Therapy Today
Therapy
Today
For counselling
and psychotherapy
professionals
December 2013
Vol. 24 / Issue 10
www.therapytoday.net
December 2013, Vol. 24 Issue 10
Racism in training
What is the future for counselling courses?
Working overseas – culture clashes and ethical dilemmas
December
2013
Volume 24
Issue 10
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Contents
Sarah Browne
Editor
Features
10 ADHD – passport or label?
Catherine Jackson explores the recently reignited debate about ADHD in children, its diagnosis and how it should be treated.
Eugene Ellis and Niki Cooper discuss racism in training from the perspective of Black students.
Liddy Carver examines the challenges facing counselling training in higher and further education.
3
4
6
Editorial
News
Columns
14 Silenced: the Black student experience
20 Counselling training: is it fit for purpose?
Regulars
Rachel Freeth
Julie Storey
Rosie Dansey
Barry McInnes
Leyla Hussein
25 Talking point
36 Dilemmas
BACP
their experience of the course. Despite the fact that the course included a thread on
diversity and difference, people were still
feeling excluded, not understood and not
heard, and unable to express this.
As Eugene explains, from his experience of trainees and colleagues, having a weekend
module on difference and diversity doesn’t
really address what is going on personally
between students and trainers in, for example,
group process or the course as a whole. In his
view, counselling and psychotherapy trainings
have not really begun to address how racism
affects the therapeutic dialogue. Furthermore,
he says, the way that person-centred and
psychodynamic theory are presented on
training courses is colour-blind – ie devoid of the experience of race and culture. He looks forward to a time when an organisation
like BAATN will no longer be needed and what he calls a ‘rainbow coloured therapeutic
community’.
We’d be interested to know your views.
Earlier in the year we featured an interview
with Eugene Ellis, the founder of the Black and Asian Therapist Network (BAATN) on
why he became a therapist. He commented
that there are still not enough practitioners
who feel confident about working with the
interpersonal dynamics of race and cultural
issues, which means that, for some Black and minority ethnic clients, therapy can be a bit hit and miss. Niki Cooper, a counselling
trainer, read our interview with Eugene and signed up for BAATN’s ‘Black issues’
workshop. In a bravely honest conversation
with Eugene that we publish in this issue, Niki explains her journey as a white middleclass trainer from a position of unexamined
commitment to equality – albeit one where she was sometimes anxious about saying the wrong thing or exposing her ignorance if a person of colour named the difference
between them – to a realisation that on
training courses that she was running Black
students were feeling unable to speak about
50 From the Chair
51 BACP News
54 BACP Register
54 Professional conduct
55 BACP Policy
56 BACP Research
57 Professional standards
26 On the edge of another culture
Karen Stuckey describes the culture clash of working as a volunteer in Sri Lanka.
Mick Cooper talks to John Wilson about the benefits of systematic feedback.
Peter Jenkins reviews the arguments for and against mandatory reporting of suspected child abuse.
Cover illustration by Luke Best
30 Systematic feedback: a relational perspective
33 Pelka’s law: reporting abuse
38 The interview
Alessandra Lemma
Jelena Watkins
41 How I became a therapist
42 Letters
46 Reviews
58 Classified
59 Mini ads
62 Recruitment
64 CPD
Visit TherapyToday.net for Colin Feltham’s
in-depth interview with Peter Jenkins about
mandatory reporting of abuse; Clare Pointon
discusses diversity in training; Luke Best
explains the ideas behind his illustrations; plus the latest online news and noticeboard.
December 2013/www.therapytoday.net/Therapy Today 3
News
Survey prompts IAPT training fears
A worrying number of
psychological therapists
working for the NHS have
had no formal training in
the therapies they are using,
a national survey reveals.
The findings from the
second National Audit of
Psychological Therapies
(NAPT) were released last
month at the seventh annual
New Savoy Conference on
psychological therapies in
the NHS. The audit, by the
Royal College of Psychiatrists’
Centre for Quality
Improvement, was first
conducted in 2010 and
covers all services providing
psychological therapy
services for anxiety and
depression through the NHS.
A total of 220 services
submitted data for the second
audit, 145 of whom had taken
part in the first, baseline
audit. Questionnaires were
completed by 4,770 therapists
and 15,000 service users, and
the 220 services submitted
155,300 clinical case records.
Overall, the audit found
improvements in waiting
times for therapy but no
improvement overall in
access to psychological
therapies for older people:
just six per cent of people
aged 65+ who would be
expected to need therapy
were accessing it, compared
with 22 per cent of working
age adults. There was also
no change in the percentage
of patients who dropped
out of treatment (24 per
cent) and more (11 per cent)
people declined treatment
than in the first round.
But Care and Support
Minister Norman Lamb
described as ‘extremely
disturbing’ the finding that
nearly a third of therapists
currently practising in the
NHS do not have formal
training in all the modalities
they are using. Some 4,200
of the therapists surveyed
said they were providing
high intensity therapies
but of these 30 per cent
said they had no formal
training in seven of the
treatments being offered:
EMDR, systematic/family
© KEITH BROFSKY/PHOTODISC/THINKSTOCK
Helpline launched for lonely older people
Esther Rantzen, founder
of Childline, has launched a
new, confidential telephone
help and chatline specifically
for older people.
The Silver Line has
received a £5 million, twoyear grant from the Big
Lottery Fund, which the
organisers say means it can
go live before Christmas.
The 24-hour, seven days
a week, free telephone
helpline is intended to
tackle the increasing
problem of loneliness
among elderly people. More
than half of all 75-year-old
people live alone and one in
10 suffers intense loneliness,
The Silver Line says. Its own
poll, conducted to publicise
the launch, found that nine
out of 10 respondents felt
that a ‘chat on the phone’
was the most helpful way
to manage loneliness and
one in four said they rarely or
never had anyone to talk to.
The phoneline will be
staffed by trained volunteers
working in pairs, who will
offer advice, information
and befriending and
signpost callers to local
groups, services and
activities. It will also take
4 Therapy Today/www.therapytoday.net/December 2013
calls from elderly people
who are being abused or
are at risk of abuse.
The Silver Line was piloted
in the north east and north
west, the Isle of Man and
Jersey, with a £50,000 grant
from the Department of
Health, before being rolled
out nationwide.
therapy, interpersonal
therapy, couples therapy,
cognitive analytic therapy,
dialectical behaviour therapy
and arts psychotherapies.
Some 13 per cent of the
therapists providing
supervision said they had
not been trained to do so.
Almost a quarter of therapists
also felt they were not getting
enough support from their
service to meet the CPD
requirements of their
professional body.
‘We must absolutely resist
any dumbing down of the
service,’ Norman Lamb told
delegates at the conference.
‘We are completely
committed to this being
a properly trained service.’
Reparative
therapy debate
Care and Support Minister
Norman Lamb has
condemned gay reparative
therapy as an ‘abhorrent’
practice that should not
be offered by the NHS.
In a parliamentary debate
last month, MPs called on
the Government to ban
gay reparative therapy as
‘voodoo’. Lamb said he
personally believed it has
‘no place in a modern society’
and that the Department of
Health was not aware that the
NHS commissioned it, did not
recommend it and that it was
‘completely inappropriate’
for any GP to refer a patient
to this type of therapy. But he
said the Government did not
believe statutory regulation
for psychotherapists would
necessarily prevent it and the
costs ‘could not be justified’.
Couple therapy concerns
Too few IAPT services are
offering Couple Therapy
for Depression, and many
are referring clients to
alternative services that will
not meet their needs, the
Tavistock Centre for Couple
Relationships (TCCR) says.
The TCCR used a
Freedom of Information
request of all clinical
commissioning groups and
mental health trusts and a
‘mystery shopper’ exercise
with 20 IAPT services to
collect data on availability
of the NICE-recommended
therapy. It found that just
one in every 161 sessions
(0.62 per cent) of high
intensity (step 3) therapies
delivered through IAPT
are Couple Therapy for
Depression.
TCCR says that the
prevalence of depression
in which the relationship
is a factor is ‘sizeable’ and
that 0.62 per cent does not
represent adequate provision
to meet the need. It says some
couples are being referred to
couple counselling, which is
not an equivalent treatment.
The TCCR is a member
of the Relationships Alliance,
which last month launched
a campaign calling on the
In brief
Government to give
greater recognition to the
contribution of relationships
to health and wellbeing.
The Alliance, which also
includes Relate, Marriage
Care and OnePlusOne, says
the Government and local
authorities should publish
couple, family and social
relationships strategies
and that directors of public
health should be required
to measure the quality of
relationships in their region.
The Alliance estimates that
relationship breakdown
costs the UK economy
£50 billion a year.
© ALEX RATHS/ISTOCK/THINKSTOCK
Girls and young women ‘unhappier’ about looks
More and more girls and
young women feel unhappy
about their looks and the
influence of media images
is increasing among girls and
boys alike, the 2013 annual
Girls’ Attitudes Survey
from Girlguiding reveals.
The fifth annual survey
by the girls’ and young
women’s charity finds what
it says are ‘shocking’ levels
of sexism. Three quarters
of girls and young women
say that sexism affects most
areas of their lives, including
sexual harassment in school
and college and negative
experiences online.
The survey also reveals
growing levels of unhappiness
among girls and young
women about their bodies
and how they look. The
overall proportion saying
they are not happy with
their looks increased this
year to 33 per cent, up from
29 per cent last year and
26 per cent two years ago.
••Risk and severity of
depression reduces markedly
following the menopause,
a new study has found. The
US study followed up 203
women over a 14 year period
around their menopause. It
found a 15 per cent annual fall
in prevalence of depression
from 10 years before to eight
years after the final menstrual
period (FMP). The reduced
risk of depression occurred
in women with a history of
depression and women who
first experienced depression
shortly before the
menopause. JAMA Psychiatry
••Antidepressant prescribing
is rising sharply worldwide
in Western industrialised
countries, the OECD annual
report Health at a Glance
shows. Iceland has the
highest prescribing rate, at
106 doses a day for every 1,000
inhabitants in 2011, up from
70.9 in 2000. Next highest
is Australia at 88.9, up from
45.5 in 2000. The UK is in
seventh place (71 daily doses
per 1,000 people) – roughly
double the prescribing rate
in 2000. The OECD says the
rise ‘raises concerns about
appropriateness’. OECD
••Hospitals are still failing
Unhappiness also increases
with age: 89 per cent of girls
aged up to 11 years say they
are happy with their looks,
but by ages 14–16 51 per cent
are unhappy with the way
they look, and 42 per cent at
age 16. The impact of media
images is greatest on girls
who are already unhappy
with their looks: 76 per cent
say that they would like to
look more like the pictures
of girls and women they see in
the media, compared with 40
per cent of girls who say they
are happy with the way they
look. Among 11–21 year olds,
71 per cent say they would like
to lose weight and one in five
girls of primary school age
say they have been on a diet.
Three quarters of girls aged
11 to 21 feel that boys expect
girls to look like the images of
girls and women in the media.
routinely to conduct
psychosocial assessments
when people seek treatment
for self-harm, a survey of 32
hospitals in England reveals.
In the best hospitals, 88 per
cent of patients received a
psychosocial assessment, in
line with national guidance;
in the worst it was just 22
per cent. BMJ Open
Visit www.therapytoday.net to
read our weekly news bulletin.
December 2013/www.therapytoday.net/Therapy Today 5
In practice
Travelling
hopefully
Rachel Freeth
How often do we think
about the nature and
experience of hope in the
clinical, therapeutic context?
Speaking for myself, not
enough. The subject of hope
is one I have particularly
wanted to touch on in these
columns. I only wish that I
hadn’t left it until my final
one! However, it feels good
to write my last column
for Therapy Today in a spirit
of hope that I know hasn’t
often been apparent in my
previous columns.
Over the past 18 months
I have valued sharing my
clinical experiences as a
psychiatrist and, in a
different setting, as a
counsellor. In doing so,
I have highlighted and
commented on some of
my own personal and
professional tensions and
struggles that arise from this
dual professional allegiance,
and those that arise from an
organisational (and wider)
culture that is dominated by
medical model assumptions
and values, with which I
often feel uncomfortable.
I have greatly benefited
from, and am therefore
grateful for, having had
this opportunity to express
some of these challenges –
ones that I know a number
of readers also experience.
Furthermore, I find writing
is a good way to work out
what I think and deeply
believe – another reason
to be grateful.
One of my other aims
has been to affirm the
value of counselling and
psychotherapy, particularly
from the perspective of a
psychiatrist who sees in our
mental health services, and
other arenas, increasingly
limited opportunities for
the kind of therapeutic
relationship, attentive
listening and safe spaces
6 Therapy Today/www.therapytoday.net/December 2013
‘Therapy has the
potential to facilitate
and nurture hope
in clients. Is it
hope that fuels the
process of discovery,
change, healing and
meaning-making?’
that much counselling and
psychotherapy can offer.
I also affirm counselling
and psychotherapy from
the perspective of someone
who works in this way
too, witnessing the
transformation in clients
as they make use of that
regular, weekly hour. (I do
of course recognise that
therapy doesn’t help
everyone, and in some
circumstances may even
cause harm.)
Returning to the subject
of hope, I find myself
wondering how, and how
much, therapy has the
potential to facilitate and
nurture hope in clients. Is it
hope that fuels the process
of discovery, change, healing
and meaning making? It also
seems important to consider
on what the therapist bases
their hope when working
with clients. What kind of
hope enables the therapist
to stay with clients whose
distress seems endless
and intractable? Is it hope
that helps the therapist to
visualise a more positive
and healthy future for
clients who cannot entertain
this themselves, and what
underlies this vision?
To me these questions
have no ready answers and
the nature of hope seems so
mysterious. But I still enjoy
the questions and I want to
make more time to ponder
them. Whatever its essence,
the capacity to hope is surely
something fundamental to
the human condition. This is
not to disregard the states of
despair that can grip human
beings. But I don’t see despair
and hope as necessarily
mutually exclusive. In my
own clinical experience, quite
often it has been an awareness
and acknowledgement of
despair that enables hope
to break through – just one
of the many paradoxes of
being human.
Since starting to work as
a counsellor again, I do feel
to some extent liberated
from the quite common
expectation of my role as
a psychiatrist that I will ‘fix’
people. That said, it has been
noticeable how much more
this expectation pervades
the counselling room these
days. It also feels liberating
to be able to listen to people
at length, with much less
distraction from competing
medicalised agendas.
However, it can still be
every bit as demanding
as a counsellor to sit with
someone in mental and
emotional pain or confusion,
exploring questions that
have few easy answers, and
hoping that just being there
may be enough, at least for
that moment.
Working in a way that
pays particular attention to
the therapeutic relationship,
in whatever form of helping,
may make considerable
demands. Is it ultimately
hope that enables me to
continue working in this
way, despite the costs?
My answer is of course ‘yes’.
For there is nothing more
inspiring than witnessing
human resilience and healing.
Hope lies at the heart of
effective therapeutic
relationships, however
this manifests. In hope,
the journey goes on.
In the client’s chair
Fighting
to be heard
Julie Storey
I was born Deaf. My mam
had rubella when she was
pregnant. I was brought up
orally. I didn’t learn to sign
until I was 16. They wouldn’t
let us sign in Deaf school;
you got whacked with a ruler
if they caught you signing in
the classroom. I was forced to
wear hearing aids and to learn
to lip read. My mam taught
me to speak, by putting my
hand on her throat so I could
feel how it sounded. I’m
grateful to her because I can
communicate in both worlds,
but I prefer to sign. Speaking
isn’t me; it’s not who I am.
My father used to abuse
me, verbally and sexually.
It started when I was about
six and went on till I went to
live with my nana at 17 or 18.
He did it because he could.
He’d put his hand over my
mouth and tell me not to
say anything but he knew I
couldn’t really talk. I asked
my sister once, ‘Did he touch
you?’ but she didn’t answer
and I just left it there. It’s
her choice.
He did a lot of damage
to me. I’m still emotionally
scarred from it. I’m 56 and
it still bothers me. He used
to beat my mam up as well.
He was a policeman, very
powerful and controlling.
My mam and I are extremely
close. They were married for
44 years and I pleaded with
her to leave him. I thought
one day he’d kill her.
I went to counselling
because I wanted to be a
healed person. I wanted to
get rid of him from inside
my head. My first counsellor
was when I was 25. I went
to a women’s centre. I went
on my own. I didn’t know
about interpreter services
then. There was a woman
there who could sign a little
and I thought that was better
than nothing. She gave me
a piece of paper and said,
‘What do you feel about
your father? Can you draw it?’
I didn’t understand what she
meant so I drew a circle for
his head and stick arms and
legs and I did it all in black
and then all of a sudden I had
this horrendous flashback
and I picked up a red pen
and scribbled red ink all
around his private parts and
that was it. I never went back.
I thought we would be talking
about what happened to me.
I have nightmares. I see him
standing in the doorway with
an Alsatian. We never had an
Alsatian. I went to the John
Denmark Unit in Manchester
and saw a woman there.
She was absolutely brilliant.
I asked her about the dog
and she said it represented
his penis and his power and
I was just completely shocked.
But I only had the one session
with her. They said she was ill.
I was very sad that it ended.
My GP referred me to
another counsellor but the
interpreter had no idea about
counselling and she couldn’t
take a back seat and she got
confused and then I got
confused and I thought ‘I
don’t want to go through
this again’. The fourth time,
the interpreter was OK but
she got too personal; she
was hearing but from a Deaf
family and she’d talk about
her family and I wasn’t sure
I trusted her because the
Deaf community is very small.
The last counsellor has
been brilliant. I’m sad it had
to stop because the Clinical
‘The commissioners
have no idea how
many Deaf people
like me are hitting
a brick wall when
we try to access
Deaf counselling’
Commissioning Group
(CCG) won’t pay for any
more sessions. The sessions
were arranged through Sign
Health. She’s hearing but
has a Deaf mother and can
sign. I started with eight
sessions and she said to ask
my doctor if I wanted more.
I didn’t expect another eight.
I was really thrilled because
every week I was improving.
I stopped dreaming about
him. It was like I could push
him away. But then it finished
and I just went ‘Ooooof ’.
I’m not right. I’m not the
Julie I should be. If I were
rich, I’d carry on at the drop
of a hat.
She was very down to
earth, very empathic. We
had a rapport, and that’s
important. She didn’t follow
the rules. She let me tell my
story in my own time. She
was like a dustbin. I don’t
mean she was rubbish; it felt
like my dustbin was full and
I knew that whatever I threw
at her, she could take it all
from me and put it in her bin.
She encouraged me to go back
to writing my book. I stopped
in 2003 because it was too
painful. I’m trying to write
and I’d like to make a film
out of it, to tell other Deaf
people who’ve been through
what I’ve been through that
they aren’t the only one.
But it’s not all out by
any means. I’m still having
nightmares. Sometimes I
think I’m doing well and
then something triggers
me and I lose the plot again.
I get angry. Sometimes I want
to take it all to the CCG and
say, ‘This is my life. You deal
with it’. They have no idea
how many Deaf people like
me are hitting a brick wall
when we try to access Deaf
counselling. Deaf people
have a right to counselling
too. My journey is unfinished
and I want to finish it.
December 2013/www.therapytoday.net/Therapy Today 7
In the supervisor's chair
Power and
authority
Rosie Dansey
References
1. Mehr KE, Ladany N, Caskie
GIL. Trainee nondisclosure in
supervision: what are they not
telling you? Counselling and
Psychotherapy Research 2010;
10(2): 103–113.
2. Proctor G, Napier MB (eds).
Encountering feminism:
intersections between feminism
and the person-centred approach.
Ross-on-Wye: PCCS Books; 2010.
3. BACP. Supervising and managing
– BACP Ethical Framework.
Lutterworth: BACP; 2013. www.bacp.
co.uk (accessed 6 November 2013).
Authority and power are
seen as synonymous. Yet
I respect ‘authority’ and
am always wary about the
concept of ‘power’.
Is a collegiate supervisory
relationship difficult because
of the risk of a power
imbalance or of power being
misused? I wonder if this
is less so if a supervisor has
received training? It is not
a natural progression from
therapist to supervisor;
it’s a different specialism,
with its own set of skills and
ethical awareness. Also the
role does not fit everyone.
I have been fortunate never
to have experienced a power
imbalance with a supervisor
who is overly ready to seek
out and identify failings; I
trust that the experience of
my own supervisees has been
positive. I believe a ‘policing’
role leads the supervisee to
lack confidence, be defensive
and hide mistakes. And the
research alerts us that we
do need to be concerned
about what is not disclosed
in supervision.1
I see the art of supervision
as overseeing the process,
as not directly pointing out
mistakes but saying, ‘Let us
explore how you could have
done that differently’. The
supervisory process allows
therapists to recognise
weaknesses and blind spots.
I too, as supervisor, make
mistakes and have my blind
spots and when a supervisee
challenges me I know the
relationship is secure and
that power is shared.
Trainee therapists tend
to be more deferential to the
supervisor’s expertise but if
they are giving too much
power to the supervisor this is
itself an issue for supervision.
Often a supervisor has to
write a report for the
training institution, even
to recommend a pass or fail,
8 Therapy Today/www.therapytoday.net/December 2013
‘I value collaboration
and consultation…
I see real power
as facilitating
and enabling the
supervisee to achieve
their potential’
and this makes a collegiate
relationship difficult. My
practice is to involve the
supervisee, to ask if they are
ready to go out and practise
without the safety net of
their tutors. This can be a
very interesting exploration
but I, as supervisor, still
hold the responsibility for
the final decision. Sometimes
the supervisor is required to
write an annual review for
an employing organisation
but if good practice has
been followed, there will
have been regular supervision
reviews. In all reports,
whether they concern a
trainee or an experienced
therapist, I believe the
content should not be a
surprise to the supervisee.
I share the writing of these
reports with the supervisee
as a collaborative exercise.
It is an opportunity for
feedback on the supervisory
relationship: is it developing,
growing, stagnating or
becoming collusive? If
there are concerns about
a supervisee’s practice, I
raise and discuss them at
the time. Rather than saying,
‘I don’t think you should
be practising’, I trust the
supervisory process: that
through the exploration of
these issues the supervisee
will recognise this for
themselves. If not, I, as
supervisor, have to use
my power and authority
to intervene but this has
been rare in my experience.
If the relationship is secure
and based on mutual respect,
the supervisor can usually
challenge effectively but
in so doing she carries the
responsibility for client
welfare – the heart of
supervision, ethically.
Proctor and Napier2 explore
the difference between
‘power over’, ‘personal
power’ and ‘power from
within’. It is so easy to give
away power; often part of the
therapist training process is
the development of assertion
skills. The supervisee has the
power to challenge a ruptured
relationship and, if necessary,
to change their supervisor.
If a supervisor has been
allocated by the employing
agency then this too raises
issues of power, but here
it may be more difficult to
change a supervisor. In group
supervision supervisors are
often allocated. There is
the potential for a powerful
supervisor to take over or
it can be a rich co-learning
experience, especially in
a peer group where power
can be held in the group.
I still remain uneasy
about the use of the word
‘supervision’ and wonder
whether the term
‘consultative support’ may
be more appropriate. BACP
does use both in its literature.3
I value collaboration,
consultation and powersharing as much as is feasible
ethically and I aim to use
my authority wisely to allow
the supervisee to grow and
develop their own style. I
see real power as facilitating
and enabling the supervisee
to achieve their potential.
Where does power reside in
your supervisory relationship?
Is there anything you are
reluctant to disclose to
your supervisor?
To get in touch with Rosie, email
[email protected]
The researcher
Written in
the genes
Barry McInnes
References
1. Cain S. Quiet: the power of
introverts in a world that can’t
stop talking. London: Penguin; 2012.
2. Belski J, Jonassaint C, Pluess M
et al. Vulnerability genes or plasticity
genes? Molecular Psychiatry 2009;
14(8): 746–754.
3. www.uccs.edu/Documents/dsegal/
An-empirical-investigation-Jungstypes-and-PD-features-JPT-2.pdf
My previous column explored
research that suggests that
introversion and extroversion
are aspects of temperament
that are significantly heritable
and linked to our body’s
capacity to tolerate stimulus.
In this column I consider the
implications, for our clients
and for us as therapists.
Remember the cool kids
at school? The ones that
were confident, easy-going,
gregarious, popular? The
ones the other kids wanted to
be like, or at least be around?
Nerd chic might be cool
now, but it didn’t exist in my
teens. Back then introversion
did, and still does, carry
disproportionately negative
connotations. Looking up
‘introvert’ on my online
thesaurus, I’m offered the
synonyms ‘shy, withdrawn,
reclusive, reserved, reticent,
timid, quiet’. ‘Extrovert’,
on the other hand, brings up
‘social, gregarious, outgoing,
extroverted, friendly, social,
livewire’. In terms of common
markers of social desirability,
extroverts win hands down.
Introvert children often
struggle to get a good start
in life. A gene known as the
serotonin-transporter (SERT)
seems to be implicated. This
gene helps to regulate the
processing of serotonin, a
neurotransmitter that affects
mood. According to Susan
Cain, a variation of this gene
known as the ‘short allele’
is thought to be associated
with high reactivity and
introversion, as well as an
increased risk of depression
in individuals who have had
difficult lives.1
What appears to be critical
to the emotional development
of introvert children is a
supportive and validating
environment. Research by
Jay Belsky and colleagues2
has suggested a framework
of ‘differential susceptibility’.
It seems that those most
susceptible to adversity
because of their genetic
makeup are also most likely
to benefit from supportive
or enriching experiences.
In other words, children
with the short SERT gene
seem to be more susceptible
to environmental influences
– for better and for worse.
Given the right
environments, says Cain,
highly reactive children
may have fewer emotional
problems and greater social
skills than their peers, and
also be highly empathic,
caring and co-operative.
They may also be better
at some types of decisionmaking, less likely to be
killed while driving, and less
likely to smoke, have risky
sex, have affairs and remarry.
In the absence of a
validating environment,
we can imagine the likely
response to the
temperamental cautiousness
of the introverted child and
how their sense of self and
their place in the world is
likely to develop. They may
hover on the fringes, not quite
sure how to join in, feeling
awkward, envying others
their social ease, and probably
feeling there’s something not
quite right with them. I only
had to endure being labelled
boring, tedious and antisocial
when I needed some ‘me
time’. It could have been
much worse, as it is for
many of our clients .
‘We may help clients
develop new skills
and ways of thinking
and being, but their
temperament is
what it is. We need
to help them play
to their strengths’
A sobering illustration
of the connection between
introversion and
psychopathology is contained
in a study by researchers at
the University of Colorado
that looked for correlations
between 14 personality
disorder types and the four
MBTI dimensions, including
Extrovert–Introvert (E–I).3
Ten of the 14 personality
disorder scales had
statistically significant
relationships to the E–I
dimension; of the 10 scales,
nine were correlated with
introversion and only one
with extroversion. In other
words, introversion is much
more highly correlated with
features of personality
disorder than extroversion.
These findings raise questions
about the extent to which the
behavioural characteristics of
introverts may be more likely
to be seen as problematic and
consequently pathologised.
The challenge for therapists
surely is to recognise which
aspects of a client’s
presenting concerns may
be linked to environmental
factors and which to heritable
temperament. We may be
able to help clients develop
new skills and ways of
thinking and being, but their
temperament is what it is.
We need to help them value
their core characteristics
and play to their strengths
in a way that they may never
have previously considered.
If we fail in this then we run
the risk of colluding with their
belief that they are inherently
flawed and encouraging them
to believe that, in order to be
happier, they simply need to
fake it more effectively. This
strategy clearly hasn’t worked
for them in the past, and nor
will it in the future.
To get in touch with Barry, email
[email protected]
December 2013/www.therapytoday.net/Therapy Today 9
News feature
ADHD – passport
or label?
Are we over-diagnosing and over-medicating children with ADHD?
A new paper in the British Medical Journal has reignited the debate
Catherine Jackson reports
ADHD diagnosis has always been
controversial and has long been
of concern to counsellors and
psychotherapists working with children
and young people. For desperate parents
struggling to cope with the behaviour of
a seemingly unmanageable, hyperactive
four-year-old, and for the equally
desperate teacher trying to engage a
child who is unable to focus on their
work and is disrupting the whole class,
a diagnosis brings a welcome medical
explanation and a passport to treatment
and educational resources.
But sceptics have long voiced fears
that the Western world is pinning a
medical diagnosis on what is, essentially,
normal childhood behaviour. They
argue that the problem lies not with
the child him or herself but with their
environment, including poverty, lack
of boundaries, inconsistent parenting,
violence and abuse at home, and the much
greater challenges that families face in
raising children in today’s increasingly
harried and hurried world.
Should counsellors and
psychotherapists be working with the
diagnosis? How should they respond
to parents coming to them convinced
that medication will solve their child’s
poor exam results or uncontrollable
temper tantrums? The debate has been
recently reignited by an article in the
British Medical Journal, in its ‘Too Much
Medicine’ series. The article highlights
the sharply upward trend in the reported
prevalence, diagnosis and medicating
of children and young people with
symptoms of ADHD in the Western
industrialised world. In the US, for
example, the numbers of parents
reporting that their child has ADHD
rose from 6.9 per cent in 1997 to 9.5
10 Therapy Today/www.therapytoday.net/December 2013
per cent in 2007. Prescribing rates
showed correspondingly sharp rises:
in Australia prescriptions went up
by 73 per cent from 2000 to 2011; in
the UK (where prevalence rates are
estimated at between two and four
per cent of children) rates doubled
between 2003 and 2008.
According to the latest Care
Quality Commission (CQC) data,
NHS prescriptions for methylphenidate
(Ritalin) for treating ADHD topped
657,000 in 2012: a 50 per cent increase
on 2007. Private prescriptions rose to
5,000 from just under 2,000 in 2007.
The BMJ article says one factor
driving the increase is the widening of
the diagnostic criteria in the influential
Diagnostic and Statistical Manual of
Mental Disorders (DSM), recently
reissued in a revised, fifth edition.
The article maps the prevalence of
ADHD diagnoses against each revision
of the DSM to show that, as the diagnostic
criteria in each edition have expanded,
there has been a corresponding increase
in the prevalence of diagnoses of ADHD.
The article’s authors say DSM-5 will
exacerbate this upward trend: it not only
includes more examples of behaviours
that are considered to indicate ADHD
but extends the maximum age for onset
from seven to 12 years. These changes
increase the risk of even more normal
childhood developmental behaviours
being captured in the diagnostic net.
The BMJ article does not question
the validity of ADHD as a behavioural
condition that can severely affect a
child and its family, with life-long
implications. Its concern is that the
too-ready diagnosis of children and
young people with less severe symptoms
will fuel scepticism about the diagnosis
itself and mean those with more
severe problems don’t get the help
they undoubtedly need. But the article
also raises the very important question
about what the powerful stimulant
medications used to treat ADHD may
be doing to children. They also argue
that this is yet another toxic intersection
of diagnostic elasticity and the influence
of the drug industry.
The UK comes out well in the
article: our NICE guidelines use the
conservative, stepped approach it
recommends. This includes careful
assessment of all the social, family and
educational factors in the child’s life,
their physical health, and the mental
health of the parents/carers; referral
first to behavioural management/
parent training programmes, and
teacher training in behavioural
techniques to help the child focus in
class. Medication should be offered
as a first-line treatment only to children
with severe ADHD, and then only as
part of a comprehensive package of
psychological, behavioural and
educational support and interventions.
And only specialist paediatricians and
child psychiatrists can make a formal
diagnosis and initiate medical treatment.
But how meaningful are these
restrictions? Severe ADHD is obvious,
as the BMJ article points out, ‘but in mild
and moderate cases, which constitute the
bulk of all ADHD diagnoses, subjective
opinions of clinicians differ’. As with
many other psychoactive medications,
here too the drug companies are facing
accusations that they are exploiting a
lack of clinical clarity and the credulity
and desperation of parents to promote
drugs that may not always be necessary
or helpful, and could be harmful.
© YUN YULIA/ISTOCK/THINKSTOCK (POSED BY MODEL)
December 2013/www.therapytoday.net/Therapy Today 11
News feature
‘Medication doesn’t cure ADHD. It doesn’t
change parenting styles. It doesn’t make
kids smarter. But it’s an opportunity to put
in place the right programmes that can help’
Under-diagnosed and treated?
Eric Taylor, Emeritus Professor at
Kings College London and a retired
child psychiatrist, chaired the NICE
guideline group and was a member of
the working group that produced DSM-5.
He questions the relevance of the BMJ
paper to the UK. ‘I agree over-diagnosis
and over-medication are a problem in
the US and Australia but I think we
under-diagnose and under-treat here in
the UK. We prescribe stimulants at only
about a tenth of the rate that applies in
the US.’ He says that the rise in rates of
diagnosis is warranted: more diagnoses
mean more children and adults are now
getting the help they deserve and need.
Andrea Bilbow, Chief Executive of the
charity ADDISS (the national Attention
Deficit Disorder Information and
Support Service, which Professor Taylor
advises) agrees: ‘There are 400 child
psychiatrists in the UK who won’t all
specialise in ADHD and about a thousand
paediatricians who won’t be specialists
either. We don’t have enough clinicians
to get to the point where we could be
over-prescribing,’ she says. Her worry
is that adverse publicity will result in
a narrowing of the diagnosis. ‘If we do
that, there is a whole group of kids who
won’t get the help they need in school.
Our schools are still very ignorant about
ADHD. The biggest area of my work is
getting excluded kids back into school
and the schools won’t help if you haven’t
got a diagnosis. These kids have what you
would call moderate ADHD. They have
good parents who support them through
their education but the minute they leave
home to go to university it all falls apart.
Their impairments are still there.’
And the implications of school
failure and exclusion can be life-long,
as Tim Kendall, Director of the National
Collaborating Centre for Mental Health
at the Royal College of Psychiatrists,
points out. He was Facilitator on the
NICE ADHD guideline group and has
absolutely no doubt that ADHD exists
as a clinical reality: that there is a cluster
of symptoms that differs significantly
12 Therapy Today/www.therapytoday.net/December 2013
from conduct disorder and autism and
other behavioural and learning disorders.
‘I don’t mind what you call it,’ he says.
‘The key thing is, does the diagnosis help
us provide interventions that can help
that child and improve their outcomes?’
The difficulty here is a lack of good,
long-term follow-up studies. Kendall
says his own impression from working
in this field over many years is that
children who don’t get help have a very
poor future ahead of them. ‘If we treat
them, they might have a future. If not,
as the kids get older and the less well
you manage the problem and the less
you help them, the more likely they
are to end up with a conduct disorder,
whatever they started with.’ He says
more than half of those with severe
ADHD are likely to end up with a
diagnosis of antisocial or borderline
personality disorder, many will end up
in prison, and all will struggle to hold
down jobs and long-term relationships.
Says Bilbow: ‘We get parents in their
60s and 70s still ringing us for help
with their child who’s now aged 45.
They are still scaffolding a 45 year old.
They end up with gambling problems,
drink problems, money problems
and their families are still dealing
with it. Medication doesn’t cure
ADHD. It doesn’t change parenting
styles. It doesn’t make kids smarter.
But it’s an opportunity to put in place
the right talking therapies, the right
parenting programmes, the right
education programmes that can help.’
Professor Taylor goes further.
Methylphenidate increases the dopamine
levels in the brain. Mostly it is regarded
as having only a short-term effect.
Professor Taylor says that comparative
studies with children with ADHD who
don’t receive medication show that,
long term, it actually restores the normal
development of the child’s brain. He
also argues that medication has a more
powerful impact than parent training,
although this is largely because the
benefits of parent training often aren’t
matched by teacher training in schools.
‘Comparable types of teacher training
aren’t much done here but where they
are, it’s shown to be quite effective,
especially if teachers see ADHD as a
special kind of behaviour management
issue.’ In one UK study, teachers were
given a leaflet explaining ADHD. ‘It had a
small but measurable impact on reducing
ADHD problems in the classroom.’ The
teachers no longer regarded the children
as naughty or lazy and instead regarded
them as having a neurobiological problem,
a special educational need, and that
changed how they responded to them.
‘A lot of children’s conditions are
increasing over time but rates of ADHD
aren’t and that’s because it isn’t primarily
affected by the kinds of factors that are
affecting other childhood problems,
like family breakdown and domestic
violence. It’s much more like a
neurodisability,’ he argues.
More harm than good?
But many equally convinced clinicians
and researchers take a different view:
yes, these children have behavioural
and attention problems, sometimes of
immense severity, and yes, they and their
families need help. But the ADHD label
helps only in that it provides a passport
to educational resources and parenting
support; in the long term, it may do
more harm than good. We are reaching
too quickly for the prescription pad.
Jeanine Connor is an experienced
child psychotherapist who often sees
children brought to her by anxious
parents convinced their child has
ADHD. ‘The diagnosis can give parents
a socially acceptable explanation for their
child’s behaviour. They come wanting
that magic pill. But for others, it’s really
empowering when you tell them that
their child doesn’t have a disorder and
that what the child needs is for them to
do things differently – to be more robust,
calm, structured. They find it a huge
relief: there is something they can do.’
She conducted her own small-scale
survey. Of 100 consecutive new referrals,
74 (64 boys and 10 girls) had symptoms
‘We need to ask ourselves what it is that we are
really measuring when we assess these children.
It’s no coincidence that providing their families
with support results in better outcomes’
that the referrer felt met the criteria
for ADHD, she says. But of these, 66
per cent were playing 18+ console games
regularly (more than three times a week)
– 72 per cent of the boys and 30 per cent
of the girls – and 72 per cent were living
in homes where there was domestic
violence. ‘Children often present with
symptoms of the environment they are
living in,’ she says. ‘If there’s violence,
lack of structure and chaos, of course
the child will behave in an erratic,
unstructured way. Medication isn’t
magic; it might take the edge off a
child’s symptoms but it won’t change
their environment. For a tiny minority
it may be useful but, in my experience,
the vast majority of children with a
query of ADHD would benefit far more
from parenting programmes, counselling
and psychotherapy and from educating
their parents and teachers. Both the child
and family need to learn ways to manage
their behaviours.’
‘It’s part of a broader pattern of the
medicalising of human distress and
locating the problem in the individual,’
argues psychologist Professor John
Read, at the Institute of Psychology,
Health and Society at the University
of Liverpool. ‘Show me a child with
an ADHD diagnosis and nine out of
10 times I will show you parents who
need some support in their parenting.’
Medication can help some children
but it is massively over-prescribed,
he believes: ‘The child may be likely
to be able to pay attention for longer
and be less “naughty” but there’s very
little evidence that it improves academic
performance over the longer term and
it has some very major side effects.
For example, it stunts physical growth
by an average of one centimeter a year.
These are not drugs to be trifled with.’
He is concerned about the lack of longterm follow-up research: ‘We just don’t
know what these drugs are doing to the
brain on a long-term basis; there haven’t
been any good longitudinal studies.
We should be much more careful about
interfering with the child’s developing
brain. It used to be accepted practice
that if a kid is struggling, the family needs
support. As a result of the dominance of
a simplistic medical model, that view has
gone out of the window. Family-based
and behavioural approaches are underfunded but the drugs aren’t necessarily
cheaper in the long run – and the drug
companies are benefitting very nicely.’
Child psychiatrist Sami Timimi is one
of a very small number of psychiatrists
who have stood out against the status
quo. For more than a decade he has
challenged the prescribing of
methylphenidate to treat ADHD in
children. He was lead reviewer on
the NICE guideline group but says his
presence was tokenistic. ‘There is this
get-out clause that medication should
only be used with severe cases. But there
is no clear definition of the difference
between mild, moderate and severe,’
he says. He points to emerging
evidence from naturalistic studies
that the long-term outcomes from
the NICE recommended approach to
treatment are not good. ‘We should sack
the original guideline group and form a
more representative one,’ he argues; all
children and families should be offered
purely psychosocial interventions first.
‘ADHD describes sets of behaviours.
That is all it does. It doesn’t tell you
anything about what has been going
on in the child’s life that might explain
why they have developed these sets
of behaviours and there isn’t any one
process you can follow that leads to
amelioration. You can’t understand a
child’s behaviour unless you take account
of the family context, family education
levels, parental mental health, family
conflict, where they live, their income,
violence in the home – these factors all
predict these kinds of behaviours. An
ADHD diagnosis is not an explanation.’
He describes children and young
people referred to his service who have
been taking Ritalin for years and still
their lives are going badly. ‘No one has
ever sat down with them and asked about
what is going on at home, at school, in
their lives. For years the system has been
focused on managing their symptoms.
They have a story to tell about things that
are meaningful to them, and no one has
taken it seriously and wondered what it
might be like to be going through all this.’
Clinical child psychologist Angela
Southall describes similar experiences.
‘I have seen a lot of children with this
label and it makes me feel very sad when
children’s problems are over-medicated,’
she says. Her book, The Other Side of
ADHD (Radcliffe, 2007) found a 180fold rise in prescribing rates for ADHD
from 1990 to 2005. ‘That’s on the scale
of an epidemic and begs the question,
what is causing it? Medication doesn’t
answer that fundamental question.’
She regards it as her responsibility as
a clinician to challenge the argument that
over-diagnosis is not a problem in the
UK. ‘Children can’t tell us their problems
but they show us in their behaviours.
It’s up to us to be very careful in how we
interpret that. It’s too easy to come up
with a diagnosis of ADHD, which doesn’t
tell us anything. I find it extraordinary
that people can locate the problem in
the child and then medicate it.’
She led a multi-disciplinary CAMHS
for many years: ‘We never had a diagnosis
of ADHD because we simply never found
ourselves having to go down that route.
We spent a lot of time on assessment,
understanding where the child and
family were coming from and putting
in the support where it was needed, both
at home and at school.’ She points to the
research showing that ADHD diagnosis
is highly correlated with poverty and
disadvantage: ‘We need to ask ourselves
what it is that we are really measuring
when we assess these children. It’s no
coincidence that providing their families
with support results in better outcomes
for them. Children deserve more and
they deserve our advocacy.’
Reference
Thomas R, Mitchell GK, Batstra L. Attentiondeficit/hyperactivity disorder: are we helping
or harming? British Medical Journal 2013; 347:
f6172.
December 2013/www.therapytoday.net/Therapy Today 13
Training
Silenced: the Black
student experience
14 Therapy Today/www.therapytoday.net/December 2013
Black and Asian counselling students often complain
that their di�erence and experience is ignored in
counselling training. Eugene Ellis and Niki Cooper
discuss the reasons for this failure to acknowledge
cultural diversity Illustration by Luke Best
Eugene: I’d like to start off with a
general discussion about therapy
trainings and the Black student’s
experience. In my experience and
the experience of colleagues, and from
what I hear from students, counselling
and psychotherapy trainings haven’t
really begun to address how racism
affects the therapeutic dialogue. There
is diversity on the curriculum, it’s dealt
with objectively, as an issue out there,
but not subjectively and personally.
There is little examination of what’s
going on in the classroom. For example,
group process in therapy trainings
can be tough for some Black and
Asian students. I have spoken to many
who despair at the silence and lack of
understanding when they try to voice
their experience of the group in the
way that white students do. There is
no conversation, just silence, which is
very distressing. There is a conversation
to be had and it hasn’t, for the most
part, even started.
Niki: The difficulty about having the
conversation is paving the way. Unless
someone forces people like me, the
person who is writing the training
programme and delivering the training,
to have the conversation, then we won’t
think we need to. We won’t even know
that there is a conversation to be had.
My position with regards to students
from other races and cultures used to
be: ‘Well, I’m absolutely committed to
your entitlement to everything that I’m
entitled to. We are all absolutely equal.’
I have always believed that, so it was
very puzzling for me to have to take
on board the idea that not everybody
felt that sense of entitlement. I didn’t
get why anybody wouldn’t, regardless
of their colour or race – if they’ve
lived in this culture their whole life
and they’ve been to school here, why
wouldn’t they feel as entitled as me?
And if they’d experienced any racist
events in their life then yes, that was
terrible and it shouldn’t happen, but it
was nothing to do with me. To me, there
wasn’t anything to talk about. At the
same time, when faced with any person
of colour who was naming the difference
between us, I would be overcome with
anxiety about saying the wrong thing,
about upsetting them or exposing my
ignorance. Maybe that explains some of
the silence. It’s easier to stay quiet than
face the embarrassment of messing up.
I think the step that I needed to take
was to realise that I was part of the
problem as well as the solution. Not
that it was my fault, not that I was
entirely to blame for all the ills and
evils of racism in the world, but that
my lack of understanding about my
December 2013/www.therapytoday.net/Therapy Today 15
Training
own culture meant that I was also
maintaining a problem. I’m not saying
we have to go into a silent, guilty, selfflagellating shameful place – although
that was a necessary phase for me as
well – what Isha McKenzie-Mavinga
calls ‘recognition trauma’.1 I’m talking
about the process of getting to the
other side of that and accepting that
we are not all lovely people and there
is a conversation to be had.
That recognition came to me when I
was delivering Place2Be’s postgraduate
diploma in child counselling with my
colleague Kelli Swain-Cowper, who
is Korean-American. We had three
particular students of colour on the first
cohort who taught us a huge amount.
The courses always included a thread
on difference and diversity but, despite
our best intentions, we realised from
these three students that our training
was still leaving some people feeling
excluded, not understood or not heard.
Eugene: Did they voice that directly
to you?
Niki: They did yes, but it took time.
It wasn’t until the second year really
that they were able to articulate that.
Up until that point there had been a lot
of silence but by the second year they
found their confidence and their voices
and were able to tell us what it was like
for them. I think the reason that it had
never been flushed out before is that
all of our other courses are quite short.
That was when I came face to face
with my own ignorance and
incompetence as a white, middle-class
woman who’d been brought up in this
culture and completely immersed in it
my whole life. There were lots of things
I didn’t know I didn’t know. Previously
I hadn’t felt that; I’ve been really
committed to equality, committed
to antiracism and anti-discriminatory
practice to the core of me. I was
convinced of it. The experience of
these three trainees is what drew me
to doing the Black and Asian Therapist
Network (BAATN) ‘Black Issues in
the Therapeutic Process’ training.
I wanted to feel confident that our
Place2Be courses were not just going
to be able to attract a broad diversity
of people but also that all participants
would have an enjoyable, stimulating
and inclusive experience.
Eugene: It’s so refreshing to hear you
say that. What tends to happen with
Black trainees is that they enter into
the spirit of enquiry that is encouraged
on any counselling or psychotherapy
training course, but when they do so
in the area of their culture and their
race, there is all this silence and it’s
like you’ve just opened a huge hole
in the floor. Somehow it becomes your
fault. You can then choose either to say
nothing, because it’s too painful, and
focus on just getting your qualification,
or you insist that your voice is heard,
get labelled as the troublemaker, and
risk not making it to the end because
you’re worn out by the fighting.
It’s so sad to see this happen and I
have heard this from so many Black and
Asian students. It all goes on under the
surface. Just naming what’s going on
becomes almost impossible and everyone
gets defensive and blaming. It’s normally
the student of colour who gets the
rougher end of things because that’s how
oppression works. What then happens
is that students have to go outside their
training to get what they need to develop
as therapists within the profession.
When I was training there were
precious few avenues to explore these
issues and it was only since setting up
BAATN that I truly found my voice as
a Black therapist. I think there was an
assumption that I was already an expert
in issues of culture and race. But I also
needed training in Black issues – issues
pertaining to skin colour. I had to take
on new ideas and new ways of looking
at things that allowed me to put my
experience into words.
Making space for difference
Eugene: Could you talk a bit about your
experience with these three students
and what happened? Was it just that
these students were saying ‘Our needs
are not being met in this particular area’?
Niki: What was painful was realising that
they hadn’t been able to say anything.
The students had all been invited to
work in groups to do a sculpt of their
experience of the training. These
three women had ended up together,
apparently serendipitously, and they
made a sculpt of ‘Hear no evil, speak
no evil, see no evil’. I don’t know how to
describe it… even thinking about it now
gives me goose pimples. The whole room
completely froze. Kelli, my co-tutor, as
another woman of colour, was the only
person who was able to name what had
happened. She reflected the painfulness
of the image and the importance of the
moment for those students. She was the
person who, in that instant, enabled the
students to feel heard and understood.
I was, very uncharacteristically, struck
dumb. It was a real turning point for the
group and for us as tutors. It also led to
some important, honest and necessary
conversations between Kelli and I about
our own cultural differences that, up to
that point, we had not made the space
for. I saw Kelli as the same as me, with
the same values, beliefs and experiences.
‘Faced with any person of colour who was naming
the di�erence between us, I would be overcome
with anxiety about saying the wrong thing,
about upsetting them or exposing my ignorance.
Maybe that explains some of the silence’ (Niki)
16 Therapy Today/www.therapytoday.net/December 2013
It was she who pointed out, very kindly:
‘Niki, I am neither white, nor middle
class.’ The conversation went from there.
Up until that point I felt the
participants were choosing not to
speak. With their sculpt the students
had articulated that their silence wasn’t
something they had chosen necessarily.
It swivelled the lens round to point at
us, and made me think ‘Maybe there
is something about this course that is
silencing and having a silencing impact’,
and that was very troubling; that was
horrible and shocking but it also
represented a turning point for me
personally because I could have those
conversations and they were probably
not as difficult as before.
It was one of these three women who
introduced us to Val Watson’s work2
and Colin Lago’s books on transcultural
counselling.3, 4 There was a particular
chapter that resonated a lot with me,
which was about our majority culture’s
ignorance and how absolutely everything
is loaded with messages, beliefs and
assumptions. For example, my family
comes from Bristol. Bristol has got
its own particular history and culture
around slavery and my father’s family
have been there for a couple of
generations. So I’m quite steeped
in that mixture of guilt, denial,
defensiveness and division.
Eugene: That’s the recognition trauma
that you talked about before, which
is so important here; it’s that moment
when everything freezes. It’s like so
many other kinds of trauma where
people become triggered, frozen and
then preoccupied by their side of the
story. What you’re saying is that you
had become preoccupied with the
perpetrator side of racism. To distance
yourself from being this kind of person,
especially given your morals and
ethics, you had to deny your part in
racism and find some other explanation
for the guilt and shame you felt.
On my side of the fence, we become
preoccupied by the victim side of the
racism story, which is often backed up
by personal experience, even if it’s on
a micro scale over many years. When
a white British person says all the right
things and clearly thinks s/he believes
them but has not recognised or seen
their part in what’s happening, you are
left with the option of either colluding
with that denial, which is a painful act
in itself, or challenging the denial and
risking being more of a victim than you
already feel. It’s not a great place to be,
to feel silenced by that denial and also
silenced by the denial inside yourself.
I couldn’t put it into words until I came
into contact with new concepts to
organise it for me and make sense of it.
Niki: What you describe sounds like
a rock and a hard place. Was there a
particular moment or relationship for
you that enabled you to make sense of
that and wriggle free?
Eugene: I’m still wriggling and I can’t
see an end to that for the time being but
I am wriggling less. It has been more of
a gradual process over time. As I think
about it, the moment that I was no
longer a student felt very significant.
I felt freer and less constrained by the
course requirements to pursue theory
that wasn’t Euro-American centred,
especially as I had the safety of a
qualification, which meant that I could
legitimately work as a therapist and earn
a living. Also my relationship with Isha
McKenzie-Mavinga, her work on ‘Black
Issues in the Therapeutic Process’1 had
a big impact on me. It looks at the hurt
of racism on both sides of the fence, which
resonates with my own sensibilities and
style of relating and has given me more
of a feeling of confidence in this area.
Niki: If you had had your voice when you
were a trainee, with the wisdom you have
now, what would you have said?
Eugene: That’s an interesting question.
I tend to see these situations as a
therapist/client situation. If I just give
information it rarely moves things on
unless others are really motivated and
committed. If I go with the process of
how these things usually unfold, at my
own and everyone else’s pace, we can
take small steps together. For me it’s
about what we can all tolerate in that
moment so what I would say would
very much depend on the situation.
Having said all that, though, it is a
very familiar feeling, one that many Black
people might recognise, when issues of
culture and race are ignored. It can be
very overwhelming and very consuming
in the moment, especially when there are
no allies around. I’m thrown back to that
rock and a hard place dilemma of ‘No
one acknowledges that what I am saying
is relevant’. It’s like gender oppression
or class oppression; no amount of
integration of the issues matters when
you are facing a brick wall. The relief
when you are given an invitational space,
even if you don’t use it, can be immense.
Permission to get it wrong
Eugene: I was interested that Colin
Lago’s books seemed to help you shape
the experience you were having. Was it
after this that you decided to go on the
‘Black Issues’ workshops?
Niki: It was after reading your ‘How I
became a therapist’ article in Therapy
‘I have spoken to many who despair at the silence
and lack of understanding when they try to voice
their experience of the group in the way that
white students do. There is no conversation,
just silence, which is very distressing’ (Eugene)
December 2013/www.therapytoday.net/Therapy Today 17
Training
Today.5 I thought, ‘At least at this event
I won’t be in any danger of silencing
anybody’. Your article sounded
welcoming and what I’d been going
through for the previous two years in
confronting this as a tutor had been so
difficult; I couldn’t imagine that anything
could be more difficult and more gutchurning. I felt I could come and listen
and understand. I wanted to learn more
about good and not-so-good practice
in training especially. I wanted to gain
a greater understanding about my own
implicit attitudes and how they could
feed into exclusivity in training. I was
aware that I would be stumbling around
in the dark and not getting it right but
I was resolved not to be silenced myself
by that anxiety.
Eugene: Certainly in your training, and
I know that this is the experience of other
people on trainings as well, it sounds like
the silence means people don’t feel safe,
and if they don’t feel safe they are not
going to explore.
Niki: What was good was that the
potential for feeling silenced was named
quite early on. I think you said to me
when we were in a small group together:
‘I’m really aware of feeling anxious about
you’, or that you were ‘feeling like I need
to protect you’ or ‘to be careful about
what I say’. You named the potential
for you to be silenced by me being there
and I was able to acknowledge that I
was probably feeling the same. It gave
us permission to stumble around and
get it wrong. I came away really buzzy
– a real sort of ‘Yeah, we can do this.
Nobody died during the conversation’.
Eugene: I’m so glad that you felt that
way because that was what we wanted
to engender. There were a lot of areas
covered during the ‘Black Issues’
training. Was there one thing in
particular that you took away with
you from the training?
Niki: One of my students happened
to be on the same course as me – this
was very early on in her training and
I’d recommended it to everyone on
the course. By coincidence we attended
the same day and we fed back to the
group together. That had a massive
impact on that group in that they were
willing, right from the beginning, to tie
into their thinking an understanding
that counselling and psychotherapy
theory, in itself, is very Euro-American
and white and that we can’t assume that
it applies equally to everyone. So from
the start this student, who was from
Ghana, had the confidence to say when
something didn’t make any sense to
her, and she was heard by the group.
This had a big impact on that group and
on the training generally, which had a big
ripple effect through all the trainings.
At Place2Be we have a complete
professional qualifications pathway
as well as CPD training for all our staff
and volunteers. All of the courses and
workshops have been revisited with
an eye to acknowledging difference.
We still have workshops and modules
that focus on difference and diversity
but I hope now an acknowledgement of
different cultural and social experiences
is threaded through all the courses,
enabling Black and minority ethnic
students to have the space to name
their unique responses and be heard.
Something I came away with that
really stuck was the trainer, Isha
McKenzie-Mavinga’s concept of
‘ancestral baggage’. Rather than
demonising everybody as deeply evil
because they have these racist attitudes,
‘It made me think maybe there is something
about this course that is silencing and having
a silencing impact, and that was horrible and
shocking but it also represented a turning
point for me personally’ (Niki)
18 Therapy Today/www.therapytoday.net/December 2013
it’s saying we all carry around our
histories, in our bone marrow and in our
blood and in our skin and in everything.
That seems critical to me, in my role
as teacher: that the way to facilitate
dialogue is to accept and normalise
wherever you are on the journey. Rather
than beating myself up and saying ‘I feel
so ashamed, and so disgusting, and so
terrible’ I’m instead saying, ‘OK, there
is a perfectly good reason why I’m
thinking that way. Now what? What do
I do with that? How can I change that?
What conversation do I need to have
with somebody else or with myself or
with my therapist?’
Eugene: There’s so much stuff there,
and it’s on both sides of the Black–white
divide. It’s the same for Black people
too. You want to be a good person – who
doesn’t? – and people genuinely come
with that, and yet there are these thoughts
and feelings that sort of just appear in
your mind, seemingly out of nowhere,
horrifying stuff. Things like strong
feelings of ill will towards white people,
never trusting them to understand you
and also that they are inherently evil;
all those types of historical defences
passed down from colonialism and
slavery. How do you reconcile your
perception of yourself as a good
person while also having these types of
thoughts? I guess the idea of ancestral
baggage makes some sense of that.
Colour blind theories
Niki: For me psychotherapeutic
concepts like transference and
projection help me to make sense of
and humanise relationships with others.
I’m wondering what (if any) particular
aspects of traditional person-centred
or psychodynamic theory were helpful
to you on your professional journey?
Eugene: I trained as an integrative
arts psychotherapist. I have found both
person-centred and psychodynamic
theories invaluable when working
therapeutically but all the theories,
as they were presented on my course,
seemed devoid of the race, colour and
culture aspects of experience. They
certainly contain valid dynamics about
what it means to be human but if you do
not see there is a conversation to be had
then no theory will be effective in these
areas. Most Euro-American theories,
as they are presented, fall into this trap.
I’m not discounting them as relevant but
they are all colour blind, to coin a phase.
The lens I use is trauma theory: I see
everything that we have been talking
about as trauma symptoms – the
preoccupation with the self, the overactivation of emotional response to
triggers, the activation of the fight–flight
response, the inability to think rationally.
In trauma theory the alleviation of these
symptoms is through psycho-education.
It conceptualises the symptoms in
such a way that it distances you from
the blame and shame narrative and
turns the attention towards the physical
sensations of the experience rather than
the negative narrative. I see recognition
trauma in the same way, with the trauma
triggers being the generational impact
of racism on us all.
Niki: We’re in an evolving profession.
It’s not even 100 years old. At Place2Be
we work with children, which is an even
younger discipline in counselling and
psychotherapy. If we are committed to
further evolving something that works,
there’s so much to be gained, so it’s really
exciting to learn about and think about
other models and talk about them. Of
course there needs to be a willingness
and the desire.
With BAATN you have made an
enormous contribution to the profession.
What is your vision for the future? And
what do you think are the barriers in
the way?
Eugene: My vision for the future is
that there is no longer a need for an
organisation like BAATN and that there
is what I metaphorically call a rainbow
coloured therapeutic community.
My experience is that there is a
willingness and desire among many
people to change things. But I think
you’re right, most people aren’t aware
that there is a conversation to be had,
that actually there is something to be
spoken about here and it is quite often
a painful journey. My hope is that the
mental health community in the UK
truly addresses the needs of BME people.
To do this I think it is essential for the
therapy profession as a whole to have
language and concepts that describe
the experience of both sides of the
colour divide. It will probably start
with individual trainers seeking this
out for themselves.
Also, the profession needs to create
safe spaces where people can work
through racism on a personal level
and take on new ways of thinking
that relieve us of our need to defend
ourselves. This again will probably
start with individuals becoming more
confident and able to find their voice
and creating these types of spaces in
training courses. To get to where we
need to be will probably take a mixture
of some kind of legislation through
government or the governing bodies,
individuals taking it on themselves
to top up their skills and process their
own defences around race, and telling
new stories to the profession that say
it is possible for people to work in this
area if they are willing and committed
– like we are now. So thank you for
giving us a glimpse into the journey
that you’ve made with your students
and thank you for your honesty and
courage.
Niki: It’s my pleasure and thank you
for inviting me to this discussion and
for all the support and inspiration that
BAATN has offered my students.
Eugene Ellis is an integrative arts
psychotherapist and the founder of the Black
and Asian Therapists Network, a network
of therapists who are committed, passionate
and actively engaged in addressing the
psychological needs of Black and Asian
people in the UK. BAATN runs support
groups for BME students and therapists
as well as training in Black issues for the
profession as a whole. Email eugene@
baatn.org.uk or visit www.baatn.org.uk
Niki Cooper is Programme Leader for
Professional Qualifications and Tutor at
Place2Be, a charity providing school-based
emotional and mental health support
services. Email Niki.Cooper@place2be.
org.uk or visit www.place2be.org.uk
References
1. McKenzie-Mavinga I. Black issues in the
therapeutic process. Basingstoke: Palgrave
Macmillan; 2009.
2. Watson V. Key issues for black counselling
practitioners in the UK, with particular reference
to their experiences in professional training. In:
Lago C (ed). Race, culture and counselling: the
ongoing challenge (2nd edition). Maidenhead:
Open University Press; 2006 (pp187–197).
3. Lago C. The handbook of transcultural
counselling and psychotherapy. Maidenhead:
Open University Press; 2011.
4. Lago C (ed). Race, culture and counselling:
the ongoing challenge (2nd edition). Milton
Keynes: Open University Press; 2006.
5. Ellis E. How I became a therapist. Therapy
Today 2013; 24(4): 29.
‘The profession needs to create safe spaces
where people can work through racism on
a personal level and take on new ways of
thinking that relieve us of our need to
defend ourselves’ (Eugene)
December 2013/www.therapytoday.net/Therapy Today 19
Training
A chance question about how or
whether counselling and psychotherapy
training differs from teaching in any
other academic discipline made me
curious about how much we counselling
trainers actually know about the theory
and practice of learning, teaching and
personal development. My interest in
this subject extends beyond the ‘content’
of the training environment to examine
the ‘process’ of training.
I am a visiting lecturer, conducting
research into trainers’ experiences of
counselling and psychotherapy training.
Having finished practitioner training
in 2011, I clearly lay myself open to
the question: ‘What do you know?’ I sit
betwixt and between course members’
vociferous concerns that their training
is becoming more didactic, that what
they signed up for is not what it seems,
and a palpable concern among trainers
that facilitation is becoming increasingly
difficult within a further and higher
education context.
Counselling and psychotherapy
training has seen a phenomenal
increase in professionalisation and
standardisation over the past 30 years,1
with students on accredited courses
automatically gaining membership
to a professional organisation once
qualified. Yet this has been complicated
by a number of factors: the various
and ever-expanding theoretical models
of counselling; several main bodies
separately representing the profession
(eg BACP, UKCP and BABCP);
Counselling
training: is it
fit for purpose?
Counselling training has a dwindling presence in
both further and higher education. Liddy Carver
seeks to open the debate on whether and where
the profession is at fault Illustration by Luke Best
20 Therapy Today/www.therapytoday.net/December 2013
December 2013/www.therapytoday.net/Therapy Today 21
Training
References
1. Moodley R, Gielen U, Wu R
(eds). Handbook of counseling and
psychotherapy in an international
context. London: Routledge; 2013.
2. McLeod J. A study using personal
accounts and participant observation,
of two ‘growth’ movements as
social-psychological phenomena.
Unpublished paper. Edinburgh:
University of Edinburgh; 1978.
3. Ballinger L. The role of the
counsellor trainer: the trainer
perspective. Unpublished paper.
Manchester: University of
Manchester; 2012.
4. Johns H. Personal development
in counsellor training (2nd edition).
London: Sage; 2012.
5. House R. In, against and beyond
therapy: critical essays towards a
‘post-professional’ era. Ross-onWye: PCCS Books; 2010.
6. Rizq R. On the margins: a
psychoanalytic perspective
on the location of counselling
psychotherapy and counselling
psychology training programmes
within universities. British Journal
of Guidance and Counselling 2007;
35(3): 283–297.
conflicting views among counsellors
and psychotherapists on the issue of
state regulation, and a rapidly changing
wider socio-political context.
The 1960s and 1970s were a time of
innovation and change. Diploma courses
were established at ‘new’ universities and
polytechnics, including Reading, Keele
and North East London Polytechnic,
while workshops at the Facilitator
Development Institute2 emphasised
the person-centred approach and
particularly its application to large and
small groups, heralding the foundation
of the Counselling Unit at Strathclyde
and the Centre for Counselling Studies
at the University of East Anglia (UEA).
Today, in stark contrast, courses at
Reading, Sheffield Hallam, Southampton,
Sussex and Durham Universities have
disappeared, along with countless others
in further education and the independent
sector. Are we potentially a profession
in crisis? Ballinger3 writes that the 2009
BACP training directory listed accredited
courses at over 350 universities, further
education colleges and specialist training
providers. In 2013 there are only 88.
Yet, the truth is we have always
known about the ‘clash of cultures’4
within a higher education environment
where emphasis is placed on academic
achievement – a situation that House5
argues is ‘highly questionable’. Personal
development within an academic
environment is inherently difficult:
Rizq6 asserts that universities are loath
to provide the staff required for small
group teaching, while Waller7 suggests
that resentment can be directed towards
training programmes with higher
staff–student ratios, notwithstanding
regulatory requirements. This is reflected
in the recent report from the Higher
Education Academy8 that identifies
a perceived lack of respect among the
22 Therapy Today/www.therapytoday.net/December 2013
7. Waller D. Should psychotherapy
go to the (ivory) tower? Response
to papers presented at the UPCA
conference. European Journal of
Psychotherapy, Counselling &
Health 2002; 5(4): 399–405.
8. Rutten J, Hulme J. Learning
and teaching in counselling and
psychotherapy. York: The Higher
Education Academy; 2013.
9. Turner D. On being unaccredited.
Letters. Therapy Today 2010; 21
(2): 39.
wider education community towards
counselling and psychotherapy staff
and courses.
So why whine? Trainers have a
healthy income, generally speaking,
an intellectually vibrant working
environment, and only relatively recently
an obligation to produce some research.
Although the situation is evidently far
less rosy in further education or the
independent sector, our responsibility
in the current economic climate is surely
to actively and publicly engage with the
criticism that devoting time in training
to personal development is a waste of
our organisation’s money? As we have
few criteria to evaluate our practice,
and no clear idea of what to do with
that information, is there any wonder
that counselling and psychotherapy
training remains an impenetrable
irritant within higher education?
Are training standards fit for purpose?
Counselling and psychotherapy
programmes are scattered across higher
and further education institutions and
private training providers and lodged
within diverse departments, faculties
and schools, including education,
sociology, allied health professions,
psychology and health service research.
This is nothing short of eclectic. How
has this come about and what has been
the outcome for us as professionals?
Is the challenge now for trainers to
respond collectively to complexities
such as these, in order to influence the
future of the profession, rather than
providing a philosophic commentary
on that process of change?
BACP stopped accrediting trainers
in 2010, incurring the simmering fury
of a number of those who were thereby
de-accredited.9 How interested are we
in discovering what has happened since
10. BACP. BACP’s response.
Therapy Today 2010; 21(6): 41–42.
11. West W. Training matters: on
the way in. In: Gabriel L, Casemore
R (eds). Relational ethics in practice:
narratives from counselling and
psychotherapy. Hove: Routledge;
2009. (pp131–138).
12. Rogers C. Client-centered
therapy: its current practice,
implications and theory. London:
Constable & Robinson; 2003.
BACP’s statement that ‘All categories
of accreditation are currently under
review and a new category of senior
accreditation for trainers/educators
may be introduced’?10 Juxtapose this
absence of accreditation for trainers
within BACP with the 58 trainers
accredited via COSCA. Into this
mix comes the paradox that most
professional organisations overseeing
counselling and psychotherapy
training provision advocate co-training,
which brings with it issues of poor
communication, lack of advance
preparation for working together,
disparities of power and status and
co-facilitator concerns about competence.
Co-facilitation is also costly, and suggests
a pressing need for research into the
place of pedagogy in our vision for
training, and how that might fit with
pedagogy in a higher education context.
These issues are compounded by
what West11 identifies as the inherent
difficulties of informal appointments
and part-time counselling staff, with
associated problems of nepotism and
lack of support, a minimal sense of
belonging, and erratic supervisory
support or team commitment to address
ongoing issues. Collaborative efforts are
inevitably subject to increasing pressures
on time, changing organisational culture
and the absence of mentorship when it
is most needed by new appointees. In
the absence of a systematic or integrated
means of monitoring and reviewing
our own practice and accountability
to students, self-reflection and self-care
will inevitably become less plausible.
Where is the necessary framework of
ongoing face-to-face relationships with
other trainers mutually committed to
supporting and challenging our work?
My purpose here is to stimulate
discussion about the theory and practice
13. Freire P. The banking concept
of education. In: Freire P, Friere A,
Macedo D (eds). The Paulo Freire
reader. New York: Continuum;
2001 (pp67–79).
14. Gabriel L, Casemore R (eds).
Relational ethics in practice:
narratives from counselling and
psychotherapy. Hove: Routledge;
2009.
15. Baker EK. Commentaries.
Therapist self-care: challenges within
ourselves and within the profession.
Professional Psychology: Research
and Practice 2007; 38(6): 607–608.
16. Shumaker D, Ortiz C,
Brenninkmeyer L. Revisiting
experiential group training in
counselor education: a survey of
master’s-level programs. The Journal
for Specialists in Group Work 2011;
36(2): 111–128.
17. Rizq R. Teaching and
transformation: a psychoanalytic
perspective on psychotherapeutic
training. British Journal of
Psychotherapy 2009; 25(3): 363–380.
18. Gil-Rodriguez E, Butcher A.
From trainee to trainer: crossing
over to the other side of the fence.
British Journal of Guidance &
Counselling 2012; 40(4): 357–368.
of learning, teaching and personal
development before it is too late.
Can we articulate what we do, and
ask ourselves what the impact of this
might be and why we do it? Can we
nurture an environment that promotes
research and advocates for reflection
and participation so as to provide for
ourselves a pedagogy that encompasses
learning and personal development? Can
we take into account the social, cultural
and political contexts and, importantly,
our working relationship with students?
A working alliance
Hazel Johns4 contends, that regardless
of the trainer’s theoretical orientation,
the working alliance is a central precept
in virtually all models of training, and
the ability to communicate the core
conditions is essential in creating
an effective working relationship. It
might well be that trainers emphasise
‘valuing the individual’,12 or envisage
what Freire13referred to as an equal
relationship based on principles of
adult education, where both teacher
and pupil share power, authority and
responsibility. However, defining
individuals from theoretical counselling
orientations within the parameters
of a working alliance,14 a concept
rarely used with reference to trainers
and students, may undermine trainers’
meaningful experiences. Whether
students find the concept of a working
alliance constructive is also a moot point.
Experiential learning involves the
trainer’s process of self-development
alongside that of the student.
Unfortunately, this makes it difficult
to specify learning outcomes in advance
and there are no guarantees that the
student will acquire the necessary
competencies to practise effectively.
Baker15 identifies a ‘culture of silence’
19. Watson V. The training
experiences of black counsellors
[Doctor of Philosophy]. Nottingham:
University of Nottingham; 2004.
20. Yalom I. The theory and practice
of group psychotherapy. Cambridge,
MA: Basic Books; 1995.
21. Mearns D. Person-centred
counselling training. London:
Sage; 1997.
22. Trotzer J. Personhood of the
leader. In: Conyne R (ed). The
Oxford handbook of group
counseling. New York: Oxford
University Press; 2010 (pp287–306).
wherein personal development and
genuine empathy co-exist uneasily with
responsibility for objective summative
evaluation. According to Shumaker and
colleagues,16 using experiential groups
for counselling students presents
multiple ethical considerations,
particularly within personal
development groups when the
facilitator is also the assessor.
The theoretical framework
(psychodynamic, person-centred,
cognitive-behavioural or an integration
of these) underlying the majority of
counsellor training, founded on
experiences with clients in individual
settings, is limited at the interpersonal
and group levels of experiential work.
Working with groups requires an
understanding of stages of group
development, group norms and group
dynamics – particularly sentiments
like projection, transference and
identification. However, it is debatable
that trainers have this necessary
expertise, whether through lack of time
or organisational support or by personal
choice. As Rizq incisively argues: ‘... the
capacity of trainees and their tutors to
engage with and resolve conflict and
difference, to achieve a degree of mutual
recognition, could be seen as a measure
of professional development.’17
However, this seems little more
than a pipe dream when viewed in the
context of Gil-Rodriquez and Butcher’s18
experiences of attempts by students
to split the teaching team, their own
aversion towards ‘challenging’ students,
and the absence of a ‘therapeutic frame’
to establish the parameters for the
working alliance between trainer and
student. Given Rizq’s assertion that
trainers’ projections towards their
students impact powerfully on that
relationship,17 and that those entering
23. Johnson W. Can psychologists
find a way to stop the hot potato
game? Professional Psychology:
Research and Practice 2008; 39
(6): 589–599.
24. Wilkerson K. Impaired students:
applying the therapeutic process
model to graduate training
programs. Counselor Education &
Supervision 2006; 45(3): 207–217.
25. Gibb J. The effects of human
relations training. In: Bergin A,
Garfield S (eds). Handbook of
psychotherapy and behavior change:
an empirical analysis. London: John
Wiley & Sons; 1971 (pp839–862).
the profession should receive regular
in-house supervision or mentoring for
the first two years of their employment,
we could be forgiven for asking why
this hasn’t happened anyway within
a community purportedly working
towards ‘professionalism’. Why has
it yet to be addressed within BACP?
Training for trainers
Despite recent interest in course
members’ experiences during training
in a higher education context, the
reciprocal relationship between trainer
and course member, the experiences of
Black counsellors during training,19 and
trainers’ experiences in counsellor and
psychotherapy training within a higher
education context, there is almost no
discussion in the literature about the
formalisation of training for trainers.
Yet it is axiomatic that many people
will not make natural facilitators,
notwithstanding their experience as
practitioners. Yalom20 remonstrates that
potential facilitators should participate
in groups as part of their training but,
given that many trainers have had no
training in how to facilitate groups
prior to becoming a trainer, nor any
education in group theory, this appears
with hindsight a rather specious request.
As trainers, are we watching our own
obsolescence? ‘Training for trainer’
forums are virtually non-existent.
Departmental funding for trainers
to attend conferences and workshops
and undertake group/team supervision
is becoming a distant memory. To the
uninitiated or cynical, it might seem
as though we are being written out of
the higher education landscape. Or is
it that the landscape is changing and,
having failed to notice this, we have
been overtaken by that transformation?
Virtual learning – blended learning –
December 2013/www.therapytoday.net/Therapy Today 23
Training
‘To the uninitiated or cynical, it might seem
as though we are being written out of the
higher education landscape. Or is it that
the landscape is changing and we have
been overtaken by that transformation?’
is now in vogue. Are we embracing this
simply as another method of delivery
that permits wider participation as the
traditional training experience becomes
for many prohibitively expensive and
exclusive, or does it in fact presage our
own demise? As a ‘community’, what
conjoint response do we have to these
changes and the many others that are
occurring around us?
Behind the scenes, resentment
intermittently rises to the surface,
but what seems more prevalent is a
debilitating lethargy. Are we good at
reflecting on our parlous situation but
hopeless at doing anything about it? At
the last (2013) BACP research conference
I overheard a statement, unchallenged
by others, that a forum for trainers would
always fail because no one wants to share
information with rival establishments.
This sentiment is not new – ethical
considerations are paramount in any
collaborative endeavour and a forum
is not necessarily the answer – but what
is dismal is our ability to accept with
equanimity the holding onto information
within an academic environment while
carping from the wings.
Counselling training
Do we not have a responsibility to
evaluate our own practice as rigorously
as we require the evaluation of our
students? For Dave Mearns,21 ‘a high
degree of pathology within even a few
members of the course presents an
exceedingly threatening experience
for all concerned’, but I wonder how
the facilitator’s own pathology might
also affect the relationship, and what
happens when the two collide? There
is little support for trainers in navigating
their responsibilities. What is our
response to Trotzer’s question,‘Who
are we together?’22 Trainers inevitably
24 Therapy Today/www.therapytoday.net/December 2013
encounter personal development issues,
and feel themselves inadequate or
deficient in relationship with students.
To what extent do overwhelmingly
difficult decisions – for example,
upholding standards and dismissal,
especially when the individual feels
unfairly treated and appeals against
the decision – have a destructive
impact on the trainer’s sense of self
and relationships with others?
Although assessment of fitness
to practise is now an increasing part
of trainers’ vocabulary, it remains a
‘hot potato game’.23 A disinclination
to address competence problems or
to fail students, particularly for nonacademic reasons, when they have
spent substantial sums of money on
fees is heightened when criteria are
unclear, or if there is a fear of litigation
– as evidenced, for example, in the
focus on ‘impaired’24 students in
training and applicant screening.
However, a working alliance that
supports students to become active
participants in the training process may
also provide the means to support them
to participate actively in decisions to
intercalate or terminate their studies.
In England there is currently no
systematic or integrated means of
monitoring trainers’ practice. One
can only conjecture why researchers
have assiduously avoided evaluating
the performance of their own profession.
However, the fact is that we have not
done as much as we might in the
development of training standards and
measuring training impact with our own
students. Regrettably, it also appears
academically fashionable to opine on
the scarcity of research in counselling
and psychotherapy training without
necessarily acknowledging critically
valid contributions by researchers.
Gibb25 maintains that difficulties in
undertaking such research relate to ‘the
inadequacy of theories of training and
the cross-fertilisation between training
and research’. Determining the relative
efficacy of training designs and leader
interventions in producing behaviour
change will remain difficult until
adequate measures and rigorous studies
of general outcomes of training are
available. Can we really say that we have
played a part in significantly responding
to Gibb’s analysis 40 years later? Would
a useful starting point be to establish and
modify ongoing workshops in the light
of trainer experiences and suggestions
made by counsellors in training?
While it is easy to look longingly at
our past, perhaps now really is the time
to reflect on what we can achieve for our
future: for groups of trainers to evaluate
their own efficacy and generate findings
collaboratively. At present, despite
significant demand for training courses
and identification of interpersonal and
intrapersonal conflict as a key challenge
to the development of training alliance
in practice, there is little information
available on the processes involved in
delivering a consistent approach. I want
to address this gap, to establish a practice
model to support trainers to develop a
consistent, relationship-centred learning
approach within higher education, and
I am keen to do that collaboratively.
Liddy Carver is a BACP counsellor and
visiting lecturer and PhD student at the
University of Chester. Her research focuses
on trainers’ experiences in counselling
and psychotherapy training. Email
[email protected]
There will be a response from BACP in
our next issue, February 2014, about its
work in the field of training development.
Talking point
Violated and scarred
Psychotherapist
Leyla Hussein
explains why she
campaigns against
female genital
mutilation
To support the campaign against
FGM visit http://epetitions.direct.
gov.uk/petitions/52740. For more
details about the Dahlia Project
visit www.mayacentre.org.uk/
dahlia-project-survivors-fgm/.
Leyla’s documentary about
FGM, The Cruel Cut, can
be viewed on 4oD.
I am no stranger to talking
about female genital
mutilation (FGM). I have
been an anti-female genital
mutilation activist for the
past 11 years. I co-founded
Daughters of Eve, an
organisation campaigning
to end FGM. I’m also a
trained psychotherapist
and a community facilitator
at the Manor Gardens health
advocacy project in North
London, which is partnered
with the Maya Centre
women’s counselling service.
Here, I’ve set up a support
therapy group, the Dahlia
Project, for FGM survivors
that aims to provide a safe
space for women and girls
to unpack the effects of FGM.
It’s the only such group in
the European Union.
FGM is a human rights
violation that affects girls
and women not only
immediately after they have
been mutilated but for the
rest of their lives. The World
Health Organisation defines
FGM as ‘an extreme form
of discrimination against
women’.1 It has been illegal
in the UK since 1985 but the
law has never been enforced.
One of the hardest aspects
of FGM is living with it and
particularly how to accept
it as part of your life. The
physical wounds may heal
but the psychological trauma
haunts the individual for a
lifetime. I only became aware
of how much I’d been affected
psychologically when I fell
pregnant. I was severely
depressed and I would black
out when undergoing vaginal
examination. I remember
the doctors and midwives
wondering why I was reacting
in such a way but none of
them dared to ask.
It was only after I gave
birth to my beautiful little girl
that I met an amazing practice
nurse who was also a trained
counsellor and who dared to
ask the question: ‘Were you
cut as a child?’ She invited
me to attend a presentation
she was doing on FGM. Just
before the presentation she
took me aside and warned
me that I might feel distressed
and upset. I told her, ‘I’m OK.’
Then, as she proceeded with
the second slide, I began to
feel sick and faint. I ran out
of the room in tears, yet I
was very confused as to why
I was so upset. I also couldn’t
shake off a sense of shame.
The counsellor asked if
I’d ever felt this way before.
I said, ‘Yes, during my
pregnancy and every time
I have a smear test.’ This was
the first time I learned that
my body was experiencing
flashbacks and it was also
the day I decided my daughter
was not going to face or deal
with the psychological scar
that I still carry around today.
I was lucky: I had type II
FGM, which has less physical
scarring than type III, but
the emotional effects are
the same, whatever the
type. Many people fail to
understand that, from the
moment a child is grabbed
and pinned down to a table,
they have been violated and
they carry the emotional scars
for the rest of their life.
The UK primary health
services, GPs and hospitals
primarily focus on the
physical effects of FGM,
such as chronic urinary tract
infections, painful periods
and acute and chronic pelvic
‘From the moment a
child is grabbed and
pinned down to a
table, they have been
violated; they will
carry the scars for
the rest of their life’
infections that can lead to
infertility. The emotional
and psychological effects
are ignored. Many FGM
survivors also suffer from
sexual dysfunction and
this too needs to be tackled,
especially by those who work
in the mental health sector.
Therapy is a chance to
heal, a start of self-acceptance.
It provides a safe space
where women and girls
can acknowledge the impact
FGM has had on them and
explore the many cultural
and religious justifications
that are used to perpetrate
this harmful practice. Most
FGM survivors were told,
and it is engraved into their
psyche, that FGM was done
out of love, and they are led
to believe that it is done for
their own benefit. There is
no religious basis for FGM;
it is practised by Christians,
Muslims and followers of
traditional African religions.
No one can go on this
journey without specialist
support. That is why I
continue to offer counselling
for women today, even
when funding is scarce or
non-existent. I can’t turn
women away. Services like
the Dahlia Project need to
be mainstreamed and widely
available for survivors around
the country. From my own
experience, therapy was the
only space where I could
finally acknowledge the
violence I’d endured from
those I trusted most and not
feel judged. But women will
only feel safe to speak out
when society recognises the
severity of this issue. For the
past 11 years, I have been one
of the few women who speak
out about FGM and I still
receive threats for doing so.
Reference
1. http://www.who.int/mediacentre/
factsheets/fs241/en/
December 2013/www.therapytoday.net/Therapy Today 25
International
Karen Stuckey reports on
the challenges she faced
when she volunteered to
deliver counselling skills
training in Sri Lanka
Illustration by Luke Best
A letter in the November 2011 issue
of Therapy Today1 was the catalyst for
what was to become an interesting and
challenging experience, full of learning
for me. The letter invited volunteers to
teach listening skills to outreach workers
at a social Catholic centre working
with Tamil tea pickers in Sri Lanka. I
volunteered, along with another personcentred, older female counsellor, whom
I had never met before. I am writing
this article to pass on our experience to
others who may be thinking of teaching
counselling skills in a different culture.
There are so many variables to consider,
not least the expectations and
projections of the volunteer worker
herself, which, in hindsight, I recognise
can really get in the way of the work
and of relationship building.
Both I and my co-volunteer were
seasoned travellers. I knew Sri Lanka
to be a beautiful country, having visited
in early 2004, before the tsunami, and
was keen to see the changes and how
tourism had been re-established there.
Although my experience as a tourist
had been wonderful, I knew that on
my next visit to a developing country
I really wanted to both give and get
back something more. I felt that
teaching would be a way to ‘get under
the skin’ of a different culture and to
engage on a deeper level with its people.
History and context
We knew some aspects of the history
of the civil war in Sri Lanka, which ended
in 2009, when over 700,000 people were
killed. There had been innumerable
reports of horrific war crimes against
civilians and we also knew about the
recent ‘resolution’ between the present
Government and the Tamil Tigers from
TV documentaries,2 international media
coverage and the book Anil’s Ghost by
Michael Ondaatje.3
The centre where we were based
supports the marginalised community
of tea workers in the hill country of
Sri Lanka. This group tends to live in
isolation from the rest of the population
and to have different concerns from
the Tamils involved in the civil war.
The Tamil tea pickers are not directly
related to the Tamils of the north; they
are immigrants from the Tamil Nadu in
India, brought in more recently by the
British and often still seen as outsiders
by the majority Sinhalese population.
Tea is one of Sri Lanka’s biggest
cash crops. The idyllic landscape of
the tea plantations is, however, in
sharp contrast to the poverty and
living conditions of the marginalised
workers. The families working on the
tea plantations are among the nation’s
poorest; pickers are paid according to
the number of leaves picked. When
we visited a local tea plantation we saw
women picking tea in the most appalling
conditions of torrential wind, rain and
mud, because the reality is that if they
don’t pick they simply don’t get paid.
We found the Sri Lankan people
to be hospitable and welcoming. The
end of the civil war has boosted tourism
considerably. Yet, once we looked
beneath this surface and got to know
people a little better, we became aware
of a sadness and edginess: we felt we
were communicating as outsiders
with little real understanding of the
reality of their situation. The stories
of experiences during the civil war
were incredibly powerful and showed
how deeply scarred Sri Lanka is.
Such experiences are clearly not
easily forgotten and emotions are
understandably raw. We later learned
about the many missing people, the
high suicide rate among young men,4
and the high levels of alcoholism and
domestic violence.5
On the edge of
another culture
December 2013/www.therapytoday.net/Therapy Today 27
International
The listening skills training was to
run over four days and broadly followed
a typical introductory counselling skills
course, covering such topics as the core
conditions, Maslow’s hierarchy of needs,
the Johari window, listening skills, blocks
to listening, self-care, confidentiality and
ethical issues.
We tried to prepare ourselves for
working in this different culture by
reading the article Reaching the Poor in
Rural India,6 and Egan’s helpful pamphlet
Skilled Helping Around the World,7 with
its advice about being aware of our
own culture; understanding the values
and beliefs of the people with whom
we would be working; being aware of
how socio-political influences such
as poverty, oppression, prejudice and
marginalisation have affected the group
and individuals with whom we were to
work; recognising that our Western
theories of psychology, diagnostic
categories and professional practices
might not fit other cultures; getting
to know family structure and gender
roles; and being aware of language and
non-verbal communication differences.
This preparation helped but, as we were
to discover, it was of limited use once
we were actually doing the training.
Challenges
Communication
Communication was the main challenge
that we encountered. Not only are
communication skills essential for
building the training partnership;
paradoxically, they were also the very
skills in which we were trying to train
our participants. We had appreciated that
not all the participants would understand
English and had been primed in advance
that we would need an interpreter. The
role of the interpreter8 is pivotal: s/he
has the power to filter out or influence
what is being communicated without
the speaker being aware of this.
Talking through an interpreter
was challenging for us both. We soon
realised how much in our teaching
we use humour and culture-specific
asides, such as shared experiences or
non-verbal cues, to create a good training
relationship with students and to assess
how the training is being received. In the
training there was a time lapse during
which all of us looked uncomfortable
while waiting for the translation –
particularly if a joke was involved – and
avoided eye contact. The interpreter
(not unsurpisingly) did not have specialist
counselling knowledge and so did not
fully understand some of the concepts
that we introduced. And, although his
28 Therapy Today/www.therapytoday.net/December 2013
English was proficient, he was not able
to express the nuances and complexities
of terminology. We were limited with
the written word, too; we weren’t sure
that the students’ understanding of
English was fluent enough to read our
handouts or our flip charts. There were
offers to have them translated, which
was really useful, but it emphasised
for us how important to training the
immediacy of communication can be.
The interpretation challenge meant
that we started to adapt the course
material. We worked as creatively as
possible, but in retrospect we felt we
could have worked more visually with
the students by using music and art.
Group expectations
Education is valued very highly in
Sri Lanka and people were keen to
join the training, even though it was
not specifically appropriate to their
work. In the introductory session we
discovered that the 15 participants were
not the outreach workers we had been
expecting but mainly children’s workers
and office workers, and most were
unsure how they would use the training
in practice. It was challenging to work
with a group with a different agenda
and different expectations to us.
Sri Lankan culture offers teachers
respect and almost ‘guru’ status and
this, coupled with the cultural norms of
politeness and acquiescence to foreign
workers, generally meant that students
didn’t, or couldn’t, refuse our requests.
As a result we had to be particularly
sensitive when asking students to engage
in exercises around self-development,
for example. Similarly, we were
concerned about the issues they could
bring to the role-plays. We wanted the
role-plays to be as real as possible and
the group seemed to have no shortage
of issues to share, including alcoholism,
domestic abuse, loneliness, family
issues and severe financial hardship.
But the language difference meant
that we were not only unable to listen
to them or to circulate around the
groups to make suggestions; we were
also unable to check how truly engaged
they were with the work.
Confidentiality
We explored confidentiality at the
start of the training and we agreed that
any personal issues that were discussed
would stay in the room. However, as the
group evolved we became aware of the
intricate interweaving of relationships
within it: the translator was the employer
and the respected priest in the
community; some students were from
the same family and they lived within
the same community. These dynamics
were bound to impede open dialogue.
In retrospect, it was clear to us that our
students were not going to take risks in
being ‘real’ with so much at stake and it
would have been better to have identified
these dilemmas at the start of the course
and to have spent some time unravelling
the issues.
The training space
The training room was large, windowless
and noisy. There was a constant flow
through of other workers and the sound
of telephones ringing. We realised that
the noise and lack of confidentiality
affected us much more than it did the
students, who were used to working in
this environment. This made us question
how we impose our conditions and
standards on others.
Parallel process
As the training unfolded over the four
days, we became increasingly aware
of our difficulties in establishing a
relationship with our students. We just
didn’t know how to be more authentic.
Given the mixed roles in this group,
there was understandably a reluctance
to be open about underlying conflicts
and tensions. We too felt constrained
and began to assume the same fixed
smiles as our students. This did not fit
well with our aim to offer trust, empathy
and congruence.
Training the trainers
We had been asked to focus the final
day on ‘training the trainer’ skills so that
participants would be able to roll out
this programme with their colleagues.
The pressure was on us to role model
good practice, to show how we could
be flexible with the programme, and
to demonstrate good communication
skills. To our surprise and relief, after
our input, when we asked them to
present a day’s programme themselves,
they gave a good account of the issues
to be considered in training.
Individual tutorials
We had also been asked to give individual
tutorials and we found that most of the
students were keen to see us one to one.
However, despite our suggesting that
they focus on issues from their practice
that linked to the training content,
they mainly wanted to talk to us about
personal and work issues, and expected
us to give them counselling or offer some
kind of solution. This again seemed to us
‘It was in the tutorials
where we finally felt
we began to enter into
a relationship with the
students… In a one-toone setting they could
risk letting go of the
politeness and smiles’
to reflect the ‘power’ that is projected
onto outsiders, who are perceived to
have the authority to facilitate change.
It felt unfortunate that we then left them
with these issues unresolved, and we
hoped we had not unduly raised their
expectations. It was difficult to refer
them elsewhere as we did not know what
local support services were available.
Once again we were restricted by
the need for an interpreter. However,
it was in these tutorials that we finally
felt we began to enter into a relationship
with the students. It seemed that this
situation, experienced as a confidential
relationship, was one in which the
students were able to be themselves,
away from the complex relationships
and threats to confidentiality that were
present in the larger training group.
In a one-to-one setting they could risk
letting go of the politeness and smiles.
This energy transformed our relationship
with the group, invigorating the dynamic
between us and removing the need to
keep up appearances. On reflection,
we would have preferred to run the
tutorials earlier, rather than at the end
of the course, and to have built on the
skills identified from the one-to-one
discussions.
create a sense of unreality that seemed in
turn to lead to both trainers and students
keeping up the appearance of success.
The students were continuously polite,
submissive and, as we experienced it,
formal. This formality did not fit with our
Western understanding of congruence.
We in turn tried even harder, struggling
to be present, genuine and empathic in
the relationship and becoming more and
more exhausted with every fixed smile
and encouraging nod. We had begun the
training with excitement; by the second
day we were struggling to sustain both
our own energy and our congruence.
What could we have expected? Rogers
himself emphasised the importance of
the attitude of the facilitator in training,
and the ways of being with others that
foster exploration and encounter.9-11
We had expected that the qualities and
skills from our immersion in the personcentred approach would see us through,
that the three core conditions would
be all that would be necessary for us
to enter into a genuine relationship
with these students. We found that
it wasn’t the case. We tried, perhaps
too hard, and maybe it was this that got
in the way of our being able to be truly
present and mindful in Sri Lanka.
Reflections
Karen Stuckey is a person-centred BACP
accredited counsellor working as a student
counsellor and lecturer in further education
colleges in Somerset and Wiltshire.
The evaluations from the students at the
end of the course were overwhelmingly
positive: full of praise for our teaching
and reflecting the theoretical learning
that we had explored together. During
the course we had frequently invited
students to feed back to us how well it
was meeting their needs and if there was
anything we could do differently. These
invitations were met with either silence
or a reinforcement that the course was
meeting their needs. This, however,
was in sharp contrast to our perceived
experience of their learning. To us they
had appeared superficially attentive but
frequently disengaged and bored, flat and
uninterested. We questioned how much
we had really understood and shared of
their world during the training process.
We felt that, throughout the training,
we were working on the edge all the
time: on the edge of the real relationship
in the training room – ie that between the
students and their employer/interpreter;
on the edge of the organisation’s culture,
and its values, and on the edge of
understanding the students themselves.
Writing with hindsight, the challenges
of this work would seem to be
predictable: the struggles with the
language, translation, different humour,
histories and culture. These combined to
References
1. Tasker B. A performance project in Sri Lanka.
Letters. Therapy Today 2011; 22(9): 42.
2. Snow J. Sri Lanka’s killing fields. Channel 4.
14 June 2011. www.channel4.com/programmes/
sri-lankas-killing-fields/4od
3. Ondaatje M. Anil’s ghost. Toronto: McClelland
& Stewart; 2000.
4. Inoon A. Dying to be heard. Sunday Times
Online. 8 July, 2007. www.sundaytimes.lk/
070708/Plus/pls1.html
5. Immigration and Refugee Board of Canada
(IRBC). Sri Lanka: sexual and domestic violence,
including legislation, state protection, and
services available for victims. Ottawa: IRBC;
2012. www.refworld.org/docid/4f4f33322.html
[accessed 17 November 2013].
6. Kell C, Irvine J. Reaching the poor in rural
India. Therapy Today 2011; 22(8): 19–21.
7. Egan G. Skilled helping around the world.
Addressing diversity and multiculturalism.
Andover: Cengage Learning; 2002.
8. Tribe R. Bridging the gap or damming the
flow? Some observations on using interpreters/
bicultural workers when working with refugees,
many of whom have been tortured. British Journal
of Medical Psychology 1999; 72(4): 567–576.
9. Rogers C. Way of being. Boston: Houghton
Mifflin; 1980.
10. Rogers C, Freiburg HJ. Freedom to learn.
New York: Merrill; 1993.
11. Kirschenbaum H, Henderson VL (eds). The
Carl Rogers reader. London: Constable; 1990.
December 2013/www.therapytoday.net/Therapy Today 29
Outcomes
Systematic feedback:
a relational perspective
Systematic feedback is a powerful tool that has the potential to improve the
therapeutic process and outcomes – and is often liked by clients, argues
Mick Cooper in this interview with John Wilson of onlinevents
John: Therapists are under increasing
pressure to use systematic feedback
tools, such as CORE-OM, in their
therapeutic practice and evaluations.
But the use of such tools is controversial:
some therapists, particularly those with
a relational orientation, fear that they
will depersonalise and mechanise the
therapeutic encounter. Before we get
into this debate, could you start by
defining systematic outcome and
process feedback?
Mick: We’re talking about the use of
either paper or online forms as a way
to find out how clients are doing in
therapy. It’s sometimes called outcome
monitoring, but I think ‘feedback’ is
a better term because it’s less about
monitoring and more about having
a dialogue.
Outcome feedback has to do with
how well the client is getting on in terms
of their levels of distress, depression or
anxiety etc. We’re talking about things
like using the CORE Outcome Measure
(CORE-OM) and the Patient Health
Questionnaire (PHQ). Process feedback
is about seeing how the client is feeling
about things like the therapeutic alliance
or levels of empathy, and whether they
want to see differences in the therapy.
One of the best example is the Session
Rating Scale, which asks clients to
evaluate at the end of each session
things like whether or not they felt
understood.
When we’re talking about systematic
feedback, we mean using some kind of
form rather than just informal, verbal
feedback. ‘Systematic’ also means using
it on a regular basis – probably sessionby-session.
When I first heard a lot about these
systems, I was incredibly sceptical. I
30 Therapy Today/www.therapytoday.net/December 2013
was at a conference about 10 years
ago and John McLeod (then Professor
of Counselling at the University of
Abertay Dundee) was telling me about
this system that Mike Lambert had
developed. If a client was deteriorating
the counsellor would get a ‘red flag’
or notification in their notes that this
needed addressing. I thought it sounded
ridiculous. In fact, I’d used the COREOM a long time before that. I didn’t
really do anything with it, though. I
couldn’t see the point in it. I didn’t
feel that it was a positive thing.
John: What changed for you? What
got you into using forms every session
in your own practice?
Mick: I went to a workshop about nine
years ago led by John Mellor-Clark, who
has been very involved in developing
CORE. He said: ‘Where does the client’s
voice get heard in therapy? Where do
we really hear about how clients are
experiencing therapy?’ What he was
saying was that systematic outcome
monitoring provides a chance for clients
to say what is going on for them and
how therapy is working for them. That
was the first time I heard it talked about
in a client-centred way. Up to then, I’d
always thought it was about monitoring
what therapists do, that it was almost a
policing thing. That really helped me see
that maybe it was something for clients.
Also, we started using the Young
Person’s CORE in the research we were
doing on school-based counselling at the
University of Strathclyde. I interviewed
some of the kids who had been in the
study and asked them about using the
measures. It was clear that they were
either fine with the measures or actively
liked them. I remember one or two of
them saying their favourite bit of
therapy was where somebody gave
them a form and they got to fill it in!
Now that I’ve used the forms in my
own practice and have been getting the
feedback from clients on how they’re
doing in their lives, what they’re liking
and finding helpful in therapy and how
they feel towards me, I’d find it pretty
difficult to go back.
John: That’s how much you’ve integrated
it into your practice?
Mick: Outcome monitoring can bring
out stuff that clients find very difficult
to say. We would all like to think that
our clients are honest with us and can
say whatever they want. If that were true,
then we wouldn’t need to use systematic
feedback, and particularly process
feedback, because everything would
be upfront. But what the research shows
again and again is that there are things
that happen in therapy that clients
find really difficult to voice directly to
a therapist. I’ve experienced that in my
own practice. There is a power dynamic
in the therapeutic relationship that
makes it really difficult for clients to
say ‘I didn’t like it when you did that’
or ‘I feel that the therapy isn’t very
helpful’ or ‘I’m feeling worse in my life’.
I do the same. I go to a restaurant and,
even if I don’t really like the meal, when
the waiter asks me ‘How is the food?’,
I’ll say, ‘It’s fine’.
And that seems to be true however
person-centred we feel we are as
therapists. The late David Rennie’s
work1 on ‘deference’, about 20 years ago,
showed that clients will say things to a
researcher that they wouldn’t say to their
therapist. I’ve had numerous experiences
where clients will say things on feedback
‘We would all like to
think that our clients
are honest with us
and can say whatever
they want. If that were
true, then we wouldn’t
need to use systematic
feedback’
forms or evaluations that I just wasn’t
aware of. For instance, I can come out
of a session feeling that we didn’t achieve
much and when I look at the client’s
Helpful Aspects of Therapy (HAT)
form they’re saying, ‘It was really great’.
It might be something that I haven’t
really thought about. For instance,
I’ve learned that clients often really
value positive feedback. I used to think
it was a bit cheesy and not very helpful
to say to a client, ‘You seem to be doing
really well here’. But when I looked at
the feedback forms, clients were often
saying that it was great to hear that they
were doing well.
But it can go the other way. I
remember one client, I wanted to write
down some of the things that he was
saying. So I grabbed a pad; I said to him,
‘Do you mind?’ He said, ‘No. That’s fine’.
We carried on working. At the end of the
session, I thought everything was fine
but he wrote in his HAT form, ‘I didn’t
understand why Mick got a notepad. I
wasn’t sure what he was writing about.
It didn’t make sense to me.’ I wouldn’t
have seen that otherwise.
That’s why I’m saying I wouldn’t go
back. I’ve realised that there is so much
hidden that goes on in the therapeutic
relationship, no matter how transparent
I might be or think my clients are. I’d
love to trust my intuitive sense, but
my intuitive sense is sometimes wrong.
These measures give us a different angle.
John: In those moments when maybe
we feel really empathic, it could be
received very differently by the client?
Mick: One of the things I do every
session is try to rate on a very simple 1–10
scale how ‘good’ I think the session was.
I ask clients to use the same measures
and do the same. And what I’ve found –
over hundreds of sessions – is that the
amount of overlap between my rating
of what is good and that of the client is
maybe 15 to 20 per cent at most. That’s
very consistent with the research, which
shows that our understanding of how
clients are experiencing therapy is not
bad, but there are a hell of a lot of times
when we don’t understand or sense
what’s going on for them. Therefore,
from a person-centred perspective,
anything I can do to help me understand
more about what goes on for clients
is a good thing. It’s about tailoring
the relationship more and being more
attuned to my clients.
John: That’s the bit that we’re talking
about – person-centred practice. It’s a
way of attending to the client or enabling
them to articulate the bits that they
can’t say or struggle to say to us.
Mick: I think we person-centred
counsellors should be at the forefront
of developing ways of tailoring our
work to individual clients. It can really
help us meet the needs of the people
we work with. And the people who are at
the forefront of the systematic feedback
‘movement’ – Mike Lambert, Scott
Miller, Barry Duncan or Sami Timini –
are not technocrats or bureaucrats; they
are deeply relational practitioners and
thinkers. Recognising that was another
thing that really changed my views.
Evidence-tailored practice
Mick: What’s particularly interesting
right now is that Barry Duncan in the US
has had his ‘Partners for Change Outcome
Management System’ (PCOMS) validated
as an evidence-based practice. He
basically says it doesn’t matter too much
December 2013/www.therapytoday.net/Therapy Today 31
Outcomes
‘We’re using evidence
to tailor our practice
to an individual client
and monitor the
process… It’s moving
from an evidencebased approach to an
evidence-tailored one’
what kind of therapy you start with; as
long as you are monitoring it and checking
out that the client is getting better and
they’re OK with the relationship. So,
for the first time in the US, people have
accepted that basing the therapy around
the relationship and tailoring the therapy
to the individual can actually be a very
effective way of working.
John: That sounds like a huge shift.
Mick: Up to this point, when we talked
about evidence-based practice, it has
always been about what works generally
for people. Evidence-based practice
means doing something that on average
has been shown to be effective, but
it’s completely on average. You can say
that CBT is evidence-based for working
with depression, but that just means
that on average people show significant
improvements with CBT. If we’re using
evidence to tailor our practice to an
individual client and monitor the
process and see what happens and
whether there are changes, that’s a
radically different approach, and it also
may be a more effective one. It’s moving
from an evidence-based approach to an
evidence-tailored one.
John: One of the questions that we’ve
had from the onlinevents chatroom is
about whether a client would feel judged
in that process. Is that a possibility?
Mick: I haven’t experienced that. I
don’t think it comes up that much in the
evidence. It is absolutely true to say that,
for some clients, outcome monitoring is
really not helpful. For some clients, for
some of the time, it really doesn’t work.
For instance, most of the clients I work
with like identifying goals and rating
their progress towards them, but some
clients say they really don’t want to
do that.
John: I’ve heard that it can also be
helpful for the therapist to use client
feedback in their professional
development.
Mick: Absolutely. What better way of
learning about yourself as a therapist
than by getting feedback from clients?
I can go into supervision and talk about
how I think a client sees me, but there’s
such a richness in having a client who’s
actually said, ‘This is what I found
helpful’, ‘This is what I didn’t find
helpful’. And it’s often very encouraging.
One of the fears is that you’re going to
get a lot of negative things. In my
32 Therapy Today/www.therapytoday.net/December 2013
experience clients tend to be very
positive; they seem almost to want to
give something back. So it can also help
us to understand and feel good about
the work that we do.
John: Everybody is benefiting.
Mick: And it also helps the wider
professional community, like the
community of person-centred therapists.
Otherwise, how are we going to learn
to improve the work that we do, our
theory and our ideas about practice?
In the person-centred world we’ve got
the six ‘core conditions’. That’s great,
but Rogers would probably be turning
in his grave if we said that’s the last
word on what is effective. These were
six hypotheses that were developed over
50 years ago. So how can we improve on
them? For instance, might we learn that
the key thing is about trust? Or maybe
there are ways of developing empathy?
And I can’t think of a better way of
learning than actually hearing that
from the voices of clients.
This dialogue has been edited for publication
purposes. The full conversation, and many
more with leading figures in the counselling
and psychotherapy field, can be found at
www.onlinevents.co.uk. For further details
about the measures mentioned in this
article, for CORE visit www.coreims.co.uk;
for PCOMS (including the Session Rating
Scale) visit www.heartandsoulofchange.com
or www.scottdmiller.com; for the HAT and
a range of other process measures visit
www.experiential-researchers.org
Mick Cooper is a Professor of Counselling
at the University of Strathclyde, National
Advisor for Counselling for Children
and Young People’s IAPT, and an
HCPC-registered counselling psychologist.
Mick is author of a range of texts on
person-centred, existential and relational
therapeutic approaches, and is co-editor
of The Handbook of Person-Centred
Psychotherapy and Counselling (Palgrave,
2013). From February 2014 Mick will be
based at the University of Roehampton
as a Professor of Counselling Psychology.
John Wilson maintains a small private
practice online and in West Lothian, is
business manager and a tutor at Temenos
Education Ltd and facilitates blended reality
CPD events via www.onlinevents.co.uk
Reference
1. Rennie DL. Clients’ deference in psychotherapy.
Journal of Counselling Psychology 1994; 41(4):
427–437.
Law
Peter Jenkins reviews
the arguments for and
against a mandatory
requirement on
professionals to report
suspected child abuse
Following recent child abuse deaths,
increasing reports of child sexual
exploitation and the re-emergence
of the issue of historic child abuse,
there is renewed media interest in
the state’s responsibilities for the
welfare of children and young people.
In the UK as a whole there are signs
of progress towards universal school
counselling provision, and more
funding for the extension of the
IAPT programme to younger clients.
Recent child abuse inquiries, notably
that of Daniel Pelka, a four-year-old
child who died after years of neglect
and abuse, have kick-started public
pressure to introduce ‘Pelka’s Law’
– the mandatory reporting by
professionals of suspected child abuse.
A coalition of charities, lawyers and
abuse survivors recently launched
an online petition supporting such
a law that has rapidly gained 50,000
signatures.
Provision of counselling in schools
has undergone massive growth and
expansion over the last decade. In
secondary schools there is now
approaching 80 per cent coverage in
England and Scotland and 100 per cent
in Wales.1 However, while school-based
counselling is widely seen as making
a major contribution to the health and
welfare of children and young people,
it is not seen as the state’s responsibility
to provide it in all four parts of the UK.
In Northern Ireland, post-primary
school counselling has been funded
by the Department of Education since
2007. In England, there is no central
funding for school counselling and only
sporadic provision in schools via Child
and Adolescent Mental Health Services
(CAMHS). Schools fund counselling
services out of their own budgets,
without central direction from the
Department for Education, reflecting
government preference for promoting
the managerial autonomy of head
teachers. In Wales schools are now
under a statutory duty, via s92 of the
School Standards and Organisation
(Wales) Act 2013, to make ‘reasonable
provision’ of counselling for pupils
aged from 11–18 years. Scotland has
increasing provision of counselling at
secondary level but has failed to make
this a formal statutory requirement in
the recent Children and Young Persons
(Scotland) Bill, despite BACP’s urging
in this direction.
So far, Wales stands out in terms
of its unwavering commitment to
fund and protect statutory provision
of school counselling. This may, in turn,
have been heavily influenced by the
origins of the push for such counselling
provision. It was a key conclusion of
the Clywch Report into child abuse in
a secondary school setting.2 The report
had the effect of raising both the issue
of abuse within schools and the need
for confidential counselling as a vital,
protective measure for young people.
In the rest of the UK, the alarm
over the apparently growing extent
of child abuse in its many forms has
instead taken the form of renewed calls
for the introduction of a law to require
mandatory abuse reporting, sparked in
particular by the Jimmy Savile inquiry.
Following media publicity and the
initial investigation, there have been
calls by both the police and MPs on
the House of Commons Home Affairs
Committee for the introduction of
mandatory reporting by professionals
of child abuse.3, 4
Pelka’s law:
reporting abuse
December 2013/www.therapytoday.net/Therapy Today 33
Law
Mandatory reporting
So what is ‘mandatory abuse reporting’
and how would it work? At present,
professionals in the UK, including
counsellors, are often bound by the
terms of their contract of employment,
or by their agency’s policies, to report
suspected child abuse to the authorities.
However, this is not a formal legal
obligation as such. Failure to follow
such a reporting policy would constitute
grounds for disciplinary action, or
sacking, by an employer but would
not constitute a criminal offence.
The situation is slightly different
in Northern Ireland, where citizens
do have a legal obligation to report all
illegal activity to the authorities. It could
be argued that this represents a form
of mandatory reporting of child abuse,
although the framers of the original
law did not necessarily intend this.
Even if there is currently no criminal
sanction for failing to report abuse,
what about a professional’s ‘duty of
care’? Surely a counsellor, or other
professional, who failed to report it
would run the risk of being sued?
Leaving aside ethical considerations
just for the moment, in a narrow, legal
sense individual counsellors do not
carry personal liability for failing to
report abuse. At least, the courts have
not so far decided that they could be
deemed negligent for failing to do so.
Some lawyers would strongly disagree
with this view, no doubt, but there is
no case law, so far, that would establish
a duty of care under civil law to report
abuse, other than via a contract of
employment. In fact, the Education
Act 2002 was specifically framed to
leave responsibility for implementing
safeguarding policies with the local
References
1. Cooper M. School-based
counselling in UK secondary
schools: a review and critical
evaluation. Strathclyde: University
of Strathclyde; 2013. www.iapt.
nhs.uk/silo/files/school-basedcounselling-review.pdf
authority, rather than push it down to
the level of individuals, such as heads
of school, teachers or counsellors.
No doubt this could change in the
future. The law is not fixed for all
time and is subject to constant
change, via decisions in the courts
and via legislation. However, the UK
Government has been very reluctant
to introduce mandatory reporting of
any kind within the UK, with the notable
exceptions of terrorism and drug money
laundering.5 Mandatory reporting of
abuse was considered for inclusion
in the Children Act 1989, but rejected.
In the US the mandatory reporting of
suspected child abuse had mixed results.
There was an increase in the numbers
of cases reported to the child protection
authorities, but the high proportion
of unfounded allegations resulted in
overloading of social services’ already
limited resources.6
Back in the UK, in 2009 Lord Laming’s
review of child protection systems
following the tragic case of ‘Baby P’
decisively rejected the need for further
legislative changes to protect children.7
In tune with this, under the current
Government, the main policy thrust
in child protection has been to radically
slim down the weighty tomes of child
‘Individual counsellors do
not carry personal liability
for failing to report abuse…
There is no case law, so far,
that would establish a duty
of care under civil law to
report abuse, other than via
a contract of employment’
2. Clarke P. Clywch: report of
the examination of the Children’s
Commissioner for Wales into
allegations of child sexual abuse
in a school setting. Swansea:
Children’s Commissioner for
Wales; 2004.
34 Therapy Today/www.therapytoday.net/December 2013
protection manuals. Eileen Munro,
Professor of Social Policy at the London
School of Economics, has been given
the brief to reduce the proliferation
of existing protocols and create a
more humane, relational model of
child protection. This would ideally be
less procedurally driven: social workers
currently spend up to 80 per cent of
their time in front of a computer, filling
in forms.8 A crucial factor may well be
that Michael Gove, Secretary of State
for Education, is generally opposed
to greater state intervention and
favours increasing the autonomy
of head teachers to manage schools.
It seems very unlikely that he would
support a radical strengthening of
the interventionist duties of local
authorities, despite media pressure.
Arguments for mandatory reporting
There are several types of argument
in favour of mandatory reporting.
One is often framed as simply a moral
absolute: ‘You must report abuse,
otherwise you collude in the abuse.’
Clearly, this has some force; no
counsellor would want to place, or
leave, a child of any age in a situation
of continuing risk or abuse. However,
counsellors working with mid-range
teenagers are likely often to be in
situations where the immediate risk
to the client is less evident, or where
the abuse is historic rather than current,
and where, crucially, the young person
refuses, or withdraws, their consent
for onward reporting. Reporting abuse
in such a situation runs the risk of
the young person later retracting
the allegation and of breaking the
therapeutic alliance, thereby removing
this source of ongoing support. Equally,
3. Her Majesty’s Inspectorate of
Constabulary (HMIC). ‘Mistakes
were made’: HMIC’s review into
allegations and intelligence material
concerning Jimmy Savile between
1964 and 2012. London: HMIC; 2013.
4. House of Commons Home Affairs
Committee (HC/HAC). Child sexual
exploitation and the response to
localised grooming. Second report
of session 2013–14, Volume 1.
London: Stationery Office; 2013.
Assessing abuse indicators
Benefits
Disadvantages
Clearly states that governments
take child abuse seriously
Overloads child protection services
Encourages early notification to
protect children and prevent child
deaths
Leads to increased reporting to
child protection agencies
Inhibits self-referrals by children
and parents because they will lose
control of what happens to them
Resources are dominated by the
need to investigate and little remains
for intervention
Table 1: Benefits and disadvantages of mandatory reporting of child abuse
(adapted from Gilbert et al9)
reporting without consent might
have very positive outcomes for client,
counsellor and the therapeutic work.
However, posing abuse reporting as
simply an ethical imperative, even
without the force of law, may also
understate some of the key therapeutic
issues at stake.
A review article in The Lancet put both
sides of the case for mandatory reporting
very succinctly (see table).9 This takes
the debate out of a purely moral and
ethical arena, important though that
is for counsellors, and takes a wider
policy view. Mandatory reporting, in
the absence of increased resources, must
surely lead to raised thresholds for social
work investigation at a time when social
services are already buckling under the
pressure of increased public awareness
of child abuse in the wake of ‘Baby P’
and the Jimmy Savile investigations.
Finally, there is the ‘missing bit of the
jigsaw’ argument, strongly favoured by
child protection trainers. If counsellors
fail to report abuse disclosed by their
clients, out of mistaken loyalty to client
5. Jenkins P. Counselling,
psychotherapy and the law (2nd
edition). London: Sage; 2007.
6. Levine M, Doueck HJ, with
Anderson EM et al. The impact
of mandated reporting on the
therapeutic process: picking up
the pieces. London: Sage; 1995.
confidentiality, they may well deprive
social workers of the key bit of
information that would complete an
emerging picture. Any argument by
metaphor carries a strong appeal, and
this one is clearly stronger than most.
However, it does assume that there
is a jigsaw to be completed and that
the single disclosure, if reported,
will fit neatly into a missing gap and
provide an instant gestalt of abuse.
The ‘jigsaw’ argument claims to
rest on the evidence of a long line of
child abuse inquiries, dating back to
the early 1970s. Here, there has long
been a conclusion that professionals
involved with the abused child have
failed to share information effectively.
However, this view is challenged
by well-informed critics, such as
Professor Munro. She has pointed
out that the same inquiries in fact
focused less on the failure of agencies
to share information and much more
on their failure to accurately assess
the information that they already
possessed in terms of risk to the child.10
7. Lord Laming. The protection
of children in England: a progress
report. HC 330. London: HMSO;
2009.
8. Munro E. The Munro review of
child protection: a child-centred
approach: final report. Cm 8062.
London: Department for Education;
2011.
Tragically, this does seem to have been
the case with Daniel Pelka. Daniel came
from a Polish immigrant family and
had a long history of exposure to
domestic violence and, unknown to
the authorities, neglect, malnutrition,
possible salt poisoning and frequent
physical abuse. A close reading of the
Coventry Serious Case Review suggests
that the school was the main agency with
close contact with Daniel on a day-today basis. However, the dominant view
among teaching staff was that his mother
was a caring and concerned parent. This
relatively benign view of his parenting
meant that his frequent bruises and his
scavenging for food were not identified
as symptoms of physical abuse and
extreme neglect. According to the
Review, ‘if the practitioners were not
prepared to accept that abuse existed
for Daniel, then they would not see it’.11
Only a radical reframing of the accidents
and scavenging as potential indicators
of abuse could have changed this.
Mandatory reporting, arguably,
would not have saved Daniel, and nor
perhaps would it save other children
in a similar situation, precisely because
they are already too well known to the
professionals and agencies involved.
Peter Jenkins is a senior lecturer in
counselling at the University of Manchester,
and author, with Debbie Daniels, of
Therapy with Children: children’s rights,
confidentiality and the law (2nd edition,
Sage, 2010).
This article was first published in the
December issue of BACP Children & Young
People, the journal of the BACP Children &
Young People division. Visit www.ccyp.co.uk
9. Gilbert R, Kemp A, Thoburn J
et al. Recognising and responding
to child maltreatment. The Lancet
2009; 373(9658): 167–180.
10. Anderson R, Brown I, Clayton
R et al. Children’s databases –
safety and privacy: a report for
the Information Commissioner.
London: Foundation for Information
Policy Research; 2006.
11. Coventry Local Safeguarding
Children Board (LSCB). Final
overview report of serious case
review re Daniel Pelka – September
2013. Coventry: Coventry LSCB; 2013.
December 2013/www.therapytoday.net/Therapy Today 35
Dilemmas
Counseller and astrologer?
This month’s dilemma
Martha is a person-centred
therapist who has been
working with Joan for some
weeks. Joan has expressed
some dissatisfaction with
the counselling, saying she
is still feeling stuck. She has
also talked about wanting
to explore astrology, which
Martha knows that Joan
is interested in, as a way
of moving forward. Martha
is herself an astrologer,
but has not disclosed this
to Joan, although she has
talked about it in supervision.
However, Joan has
found Martha’s name on an
astrology site and comes to
the next session very upset
that Martha has not shared
this information with her.
Joan also says that she now
wants to change the therapy
into working astrologically.
What should Martha do?
Opinions expressed in
these responses are those
of the writers alone and not
necessarily those of the
column editor or of BACP.
Justyna Muller
Registered Member
MBACP (Accred),
counsellor in private
practice and in an agency
During an astrological
consultation, the astrologer’s
knowledge and expertise
of planetary influences are
important and the focus is
on the chart and the client
simultaneously. In personcentred therapy, the
emphasis is on the innate
self-actualising tendency
of the client. The difference
is that in person-centred
therapy the client holds the
knowledge that would allow
her to fulfil her individual
potential and the therapist
helps to facilitate this
knowledge through a nonjudgmental, genuine and
empathic relationship.
A really well-interpreted
astrological chart could
offer a great depth of selfunderstanding and could
be used in an astrological
consultation and ‘astrological
counselling’, where the
contracting boundaries have
been set from the beginning.
But if Martha brings the
astrological chart and her
interpretations of it into
therapy at this stage, she
would change the dynamic of
the therapeutic relationship.
Martha might want to
explore in more depth how
Joan felt when she found
out that she is an astrologer.
She could also explore what
Joan wants from the therapy
and what it means for Joan to
work astrologically. If Martha
feels comfortable, she might
want to let Joan know that it
is OK to bring her reflections
about her own astrological
chart or planetary influences
into the counselling sessions.
Space could be given to
explore how this knowledge
is affecting Joan and her
individual process. Martha
36 Therapy Today/www.therapytoday.net/December 2013
‘If Martha brings the
astrological chart and
her interpretations
of it into therapy at
this stage, she would
change the dynamic
of the therapeutic
relationship’
would need to be careful not
to interpret Joan’s chart or to
add her own ideas of how the
different planetary positions
might influence her, as this
would change the power
dynamic of their therapeutic
relationship by placing
Martha in the role of ‘expert’.
However, if Martha were
to show genuine interest
in Joan’s understanding of
astrology, their therapeutic
relationship might deepen
and Joan might be able to
open up about her other
interests without worrying
that she will be judged,
criticised or dismissed.
This could help Joan to
feel more empowered.
In short, Martha should
allow space for Joan to
explore her feelings and
expectations of therapy
and astrology and continue
to facilitate Joan’s selfactualisation through a
non-judgmental, genuine
and empathic relationship.
David Neal
Registered Member
MBACP (Accred)
First, Martha needs to deal
with Joan being upset that
Martha did not tell her she
is an astrologer.
From Joan’s point of view,
she has already expressed
dissatisfaction with her
counselling, saying she feels
stuck and, having told her
counsellor she was interested
in astrology, her counsellor
has withheld information
about her capabilities that
could have been helpful.
Joan may end therapy as a
result and make a complaint
to Martha’s agency, if she
works for one, or to BACP.
We do not know why
Martha did not inform Joan.
Most likely Martha did not
reveal it because she works
in a person-centred way
and believes her own views
on astrology are not relevant
or helpful. But the contract
that Joan has with Martha or
her agency may be only for
person-centred counselling.
Or Martha’s supervisor may
have advised her she should
not mention it. Perhaps
Martha has had a bad
previous experience of selfdisclosing, or of bringing
astrology into her counselling.
Alternatively, however,
her supervisor could have
suggested she could tell
Joan, because not telling
her was making Martha
uncomfortable and impeding
her counselling. She may
have thought Joan would
find out anyway. Martha
may have been planning
to tell Joan that she is an
astrologer at her next session,
even if she could not offer
Joan ‘astrological therapy’.
Whatever the reason,
Martha needs to explain
to Joan why she did not
mention it, and check
whether or not she wishes
to continue therapy.
Second, Martha has to
deal with Joan’s request for
‘astrologically-based therapy’.
Her response depends on
whether Martha feels able
to change her approach to
an astrological one and, if
Martha works for an agency,
whether her agency will allow
her to do so. If Martha feels
unable to take this approach
she could discuss how Joan
could find someone to work
with her astrologically. She
could also offer to continue
with person-centred work,
where Joan could explore
astrological ideas, but should
make it clear she will not
give her own ideas or advice.
This dilemma demonstrates
the risk of aspects of a
counsellor’s life being
discovered by a client. In
this case it was by information
available on the internet – a
risk that is increasing. But it is
also possible that Joan could
have found out in other ways.
Counsellors have to balance
the risk of making selfdisclosures that are unhelpful
against the consequences
of not making them.
Dr Sharon Bond
Consultant family and
systemic psychotherapist
I am a family psychotherapist
who sometimes incorporates
astrological readings into
sessions with clients. I do
not advertise my abilities
as an astrologer. However,
it may enter a conversation
if a client becomes curious
about the name of my
practice – Chiron. I would
then explain its mythological
and astrological association
with healing and mentoring.
I am always hesitant
to identify myself as an
astrologer because of the
associations some people
make with this discipline.
This made me wonder
whether not disclosing
her astrological knowledge
and abilities was linked to
Martha’s professional identity
and the possibility that clients
might not take her seriously
as a therapist if they knew
she was also an astrologer.
The fact that Martha
talks about her astrology
in supervision gives me
the idea that she is aware
of the influence it has on
her thinking in her work
with clients. I am then
curious as to whether she
is taking it to supervision to
seek permission or approval
from her supervisor that it
is OK to incorporate it into
her therapy practice.
From Joan’s perspective,
it may be that she has had
previous experience of
‘astrological counselling’
or knows of someone who
has. What stood out for me
was that Joan returned and,
despite being upset that
Martha had not shared
with her what she considers
to be relevant and important
information, expressed a
wish to continue in the
relationship with Martha,
but with a change in focus.
This could be seen as
an invitation from Joan
to explore her hopes and
expectations of each of
these ways of understanding
herself and the things that
concern or worry her in
her life and relationships.
This might lead to Martha
and Joan agreeing to use
a combination of astrology
and therapy to inform their
sessions together, and
recontracting accordingly.
This might be helpful for
Joan, who seems to be unsure
about whether or not she
is getting the full benefit
of Martha’s knowledge,
and it might also help Martha
think about how she might
integrate her astrological
abilities into her practice in a
more transparent way, if this
is what she would like to do.
‘Martha may wish
simply to explain
that, when in her
counselling role, she
prefers to keep her
other professional
roles/identities
separate’
Duncan Lawrence
Trainer/counsellor and
BACP Fellow
It is common modern practice
for practitioners to have a
variety of income generation
roles in order to make a living.
For example, a counsellor
might be counselling one day
a week, training 10 days per
month and a self-employed
chef the rest of the week.
This seems to be becoming
the norm for counsellors
and psychotherapists.
In this case, Joan has found
out on her own initiative
about one of Martha’s other
professional roles. Martha
may wish simply to explain
that, when in her counselling
role, she prefers to keep her
other professional roles/
identities separate.
This would be in line with
how and when other modern
practitioners might divulge
their own varied professional
roles. It is generally totally
up to them (having consulted
suitably) and therefore
Martha is not under any
obligation to discuss this
with Joan, unless she wishes.
However, some
practitioners consider
astrology, and other forms of
helping, as a complementary
activity that can usefully
work alongside a counselling
relationship (as opposed
to an either/or situation)
to generate enhanced
self-insights. Martha, as
an astrologer, would surely
have some understanding
of its value and empathise
with Joan’s keen interest
in it and her feeling that it
might fit into her own life.
Finally, using her own
supervision, Martha might
wish to explore if Joan has
become too distracted by
her (Martha’s) other role
and consider with Joan
whether or not a referral
is the best next step.
February’s dilemma
Arthur, a psychotherapist,
is having a dinner party.
A couple of weeks before,
one of his friends rings
to say that he has a new
partner and would it be
all right to bring him. Arthur
is very pleased: his friend
has been single for some
time and has been looking
for a new relationship.
However, on the day of the
dinner party, the friend turns
up with his new partner who
is not only one of Arthur’s
current clients but someone
who Arthur knows has a
history of abusive and
disastrous relationships.
What should Arthur do?
Email your responses (500
words maximum) to Heather
Dale at [email protected]
by 27 January 2014. Readers
can send in suggestions for
dilemmas to be considered
for publication, but these will
not be answered personally.
December 2013/www.therapytoday.net/Therapy Today 37
The interview
In praise of
pluralism
Colin Feltham interviews psychoanalyst and
clinical psychologist Alessandra Lemma about body
modification, the benevolence of humour and the
call of the circus Photograph by Stephen Perry
You’ve published and edited a lot
on psychoanalytic themes, somatic
and body image topics, brief therapy,
therapeutic competencies and other
subjects, as well as taking on high
profile leadership, teaching and
practitioner roles in mental health.
Can you give us a précis of how you
arrived where you are today?
I knew from a very young age what
I wanted to do. I had a very positive
experience of seeing a therapist as
an adolescent and this inspired me
because I could see the power of being
in a relationship in which I was listened
to and helped to know that I had a
mind. At 17, I began work for a charity
started by Lord Longford supporting
offenders in prison. When I finished
my undergraduate psychology degree
I was offered a full-time post with the
charity to develop a service for young
offenders. I then worked for several years
in schools as an education social worker.
As a clinical psychologist, I worked with
severely disabled individuals in inpatient
and outpatient settings. These early
experiences on the front line were
deeply formative, and the rest is history.
You’ve been very involved in
developing explicit psychoanalytic
competencies for Skills for Health.
Where do you see meaningful lines
being drawn between psychodynamic
counselling, psychoanalytic
psychotherapy and psychoanalysis?
These are sensitive questions within
the psychoanalytic community because
the applications of psychoanalysis can
be (mis)perceived as a dilution of the
so-called ‘gold’ of psychoanalysis and
this can obstruct sensible discussion.
I want to make two brief points. First,
‘psychoanalysis’ is not the same as
38 Therapy Today/www.therapytoday.net/December 2013
‘psychoanalytic’: a totally different set
of techniques may be based on genuine
psychoanalytic theories. Second,
intensive psychoanalysis is very helpful
to some patients but not all. It’s vital we
ensure that we can draw the maximum
benefit from psychoanalysis as a theory
of development and of therapeutic
process to ensure that we can provide
not ‘everything for one’ but ‘something
for everyone’. In other words, we need
to respect the differences between a
five times weekly analysis and once
weekly psychodynamic counselling.
The most interesting questions don’t
relate to ‘what is best’ but to the specific
effects of particular interventions for
particular problems. We simply don’t
know enough to make claims of
superiority in any general manner.
In your fascinating book Under the
Skin: a psychoanalytic study of body
modification (Routledge, 2010) you
explore the growing trend in tattooing
and body piercing. How far do you
think this trend is healthy or otherwise,
and why is it so epidemic?
We should be cautious about assuming
pathology too readily. The relegation
of these practices to the domain of
pathology – as something ‘we’ don’t do
– may itself be construed as a defensive
manoeuvre. After all, we all modify
our bodies, if only through clothes,
make-up or hair dye. We are all dependent
on the gaze of the other, and hence these
practices most likely provide solutions
to universal anxieties. Indeed, we all
struggle with two basic facts: we are
beings-in-a-body, and we are the subject
of the other’s gaze. These facts present
ongoing challenges to integrate the
meaning of our corporeality into our
sense of who we are. In the book I was
particularly concerned with how, for
some people, the challenges presented
by these two ‘facts’ are managed
internally, primarily through the external
manipulation of the surface of the body.
We all modify our bodies somewhat to
manage these anxieties. Feeling at home
in our body and mind is challenging; it
always requires psychic work, no matter
how good our early experiences have
been, though the experience of feeling
loved and desired in early life is a
noteworthy asset in this respect –
when we’re not buffered by early
loving experiences, being-in-a-body
can feel an impossible task.
At a societal level, other forces
operate and impact on these internal
processes. The delicate and intricate
processes that support a secure sense
of self as confidently rooted in the body,
and the capacity to reflect on experience
rather than enacting it on the body,
are undermined by, for example, new
virtual technologies that encourage
disembodied communication and the
relentless emphasis on transformation
and change that various media reinforce
– all of which impinge on how we
negotiate the task of integrating body
and mind into a coherent image and
experience of ourselves. Nowadays
self-identity has become a global
product. Specifically, as sociologists have
articulated,1, 2 it is far more ‘deliberative’
and we are witnessing an ongoing
‘re-ordering of identity narratives’ in
which a concern with the body is central.
Faced with the complex demands of
the modern world, especially on young
people, and the internal complexity
and pain inherent in what is psychically
required to develop a body and mind that
feel one’s own, it is tempting to retreat
© WWW.STEPHENPERRY.COM
December 2013/www.therapytoday.net/Therapy Today 39
The interview
into more manageable self-improvement
projects. The body lends itself to
becoming just such a ‘project’. The
narcissistic cultivation of appearance is a
response to these social realities, but it is
also an expression of a need to construct
and control what the body unconsciously
represents for each one of us.
Your book with Mary Target and Peter
Fonagy, Brief Dynamic Interpersonal
Therapy (Oxford University Press,
2011), expounds the principles of an
innovative clinical approach. Can you
say a little about dynamic interpersonal
therapy (DIT) and its applications?
DIT is based on a distillation of the
evidence-based brief psychoanalytic/
psychodynamic treatments. It
deliberately uses methods taken from
across the board of manualised dynamic
therapies.3 Those who have developed
other brief dynamic models will
find many familiar strategies and
techniques here. Currently DIT is the
psychodynamic protocol for depression
adopted by IAPT and we are undertaking
an RCT of DIT for depression.
The model is also being applied
to functional somatic disorders by
Patrick Luyten and others in Belgium.
I’ll shortly be publishing, with
colleagues, preliminary observations
on its application to the treatment of
body dysmorphic disorder. We’re also
developing an adaptation of DIT for
adolescents and have piloted a groupbased online DIT intervention. We’re
keen to extend DIT beyond its original
focus on depression and to explore
creatively its applications to ensure
its sustainability in an ever-pressured
healthcare economy.
Among other themes, you’ve written
about the usefulness of psychoanalytic
principles in CBT practice. How far do
you see this as a productive, integrative
direction?
If our applied psychoanalytic work
is to evolve, we have to engage with
opportunities for developmental
transformation. One of the keys to
the kind of transformation I have in
mind is a genuine intercourse with the
outside: a willingness to take something
in, something felt to be ‘other’ – for
example, engaging with CBT colleagues
to better understand the potential
added value of integration. This means
that on both sides we have to face the
inevitability of loss of what we were and
felt ourselves to be before in this realm.
Psychoanalytic ideas continue to
provide the foundations for a wide
range of applied interventions. Research
and clinical observation show that
40 Therapy Today/www.therapytoday.net/December 2013
other modalities – particularly CBT –
have made use of theoretical and
clinical features of the psychoanalytic
approach and incorporated these
into their techniques. For example,
some evidence suggests that the good
outcomes achieved by other therapies
correlate with the extent to which they
use psychodynamic techniques.4 But
integrative work is very hard because
it requires the solid internalisation
of at least two different ways of working.
We can’t simply export the notion of
transference into a CBT framework.
The challenge lies in how we do this
meaningfully and provide the necessary
training to ensure staff are able to use
such ideas to best effect.
You have published on psychoanalysis
and humour. Is this still an interest?
A sense of humour is integral to who
I am and how I approach all aspects of
my life. As Freud so helpfully highlighted,
humour is the most sophisticated
defensive manoeuvre at our disposal
to cope with the realities of the human
condition. He believed humour was a
mature adaptation because it may find
an alternative between suffering and
its denial. Indeed, one of the constants
in life, cutting across historical periods
and cultures, has been the function of
the ‘comic spirit’ as a way of managing
the inescapable difficulty of being. In
his own way Charlie Chaplin recognised
this essential function. Humour, he
said, ‘is a kind of gentle and benevolent
custodian of the mind which prevents
us from being overwhelmed by the
apparent seriousness of life’.5
The development or rediscovery of
the capacity for humour may be one of
the positive outcomes of an analysis or
psychotherapy. As I have written,6 the
capacity to enter the ‘humorous space’
involves far more psychically than simply
consoling and reassuring the self. In its
most consolidated form – which is, I
think, what Freud had in mind when he
viewed humour as a ‘rare and precious
gift’ – the humorous attitude denotes the
self ’s capacity to be an observer of itself,
allowing for a broadening of perspective.
Humour then can be used constructively
actually to ‘work’ on our conflicts. I don’t
know where I would be without it.
Given your professional experience
and your position as Director of the
Psychological Therapies Development
Unit, Tavistock and Portman NHS
Foundation Trust, what is your vision
for the future of the psy-professions?
Lord Layard’s work and the launch of
the IAPT initiative has consolidated the
importance of psychological therapy
generally and resulted in an
unprecedented investment in
psychological therapy. The threat
arises from the cuts hitting public
health service provision and the current,
simplistic emphasis on evidence-based
practice that has privileged CBT as
the treatment of choice for a range
of conditions. This ‘one size fits all’
approach to treatment has strongly
marginalised psychoanalytic and other
interventions. The superiority of CBT in
this respect has been rightly questioned,
not because it is not helpful to many
patients – it evidently is – but because
it is not helpful to all patients. Any good
service needs to address the diverse
needs of the people seeking help and
this should be reflected in the provision
of a range of psychological therapies.
My vision is simple: we need to ensure
that we retain a genuinely pluralistic
approach at the level of service provision.
I’m sure no one would ask more of
such a prolific and busy person, but
I wonder what your most recent and
developing interests are, and how
these intersect with your nonprofessional life?
I‘m afraid I have got a bit stuck on the
body because it is such an interesting
area. I’m currently working on a book
called Minding the Body, which will
address the progression of my work
on body modification through to my
present-day work with transsexuals
and more generally focusing on the
importance of the body in the analytic
situation. How does this intersect
with my non-professional life?
Writing is a passion for me. It’s the
only way I discover what I think about
something, so I cannot clearly demarcate
professional and personal here. Besides
this, I have a passion for aerial acrobatics
and rope work in the circus context so
I follow a lot of alternative circus events,
which intersects with my interest in the
body. Maybe there’s a book in that or in
my old age I will join a circus. I’m told
it’s never too late…
References
1. Giddens A. Modernity and self identity.
Cambridge: Polity; 1991.
2. Featherstone M (ed). Body modification.
London: Sage; 2000.
3. The full list of DIT competences can be
accessed at www.ucl.ac.uk/CORE
4. Shedler J. The efficacy of psychodynamic
psychotherapy. American Psychologist 2010; 65:
98–109.
5. Boskin J. The complicity of humour. In: Morrell J
(ed). The philosophy of laughter and humour. New
York: State University of New York Press; 1987.
6. Lemma A. Humour on the couch. London:
Whurr; 2000.
How I became a therapist
Jelena Watkins
Her brother’s death
in the 9/11 terrorist
attack led Jelena
Watkins to question
the relevance of
psychotherapy to
collective trauma
I was born in the former
Yugoslavia in the mid-1960s.
I came to Britain 21 years
ago as my country’s violent
fragmentation gathered
pace. This, along with my
experience of immigration
and separation from my
family and community, led
me to have psychotherapy.
Being in therapy was
deeply transformative and
inspired me to become a
therapist myself. In 1997 I
started my counselling and
psychotherapy training at the
Institute of Psychosynthesis
in London. Psychosynthesis
appealed to my analytical
mind and to my newly found
spiritual interests. I felt I
had found my calling.
Four years later, on Sunday
9 September 2001, I waved
my older brother Vladimir
goodbye at Toronto airport.
He was travelling to New York
to attend a conference; I was
heading to Cuba for a much
needed holiday. Two days
later he vanished, along with
nearly 3,000 other people,
in the terrorist attacks on
the World Trade Centre.
For the second time in
my life I was faced with a
collective trauma.
In a desperate attempt
to deal with my pain I
searched through endless
psychotherapy papers
and books and attended
international psychotherapy
conferences. I was
disappointed to discover
that therapists were primarily
focusing on individual
psychological responses
to trauma and methods for
healing from trauma. Missing
from the conversations were
the social and political
dimensions of the traumatic
experience, which were
central to my own experience.
Issues of justice and truth
seeking had only limited
space in the psychotherapy
literature I came across. At
times the exclusive focus on
the intrapsychic causes and
solutions to an individual’s
distress has created problems
for survivors of, and those
bereaved by, the terrorist
attacks. Some felt that
their justifiable anger with
the sluggish political and
legal processes was being
pathologised.
I began to re-examine
my decision to become a
therapist: the profession
appeared too inward
looking, individualised
and decontextualised. I
eventually came across
the work of therapists such
as Atle Dyregrov from the
Crisis Centre in Norway. He
has worked creatively with
those affected by disasters
by delivering collective and
individual programmes. I
was also inspired by Jack
Saul, a trauma therapist
from downtown New York.
As a therapist-insider, he led
his local community in the
collective and creative efforts
of recovery after 9/11, which
included community forums,
sharing of stories and art and
media projects.
I became a founder member
of the UK 9/11 organisation
in 2002. Professor Pauline
Boss’s work on ambiguous
loss with the families of the
missing after 9/11 was a true
eye opener.
These innovative
approaches inspired me to
return to my psychosynthesis
training and to reconnect
with the key facets of
psychosynthesis: the
dynamic and interdependent
relationship between the one
and the many, the individual
and society, the inner and
outer. I completed my
therapeutic counselling
diploma in 2007 and an MA
in psychotherapy in 2013.
My MA thesis researches
bereavement after terrorism
and at its heart are the
contextual issues involved
in collective trauma.
I now work as a counsellor
in a busy West London IAPT
service. My clients come from
all corners of the world, and
many have suffered ongoing
violence, loss of community
or their social networks.
My experience of 9/11 has
changed the way I work as
a therapist. I am more aware
of the broader social, political
and cultural influences on
my clients. I also work for a
charitable organisation called
Disaster Action and was part
of the response team after
the South East Asian Tsunami
in 2004 and the 7/7 London
bombings. In these situations
I focus on inclusion and
challenging the inequality
of assistance available to
those affected by a disaster.
It is important that the
therapy world further
develops models for working
with collective trauma on
several levels. I plan to
develop seminars for
therapists on a range of
disaster interventions, from
individual to group. I would
also like to start a debate on
the role of psychotherapists
in healing from collective
trauma.
Jelena Watkins is a UKCP
registered psychotherapist with
a particular interest in healing
from disaster trauma. For a copy
of her MA thesis, email her via
www.jelenawatkins.com
December 2013/www.therapytoday.net/Therapy Today 41
Letters
Sexual
abuse and
women
o�enders
Contact us
We welcome your letters.
Letters that are not published
in the journal may be published
on TherapyToday.net subject
to editorial discretion. Please
email your letter to the editor
at [email protected] or
post it to the address on page two.
We were really pleased to
read the article ‘Counselling
women offenders’ (Therapy
Today, November 2013);
it’s so important that the
facts about the lives of
women in custody can
reach a wider audience.
We are counsellors at
Bradford Rape Crisis and
Sexual Abuse Survivors
Service, and we have been
running a counselling
service in HMP New Hall
for 18 years. We’d like to
add to the information in
the article by sharing our
statistics about the numbers
of women in prison who are
survivors of sexual abuse.
We have been keeping
detailed, anonymous
monitoring data for over
10 years. The counselling
service we offer in the prison
is a general one, and women
can contact us about any
issue they are dealing with.
However, we have found
that overwhelmingly the
women we work with at New
Hall are survivors of abuse.
Between 1 April 2004
and 30 September 2013
(a period of nine years and
six months), 1,849 women
accessed our counselling
service. Of those women,
70.8 per cent told us they had
experienced sexual violence
at some point in their life,
and 45.4 per cent of the
women we saw disclosed
that they were adult survivors
of child sexual abuse.
These figures are truly
shocking. Yet it’s important
to add that these figures,
as high as they are, almost
certainly under-represent
the true number of women
who are survivors of sexual
abuse. We see quite large
numbers of women for
one initial session only,
as they may be released or
transferred before we get
a chance to work with them.
42 Therapy Today/www.therapytoday.net/December 2013
‘Women won’t
disclose their
experience of sexual
abuse until they
feel they can trust
the person they
are working with’
Since, for the most part,
women won’t disclose their
experience of sexual abuse
until they feel they can trust
the person they are working
with and the level of
confidentiality being offered,
it’s reasonable to assume that
more women would disclose
abuse, given the opportunity.
We’d like these figures
about the large numbers
of women in prison who
have been raped and sexually
abused to add their weight
to the questions raised in
the article about support
and punishment. We also
want to throw the weight
of our experience behind the
recognition that therapeutic
work should be available to
all women in prison, and
should continue to be a
central part of the more
appropriate community
alternatives to custody that
are currently being developed.
Sarah Cotton
Qamar Hussain
Sarah Bambridge
Many kinds
of love
Thank you for publishing
the truly wonderful article
by Elizabeth Freire on ‘The
healing power of self-love’,
Therapy Today, November
2013). Elizabeth has managed
put into words something
I have struggled to express
adequately since starting
to work as a counsellor. This
quality of love as described
in her article is a commodity
seen rarely outside of
professions like ours, of
which I feel so privileged
to be a part.
There was just one point
I would like to add. I believe
I’m right in saying that
Carl Rogers talked in terms
of offering his clients an
‘Agapé’ love, which always
struck me as being very
clever on his part because,
by using the word ‘Agapé’,
he was being very specific
about what he was offering.
A fuller understanding of
what Carl was alluding to
can be found in the Bible,
in what has become known
as the ‘love chapter’ in 1
Corinthians 13.
In classical Greek there
are four completely different
words for love, not just one,
as we have. They are ‘Eros’,
meaning an erotic or sexual
love; ‘Storge’, which is natural
affection like a parent for
their offspring; ‘Philia’, or
brotherly love, and, finally,
‘Agapé’, which is a god-like
spiritual and sacrificial love –
in other words, unconditional.
Michael Nokes
Counsellor therapist, life coach
and mentor
Inspiring
presence
I was pleased to see the
work of sex therapists and
the governing body COSRT
make the pages of Therapy
Today last month. While
historically akin to an
exclusive club, I cannot help
but notice the increasing
influence this work is having
in the fields of counselling
and psychotherapy; it seems
many are being drawn to
the hitherto mystical world
of what sex therapists do
– clients as well as therapists
of differing backgrounds –
due to the figural nature
of sex in people’s lives.
This is perhaps in part a
reflection of social changes
in the acceptance, desire
and willingness to approach
the nitty gritty of what
people do, don’t do or
have concerns with under
their bedcovers!
It is a very positive
development, whether
people are getting enough
sex or not, and especially
in raising awareness of
the increase in sexual
compulsivity, as mentioned
in Paula Hall’s article
‘Sex addiction: the clinical
reality’ in the same issue.
However, I would like
to draw the above into my
main reason for writing,
which was the inspiring
article on ‘Cultivating
presence’ by Manu Bazzano.
Two years after gaining
the COSRT psychosexual
diploma and integrating
it with a thorough previous
counselling training, I
absolutely testify that,
no matter what we do in
the practice room, there
is no greater ongoing
‘achievement’ than therapist
presence and I would go so
far as to say that sex therapy
alone is redundant without
it; clients still only really
shift through the nurturing
of the therapeutic
relationship. For that
personal cultivation of
presence, I am eternally
grateful to those who
helped pave my way all
those years ago.
Richard Cruz
MBACP (Accred) counsellor
and COSRT (Accred)
psychosexual and relationship
therapist, Harley Street and
Worcester Park
Pre-trial
therapy
At Manchester Rape Crisis
we welcomed many of
the points raised in Peter
Jenkins’ article on pre-trial
therapy (Therapy Today,
May 2013). It seems to us also
that change is indeed ‘much
needed’ to the provision of
pre-trial therapy and to the
Crown Prosecution Service
(CPS) guidance on pre-trial
therapy.
We are left wondering
what BACP plans to do,
following on from the
publication of this article,
in its commitment to
‘sustaining and advancing
good practice’, as detailed
in the Ethical Framework
(p4). With Jenkins, we
struggle to understand
how the guidance for pretrial therapy provides us
with the space to offer a
service that complies with
the Ethical Framework.
Jenkins raises a number
of issues that require taking
forward. We would like to
know how BACP is taking
these concerns to the CPS
– is the Association working
to explain the nature of the
therapeutic relationship that
the current document seems
to confuse with coaching? Is
it asking to see the research
that justifies the preference
of CBT over other
therapeutic disciplines? Or
perhaps commissioning its
own research to demonstrate
efficacy and limits under the
current guidelines?
We would love to hear
how BACP is working to
represent its members
in a dialogue with the
CPS to develop a greater
understanding between
these two worlds, not just to
prevent another tragedy like
Frances Andrade but also
to create space for therapy
to really support rather than
restrict those waiting for trial.
Anne Stebbings
EAP ‘bread
and butter’ in
short supply
Reading Nicola Banning’s
excellent article on workplace
counselling (Therapy Today,
October 2013) has certainly
given me some food for
thought. It has made me
wonder if it is time to
reconsider my own position
regarding potential clients.
I have worked in private
practice for seven years and
when I am approached by
members of the public asking
about therapy I have always
made them aware, if they
work for a large employer,
that they may be eligible for
counselling provided by their
employer under an Employee
Assistance Programme.
I am now beginning to
question this approach,
partly because of some of
the information in Nicola’s
article. It was interesting
to note that the price of
EAP services has been halved
over the last 10 years. Maybe
counsellors in private practice
should take note of some of
the implications of this fact.
EAPs can often be regarded as
the ‘bread and butter’ staple
for independent counsellors,
as a steady stream of work
has usually been supplied
by well-run organisations
with experienced in-house
EAP counsellors assessing
the needs of employees.
I was recently approached
in my private couples practice
by a potential client and,
after a brief chat by telephone,
I suggested that their
international employer might
offer funded counselling. Two
months later they returned
to me to fund their own
work. The counsellor to
whom they were referred
had no recognisable couple
counselling qualifications
and was accredited by an
unfamiliar organisation. Some
worrying underlying issues in
the couple relationship had
not been detected, putting
one partner at potential risk.
It appears that EAP
packages now often comprise
legal advice and telephone
support, with counselling
considerably marginalised.
Properly managed counselling
can support employees to
manage stressful situations
and all types of difficulties
and allow disruption in the
workplace to be minimised.
It would be a great shame
to see such a useful function
continue to be devalued.
Employers may remain
unaware of the vicarious
liability of exposing their
workers to counselling that
is not properly accredited,
particularly in work with
couples, and I think BACP
might be ideally placed to
alert human resources units
to some of the hazards of
these new trends.
Denise Pickup
Unrealistic
demands
We are a team of supervisors
who have been working for
many years for a small but
very busy south east London
counselling agency that
regularly recruits trainee
and student counsellors.
We provide monthly group
supervision for two hours for
a maximum of six supervisees.
December 2013/www.therapytoday.net/Therapy Today 43
Letters
We have become increasingly
concerned at what we
consider to be completely
unrealistic demands made on
us by the students’ training
establishments. These
demands are: being asked to
regularly ‘sign off’ paperwork
that we will not have had
sight of before the supervision
session but are expected to
read in our own time, unpaid;
and being asked, often at very
short notice, to write and
submit substantial reports on
a trainee’s progress once or
twice a year, sometimes with a
need for a personal discussion
with the student beforehand.
Trainees are informed
before joining the agency
that such reports have to
be paid for by them, as it is
the training establishment,
not the agency, that requires
them. Despite advance notice
of payment, many trainees
are unhappy about being
asked to pay for reports,
given their existing financial
commitments in respect
of their training. This can
also affect their ongoing
relationship with their
supervisor.
In order to ensure that
the student is working
effectively and professionally,
and progressing in their
development, the agency
does ask us to write reports
approximately six months
after a student counsellor
has started client work, for
which the agency pays us.
Students are informed that
these reports can be made
available to their training
establishments, but it seems
they are not sufficient.
We consider that the
training establishments
themselves should be
paying for reports and any
other documentation they
need and not the trainees.
Agency supervisors should
not be used in the way they
clearly are – to be assessors
of trainees’ work to the extent
that they may pass or fail their
training course. This surely
is the role of the tutors?
We need to restate that
we are a practice agency,
publicly funded to meet the
needs of our clients, but are
often treated as a placement
agency working to meet the
needs of trainees!
We imagine other agencies
will be facing very similar
problems to us. We consider
this matter needs to be aired
more openly and a solution
found that is acceptable to
all parties involved.
Jenn Graham
Registered MBACP (Snr Accred)
Tom Hanchen
Registered UKCP
Gloria Steemsonne
Registered MBACP (Snr Accred);
Registered UKCP
Where are
all the men?
I am just about to start
teaching on a counselling
certificate course. There
are eight participants on this
course and all are women. So
where are all the men? Does
it frustrate the females that
there are no men, I wonder?
I do not think that men
realise how valuable their
presence is to any course
or group. A colleague in
the Midlands is offering
workshops on working with
men and developing a malefriendly counselling service.
Yet his experience is that
the majority of attendees
on his workshops are women.
In my hometown in the north
of England, there are few male
counsellors and supervisors.
I work with lots of male
clients: young boys, adult men
and older men. I know how
44 Therapy Today/www.therapytoday.net/December 2013
much my clients value seeing
a male therapist because they
tell me so. What makes the
therapy different to working
with a female? Perhaps it
is a feeling of acceptance
of maleness. For me, it is
about male energy, which
is different to female energy.
I wonder if male
counsellors can value their
maleness when working with
a group of female colleagues?
Is it possible to allow the
male energy to blossom while
at the same time allowing
female energy to develop too?
I want to raise this issue
based upon my experience
of training groups and
clients. I would really value
any feedback from anyone
(male or female) if they share
any similar experiences of
the counselling profession,
clients and training groups.
John Bradley
Registered Member MBACP
(Snr Accred), counsellor/
supervisor in private practice.
Email [email protected]
In praise of
scientism
I have to have a rant. I
nearly pulled my hair out
and then I almost tore up
my accreditation. Then I
wondered if I was being a bit
unfair or politically incorrect
– aren’t we supposed to be
pluralist and open to all
possibilities and all ideas
and notions and be nonjudgmental and accepting?
Of course we are, and that
ideology has certainly led
to a more liberal society
and a greater acceptance and
understanding of difference.
It was reading the letters
pages in the October issue
of Therapy Today that caused
my tolerance to evaporate.
I was surprised by my
reaction on the one hand,
but know that I am intolerant
of the supernatural having
any sort of presence in my
profession. I cannot exclude
that there is mystery in the
universe and that many
aspects of the natural world
remain unexplained, but I
know that over time science
will get there. In the
meantime I prefer to remain
with what I know and what
can be demonstrated.
This was the sentence
in one of the letters that
prompted this response:
‘The point is that there is
now a counter position to
that of scientism and it is
supported by a growing
number of people, many
of whom hold the highest
scientific and other
qualifications’ (‘Spirituality
takes many forms’; Letters,
Therapy Today, October 2013).
This statement causes me
the same sharp intake of
breath and anxiety as the
notion that creationism is a
counter position to evolution.
A Google search brings
the following definition of
scientism: ‘Scientism is a
term used, often pejoratively,
to refer to belief in the
universal applicability of
the scientific method and
the view that empirical
science constitutes the most
authoritative worldview or
most valuable part of human
learning, to the exclusion
of other viewpoints.’
What is the counter
position to science that
might support, for example,
telepathy, as suggested in
the letter? Would it benefit
clients if therapists could
read their clients’ minds?
I read the BACP Ethical
Framework in search of a
smart quote that would
support my rant but I could
not find one. In fact the whole
of the Ethical Framework is
against the idea that it would
be beneficial to be telepathic,
to be able to read a client’s
mind. Our task surely is to
help individuals know their
own mind, to bring a sense
that their own mind is
more significant than their
therapist’s? Would I want to
attend a therapist who could
read my mind? Would you?
I know that today we are
all entitled to our views,
opinions, beliefs, quirks and
so on, but please, if BACP
is going down the road of
the paranormal and counter
positions to scientism, then
frankly I would not want to
be a part of it. I noticed the
standard disclaimer next to
one of the letters and I just
shook my head.
Christopher Murray
Humanistic and integrative
psychotherapist, rationalist,
naturalist and scientist.
Editor’s note
Truly – the opinions expressed
in Therapy Today are those of
the authors and not necessarily
the views of either BACP or
Therapy Today
Qualifications
abroad
I was reading the September
special international issue
of Therapy Today. I am a
bilingual person who studied
in London to become a
counsellor, then wanted to
go home and work in Turkey.
My dream of working In
Turkey became a hell. When
I read the September issue,
I thought: ‘If I don’t share my
experience how will people
understand the cross-cultural
issues? How is it possible
to change the world for
humanity, peace and success?’
I applied to YOK, the
Turkish Educational Board,
to obtain the equivalency
of my diplomas gained in
the UK. This is necessary
to work legally in Turkey.
After waiting a year and a
half without any information,
all my original papers and
translations were sent
back to me saying I was not
eligible to get equivalency.
My discrepancies were
that I studied in London.
I completed my education
by getting degrees from
Metanoia, which is supported
by Middlesex University, of
which I am very proud.
All the knowledge,
experience, placements, code
of ethics, learning skills and
philosophies I have acquired
have been crushed by these
barriers. I wanted to share
my learning back home; my
goodwill did not last long.
After this, I do not know
where I am heading. All
my plans have gone down
the drain. I have hit a wall.
Thinking global, sharing
global is only possible by
educating ourselves.
Perhaps BACP will now
work on global marketing,
so that other countries’
educational departments
recognise other boards and
professional associations.
Sevdal Ayger
MBACP Reg, clinical supervisor
and counsellor/psychotherapist
Support for
the deafened
Further to the report from
Action on Hearing Loss about
counselling help for deaf
people (News, Therapy Today,
November 2013), I would add
the need for consideration
of the needs of partners and
close family members.
As stated in the article,
the loss of hearing, often
referred to as the hidden
disability, has an impact on
daily life at a profound level.
I have worked with the
deafened and their partners
and friends through the
work of the charities Hearing
Link and the East Sussex
Hearing Resource Centre,
both of which are based in
Eastbourne, East Sussex.
From this experience I have
witnessed the confusion and
great adjustment that they
face. The taken-for-granted
process of communication
has to undergo great change;
the intimate conversation
comes to an end and is
replaced with an alternative
structure that inevitably is
not an effective replacement.
Currently I am completing
an independent research
project by interviewing the
partners of the deafened.
The consistent comment
has been that the partner is
faced with a great loss that
has echoes of a grieving
process. The partner who
once was is no more and the
strain on the relationship
is great. No wonder some
relationships do not survive.
A further interesting
revelation is that the
partner often adjusts to
their partner’s hearing loss
through denying aspects
of their own life that they
once enjoyed. They no longer
listen to music, the radio is
switched off, they stop going
to the cinema and their social
life becomes restricted.
In all, I echo the call from
Action on Hearing Loss for
a response to the needs of
the deafened but equally
those that live with this loss
in their lives – the partners
and close friends, also need
this help and support.
Dick Hill
MBACP (Accred)
Understanding
sex and other
addictions
While reading Paula Hall’s
article on sex addiction
(Therapy Today, November
2013) I was wondering about
the hesitance of my own
local group of therapists
to tackle this subject, which
led me to facilitate an evening
earlier this year and draw on
my experience with GamCare
of working with compulsive
gamblers. It turned out to
be very well attended.
Prejudice against/
fascination with these
personal responses to the idea
of addictive sexual behaviours
is surely what a client will
sense in the therapy room.
So I was relieved to read
‘people with attachment
wounds may find it easier
to turn to something in times
of need rather than someone’,
and ‘most addictions [most?]
mask a deeper need, one
that, if not addressed,
will continue to trigger
compulsive behaviours’,
because understanding
this brings someone’s use
of sex in this way back in
from the cold of being split
off by judgment and fear.
I like Paula’s request that
we don’t get lost in labels
and believe that addiction
is on a continuum: wanting
to answer unmet needs is a
human drive; it’s when use
of a substance or behaviour
‘becomes a primary coping
mechanism that feels out
of control’, and actually
increases rather than
reduces distress, that the
term ‘addiction’ has its use
as a tool of understanding.
Jane Barclay
Registered MBACP, AHPP,
UKCP
December 2013/www.therapytoday.net/Therapy Today 45
Reviews
Retirement
comes for
us all
The empty couch: the taboo
of ageing and retirement in
psychoanalysis
Gabriele Junkers (ed)
Routledge, 2013
186pp, £26.99
ISBN 978-0415598620
Reviewed by Gillian Ingram
This is an outstanding book,
passionate, coherent and
unflinching in its approach
to a particular dilemma
for psychoanalysts when
approaching their own
retirement, especially one
enforced by illness or age.
Gabriele Junkers has
brought together 14
contributions by European,
Canadian and American
analysts with six of her own
essays in a book that would be
of great help and paradoxical
comfort to any therapist,
whatever their age or model.
The reluctance of anyone
to engage with their own
mortality is profoundly
human but is possibly
more complex for analysts
because of the potentially
interminable, seductively
open-ended nature of the
frame itself. The timelessness
of the analytic ‘hour’ and of
the unconscious can create
a phantasy of immortality.
Unconscious reparation in
all of us and its origin in our
own early mental suffering
drive us to take up this job
in the first place. This is a
powerful motive to carry on
working. Who are we without
our patients? Threatened loss
of identity and meaning can
force us to turn a blind eye
to an inevitable diminution
of expertise and good practice.
Analysts become so out of
passion and commitment
to the beauty of the model;
this is not a state of mind
in which to face even the
thought of retirement, never
mind put it into practice.
The book contains
impressively open and
moving accounts, ranging
from the development of an
analyst’s own terminal illness,
and the concomitant countertransference response, to the
havoc wreaked on colleagues
and analysands alike by a
training analyst’s dementia.
46 Therapy Today/www.therapytoday.net/December 2013
Two of the contributors
are particularly unequivocal
in what they describe as the
sadism and exhibitionism
of the analyst who is patently
dying in front of the patient
while refusing to acknowledge
the reality of it: ‘A form of
vampirism develops, an
overinvestment in patients
necessary for remaining
psychically alive’ (p39).
The reluctance of training
institutions to confront the
matter is also squarely faced
– the frequently insidious
culture of silence and denial
in the face of perceived
boundary transgressions.
Who has the heart and
courage to confront a
colleague with the most
hurtful and yet most
necessary of suggestions,
that they may no longer
be fit to practise? Junkers
is firm in her solution: ‘It
is the responsibility of the
institution to help contain
problems that may not be
amenable to the individual
solution’ (p31).
The third part of the
book then deals in a highly
pragmatic way with precise
recommendations. The
setting up of ‘Psychoanalyst
Assistance Committees’ is
proposed. Shame, humiliation
and fear need to be contained
by the ideally collective
compassionate superego
of the group committee.
The task is likened to
‘holding a terrified child for a
necessary medical procedure’
(p143). A detailed chapter on
the making of a professional
will is particularly instructive.
We will all have to face
retirement and, ultimately,
our own death. This book
is a beacon in the darkness
to help us bear the
unbearable, and act on it.
Gillian Ingram is a
psychodynamic counsellor
and supervisor
A student
companion
An introduction to
counselling and
psychotherapy: from
theory to practice
Andrew Reeves
Sage, 2013
481pp, £29.99
ISBN 978-0857020550
Reviewed by Els van Ooijen
This text is intended to
accompany novice
practitioners from the very
beginning of their journey to
qualification and beyond. The
book is in three parts: ‘Setting
the context’, ‘The therapeutic
relationship’ and ‘The
professional self ’. Part one
includes a brief discussion of
the history of psychotherapy
and counselling, therapeutic
approaches and skills, and
legal, ethical and social issues.
The chapter on professional
settings and organisations is
particularly helpful, as is the
author’s stress on personal
development (p27) and
critical thinking (p113).
Part two devotes a chapter
to clients and the problems
with which they may
typically present. There
is a useful discussion of
the controversial concept
of diagnosis (pp183–187).
A section on practice
discusses assessment,
contracting, goal setting,
relationship formation,
evaluation and ending.
Another section discusses
the relative merits of brief
and open-ended therapy.
Part three has its focus on
the practitioner and includes
chapters on professionalism,
engaging with supervision
and understanding research.
In the final chapter Reeves
outlines his own work as
a counsellor and helps the
reader consolidate what
has been discussed so far.
Questions for discussion
and pauses for reflection
encourage active engagement
with the text. Other features
include numerous case
studies, suggestions for
further reading and a
companion website with
additional resources. The
book is clearly set out and
thoroughly user-friendly,
which should make it a
helpful companion along
the way for anyone
contemplating counselling
or therapy training, and a
great resource for trainers.
Dr Els van Ooijen is a
relational-integrative
psychotherapist, supervisor
and co-author of Integrative
Counselling and
Psychotherapy: a
relational approach
CBT for
children
CBT with children, young
people and families
Peter Fuggle, Sandra
Dunsmuir and Vicki Curry
Sage, 2012
302pp, £24.99
ISBN 987-1446272169
Reviewed by Linda Bean
This book is intended for a
range of practitioners: those
who have some experience
of working with children
and would like to develop
basic CBT skills, mental
health professionals,
teachers and social workers,
and experienced CBT
practitioners seeking
to review their practice.
The authors work hard
to get their disparate audience
on side. The sceptical CAMHS
clinician, wary of the overvaluing of CBT, may warm
to their refreshing candour
about its efficacy. The
experienced CBT clinician
based in CAMHS may
appreciate the authors’
understanding of the
difficulties they face in
a service where there are
few CBT supervisors and
long waiting lists.
The authors introduce
a new, as yet unvalidated,
scale for assessing CBT
with children and young
people – the CBT Session
Competency Framework
(CBTSCF). The framework
aims to address the
limitations of the traditional
CBT therapist competency
assessment, the Cognitive
Therapy Scale-Revised.
It includes child-centred
practice that takes account
of the child’s developmental
stage and a systemic approach
that includes the family and
school/college.
The rest of the book
is structured around the
CBTSCF competencies. Each
competency is explained with
a summary of the knowledge
base and case examples.
To finish, the authors review
the implications for CBT
practice. It is a whistlestop
tour covering a wide range
of topics. However, there
are plenty of references
for further reading.
The book could be helpful
as an introduction to the basic
CBT skills. As an experienced
CAMHS clinician and CBT
therapist, I enjoyed reading it
and it did refresh my memory
here and there, but there is
not enough information new
to me to warrant its purchase.
Linda Bean is a BACP and
BABCP accredited
psychotherapist working with
children, young people and
their families/carers in the
NHS and private practice
Migration and
transitions
Enduring migration through
the life cycle
Arturo Varchevker and
Eileen McGinley (eds)
Karnac, 2013
249pp, £24.99
ISBN 978-1855757820
Reviewed by Ruth Barnett
For many people the words
‘migration’ and ‘immigrants’
carry intense emotional
charge, largely because
they are widely misused
and misunderstood. I have
long thought that the therapy
profession could do more to
bring the fruits of our clinical
experience and reflections
into the public domain.
Varchevker and McGinley’s
anthology of 12 articles by
different authors goes some
way towards this. It clearly
targets therapists but is
also of great value to anyone
involved with vulnerable
people of any age group,
particularly those who
have had difficulties with
geographical migration
and/or transition between
developmental stages.
The book’s focus is on
both external migration
(geographical relocation)
and internal migration from
one state of mind and being
to another. Geographical
migration, for whatever
reason, often exacerbates
problems of internal
relocation in psychic
‘inner space’; often both have
to be endured together at
considerable emotional cost.
Hence the pun in the title.
The book begins with the
original external migration
that confronts every human
being – the relocation from
the maternal womb into what
we call ‘our world’. In the first
chapter of the book, Angela
Joyce gives a poignantly
moving description of her
work with baby Anna and
Maria, her traumatised
migrant mother. The life cycle
sequence then continues with
an account of work with two
toddlers by Maria Rhode;
two adolescents by Margaret
Rustin, and three adults by
Dennis Flynn and Eileen
McGinley. Last, the final
dislocation and loss in old
age is addressed by Andrew
Balfour’s work with a woman
and a couple in old age.
The second half of the
book takes the concept
of internal and external
migration into work with
couples and families and
with groups, exploring
inner and outer conflict.
In the final two chapters,
Michael Rustin and Jeremy
Lewison address migration
and creativity. Rustin points
out a pattern (p211) in which
one generation bears the
major pain and losses and the
following generations develop
the creativity – as if to reach
beyond the losses to new gain.
There is necessarily quite a
lot of repetition in and around
defining migration from each
author’s perspective. But this
is outweighed, in my opinion,
by the richness that 12
different minds contribute
to this important theme. A
mini-dictionary of the main
psychological terms used in
December 2013/www.therapytoday.net/Therapy Today 47
Reviews
the book might have been
useful, as it has so much to
offer ‘beyond the couch’.
Ruth Barnett is a psychoanalytic
psychotherapist, former school
teacher and writer
Research for
the novice
Introducing counselling and
psychotherapy research
Terry Hanley, Clare Lennie
and William West
Sage, 2013
173pp, £20.99
ISBN 978-18447872487
Reviewed by Jo Pybis
This is an engaging, useful
and readable introduction
to undertaking research
in counselling and
psychotherapy. Clearly
intended for students with
little research experience,
the authors guide the reader
through methodological
approaches, research jargon
and techniques.
This is an introduction to
key concepts and approaches;
the ‘whats’ and ‘whys’ of
research rather than the
‘how’. It begins with a brief
overview of the literature on
the effectiveness of therapy.
This usefully sets the scene
and allows the reader to
understand from the outset
the purpose and importance
of research in this field. The
authors then address some of
the common misconceptions
among those who are
unfamiliar with the research
process and ask the reader
to reflect on what research
means to them and where
their interests lie. The key
processes in undertaking
research are explained, from
choosing a research question
through to the dissemination
of research findings.
Throughout the authors
are very much aware of the
impact of research on the
researcher and devote a
chapter specifically to this.
The use of commentary
from students is a valuable
addition, clearly defining
the audience as novice
researchers who may have
some misconceptions or
concerns about undertaking
research. The authors are
clear that any cohort of
students is likely to include
those who are ambivalent
or critical about it.
The constant yet subtle
introduction of key concepts
throughout the text make
this a great introduction for
those wishing to understand
more about why research
is important in this field.
Dr Jo Pybis is Research
Facilitator at BACP
Madness
and power
Madness contested:
power and practice
Steven Coles, Sarah Keenan
and Bob Diamond (eds)
PCCS Books, 2013
375pp, £21.99
ISBN 978-1906254438
Reviewed by Polly Mortimer
It’s hard to distil this clearsighted and comprehensive
book into a short review. We
in the West are living through
an era in which neuroscience,
genetics and the controversial
DSM-5 increasingly dominate
48 Therapy Today/www.therapytoday.net/December 2013
as tools to categorise and
instruct the ‘treatment’
of our broken minds.
The authors contributing
to this book (psychiatrists,
psychologists, service users,
sociologists, teachers and
philosophers) present
holistic, considered and
research-based alternatives
that have emerged from
the growing discontent with
the psychiatric status quo.
The book is in two parts:
‘Questioning the Dominance
of Madness’ and ‘Exploring
the Liberation of Madness’.
The first part starts with
Mary Boyle on
reconceptualising
alternative models,
followed by a biologically
non-reductionist model
of paranoia, Steve Coles on
embodiment and context,
a discussion of power
imbalances in recovery
notions, and an explanation
of Big Pharma and its
corrupting stranglehold. The
editors write compellingly
on the obliteration by
psychiatry and clinical
psychology of social models
of causation, and the need
for the dominant models
to be challenged. The great
Phil Thomas critiques the
meaningless reductionism
applied to madness.
The aristocracy of the
post-psychiatry movement
feature no less eloquently
in the second half. Among
them, the Hearing Voices
Movement and Intervoice
set out their stalls lucidly
and powerfully and itemise
the challenges, of which
combating negative media
portrayals and disputing
clinical language are but two.
Peter Beresford argues for
the ‘expert’ mad always to
be included in the discourse
about the nature of madness.
Joanna Moncrieff and
colleagues deconstruct
patient experiences of
neuroleptics to demonstrate
their harmful effects.
This is a powerful book,
setting out with clarity
and conviction how much
better and more fully we
can understand mental
distress if we look beyond
the diagnostic straitjacket
to people’s lived experiences.
Whatever your discipline,
you need to read it.
Polly Mortimer is Librarian
at the Minster Centre, London
Telephone
exchanges
Telephone counselling: a
handbook for practitioners
Maxine Rosenfield
Palgrave Macmillan, 2013
182pp, £21.99
ISBN 978-0230303362
Reviewed by Susan UttingSimon
In this concise book
Rosenfield has attempted
to answer some very broad
questions about telephone
counselling, and has largely
succeeded. The book opens
with a useful clarification
of the differences between
helpline work and telephone
counselling. Its focus is
primarily on telephone
counselling (there is some
mention of Skype but too
little for those wanting
to develop this aspect of
specialist practice), but the
inclusion of a framework for
both kinds of work makes
it a valuable resource for
telephone helpline staff too.
Rosenfield identifies the
advantages and possible
drawbacks to working
on the telephone, from
practical and therapeutic
perspectives. I liked her
description of the different
phases in a telephone
counselling session, and in
the counselling relationship
overall. She also offers
some thoughts as to why
telephone counselling
relationships often seem
to develop at a deeper
level more quickly than
in face-to-face work.
There are some helpful
suggestions on practical
issues, such as contracting,
arranging for payment
of fees and missed
appointments. Rosenfield
also covers working with
groups over the phone/
Skype, and the value of
telephone supervision,
at least some of the time,
if working as a telephone
counsellor. Throughout,
she draws from her own
wealth of experience, but
not as a template – simply
as possible options.
This is an excellent,
accessible and surprisingly
slim volume for something
that carries so much useful
information. I would
recommend it for both
experienced and trainee
counsellors alike, regardless
of their theoretical
orientation.
Susan Utting-Simon is an
MBACP senior accredited
counsellor/psychotherapist and
supervisor in private practice
RD Laing
revived
RD Laing: 50 years since
The Divided Self
Theodor Itten and Courtenay
Young (eds)
PCCS Books, 2012
371pp, £15.99
ISBN 978-1906254544
Reviewed by Peter Morrall
The trouble with gurus is
that, no matter how extreme
they or their ideas are or how
effectively they have been
debunked or superseded,
they keep resurfacing.
The cult of the personality
and fascination with the
unorthodox tend to displace
robust critical analysis and
empirical evidence.
This book is just such a
revival; its 29 chapters are
written by a mix of those who
knew Laing professionally
and personally or who were
influenced by him. The
spirit of guru-Laing is reified,
his philosophy (existentialphenomenology) paraded
and his personality defined
in a bid to demonstrate
his continued relevance.
The contributors include
psychotherapists and
psychiatrists, a yoga teacher,
an eco-feminist and a
social anthropologist and
mythologist. Only Chris
Oakley, in ‘Where did it all
go wrong?’, takes Laing to
task in any meaningful way.
I value Laing’s portrayal of
mad-doctoring as inherently
abusive, the modern Western
family as disempowering,
and the mad as the only
sane people in a mad world.
These things needed to be
said then, and even more so
today in the face of the hypermedicalisation of madness
driven by neuropsychiatry,
drug companies and the
new DSM-5. Alternative,
radical, and uncomfortable
ways of viewing the world
are essential to temper the
actual or potential excesses
of those who hold power in
society and in psychiatric/
psychotherapeutic settings.
Brian Evans’ chapter highlights
this point when he asks why
Laing is still popular among
students of psychology (they
are looking for a human and
humane account of madness
as a substitute for the diet
of scientism they receive
in their studies).
Therefore, this book is a
worthwhile read. It should,
however, be read with
Laing’s own sceptical if not
cynical stance towards both
psychiatry and life itself.
Dr Peter Morrall is Senior
Lecturer at Leeds University
and a health sociologist with
interests in madness and murder
and critiques of psychotherapy
Prompt to
reflection
The reflective journal
Barbara Bassot
Palgrave Macmillan, 2013
180pp, £12.99
ISBN 978-1137324719
Reviewed by Jeannie Wright
This pocket-sized book is
intended for ‘students’ and
those on professional courses.
Part one, ‘Models and tools
for reflection’, covers most
of the major theories and
ideas about reflective
practice. Part two, ‘More
space for reflection’, is a
series of blank pages headed
by a quotation, question
or activity/prompt as
inspiration to write. Part
three, ‘Career development’,
offers exercises and activities,
and a work placement log.
Unless you do use it for
reflective writing, the content
of this book is rather slim.
But this is an attractive little
book and worth a look for
its innovative approach to
presenting the major theories
of reflective practices
succinctly and accessibly.
Jeannie Wright is Director of
Counselling and Psychotherapy
Programmes, University of
Warwick
Visit www.bacp.co.uk/shop for great books at great prices!
Browse the BACP online bookshop for the full range of BACP
publications including: training & legal resources, directories, research
reviews, information sheets and more.
Now available: Legal issues across counselling and psychotherapy
settings: a guide to practice – by Barbara Mitchels & Tim Bond.
December 2013/www.therapytoday.net/Therapy Today 49
From the Chair
A fruitful
12 months
of change
Amanda Hawkins
welcomes four new
faces to the BACP
Board of Governors
and looks back on
a year packed with
achievement
On 16 November we held
the 37th BACP annual general
meeting. Our AGMs are never
particularly well attended,
even when they are embedded
in another event. The fact
that lots of people don’t turn
up can be viewed in a number
of ways. I choose to view it
as a positive thing: that you,
the membership are more
or less happy with what we
are doing as an organisation,
that you don’t feel the need
to turn up in droves to inform
us of our errors. I am glad,
though, that some members
do turn up and ask useful
and relevant questions.
They help us reflect as
an association and it’s
an important part of good
governance. So a big thank
you to all who turned out on
a particularly cold Saturday
to be with us in London.
The past 12 months have
been significant for us. We
changed our Board structure
to allow us to bring in
expertise from outside the
profession. This year is the
first time in BACP’s history
that we have three appointees
coming onto the Board.
Royston Flude is a blue-sky
thinker who heads up an
international NGO. We
hope that he will help us
with our international
strategy. Richard Ashcroft
is a biomedical ethicist and
we hope he can help us widen
our thinking about ethics to
ensure that our framework
remains fit for purpose.
Many of you will already
know David Weaver, a former
BACP vice president. He
will help us engage with the
political and commissioning
arenas, strengthen our
strategies for promoting
BME representation within
the profession and ensure
that we are reaching all
parts of the counselling
community.
50 Therapy Today/www.therapytoday.net/December 2013
This year the membership
elected Dr Andrew Reeves
to serve on the Board for
a first term of three years.
Again, many of you will know
Andrew as the former editor
of Counselling & Psychotherapy
Research (CPR) journal. He
will contribute a huge amount
to the strategic thinking and
direction of the organisation.
I hope the next year (my last
as Chair) will be as exciting
as the last and as productive.
There is much to do.
Currently my biggest worry
and therefore focus for
my energy is how we can
ensure that counselling
training retains its place in
universities and colleges in
these financially challenging
times. We have a group of
education providers looking
at this right now. Psychology
programmes are lecturing
200 students at a time and
are therefore more costeffective than counselling
programmes, which have
a maximum ratio of 26
students to two tutors. Our
BACP accreditation badge is
important; it denotes quality
in counselling training.
We need to rise to this
challenge. Watch this space.
I want to end with some
facts about the immense
amount of work that BACP
has been doing for its
members in the past year:
••communicating with all
40,000 of you (and it was
a very proud moment when
the 40,000th member
‘I am glad that
members do turn up
and ask useful and
relevant questions.
They help us reflect
as an association and
it’s an important part
of good governance’
joined BACP at 10.21am
on 1 November). We are the
second biggest counselling
and psychotherapy
association in the world
••upholding standards via
the BACP Ethical Framework
– and as we speak it is going
through a major review to
ensure that it is still the
jewel in our crown. The plan
is to make the framework
interactive and link it through
to the other important facets
of the profession – to training
and supervision and to
online therapy
••organising more than 76
events on a wide range of
topics, and our first online
conference, as well as the
spectacular ‘Ask Yalom’
event in February
••answering over 68,437
telephone calls and 8,882
email enquiries
••organising yet another
highly successful Research
Conference, with global
representation as well as
home-grown research talent
••publishing our portfolio
of publications, both paperbased and online
••responding to the everincreasing number of media
queries – a new and important
function within BACP to
promote counselling and
psychotherapy in the media
••developing the new
Bacpac client management
software for our independent
practitioner members
••and, last but not least,
producing our increasingly
highly rated suite of journals
– not just Therapy Today
but also the seven excellent
quarterly divisional journals
and CPR. It was a truly proud
moment for us all when
Therapy Today was awarded
the 2013 Online Media Award
for the best health/education
news site earlier this year.
Here’s to an equally fruitful
year ahead in 2014.
News
2014 BACP Practitioner’s Conference
© VLADIMIR KOLOBOV/ISTOCK/THINKSTOCK
The BACP Practitioner’s Conference will be one of the biggest counselling
and psychotherapy events of the year
The BACP Practitioner’s
Conference brings together
four of its specialist divisions
and marks a significant
departure for the Association.
It is the first joint conference
involving so many divisions.
It is also the first conference
with an explicit focus on the
practitioner’s professional
development needs.
The conference is running
twice: in London on 28
February, and in Leeds on
8 March, so that as many
members as possible can get
to one or other of the venues.
The conference has been
designed by the lead advisors
and executive committees
for the four divisions
involved: BACP Workplace,
BACP Healthcare, BACP
Coaching and the Association
for Pastoral and Spiritual Care
and Counselling (APSCC). It
has been structured to appeal
to a broad cross section of
practitioners. The workshops
are arranged so that delegates
can either follow their
specialist area of interest or
tailor their own programme.
The content of both
events will be the same, or
very similar. If a presenter
can’t attend both events,
alternative speakers have
been found to cover the same
workshop topics. ‘The format
reflects today’s portfolio
practitioner, whose practice
may well stretch across
several of these divisions,’
say Elspeth Schwenk, BACP
Deputy Chair, who has been
centrally involved in the
conference planning.
The divisions are excited
by the possibilities the new
venture has opened up. Says
Tina Abbott, newly elected
chair of BACP Workplace:
‘Our members not only get
a full Workplace conference,
with workshops and speakers
from our own area of
expertise, but also the option
of attending a far wider range
of workshops and speakers
from other divisions than
we could normally provide
in a division-specific
conference. And, with the
two venues, the conference
will be accessible to far more
of our members, which we
could never have offered
on our own.’
Melody CranbourneRosser, Chair of APSCC,
says the conference will
promote dialogue between
members of the different
divisions about spirituality
and other issues that cross
the boundaries between the
specialisms. ‘Spirituality is
relevant to BACP members
in all the divisions. It occupies
an important position in the
lives of many of our clients.
Linking with colleagues in the
other divisions will promote
dialogue on how we can all
integrate spirituality into our
therapeutic and supervisory
practice,’ she says.
Themed streams
The conference is structured
in eight ‘streams’. Four will
reflect the interests of the
four specialist divisions and
four will be more generic:
the mind and body, the role
and influence of technology
in counselling today, new
perspectives on working
with trauma and exploring
issues around inclusivity.
The sessions are intended
to be practical, skills-based
and topical. Each division
has chosen a guest speaker
to deliver an opening address
for their specialist stream
and the rest of the conference
is given over to workshops.
Speakers who have already
confirmed include consultant
clinical psychologist and
psychotherapist Dr Martin
Seager, social psychologist
Dr Keon West, and technology
and online counselling and
psychotherapy specialist
Kate Anthony.
Tina Campbell, outgoing
Chair of BACP Healthcare,
sees huge potential for fruitful
collaboration and cross-over.
‘Healthcare is a diverse sector
that has links into spirituality,
workplace and coaching.
With so much cross-over,
it makes absolute sense to
collaborate on this event.’
For Jo Birch, Chair of
BACP Coaching, the
conference content and
format match the division’s
diverse membership and
interests. ‘The way the
conference is organised is
like a giant smorgasbord –
our members can pick and
choose from eight different
menus.’ It’s also a chance
for other practitioners to
dip into the world of coaching
and explore the potential for
adding another set of skills to
their portfolio, she points out.
Says Elspeth Schwenk: ‘The
conference supports BACP’s
aims to ensure the profession
is understood, valued and
protected and to build BACP
to become the recognised
leader in counselling and
psychotherapy. This will be
an event that members don’t
want to miss, and they won’t
be disappointed. It will get
your continuing professional
development off to a good
start in the new year.’
For full details of the conference
programmes, speakers and
workshops, visit www.bacp.co.uk/
events. Bookings are now being
taken for both events.
December 2013/www.therapytoday.net/Therapy Today 51
News
CYP competence framework
BACP is shortly to publish
its first ever framework of
competences in counselling
young people.
The framework has been
produced with the help of
an expert reference group
(ERG), which included
Professor Tony Roth at
University College London,
Professor Mick Cooper at
the University of Strathclyde,
and Karen Cromarty, BACP
Senior Lead Adviser on
children and young people.
The aim of the framework
is to describe what best
practice in young people’s
counselling should look
like, based on the research
evidence for this age group
(12-18 years). The framework
can then be used by training
providers to guide them
when developing their
training curricula, to ensure
consistency in standards of
both training and practice.
The framework is based on
the humanistic psychological
therapies competence
framework devised by
Professor Roth with his
colleagues Stephen Pilling
and BACP Head of Research
Andrew Hill in 2009. It will
be free to download from
the BACP website by the
end of 2013, and available
in hard copy from 2014.
It is the first in BACP’s
rolling programme to
develop competence
frameworks for a wide range
of specialist counselling and
psychotherapy practice. BACP
has appointed Ros Sewell
as Competence Framework
Development Manager to
work with Helen Coles,
BACP Head of Professional
Standards, to take forward
the programme over the next
two years.
BACP plans to publish a
competence framework for
counselling in universities
and colleges next year and
has also applied for funding
to develop a competence
framework for counselling
children aged up to 11 years.
This would complete a suite
of frameworks that cover
the range of competences
to work with children,
young people and young
adults up to 25 years. ‘This
is a very significant first for
BACP and for all counsellors
working with these age groups
and will support the work we
have been doing to promote
counselling in schools,’
Helen Coles said.
Divisional Chair and Deputy Chair changes
BACP Workplace has a new
Chair, Tina Abbott. Tina is
the Staff Counselling Manager
at Cardiff University.
Tina Campbell is stepping
down as Chair of BACP
Healthcare after three years
in the post. Zubeida Ali,
currently Deputy Chair, will
be taking on the role of Chair
from January 2014 and Hazel
Flynn will be Deputy Chair.
These changes are all
subject to ratification by the
BACP Board of Governors at
its meeting in December. For
details about the divisions, see
www.bacp.co.uk/expert_areas
Update from the BACP Coaching division
BACP Coaching has a new
network group for the
Portsmouth, Hampshire and
Guildford area. The group’s
organiser is Carole Parncutt
and its first meeting will be
on Wednesday 15 January in
West Liss, near Petersfield.
The group is open to coaches
and people considering
training in coaching. Carole
can be contacted at therapy.
[email protected]
The Cardiff and Plymouth
network groups are meeting
next in January 2014. Further
details of all the regional
network group meetings
can be found online at
www. bacpcoaching.co.uk
or by contacting Anne Calleja,
BACP Coaching Executive
for Network Groups, at
[email protected]
The University of East
London (UEL) Partnership
52 Therapy Today/www.therapytoday.net/December 2013
network group meets on
5 February, 19 March and
9 April. For more details,
email margaret.barr@
btopenworld.com. The
Central London Coaching
network group meets on
23 January to discuss the
personal consultancy model,
a framework for integrating
counselling and coaching.
Visit www. bacpcoaching.
co.uk to book your place.
BACP Private
Practice
news update
BACP Private Practice has
had an enthusiastic response
to its appeal for members
interested in setting up
regional networking groups.
Members in Ashford,
Banbury, Belfast,
Birmingham, Brighton,
Derby, East London,
Gillingham, Isle of Wight,
Leeds, Liverpool, North
London, Nottingham,
Omagh, St Albans/
Harpenden/Hemel
Hempstead, Swindon,
Wigan/Preston/Chorley and
Woodbridge have expressed
an interest in setting up
groups for independent
practitioners in their area.
The new groups in Belfast
and Swindon have already
held their first meetings
in early December, and
group leaders in Ashford,
Banbury, Leeds and Omagh
are planning inaugural
meetings in early 2014.
Volunteers are still needed
to set up groups in Scotland,
the far south west of England
and north of Liverpool.
Please contact Susan UttingSimon at s.uttingsimon@
btinternet.com for more
information.
BACP Private Practice
has a new email address
for members to make direct
contact with the Executive.
Subject to availability,
Executive members are
happy to offer advice to
members on any problems
they are encountering in
independent practice. The
Executive can also draw on a
network of other experienced
practitioners and expertise
within BACP. Email
[email protected]
Coalition deplores long waits
A new report from the ‘We
Need to Talk’ coalition says
that one in 10 (12 per cent)
people with mental health
problems are waiting over a
year before receiving talking
treatments and 54 per cent
wait over three months.
BACP is one of the 13
professional associations
and voluntary organisations
that have come together in
the coalition to campaign
for improved access to
talking therapies.
We Still Need to Talk reports
on a survey of over 1,600
who tried to access talking
therapies on the NHS in the
last two years. One in 10 (11
per cent) said they had paid
for private treatment because
the therapy they needed was
not available on the NHS.
Three in five (58 per cent)
said they weren’t offered a
choice in the type of therapy
provided. The coalition wants
the NHS in England to offer
a full range of evidence-based
psychological therapies to all
who need them within 28 days
of referral. The report can be
accessed at www.mind.org.uk/
media/494424/we-still-needto-talk_report.pdf
BACP backs local authority challenge
BACP is urging members
to support a ‘mental health
challenge’ campaign to
ensure local authorities
don’t overlook mental
health in delivering their
new public health remit.
The campaign is a joint
initiative between the Centre
for Mental Health, the Mental
Health Foundation, Mind,
Rethink Mental Illness, the
Royal College of Psychiatrists
and YoungMinds. It follows
on the Government’s decision
to give local authorities
responsibility for public
health, under the Health
and Social Care Act 2013.
The role of the member
champion will be to ensure
mental health issues are
promoted in any area of
council business as well as in
discussions with local health
services, businesses, schools
and others in the community.
Already, 13 councils have
appointed champions. BACP
is urging members to contact
their local councillors to
persuade them to join the
campaign. More information
about the challenge is
available at www.mental
healthchallenge.org.uk
What’s new in the divisional journals
The new issues of BACP
Children & Young People and
Private Practice are both out
this month.
The winter issue of Private
Practice includes a powerful
first person account by Karin
Sieger, reflecting on the death
of her own therapist and the
emotions this evoked.
In the latest issue of
BACP Children & Young People,
school counsellor Debbie
Lee confronts head-on the
perennial issue of mobile
phones and their presence
in the counselling room.
‘In our school, an ever-stricter
mobile phone policy ratchets
up the consequences after
each appearance of a student’s
phone. I wondered what to
do. “Tell you what,” I said.
“Why don’t you get it out and
show me what’s going on?”’
The next issue of Thresholds,
the journal of the Association
for Pastoral and Spiritual
Care and Counselling
(APSCC), will be published
in early January. Articles
include editor Susan Dale’s
first person account of setting
up a listening and support
project in her local town of
Machynlleth, following the
abduction and murder of fiveyear-old April Jones. What
was initially a short-term
drop-in project staffed by
volunteer listeners has since
become an established and
valued community resource.
‘The resilience, compassion
and generosity of the people
I find myself working and
living with amazes and
astounds me afresh each
day,’ Susan writes.
Counselling at Work and
Healthcare Counselling &
Psychotherapy Journal will
also be out in January.
The journals are sent
free to division members.
For details of the divisions,
visit www.bacp.co.uk/expert
_areas. To find out about
joining a division, contact
[email protected]
New members
join BACP
Board
Congratulations go to
Andrew Reeves, elected
onto the Board of
Governors, and to Richard
Ashcroft, Royston Flude
and David Weaver, all of
whom have been appointed
to the Board of Governors
in line with the Articles of
Association approved by
the members in 2012. All
four will join the Board
for a first three-year term.
Although David’s
appointment to the Board
has meant losing him from
the Vice President cohort,
we are pleased to confirm
that Juliet Lyon has accepted
the invitation to serve a
further five-year term in
that capacity. And we are
delighted to welcome two
new Vice Presidents:
Professor Sue Bailey and
Julia Samuel, each appointed
for an initial five-year term.
The full list of Governors
of the Association is:
Amanda Hawkins – Chair;
Elspeth Schwenk – Deputy
Chair; Richard Ashcroft;
Fiona Ballantine Dykes;
Royston Flude; Andrew
Reeves; Caryl Sibbett; Faith
Stafford; Mhairi Thurston,
and David Weaver.
Current BACP Vice
Presidents are: Sue Bailey,
John Battle; Robert Burden;
Robert Burgess; Pamela
Stephenson Connolly; Bob
Grove; Lynne Jones; Martin
Knapp; Juliet Lyon; Glenys
Parry, and Julia Samuel.
Any of the above may
be contacted via the
Lutterworth office. Please
address any letters c/o
Jan Watson or email
[email protected]
December 2013/www.therapytoday.net/Therapy Today 53
Register/Professional conduct
Are you on the Register?
The Certificate of Proficiency
(CoP) is a computer-based
assessment of ethical
practice, decision-making and
knowledge that gives eligible
members a way onto the
BACP Register of Counsellors
& Psychotherapists.
The CoP will be your route
to registration if you aren’t
BACP accredited and haven’t
done a BACP accredited
course. To be eligible for
the CoP, members need
to be either an Individual
Member (if they have joined
this category since 1 April
2013) or MBACP.
So far some 4,000 BACP
members have taken the
CoP, with a 93 per cent pass
rate. We will be announcing
new venues in 2014 (visit
www.bacp.co.uk/events/
conferences.php for details).
You can find out more
about the CoP and check
your eligibility status at
www.bacpregister.co.uk/
prospective/CoP.php
Withdrawal of membership
Stephen Lenehan
Reference No: 637303
Lancashire PR7 3NX
send in a written response,
and did not make a response.
The Article 12.6 Panel made
a number of findings and it
decided to implement Article
12.6 of the Memorandum &
Articles of Association and
withdraw BACP membership
from Mr Lenehan, pending
appeal.
Mr Lenehan was given
the opportunity to appeal
the decision but no appeal
was received. Consequently
his membership was
withdrawn. Any future
application for membership
of this Association will be
considered under Article
12.3 of the Memorandum and
Articles of the Association.
Full details of the decision
can be found at www.bacp.
co.uk/prof_conduct/notices/
termination.php
of Ethics and Practice for
Trainers.
The Panel made a number
of findings and the Panel was
unanimous in its decision
that these findings amounted
to bringing the profession
into disrepute in that Mr
Casemore’s actions amounted
to serious professional
misconduct, particularly in
view of his eminent standing
in the profession and in
BACP, as identified in the
testimonials that he supplied
and in his verbal evidence.
Information was brought
to BACP’s attention by Mr
Lenehan which was sufficient
to refer for consideration
under Article 12.6 of the
Memorandum & Articles
of Association.
The nature of the
information raised questions
about the suitability of his
continuing membership of
the Association and it raised
concerns about the following
in particular:
••Mr Lenehan failed to
respond in an appropriate
way to information requested
by BACP regarding his fitness
to practice
••Mr Lenehan failed to
disclose to BACP during
his period of membership
information which may affect
his suitability for continued
membership of BACP
••his actions have brought,
or may yet bring, not only
this Association but also the
reputations of counselling/
psychotherapy into disrepute
••the information further
suggested that there may
have been a serious breach,
or breaches, of the Ethical
Framework for Good Practice in
Counselling and Psychotherapy.
The member was invited to
Withdrawal of membership
Roger Casemore
Reference No: 501498
Worcestershire WR3 7HA
The complaint was heard
under the BACP Professional
Conduct Procedure and the
Panel considered the alleged
breaches of the BACP Ethical
Framework for Good Practice in
Counselling and Psychotherapy
2002 together with the alleged
breaches of the Code of Ethics
and Practice for Supervisors
of Counsellors and the Code
54 Therapy Today/www.therapytoday.net/December 2013
Mitigation
Mr Casemore stated that,
following this incident, he
changed the practice at the
university so that members
of his team, including him,
no longer provided
supervision to students.
The Panel took note of
the supportive testimonials
that Mr Casemore provided.
Sanction
The Panel was unanimous
that Mr Casemore’s
membership of BACP should
be withdrawn and took the
view that, given the serious
nature of the findings reached,
any lesser sanction would
be wholly disproportionate.
Full details of the decision
can be found at www.bacp.
co.uk/prof_conduct/notices/
termination.php
BACP
conducts
Register audit
BACP is conducting its first
audit of the Register. From
November 2013 the Register
is checking a random
selection of members when
they renew their registration.
The audit will monitor
compliance with the BACP
Register requirements as
well as gather statistical
data and information on
trends. The aim is to enhance
the confidence of the public,
the profession and other
stakeholders in BACP’s
professional competence
arrangements.
The audit process is
intended to be as
straightforward as possible.
Members who are selected
for audit will be asked for
their past year’s records
for continuing professional
development, supervision
and indemnity insurance.
A copy of the information
booklet A Registrant’s Guide
to Audit is available from the
Register website at www.bacp
register.co.uk/registrants/
Audit%20faqs.php, where
you can also access sample
CPD and supervision records.
‘This is the first time that
the Register has carried out
an audit. Should you be
selected, every effort will be
made to support you through
the process. Please remember
that you do not need to send
information in to us unless
you are contacted,’ said Sally
Aldridge, BACP Registrar.
If you have any queries
about the audit or the
Register CPD or supervision
requirements, please email
[email protected] or
call BACP Customer Services
on 01455 883300.
Policy
NHS mandate
BACP has welcomed
recognition in the new NHS
Mandate of issues raised by
the Association in response
to the formal consultation.
The Government
published A Mandate from the
Government to NHS England:
April 2014 to March 2015 on
12 November, setting out what
it expects the NHS to deliver
over the next 12 months.
The Mandate pledges
action on several key issues
of concern to BACP. They
include early intervention
with people with dementia
and support for their carers.
In the consultation BACP
highlighted the potential
role of counselling here.
BACP also called for greater
choice of therapies on offer
through the Improving
Access to Psychological
Therapies (IAPT) programme
and stressed that children
and young people with
emotional, behavioural
or social difficulties need
Around the
Parliaments
access to early intervention
through universal school
or other community-based
counselling. The Mandate
pledges a nationwide service
transformation of children
and young people’s IAPT.
Also highlighted by BACP
was the lack of waiting time
standards for mental health
services. The Mandate
states that the Department
of Health is committed to
implementing these access
and waiting time standards.
BACP backs call to action for dementia carers
BACP’s Policy and Public
Affairs department attended
the Dementia Action Alliance
(DAA) Annual Meeting in
London on 20 November.
BACP is an active member
of the Alliance.
The conference discussed
a range of issues, from the
importance of researching
dementia in order to better
understand how to prevent
and deal with the disease, to
the variation in access to post-
diagnostic support and advice
across the UK. One of the
main concerns raised was the
lack of support for the carers
of people with dementia.
One carer described how
talking to a counsellor who
listened to her and helped
her come to terms with her
situation prevented her
from having a breakdown
and provided a vital lifeline.
BACP supports the DAA
‘Carers’ Call to Action’
campaign on carers’ needs
and rights. The Call to
Action says that all carers
should have access to
psychological support to
promote their health and
wellbeing. It says that
talking therapies are a central
component of this as the
therapeutic relationship
can provide a space for
validation and a place where
the carer can develop their
independent sense of self.
Making the case for social sciences
BACP shared the platform at
the launch of a new report on
social science research from
the Campaign for Social
Science. The BACP-sponsored
publication Making the Case
for the Social Sciences – Mental
Wellbeing was launched on
27 November at Portcullis
House, Westminster.
Nancy Rowland, Director
of Research, Policy and
Professional Practice, and
BACP President Dr Michael
Shooter CBE described how
BACP had used research into
school-based counselling
and its outcomes to persuade
the Welsh Government to
provide counselling in all
its secondary schools.
Professor Lord Richard
Layard, Programme Director
at the London School of
Economics and the driving
force behind the Improving
Access to Psychological
Therapies programme,
described how he and his
team used evidence of cost-
effectiveness to make the
case to the Government for
the need to expand provision
of talking treatments through
the NHS.
Rt Hon Andy Burnham MP,
Shadow Secretary of State for
Health, called for a ‘paradigm
shift’ in the health and social
care system so more resources
are given to preventing illness.
‘Only when the social side is
in the NHS settlement will
we put prevention into the
heart of the system,’ he said.
A debate on reparative or
conversion therapy took place
in Parliament in October.
The debate was led by Labour
MP Sandra Osborne, who
called for NHS therapists to
be properly trained in lesbian,
gay, bisexual and transgender
issues, for psychotherapists
to be subject to statutory
regulation, for professional
bodies to have appropriate
complaints procedures
in place and for a ban on
reparative therapy for
young people aged under 18.
Responding to the debate,
Norman Lamb MP, Care and
Support Minister, read out
BACP’s statement on ethical
practice on the issue of
reparative therapy but
confirmed that the
Government has no plans
to introduce statutory
regulation for counsellors
and psychotherapists.
Two Private Members’
Bills relevant to counselling
are currently awaiting
their second reading.
Liberal Democrat MP Mike
Thornton’s Access to Mental
Health Services Bill is listed
for its second reading on
Friday 17 January 2014 and
Geraint Davies’s Counsellors
and Psychotherapists
(Regulation) Bill is listed
for Friday 24 January. Due
to the lack of parliamentary
time, neither Bill is expected
to be debated or voted on.
BACP was represented at
the All-Party Parliamentary
Group for Conception to
Age 2 – the first 1,001 days.
BACP also attended its
first National Assembly for
Wales Cross-Party Group for
Mental Health meeting after
our recent application for
membership was accepted.
December 2013/www.therapytoday.net/Therapy Today 55
Research/Professional standards
Bursary boost for researchers
BACP’s PhD bursary
scheme waives for 12 months
the membership fees of a
limited number of members
undertaking a PhD/Doctorate.
BACP recently conducted
a survey of all past winners
of the bursary, which found
that all the respondents
planned to remain in practice;
two thirds said they would
like to undertake further
research while in practice
and more than half would
like to teach counselling
and psychotherapy. More
than a quarter (28.6 per
cent) would like to seek an
academic position and a third
would like to seek funding to
undertake further research.
Although not all the bursary
winners had completed their
studies at the time of the
survey, 20 per cent had
already published a paper
and half had presented
their study at a conference.
A fifth of respondents
said that their research had
had a positive impact on and
improved their practice and
a quarter had either taught
or delivered training as a
result of their research, or
were planning to do so.
BACP research enquiry of the month
with ASD. Some research
suggests that music therapy
may help children with ASD
improve their communicative
skills, and a more recent
pilot study has suggested that
narrative therapy significantly
reduces psychological distress
in young people with autism.
More research is needed
that focuses on non-CBT
interventions for individuals
with ASD.
If you have a query
about counselling and
psychotherapy research
or would like the list of
references used to compile
this response, please email
[email protected]
Is your
research
outstanding?
Applications are invited
for the BACP Outstanding
Research Award 2014. The
award is open to anyone
who has undertaken recent
research. The deadline for
applications is 31 January
2014. The winner will be
presented with a specially
designed plaque at the
BACP Research Conference
in May 2014. For further
details and to apply, visit
www.bacp.co.uk/research/
resources/awards.php
Each month, the Research
department will choose
one research enquiry
that we have received
and write up a summary
of the response we gave.
This month’s question is:
‘What research is available
that has looked at the
effectiveness of counselling
and psychotherapy for
people with Autism
Spectrum Disorder (ASD),
with a particular focus on
Asperger syndrome?’
To answer this question
we searched our internal
abstract database and
scanned NHS evidence and
Google Scholar using the
key terms ‘ASD’, ‘Asperger’
and ‘psychological therapy’.
Much of the existing
research literature has
focused on cognitive
behaviour therapy (CBT)
for Asperger syndrome, as a
way of treating the common
co-morbid diagnoses of
depression and anxiety.
There is strong research
evidence to suggest that CBT
significantly reduces anxiety
and depressive symptoms
in people with Asperger
syndrome, as well as reducing
episodes of anger. However,
there is less research on the
effectiveness of non-CBT
interventions for individuals
Funding
opportunities
CPR seeks mindfulness papers Research
survey
who are involved in
Counselling & Psychotherapy
There are several new
research funding
opportunities currently on
offer. Further information
can be found on the research
funding pages of the BACP
website at www.bacp.co.uk/
research/Finding_Research_
Funding/currentfunding
opportunities.php
Research (CPR), the BACP
research journal published
by Taylor & Francis, is to
publish a special section on
‘Research into mindfulness
in relation to counselling
and psychotherapy’. CPR editor Clare Symons
is inviting expressions of
interest from researchers
based in the UK or abroad
56 Therapy Today/www.therapytoday.net/December 2013
quantitative, qualitative
or mixed method studies
that explore the integration
and impact of mindfulness
in counselling and
psychotherapy.
To submit an expression
of interest or to discuss your
ideas, please contact Clare
at [email protected]
by Friday 20 December 2013.
Research
conference
A record number of papers
have been submitted by
researchers wanting to
present their work at the 2014
BACP Research Conference.
The conference is co-hosted
with the American
Counseling Association and
takes place on 16 & 17 May in
London. For more details and
to book, visit www.bacp.co.uk/
|research/events/
BACP Research department
is to conduct an electronic
survey of all members in the
New Year asking about your
thoughts, involvement and
interest in research. We will
be asking you what you find
useful and what else we could
be doing to help our members
with research-related issues.
Thank you from BACP Research
BACP Research would like
to thank the many people
who have contributed to
our work in 2013.
Over the past 12 months
we have had the pleasure
and the benefit of working
closely with many people
who have kindly given their
time and expertise to further
research at BACP, for which
we are very grateful indeed.
We would like to mention
the following people for a
special thank you, although
the list is not exhaustive,
and please forgive us if we
have missed anybody out
unintentionally.
Our thanks go to, Mark
Aveline, Michael Barkham,
Tim Bond, Liz Bondi, BPS
Ethics Committee members,
Alison Brettle, Ruth Caleb,
John Cape, Mick Cooper,
Sue Cornforth, Robert
Elliott, Andy Fugard, Paul
Gilbert, Simon Gilbody,
Jan Hutchinson, Jane Hunt,
Naoise Kelly, Shane Kelly,
Michael King, Colin Lago,
Kate MacKenzie, Thomas
Mackrill, Davey McLeod,
Caroline Meyer, Nick Midgley,
Naomi Moller, Roy Moodley,
Sue Pattison, Peter Pearce,
Maggie Robson, Tony Roth,
Jackie Russell, Pete Sanders,
Aaron Sefi, Roz Shafran,
Seamus Sheedy, Sheila
Spong, Melinda Stanley,
Dave Stewart, William B
Stiles, Ladislav Timulak,
Andreas Vossler, Philip
Wilkinson, Jeannie Wright
and Viviana Wuthrich.
A huge thank you also to
all those who presented and
chaired sessions at our annual
research conference in May;
it was very much appreciated.
And a very special thank
you to the late Professor
David Rennie, whose
untimely death this April
left a huge void in the
research community. David
was a keen supporter of
research at BACP, serving
with complete dedication on
the CPR Editorial Board for a
number of years. Throughout
his tenure on the Board and
right to the end, David was
an ally on whom we could
always rely for professional
advice and peer reviewing
duties. David is sadly missed.
Newly senior accredited
supervisors of individuals
Donna Coupland
Carolyn Croll
Catherine de la Bedoyere
David Downes
Jane Fortune
Corinne Gladstone
Alison Glynne-Jones
María Gómez
Juliet Grace
Vera Grey
Bernadette Hallworth
David Hamilton
Karen Hannam
Frances Hayes
Jennifer Horsfall
Simone Huber
Elisabeth Hughes
Josephine Hughes
Dee Johnson
Judi King
Stacey Landsberg
Donna-Marie Lane
Matthew Lee
Tricia Leonard
Kathryn Lett
Maz Low
Brigette Luketa
Fiona Macintosh Hall
Deborah Malster
Lee Martin
Janette Masterton
Robert Mawditt
Hilary McNair
Elspeth Messenger
Noelia Moronta-Jacobs
Linda Murgatroyd
Dolores O’Malley
Gerard Pandolfo
Bronwen Pearson
Helen Peters
Don Polwarth
Eva Rembiszewski
Ann Rhodes
Kathy Rolington
Alan Rynn
Jayne Schofield-Lingard
Patrick Shea
Cheryl Simpson
Ana Sokoli
Vasileios Spyridonidis
Penelope Strange
Caroline Telkins
Rebecca Trendall
Liz Veysey
David Whelton
Jane Wildbore
Tanya Wright
Kathleen Nisbet
Pauline Price
Newly senior
accredited counsellors/
psychotherapists
Diana Armstrong
Pamela Brown
Derek Goodlake
Celia Henson
Teresa Lewis
Yewande Savage
Newly accredited
counsellors/
psychotherapists
Adekunle Adetula
Rabina Akhtar
Jo Ansell
Alexandra Badenoch
Bev Baldasera
Claire Bentley
Andrew Bridgen
Zoë Carey
Fern Copland
Members whose
accreditation has
been reinstated
Terry Claessens
Leanda Kane
Tali Lernau
Member whose
accreditation has
been restored
Jane Steele
Members not renewing
accreditation
Kate Bainton
Tina Horton
Kathleen Lloyd-Williams
Lisa Morris
Fiona Munro
Sylvie Schapira
All details listed are correct
at the time of going to print.
December 2013/www.therapytoday.net/Therapy Today 57