to be put out of my mind for the
foreseeable future. What a diff’rence a day makes.
You may be wondering (that is, if you haven’t turned
the page already) what this has to do with our lives as
members of BACP CYP who interact with children and
young people.
I think that, because of the work we do – seeking to
make a difference in the lives of those young people
who enter our therapy rooms – we need to know when
it’s time to acknowledge a change in our
circumstances. Maybe there is then a need to refresh
our minds about the theoretical ways in which we work,
a need to learn new skills, or a need to spend time with
those who are close to our hearts.
When 24 hours has made a significant change in our
lives, belonging to the BACP CYP division provides
opportunities to refresh you, maybe through the
journal, maybe through courses offered during the
year. And of course, our annual conference gives you
theory, skills and fun as well. In addition, there is
information available from BACP online via the MindEd
programme, and other links on the BACP website. All
these can equip us to continue to make a difference.
From time to time you may be asked to participate
in online surveys or asked what you think should be
the top priorities for your BACP CYP Executive
Committee. For instance, comments on the BACP
Ethical Framework are being sought as I write.
I wonder, too, if, because of the difference a day has
made in your life, you have something special to add
to the many discussions taking place within BACP, or
you have developed a tool in your work that others
would find useful, or maybe your empathic ability has
grown because of a sudden experience you have had.
You might want to tell us about the reality of being
employed in a local authority on Monday and made
redundant on Friday, or your concern about our
profession not being treated as other professionals
are in relation to pay scales and training opportunities.
And do let us know if there are particular areas you
would like to see addressed at our conferences over
the next two years.
As your Chair, I have the privilege of being aware of
the extraordinary therapeutic interventions you deliver
day in and day out, and that you are – for some of our
young clients – the catalyst that makes a difference in
their own lives, perhaps even over 24 hours. I want to
thank you for all the work you do.
I am now back at work having learnt some valuable
lessons while I was out of circulation, and am looking
forward to a holiday somewhere warm. My other
favourite song at the moment is I Will Survive – written
by Freddie Perren and Dino Fekaris and also covered
by many artists. Lyrics are powerful memes.
Cathy Bell