MAY 2017 | VOLUME 28 | ISSUE 4
THERAPY TODAY
It’s like
finding the
key to a secret
doorway
Page 32
The voice of the counselling and psychotherapy profession
Tap and talk
MAY 2017, VOLUME 28, ISSUE 4
Is the digital revolution delivering for counselling?
What can counselling offer the very old? // Working with women and sexual compulsion
Person-centred approaches to severe mental distress // How writing fuels reflection
Welcome
The rapidity of the
digital revolution has
left therapists running
to catch up. Are these
wonderful new channels
for communicating with
clients, or a threat to our
profession (and, indeed, to
our own and our clients’
mental health)?
Editor’s note
I love the way articles with no
immediately apparent connection
resonate with each other. Take
March’s article on Redeen, the asylum
seeker who could see no point in the
future, and Helen Kewell’s article this
month about her work with elderly
people at the very end of their lives.
It is shocking that the emotional
needs of older people are so
frequently and thoughtlessly
bypassed by the NHS, and that they
are so rarely offered counselling. The
assumption is that it’s too late now and, anyway, they don’t want it:
‘They would rather talk to the vicar/each other/have a nice cup of tea.’
What struck me is this article’s message that ‘it is still possible’ – that it
is, indeed, crucial – to hold onto the belief that we can ‘challenge longheld life narratives and [...] dare to write new ones’, even, and perhaps
especially, in very old age. The self-acceptance needed for change
to occur can still be achieved at the end of life, and person-centred
counselling can be the catalyst for that process.
This marries well with Stephen Joseph’s article on person-centred
counselling with people in severe mental distress, for whom it is
widely assumed to be useless. Not so, he argues: the Rogerian image
of the potato seedlings in the cellar, growing towards the far-off light
– that understanding of the damaging effects on the human psyche of
thwarted and distorted potential – can explain most, if not all, forms
of human distress. As Emmy van Deurzen points out in ‘This Much I
Don’t Know’, you have to be willing to enter the client’s world (get on
that bus to Southsea with them), ask them what stopped them going
there before, and, by doing so, help them get there now.
CHARLIE BEST
My own stance on technology is ‘love it, hate
it, wouldn’t want to work without it’. Whatever
we think, it’s here to stay, and the contributors
to this month’s News Feature and Talking Point
offer some interesting perspectives on how to
use it so that it doesn’t use us. A natural follow-on feature
would be about how the
so-called digital natives – our
young adult clients – have been
affected by growing up ‘onscreen’. How has this fast-paced,
‘always-on’ culture affected
them? Has it changed how
we relate and mate? Did the
noughties, and the rise of Facebook, Instagram,
Twitter et al, make us more narcissistic? Has the
selfie generation become too self-focused? We
know that anxiety and anxiety-related issues are
increasing, especially in the younger generation.
Has the digital revolution affected human
evolution? Let’s press ‘pause for thought’...
Rachel Shattock Dawson
Consultant editor
Editor Catherine Jackson
e: [email protected]
Consultant editor Rachel Shattock Dawson
Reviews editor John Daniel
e: [email protected]
Media editor Bina Convey
e: [email protected]
Dilemmas editor John Daniel
e: [email protected]
Group art director Jes Stanfield
Chief sub-editor Charles Kloet
Production director Justin Masters
Group account director Rachel Walder
Managing director Polly Arnold
Group advertising manager Adam Lloyds
d: 020 3771 7203 m: 07725 485376
e: [email protected]
Catherine Jackson
Editor
Disclaimer Views expressed in the journal
and signed by a writer are the views of the
writer, not necessarily those of Think, BACP or
the contributor’s employer, unless specifically
stated. Publication in this journal does not
imply endorsement of the writer’s views
by Think or BACP. Similarly, publication of
advertisements and advertising material does
not constitute endorsement by Think or BACP.
Reasonable care has been taken to avoid errors,
but no liability will be accepted for any errors
that may occur. If you visit a website from a link
in the journal, the BACP privacy policy does
not apply. We recommend that you examine
privacy statements of any third-party websites
to understand their privacy procedures.
Therapy Today is published on behalf of the British Association
for Counselling and Psychotherapy by Think, Capital House,
25 Chapel Street, London NW1 5DH
t: 020 3771 7200 w: www.thinkpublishing.co.uk
Printed by: Wyndeham Southernprint, Units 15-21,
Factory Road, Upton Industrial Estate, Poole BH16 5SN
ISSN: 1748-7846
Subscriptions
Annual UK subscription £76; overseas subscription £95
(for 10 issues). Single issues £8.50 (UK) or £13.50 (overseas).
All BACP members receive a hard copy free of charge as part
of their membership.
t: 01455 883300 e: [email protected]
BACP
BACP House, 15 St John’s Business Park, Lutterworth,
Leicestershire LE17 4HB
t: 01455 883300 e: [email protected]
w: www.bacp.co.uk
THERAPY TODAY
Case studies All case studies in this
journal, unless otherwise stated, are
permissioned, disguised, adapted or
composites, to protect confidentiality.
3
MAY 2017
Copyright Apart from fair dealing for the purposes
of research or private study, or criticism or review,
as permitted under the UK Copyright, Designs
and Patents Act 1998, no part of this publication
may be reproduced, stored or transmitted in any
form by any means without the prior permission
in writing of the publisher, or in accordance with
the terms of licences issued by the Copyright
Clearance Centre (CCC), the Copyright Licensing
Agency (CLA), and other organisations authorised
by the publisher to administer reprographic
reproduction rights. Individual and organisational
members of BACP may make photocopies for
teaching purposes free of charge, provided these
copies are not for resale.
© British Association for Counselling
and Psychotherapy
ABC total average net
circulation: 43,903
(1 January–31 December 2015)
Contents May 2017
Here and now
News
News feature
The month
Letters
The big issues
Waiting for the Southsea bus
Finding meaning in life is just as important
as we near its end, says Helen Kewell
Women at the edge
Sophie Livingstone describes her work with
women with sexually compulsive behaviours
Rethinking human suffering
Stephen Joseph sees a place for person-centred
counselling with people in severe mental distress
I write, therefore I think
Liz Cox explains how reflective writing can
power professional development
ALAMY
20
‘Counselling is all about
exploring the client’s worldview,
and, for older people who are losing
cognition, this can be a powerful
antidote in a society that isolates those
who don’t conform to the received view
of what is “real” and “right”.’
Helen Kewell joins her elderly client Tom
on his imagined seaside trips
MAY 2017 | VOLUME
28 | ISSUE 4
THERAPY TODAY
It’s like
finding the
key to a secret
doorway
Page 32
Regulars
This much I don’t know
Wisdom from experience
Research into practice
Liddy Carver discovers how creative arts can help
people with depression express their feelings
Dilemmas
Matias’s difficult client wants to see his notes
Talking point
How do you feel about working online?
Self-care
Teddy bears with issues
Analyse me
What does your counselling room
say about you?
6
8
12
16
20
24
28
32
15
36
38
40
42
74
The voice of the counsellin
g and psychotherapy profession
Your association
On the cover..
From the Chair
BACP round-up
Meet the BACP Board
Classified, mini ads,
recruitment, CPD
Tap and talk
MAY 2017, VOLUME
28, ISSUE 4
Sally Brown asks what’s
gained and lost as
counselling climbs on
board the digital express
Page 8
Tap and talk
Is the digital revolutio
n delivering for counselli
ng?
What can counselling
offer the very old? // Working
with women and sexual
Person-centred approache
compulsion
s to severe mental distress
// How writing fuels reflection
01 COVER-cjf.indd 1
26/04/2017 11:11
This is your journal. We want to hear from you. [email protected]
THERAPY TODAY
5
MAY 2017
43
44
48
51
In the news
Our monthly digest of news, updates and events
Mental health
and social media
Social media is a chief cause of
mental distress among students,
a report from the National Union
of Students (NUS) says.
The report, Further Education
and Mental Health, is based on
the views and experiences of
22 further-education students
aged 15–18 who attended an
NUS roundtable event earlier
this year.
The students said 24/7 social
media made them vulnerable
to online bullying at all hours,
often made them feel ‘isolated’
and ‘neglected’, and meant
they were continually seeking
validation from other people.
They also spoke about the
stigma attached to mental ill
health, particularly in colleges,
and about feeling ‘weak’ if they
used mental health services,
which, they said, were seen
as being only for very serious
cases. Many also said they didn’t
know where or how to get help,
either from their college or in
the community.
The report sets out a ‘Charter
for Mental Health in Further
Education Colleges’, which
says all colleges should have a
student social media policy, and
should build stronger links with
local mental health services.
bit.ly/2q4bp43
50%
of children responding
to a Department
for Education consultation say
they would like to be a mental
health/peer supporter for other
children bit.ly/2ntYNlU
Counselling wins
royal approval
BACP has warmly welcomed Prince
William and Prince Harry’s recent
backing of counselling. Prince Harry
spoke publicly about his brother’s
advice that he seek counselling after
two years of ‘total chaos’ in his late
20s, having blocked his grief since his
mother’s death. Prince William told
charity publication CALMzine that
he and the Duchess of Cambridge
wanted their two children ‘to grow
up feeling able to talk about their
emotions and feelings’. BACP Chair
Andrew Reeves said: ‘Prince Harry’s
experience has shown that access to the
right therapeutic support, at the right
time, can have a positive and lasting
effect.’ www.bacp.co.uk/media
Call for national prescribed drug helpline
Members of the All-Party
Parliamentary Group for
Prescribed Drug Dependence
(APPG for PDD) are calling on
Public Health England to fund
a national 24-hour helpline
to help people hooked on
prescribed drugs, including
opioid painkillers, tranquillisers
and antidepressants.
The call is backed by many
professional and patient
organisations and charities,
including BACP, the British
Psychological Society and
the Royal Colleges of GPs,
Physicians and Psychiatrists.
An estimated 770,000 longterm users of antidepressants
could be taking these drugs
unnecessarily in England
alone, new research suggests.
More than 250,000 people are
taking benzodiazepines and/
60,000
more people
will be treated
in IAPT services by the end of
2017/18, and 200,000 more by the
end of 2018/19, NHS England has
promised bit.ly/2mURwhT
THERAPY TODAY
6
MAY 2017
or z-drugs for longer than six
months, even though NICE
guidance says they should only
be taken for two to four weeks.
Paul Flynn MP, Chair of the
APPG for PDD, said: ‘Longterm users of these drugs
can suffer devastating effects
when they try to withdraw,
often leading to years of
unnecessary suffering and
disability.’ prescribeddrug.org
25.8%
more young
people in Wales
sought counselling last year
because they felt suicidal, up
from 244 in 2014–15 to 307 in
2015–16 bit.ly/2oNJqpj
Reporting child
sexual exploitation
The Scottish Government
has published new guidance
for health practitioners on
identifying and responding
when a child may be at risk
of sexual exploitation.
The guidance covers
‘spotting the signs’, barriers
to disclosure, young people
particularly at risk, how to
respond, and the formal
processes and procedures
in place for practitioners to
report their concerns.
A section on what young
people want from health
practitioners quotes young
people themselves. One said:
‘No one ever asked me if I
needed help.’ Another said:
‘I felt like that [the police]
were getting really annoyed
with me ’cause I didn’t have
the words for a lot of the
things.’ Another sought help
for depression and self-harm
and was told by doctors that
she was ‘being silly and to go
home and grow up’.
bit.ly/2oFYJ1X
Student stress
in Northern
Ireland
Report charts
disability inequality People with disabilities still face disadvantages and inequality
in Britain, the Equality and Human Rights Commission (EHRC)
has said. In a new report, Being Disabled in Britain: a journey
less equal, the EHRC highlights the many disadvantages and
inequalities still faced by disabled people in all spheres of life,
including people with mental health problems.
Among the issues highlighted, the report singles out the wide
variation in access to NHS talking therapies in England, Wales
and Scotland. In England and Wales, the waiting time target for
access to psychological therapies is now 28 days, but in some
areas people are waiting more than 90 days, and the report
also notes concerns about drop-out rates and whether the
programme is reaching people who need help the most, such as
those with chronic depression. In Scotland, it says, the majority
of health boards have failed to meet the target to ensure access
to psychological therapies for all patients within 18 weeks from
referral to treatment. bit.ly/2nSeKm0
STEVE BACK/REX/SHUTTERSTOCK; REX/SHUTTERSTOCK; ALAMY
New veterans’ mental health service
NHS England has launched a
specialist mental health service
for armed forces veterans and
service personnel who are leaving
military service. The £9 million NHS
transition, intervention and liaison
(TIL) veterans’ mental health service
will have the capacity to assess and
refer on for further treatment, where
appropriate, 17,500 people over
the next three years.
Service personnel approaching
discharge and veterans will be
able to either self-refer or request
THERAPY TODAY
referral via their GP, mental
health provider or a military
charity. An initial face-to-face
assessment will be offered within
a fortnight and, where appropriate,
a clinical appointment two
weeks later.
The service is intended to
identify early signs of mental health
difficulties, alcoholism, anxiety and
depression, and ensure veterans
get help for complex problems
and psychological trauma before
they reach crisis point.
7
MAY 2017
More than threequarters of students
in Northern Ireland
have experienced
stress or other mental
health problems in
the past year, a survey
by the National Union
of Students-Union of
Students in Ireland
(NUS-USI) has found.
Some 3,600 students
took part in the research,
and 78% reported
mental health worries
over the past year. Of
these, 81% reported
suffering from stress.
Other common concerns
were lack of energy,
being unhappy or down,
and anxiety. Forty-six per
cent said their mental
health problems had
affected their quality of
life, 44% said they had
affected their studies
and 43% said they had
had an impact on their
personal relationships.
The main causes
were their studies and
financial worries and
pressure. Just one in 10
of those who tried to get
help were able to get
support on the same day.
One in six got some help
within a week.
NUS-USI President
Fergal McFerran warned
of a looming crisis in
student mental health
and wellbeing in
Northern Ireland. ‘That is
unacceptable,’ he said.
bit.ly/2o5a6n8
News feature
Tap and talk
Sally Brown asks if counselling is reaping the
whirlwind of the digital revolution
W
e are in the midst of a digital
revolution that is changing
the way we communicate
with each other and how
we source and share information across
the globe. The ubiquitous smartphone
has created a 24/7 society where
the boundaries between work and
home have blurred, and there is an
expectation that we are all instantly
contactable. It amazes me how quickly
we have normalised the seismic cultural
changes of the last few decades. We no
longer wonder that we can video-call
loved ones on a different continent (for
free!), or bat an eyelid at toddlers who
can operate a tablet before they can
walk or talk, or find it curious that we
can ‘browse’ online for all our needs,
whether that’s a new partner or a new
pair of shoes.
For counsellors and psychotherapists,
the digital revolution has extended
our potential client pool worldwide,
language and regulatory requirements
permitting. We can market ourselves
globally. We can offer face-to-face
sessions from anywhere to anywhere,
and be available at any time, if we so
choose, at a press of a button. We have
gained so much, including the ability to
reach people who, for reasons of illness,
disability, finance or geography, would
not otherwise be able to access our
services. We can even augment our
work with, or be replaced by, apps.
But is there a price to pay in the quality
of the work, for us, as practitioners, and
for society in general? Are we seeing
the advent of the therapy equivalent
of Uber’s ‘tap and ride’?
Reaching clients
If we want to continue to reach new
generations of clients, we have to
do so on their terms, believes Sarah
Worley-James, Chair of the Association
for Counselling and Therapy Online.
She is the creator and co-ordinator of
the online counselling service at Cardiff
University, which provides email, instant
messaging and webcam sessions
to its students. ‘In the 21st century,
young people’s preferred means of
communication is via a range of everchanging online platforms and phone
apps. It is reasonable for them to expect
to be able to contact and work with
professionals online in a similar way.’
In the US, clients can now subscribe
to Talkspace, billed as ‘the leading
online therapy platform’, and benefit
from ‘therapy without travelling to an
office – and for significantly less money
than traditional therapy’. A monthly
subscription of $128 allows them
‘In the 21st century, young people’s preferred means
of communication is via a range of ever-changing
online platforms and phone apps. It is reasonable for
them to expect to be able to contact and work with
professionals online in a similar way’
THERAPY TODAY
8
MAY 2017
unlimited text messages with a therapist.
For $276 a month, they get four
video sessions and unlimited texting.
Psychotherapists can earn up to $3,000
per month by counselling users via
phone or text messaging.
In the UK, Stillpoint Spaces
similarly provides an encrypted videoconferencing platform, in addition
to face-to-face therapy, worldwide.
Search for ‘mental health’ in an app
store and you will find more than 2,000
apps, including those that claim to help
you manage anxiety and the symptoms
of post-traumatic stress disorder. Mental
health has been described as the ‘next
frontier’ for technology companies. In
its 2016 report, Technology and the
Future of Mental Health Treatment, the
US National Institute of Mental Health
(NIMH) predicts that behavioural health
apps will increasingly incorporate ‘faceto-face counselling to provide a balance
between technology and the human
touch’. The World Health Organization
has also backed the use of mental health
apps to promote self-care.1
Studies suggest they are effective.
For example, in a recent study of 99
adults with symptoms of depression
or anxiety, or both, who used a
mental health app called IntelliCare
for eight weeks, 37% of those with
depression and 42% of the anxiety
sufferers reported a complete
alleviation of symptoms at the end.
However, the study lacked a control
group, so the findings have only
limited validity, and it’s worth noting
that 64% of the group were also
taking medication and 22% were
also having psychotherapy.2
The mistake is to think
that, just because we are
comfortable using Skype
socially, we are equipped
to work effectively online
Emma Broglia, a PhD student at the
University of Sheffield whose research
is being funded by BACP, is currently
studying the use of apps to supplement
face-to-face therapy in a student
counselling service. One of her research
projects involves a highly rated app
called Pacifica, a CBT-based programme
that allows users to track moods and
challenge unhelpful thoughts. Pacifica
is one of 10 mental health apps recently
recommended by NHS Choices.3
A group of 20 students were
encouraged to use the app to map their
mood and carry out relaxation exercises
in between therapy sessions, with the
option of discussing their experiences
with their therapist. The therapists used
a range of modalities, including CBT
and person-centred and integrative
counselling. ‘The study is still under way
but results from an initial focus group
have been positive – clients are reporting
feeling that they have more control over
their wellbeing,’ says Broglia. ‘The levels
of depression and anxiety have been
measured using PHQ-9 and GAD-7,
and what has been surprising for the
therapists is that even those at the severe
end of the scale have experienced
benefits from using the app.’ However,
Broglia believes that the current ‘gold
rush’ of mental health apps should
raise concerns. ‘The issue is that these
apps are designed by developers who
do not have a therapeutic or clinical
background, and very few have been the
subject of clinical trials,’ she points out.
A different process
The mistake is to think that, just
because we are comfortable using
Skype socially, we are equipped to
work effectively online, says Dr Gillian
Isaacs Russell, psychoanalyst and
author of Screen Relations: the limits of
THERAPY TODAY
9
MAY 2017
computer-mediation in psychoanalysis
and psychotherapy. ‘In 2008, I closed a
30-year psychoanalytic practice in the
UK and moved to rural South Dakota.
A couple of previous patients and
supervisees hadn’t realised I had moved
and asked to work with me. I became
enthusiastic about working online – this
was going to be a magical solution to
the problem! But I sleepwalked into the
experience,’ she says. ‘It’s not just that
we lose elements of communication;
working remotely fundamentally
changes the process. Therapists are
resistant to thinking about this – we
think we’re communicating in the
same way, but the research shows
many differences. We need to become
familiar with the emerging research.
It has serious implications for the way
we practise, including the way we set
our fees.’
She also found she needed a
different kind of focus to keep the
connection going. ‘The more you have
to concentrate, the less you can relax
into presence. It’s more cognitive – you
can’t even approach that feeling of
free-floating attention or reverie.’
Yet, despite this feeling of intense
concentration, she found that her ‘state
dependent’ memory – the memory
on which we rely to access details of
what was said the last time the client
was sitting opposite us – was impaired,
making it harder to remember the
content of the sessions. ‘Sixty per cent
of communication is non-verbal. That
implicit, non-verbal communication
that is central to what you do in the
consulting room isn’t going to happen
in the same way online,’ she warns.
News feature
‘Sixty per cent of communication is non-verbal.
That implicit, non-verbal communication that is
central to what you do in the consulting room
isn’t going to happen in the same way online’
But the most significant difference
between face-to-face and online
work is the loss of ‘presence’, says
Dr Isaacs Russell. ‘Presence is a core
neuropsychological phenomenon – it’s
an organism’s capacity to locate itself
in the external world, and the ability to
interact with another in a shared physical
environment enables the nervous system
to recognise that it is in an environment
outside of itself that is not a dream state
or a product of its mind. The experience
of embodiment in a shared environment
is essential to our experience of being.
Evolution prepared us to be embodied
beings, sharing the same space, so all
screen relations are simulations of this
relational experience.’
Escaping the mess
One potential cost of the digital
revolution may be the emergence of
what is being tagged the ‘empathy gap’.
According to a 2010 meta-analysis of
studies by Sara Konrath at the University
of Michigan,4 there has been a 40%
decline over the past 30 years in the
ability of students to recognise and
identify other people’s feelings. In
comparison with their peers in the late
1970s, students today are less likely
to agree with statements such as ‘I
sometimes try to understand my friends
better by imagining how things look
from their perspective’ and ‘I often have
tender, concerned feelings for people
less fortunate than me’. And the biggest
decline has happened since 2000, when
mobile phones became widely available.
‘Research shows that when people are
together, say for lunch or a cup of coffee,
even the presence of a phone on the
table – even a phone turned off – does
two things,’ says clinical psychologist
Sherry Turkle, Abby Rockefeller Mauzé
Professor of the Social Studies of Science
and Technology at the Massachusetts
Institute of Technology (MIT), and author
of the book Reclaiming Conversation:
the power of talk in a digital age. ‘First,
it changes what people talk about – it
keeps conversation light because the
phone is a reminder that at any point
we might be interrupted, and we don’t
want to be interrupted when we’re
talking about something important to
us. Second, conversation with phones
on the table, or even phones in the
periphery of our vision, interferes with
empathic connection. Two-person
conversations that take place with a
phone on the table leave each person
feeling less of a sense of connection
and commitment to each other.’
The shift towards online communication
via Facebook, texts, email and platforms
such as WhatsApp is part of a flight
from the ‘messiness’ of spontaneous
conversation, Turkle believes. ‘What
people are fleeing is the kind of
conversation that talk therapy tries to
promote – the kind in which intimacy
flourishes and empathy thrives. Online,
we can curate the self as we want it seen.
We can edit our conversation. We can
cultivate the illusion that we can say the
“right thing”. Contrast all of this with the
simplest lessons of talk therapy: there,
we quickly learn that, when we stumble
and lose our words and are left in
silence, this is when we may reveal
ourselves most to each other.
‘We’ve always wanted to escape what’s
most difficult in our relationships, and
technology gives us a way.’
Online disinhibition
For some clients, this lack of ‘presence’
is a bonus: working online provides
them with a ‘zone of proximal distance’,
creating a sense of safety, says WorleyJames. ‘Students on the autistic
spectrum find the noisy, bright, intense
sensory experience of entering a busy
student support centre stressful and
difficult to cope with. This may deter
them from asking for our support, or, if
they do, they may come to the session
in a heightened state of anxiety. The
environmental stressors of a busy
building can also negatively affect
students with mental health problems,
such as social anxiety, creating a barrier
to them accessing our service. I have
also worked with transgender students
who are used to accessing peer support
through online forums. They may feel
safe to be themselves in the virtual
world, when face-to-face relationships
can be fraught with uncertainty about
the other person’s hidden opinion.’
There can also be a positive benefit
from the ‘online disinhibition effect’
– the abandonment of the social
rules normally applied to face-toface communication, which is often
associated negatively with cyberbullying.
However, says Worley-James, ‘The
effects of online disinhibition can be
hugely beneficial and therapeutic
for many clients. The anonymity of
‘The effects of online disinhibition can be hugely
beneficial... I am struck again and again by how
quickly clients open up online, and how effective
the online therapeutic relationship can be’
THERAPY TODAY
10
MAY 2017
Digital policy
We owe it to our clients to seek information and educate
ourselves about digital life, says psychotherapist Aaron Balick,
author of The Psychodynamics of Social Networking. ‘Most
therapists start their training in mid-life, and they are trained
by mid-life digital immigrants who are generally later to the
table than these trainees themselves, so it is taking our field
a while to catch up with the zeitgeist. I have come to a place
where I think every therapist should have a digital policy
because we don’t have the privacy we had 20 years ago.’ Balick’s digital policy includes an undertaking not to google
a client or follow them on social media, and he suggests that
his clients do the same for the duration of their work together.
‘I can’t stop clients googling me, but I can request that, if they
do so and they find something out about me that they want
to discuss, they bring it into the room. I tell clients that this is
how I keep this relationship different from other relationships,
and protect their confidentiality,’ he says.
We also need to think about the culture of ‘implicit
immediate availability’ that smartphones, email and texting
can create, he argues. ‘How will you cope if you find
digital native clients are less boundaried about contacting
you between sessions? I no longer receive emails on
my smartphone. I realised that receiving requests for
information or actions that I wasn’t in a position to carry out
until I was back in my office was creating anxiety.’ He has
also re-evaluated his relationship with social media. ‘I have
come to view it as somewhat pernicious,’ he says; he has
turned off all his notifications and now accesses it when he
chooses to. ‘This is the ideal, of course. Just like everyone
else, I’m liable to check more than I ought to and impulsively
post things I probably shouldn’t. It’s a work in progress.’
communicating by email or instant
messenging allows some clients to
explore sensitive topics without cultural
or gender issues intruding and limiting
their freedom to do so. I am struck again
and again by how quickly clients open
up online, and how effective the online
therapeutic relationship can be.’
Turkle warns that therapists are in
danger of slipping into digital therapy
without ever really questioning its
usefulness. ‘At first, treating a client
by Skype is presented as “better than
nothing”. Gradually, what you can do
on Skype begins to be presented as
equivalent to, or maybe better than,
what you can do with the client in the
room. Why are therapists so quick to
abandon the body and what it brings to
our understanding?’ she asks. ‘If you give
up on the body, you open the door for
treatment by programs, by robots, by
all kinds of artificial intelligences that
THERAPY TODAY
also don’t have bodies. This seems a
stretch, but it is a stretch that is ready
to be marketed to you.’
The answer is, of course, that we
need to ensure that we make good use
of what digital technology can bring
to our work while ensuring it doesn’t
dictate how we work, negatively affect
the therapy relationship, or become
misused as a cheap alternative to
face-to-face therapy.
Return to embodied therapy
Isaacs Russell predicts that we will soon
see a renewed valuing of talk therapy,
and a need for it, by a generation who
have become disillusioned with social
networking: ‘My prediction is that young
people growing up with technology will
have a longing for something authentic
and we will see a greater demand for
embodied therapy.’
Turkle agrees: ‘Psychotherapists are
experts at the kind of talk that digital
culture needs most, the kind of talk in
which we give each other full attention,
the kind of talk that’s relational, rather
than transactional. What therapists need
to recognise is the reason we need to
talk: to forge relationships that are the
triumph of messy, breathing human
connection over the cold instrumentality
of treating each other as apps. This does
not mean that virtual treatment doesn’t
have a place. But it should not be
allowed to sneak in as a substitute.
‘Psychotherapy has a moment to
assert what it knows best: that the
body does matter – that being in the
room does matter.’
Sally Brown
About the author
Sally Brown is a
counsellor and coach
in private practice
(therapythatworks.co.uk),
a freelance journalist,
and Executive Specialist
for Communication
for BACP Coaching.
11
MAY 2017
Dr Gillian Isaacs
Russell will be
presenting at the
Confer conference,
‘Providing
Psychotherapy
in a Digital Era’,
on 24 June, in
London (www.
confer.uk.com).
REFERENCES
1. www.who.int/
mental_health/
action_plan_2013
2. Mohr DC et
al. IntelliCare: an
eclectic, skillsbased app suite
for the treatment
of depression and
anxiety. Journal of
Medical Internet
Research 2017;
19(1): e10.
3. www.nhs.uk/
Conditions/stressanxiety-depression/
Pages/mental-healthapps.aspx
4. Konrath S, O’Brien
E, Hsing C. Changes
in dispositional
empathy in American
college students over
time: a meta-analysis.
Personality and
Social Psychology
Review 2011; 15(2):
180–198.
The month
Our monthly round-up of film, theatre, the media and events
11,796 PEOPLE
viewed cricketer Freddie Flintoff talking about
anxiety to musician Professor Green in this Heads
Together campaign video: bit.ly/2oCIx5k
Radio
TV
S MEDDLE/TV/REX/SHUTTERSTOCK; SILVERHUB/REX/SHUTTERSTOCK; SCIEPRO/SCIENCE PHOTO LIBRARY
Being Mum and Dad
The power of celebrity in helping to challenge
male stereotyping was amply evidenced by
the reaction to Being Mum and Dad, a BBC
documentary featuring Rio Ferdinand, in which
the former Manchester United player opened
up about his grief following the death of his wife,
Rebecca Ellison, from breast cancer in 2015. The
programme was watched by 5.2 million viewers,
and social media buzzed with praise in the days
that followed. It’s no longer available on iPlayer, but
let’s hope for a repeat soon. These were some of
the tweets from affected viewers:
Dr Sarah Russell @learnhospice. ‘Think this should
be mandatory watching in all health & social care
curriculums, not just palliative care.’
Tony Shepherd @tonysheps. ‘In a world where the
phrase “man up” is often used. So much respect for
@rioferdy5 for doing this programme. Much love.’
Fara Williams MBE @farawilliams47. ‘Watching
#BeingMumAndDad with a permanent lump in
my throat. So much bravery shown by @rioferdy5
massive inspiration to so many.’
THERAPY TODAY
The Uncommon Senses
We know about the five
senses, but what about
the other 28 we are
believed to possess?
Not only do we have
a multitude of senses,
such as our sense of self
and our sense of agency
– the feeling of being
in control – but we also
have to contend with
a predictive brain that
second-guesses what it
expects our senses to
tell it. Philosopher Barry
Smith and sound artist
Nick Ryan explore the
human multi-sensory
world in The Uncommon
Senses, a fascinating
seven-part series
broadcast on BBC Radio
4 in March and still
available on BBC iPlayer.
Blog
ANXIETY
SURGE
A toxic combination of political
upheaval and our addiction to 24/7
newsfeeds is driving the five-fold
increase in traffic to the Mental
Health Foundation’s online anxiety
page, says Senior Media Officer and
blogger Carl Strode. ‘The surge in
traffic started last July, the month
following the EU referendum vote…
phones and social media keep us
connected to the shifting currents
of world and home political affairs,
making it much harder to maintain
boundaries and take healthy time
out from anxiety-inducing news.’
Read more at huff.to/2o17hDO
Theatre
GOOD GRIEF
With a coffin stuffed with sympathy snacks,
comedian Jack Rooke and his 85-year-old
nan Sicely invite us to their world of grief. In
this final run of his critically acclaimed show
– a blend of sharp wit, storytelling and film –
we follow the comedian’s experiences after
the death of his father and his observations
on grief more generally. Rooke applies his
comic talent to this frank but gentle look
at how we treat the bereaved and how we
support the welfare of grieving families.
Good Grief is currently touring until 24 June.
bit.ly/2nvsW5Q
12
MAY 2017
Don’t
miss
If you only have two minutes…
Video
Know of an event that
would interest Therapy
Today readers?
Email media@
thinkpublishing.co.uk
Institutional racism has dogged the Metropolitan
Police for many years, but a subtler subconscious
bias is at play in society more widely, and it is
highly relevant to our work with clients. In a funny
and thought-provoking presentation (part of the
5x15 talks initiative) the Met’s highest-ranking
Sikh officer, Chief Superintendent Raj Singh Kohli,
challenges the everyday assumptions we make
about each other. If unchecked, this natural human
trait impels us to form networks with people just
like ourselves and to make subliminal judgments,
with potentially harmful consequences.
bit.ly/2nGk6n2
TV
REHAB
Surviving addiction is not
Event
Blooming
in Brighton
Event
Gut-Brain-Heart-Brain
Many in the psychotherapeutic and complementary
medicine communities have long held that
emotional processing crosses the Cartesian body–
mind divide, taking place not only in the brain but
also in the heart and gut. Research into the ‘gutbrain axis’ is generating techniques to harness the
powers of the bacteria and other micro-organisms
in our digestive system to heal emotional pain and
harm, particularly in trauma work. This one-day
conference brings together experts in the field
to explore the contribution of our physiological
systems to affect regulation. They include
nutritionist Michael Ash, clinical psychologist Janina
Fisher, author of the forthcoming book Healing the
Fragmented Selves of Trauma Survivors, and EMDR
specialist and medical practitioner Art O’Malley.
The Gut-Brain-Heart-Brain conference will take
place on 1 July in London. bit.ly/2nLPlsM
This year’s Brighton Fringe
arts festival (5 May to
4 June) offers the most
events ever (970), including
300 premieres. Look out
for Patrick Sandford’s
Blooming. Sandford scooped
three awards last year for
Groomed, his show about
his personal experience
Catch if
of sexual abuse. His 2017 you
can
performance is based on
a survey that asked 100
people: ‘How do you know
when you are happy?’
In what promises
to be a provocative
and kaleidoscopic
performance, Sandford
questions whether we can
ever move on from trauma
and if happiness is the key.
Blooming will run on three
consecutive weekends
from 19 May.
bit.ly/2ne8hRn
THERAPY TODAY
13
MAY 2017
only about the addict; it’s
also about all the people
and relationships around
the addict that are affected.
Phillip Wood’s first film,
Chasing Dad: a life-long
addiction, was an intimate
and visceral documentary
about his own survival in a
household of addiction, and
has been nominated for the
2017 Royal Television Society
Breakthrough award. His new
film, Rehab, explores addiction
in young people, and promises
to be equally powerful. Rehab
will show on BBC Three at the
end of May.
The month
Read a new book we should list? Email [email protected]
Professional Practice in Counselling
and Psychotherapy: ethics and the law
Peter Jenkins (Sage, £24.99) Structured
around the BACP core curriculum – and
including exercises, case studies and
tips for further reading – this training
and practice manual covers a wide
range of topics to do with ethical and
professional practice. Jenkins guides the
reader through the BACP
Ethical Framework, the
relevant legal frameworks
for practice, contrasting
models and approaches
to ethics, confidentiality
and record-keeping, and
working with key issues,
including difference and
vulnerable clients.
Essential Research Findings in
Child and Adolescent Counselling
and Psychotherapy
Nick Midgley, Jacqueline Hayes and
Mick Cooper (eds) (Sage, £24.99)
Experts in the field present current
best knowledge from the research on
neurobiology, attachment and trauma,
and the development of mental health
problems in children
and young people. What
works for whom? What
leads to change? What
can therapists learn
from research? How
can developmental and
neuroscience research
inform therapeutic work
with young people?
The Descent of Man
Must
Grayson Perry (Penguin,
read
£8.99) The nation’s favourite
transvestite, the Turner Prizewinning artist, TV presenter and author
Grayson Perry, explores how masculinity
shapes the lives and expectations of
men in Britain today and presents
a new ‘Manifesto for
Men’. Covering topics
from power to physical
appearance, this funny,
honest and tender book
is driven by the belief that,
for everyone to benefit,
men need to decide
to upgrade masculinity
for themselves.
Out of this World: suicide examined
Antonia Murphy
(Karnac Books, £19.99) Murphy
weaves together personal insight,
professional practice and a review of
the literature to provide an account
of current understandings of suicidal
states of mind. Suicide is explained as
a largely unconscious,
aggressive act, with its
roots in a perceived
or real experience of
thwarted childhood
needs. Therapy offers an
arena where the suicidal
fantasy can be worked
through, rather than
acted out, she argues.
First lines
‘Voices are waiting to speak to you. They know
your name. They could call it from the surrounds
of sleep, on a bustling street, or from your car back
seat. Samuel Johnson, Sigmund Freud, probably you,
and definitely me, have all had at least this fleeting
voice-hearing experience.’
From Can’t You Hear Them? The science and significance of hearing voices
by Simon McCarthy-Jones (Jessica Kingsley Publishers, £13.99)
THERAPY TODAY
14
MAY 2017
What is Mindfulness?
Tamara Russell
(Watkins Publishing, £7.99)
Neuroscientist, psychologist and
martial arts and mindfulness expert
Tamara Russell demystifies the common
confusions that get in the way of
successful mindfulness training. In this
short book, she seeks to answer our
questions – what does
mindfulness really mean
and how can we get the
most from it? – and to
explain how mindfulness
practice can be applied
in our daily lives, using
the right tools and the
methods that most benefit
our bodies and brains.
A book that shaped me
An Evil Cradling
Brian Keenan (Vintage, £9.99)
I read this book as I was travelling
across India, often on buses or
trains, for days at a time. With vast
expanses of time ahead of me
and nothing to fill them, I felt I was
losing grip on my mind. Keenan’s
account of being held hostage, with
English journalist John McCarthy, for
four years in Beirut,
tells how he tried to
retain a grip on his
sanity. It’s the only
book I’ve read in
which one chapter
provokes tears
of sadness, and
the next tears
of laughter.
Nicola Strudley
MBACP
(Snr Accred)
What book contributed to making
you into the person you are?
Email a few sentences to
[email protected]
This much I don’t know
‘Riquet taught me to listen to the
words of people who are mad...
He taught me that my own depth of
feeling was a precious resource, not
something I had to control or shut off’
M
y first full-time job as a
psychotherapist was in a rather
special psychiatric hospital in
the Massif Central, in a small
village called Saint Alban, where the patients
lived in a castle, surrounded by mountains and
beautiful countryside. This hospital was the
pioneer of French revolutionary psychiatry,
having taken down its walls and unlocked its
wards in the 1940s and 1950s. Patients, doctors
and nurses had created a community in which
manual work and social activities were shared
and discussed therapeutically.
I arrived there in 1973, aged 21, full of ideals
and good intentions. I loved the shared vision
of working together and I was proud to be
getting rid of my white coat.
The very first person I met was Henri,
known to all as Riquet. He became my guide
and mentor, but was never my patient. Riquet
had been a resident in the hospital most of his
life, since he was brought there as an orphan
with behavioural problems. He was a kind of
prophet and representative for Saint Alban
and had featured in a movie about it, where he
spoke about asylums as places of protection
from the outside world and its craziness.
He was in his early 50s when I met
him and thus 30 years older than I. He liked
to compare himself to the wild boy of the
Aveyron, who had been found mute and
savage in the countryside and who had
been destroyed by human culture. Riquet
had obstinately remained wild himself, and
regularly went on long excursions in the
mountains. Nobody bothered him or tried to
confine him. He often looked like a vagrant.
Riquet taught me to listen to the words
of people who are mad and to respect the
personal world they have created. He taught
me to find the value of their worlds and not
to try to dominate, cure or destroy them. He
taught me that my own depth of feeling was
a precious resource, not something I had to
control or shut off, and that it was this that
allowed me to relate to people who were
alienated and estranged from the world of
other people, because they too felt so deeply.
My relationship with Riquet formed
the basis of my growing understanding of
psychotherapy, more than my training and
supervision. He took me on walks, showing
me the flowers and the mushrooms, naming
them and telling me about their properties.
He gave me unsolicited and sometimes harsh
and rude feedback about my work, and never
spared me. He challenged me on my privilege,
even when I felt I was working very hard and
being generous with my time. He encouraged
me to take a political view of psychiatry and
personal problems. He shamed me about
everything I had taken for granted. He showed
me great affection too, and made me feel I was
talented and special.
Above all, Riquet taught me to stand
away from conformity and normality. He
showed me how important it was not to set
myself above people, but to be with them in
respectful reciprocity and plumb their depths
to find their wisdom.
THERAPY TODAY
15
MAY 2017
About Emmy
Emmy van Deurzen is a
philosopher, existential
psychotherapist and
counselling psychologist.
She works in private
practice and is founder
of the School of
Psychotherapy and
Counselling at Regent’s
College, the Society
for Existential Analysis,
and the New School
of Psychotherapy and
Counselling at the
Existential Academy
in London, where she
is Principal.
Letters
We very much
welcome your
views, but please try to
keep your letters shorter
than 500 words – and we
may need to cut them
sometimes, to fit in as
many as we can
Send your letters to the editor
at [email protected]
MATRIARCHAL BRITAIN
I was intrigued by your thought-provoking
front cover on the March 2017 issue, ‘Is
counselling women’s work?’ I was hoping
to read ideas on how to persuade men into
our profession. I was very let down.
I question the continued assumption of a
patriarchal society. I believe modern Britain
is matriarchal. However, there is no monetary
value in raising children and the majority of
primary care givers are women. Men expect
to be the primary breadwinner? I suggest they
are expected to be. I also suggest women are
just as assertive as men, and wonder if their
goals and techniques simply differ.
Overall, the article seems to focus on how
to support women into management, and
not men to be counsellors. Mark Cuddihy Napier Counselling, Glasgow CELEBRATE YIN AND YANG
I was interested to read the article ‘Is
counselling women’s work?’ in Therapy
Today, March 2017, and its exploration of
the possible reasons for many more women
than men choosing this profession.
While a passing nod was given to
‘biological reasons’, the main thrust of the
article focused, as is routine at the moment,
on the ‘socialisation’ aspects of the difference
between male and female choices.
It concerns me that there is an overemphasis on ‘socialisation’ and an avoidance
of certain hardwired, biological determinants
that, in my view, we do not need to fear.
Yes, there will always be exceptions to
the general rules about male and female
Men expect to be the
primary breadwinner? I
suggest they are expected
to be. I also suggest women
are just as assertive as men
difference, but, in my work as a couples
counsellor, I can tell you that communication
difficulties present constantly because men
and women ‘speak different languages’ in
their expression of their needs. Let us not
fear these differences, but celebrate them
and see how they can be a strength, in the
same way that yin completes yang.
I even dare to say that there will always be
more men than women attracted to the army
or to the construction industry as professions
– and it is likely that there will always be more
female counsellors than male. I wonder why
this should be a problem.
Jennie Cummings-Knight
www.goldenleafcounselling.com
WOMEN PSYCHOANALYSTS
I write in response to a point made by Sally
Aldridge in the article on counselling as
women’s work in Therapy Today, March
2017. I was dismayed to see her saying, ‘While
psychotherapy is rooted in the male-dominated
world of psychoanalysis, women have “owned”
counselling from its earliest days.’
I consider this remark as dismissive of the
enormous numbers of women who have
been leaders in psychoanalysis and who have
contributed tremendously to the feminist
cause. I cite Melanie Klein, Anna Freud, Karen
Horney, Nancy Chodorow, Joy Schaverien,
Susie Orbach, Christina Wieland, Julia
Kristeva, and I could go on.
Karen Minikin MBACP (Snr Accred)
Counsellor, psychotherapist
and supervisor
[email protected]
SUBCONSCIOUS PREJUDICE
I was interested in Sally Brown’s article on
‘Is counselling women’s work?’ (Therapy
Today, March 2017) and I was reminded of
my very first training group with the Marriage
Guidance Council in 2001, which I embarked
on to create a second career. Inevitably, I was
THERAPY TODAY
16
MAY 2017
… it is likely that there
will always be more
female counsellors
than male. I wonder
why this should be
a problem
the only man in my group of about 10 women.
Before the group had been going for more
than 10 minutes, one of the women raised the
subject of her menstrual cycle, which seemed
to me a very clear signal that a man was going
to find it tough if he wanted to break into the
female preserve of counselling.
Fortunately, I had already been in a
Robin Skynner group, and was not abashed,
and went on to qualify and enjoy private
practice, but I do wonder whether there was
a subconscious prejudice against men in the
profession and whether, maybe, that still exists.
Michael Dillon Weston
UNCONSCIOUS BIAS
I would like to offer a further perspective on
Sally Brown’s article in the March 2017 issue,
‘Is counselling women’s work?’.
In ‘Talking Point’ in the same issue, the
discourse around women being better suited
to counselling was fascinating: for example,
women are ‘more available to… and more
skilled at’ a certain kind of caring. Surely,
if counsellors of both genders offer such
opinions about the suitability, skill
and aptitude of male counsellors, then
it demonstrates unconscious bias in our
own profession, and suggests that this
also may contribute to a lack of male
counsellor representation?
If we cannot grasp this particular nettle,
and explore our attitudes and beliefs about
counselling and psychological therapies in
relation to gender, then everybody is going
to get stung: clients, colleagues and all.
Richard Mason Reg MBACP (Accred)
To the editor
PORN USE DOES NOT MEAN CHILD ABUSE
I am writing this because it was so
disappointing to see featured an
ethical dilemma around viewing
pornography (‘Cautionary Tales’,
Therapy Today, March 2017) that
seemed to be written with no
knowledge or understanding of
either sexuality or good therapeutic
and supervisory practices.
The dilemma makes clear that
the image viewed was of two adults
having sex, yet the article constantly
talks of filmed child abuse. The piece
claims that ‘the research linking abuse
to the viewing of pornography is
ambiguous’, yet offers no links to said
research. However, readers are instead
directed to an organisation that works
with survivors of and perpetrators
of childhood sexual abuse, clearly
implying that those who view
consensual adult sex are likely
to also view filmed child abuse.
One of the first things we are taught
as embryonic counsellors is that any
strong reaction must be examined.
If we have an emotional response
to something a client brings, we need
to be able to reflect on it. If we are
not sure what has prompted the
Yes, we have a duty to
ensure fellow professionals
are working ethically, but
first we have to ensure
we are working ethically
response, we take it to supervision, or
to our own personal therapist. This is
one of the ways in which clients are
kept safe. It is the bedrock of good
ethical practice.
It worries me a lot that, in less than
one full sentence, the need for this
kind of reflection was dismissed. There
is no reflection at all on Marna’s part.
One does not have to be a Freudian
to wonder if Kevin had the role of a
father figure in Marna’s life. Was this
a moment of ‘walking in on daddy’?
This would explain the strange leap to
fears of child abuse, and the inability
to treat with empathy and compassion
someone who reveals their distress.
This is, of course, speculation about
a fictional scenario, but it is the type
of challenging question one would
expect to have posed if you disclosed
that you were struggling with your
emotions to the extreme degree
that Marna is.
This directly leads to perhaps one
of the most important questions
that the piece ignores: is Marna
safe to work with clients? Watching
pornography is common; it is done
by all genders, and, with the growth
of the internet, is often a worry
for clients. Can Marna work with a
male client who tells her he watches
pornography without expressing her
clear disgust? Can she work with a
gender- or sexually diverse client who
expresses how much pornography has
helped them understand themselves?
Can she work with a female client who
has discovered a taste for BDSM from
watching porn? These are questions
that should have been asked before
anything else. Yes, we have a duty
to ensure fellow professionals are
working ethically, but first we have
to ensure we are working ethically.
The disconnect around sex that is
being encouraged in this article,
the lack of personal reflection, and
the leap to judgment all ignore the
building blocks of counselling – the
core conditions.
Counsellors and psychotherapists
who have not examined their own
attitudes towards sex honestly and
with a recognition of unconscious and
subconscious reactions are a greater
danger than someone in distress who
ill-advisedly watches porn on a break
in a private room.
Last, despite so many fine words
about being more inclusive of
LGBTQ+ people and different forms
of relationships, the entire piece
assumes heterosexuality as a norm.
Karen Pollock
Counsellor in private practice
working with gender, sexual and
relationship diversity
I believed my maleness was
not valued by my peers. I
struggled to feel validated
in my experience
CLOSED TO MEN?
I approached counselling training in my
early 30s from the position of becoming
increasingly aware of my disconnection within
myself and with others around me. I had
hitherto been a ‘good male’: sailor, salesman
and tree surgeon. I knew I needed to soften
my armour and allow a sense of ‘flow’, which
would allow myself out and others in. I needed
to reconnect and give substance to my core. I
needed to find meaning for my life and salve
my wounds.
I needed three breaks from training
because this journey was fraught with
confusion, pain and overwhelm. As such,
I was a member of four different groups.
The first thing that grabbed me was that,
in each, I was either the only male in the
group, or one of two. This I found difficult
because, while seeking a more empathic,
compassionate way of being, I also valued
much of my more ‘male’ way of being. I
often seemed at odds with the group in
this. It was a very hard process to learn that
the attributes that worked so well (at least
in certain areas) in my former life were so
denigrated in counselling training. I was often
left feeling inadequate, wrong and ostracised.
I believed my maleness was not valued by
my peers. I struggled to feel validated in my
experience, my difference misunderstood
by my peers and by me.
It was a hard journey to find the resilience
to experience the tensions caused by this
difference and keep coming back. I know of
other men who just dropped out and did not
return. I have come a long way to allow my
softer, feeling side to flower. I still wonder
how open to the male experience training
courses and students are.
Nick Tarrant MBACP
THERAPY TODAY
17
MAY 2017
To the editor
… it is the individual’s responsibility to
maintain standards as a professional,
in any sphere working with fellow
human beings
POIGNANT AND HUMANE
I am writing to both compliment and express
my gratitude to John Pasture for his contribution
‘No one can help me’ in the March 2107 issue.
I experienced his story, both in content
and style of narrative, as simply stunning in its
quality of expression and descriptiveness, its
poignancy and as a catalyst to reflect yet more
deeply on such challenging work. Thank you so very much for sharing this
first-class account of therapy with its most
unexpected turn and at its best!
For me, John’s story oozed the love and caring
for humankind that is so profoundly touching
and makes me feel proud and thankful to still
be in this profession now some 20 years on. It
also provides some balance by acting as a stark
contrast to so much of the daily world atrocities
that we are witness to and the shadow side of
what it is to be human.
Jennet de Caresle, MSc, PG Dip
Couns, MBACP (Snr Accred)
REGISTRATION STILL
HAS CREDIBILITY
It’s always sad to read a resignation letter
from a member who has worked so hard
for over 30 years with BACP (Christopher
Murray, Letters, March 2017). With only 14
years of membership, I wish the writer well,
and hope he will reconsider. Accreditation
is not a gold standard. Human nature is
what it is, and it will only take a moment’s
reflection to recognise it is the individual’s
responsibility to maintain standards as a
professional, in any sphere working with
fellow human beings. The writer’s perception with which I
disagree is that it is easier now to train,
become accredited, and then practise
privately as a counsellor, and that this is
a lowering of standards. These validation
procedures are still regulated by BACP and
the standards have to be met. As more
accredited private practitioners from a
variety of modalities offer their services
locally, this increases choice for the client,
and equally increases competition between
the services offered. There are other
accrediting umbrella organisations for
counsellors and psychotherapists, yet both
of my previous NHS posts in primary and
secondary care required BACP accreditation
and registration. I am confident this
perception of the organisation’s credibility
will continue.
Paul Frazer Reg MBACP (Accred)
EFFICACY OF EMDR
The BACP News in the March 2017 issue of
Therapy Today quoted a single recent research
paper comparing the efficacy of Eye Movement
Desensitisation and Reprocessing (EMDR) with
Emotional Freedom Technique (EFT) or
body tapping. EFT is a completely different
approach that doesn’t have the same rigorous
evidence base as EMDR, even though the
research showed them both to be effective. I
would have cited a more recent meta-analysis
of 26 randomised controlled trials between 1991
and 2013,1 which demonstrated the effectiveness
of EMDR in treating psychological trauma
and post-traumatic stress disorder (PTSD).
This is a substantial basis, which makes EMDR
recommended by many organisations, such as
NICE and the World Health Organization.
My own experience of introducing EMDR
with over 100 clients (not all with PTSD) is
that it can resolve deep-seated trauma within
minutes, or certainly sessions. Of course, this
doesn’t work with everyone, but that is the case
for all approaches, and sensitive, client-focused
work with attunement is just as important with
EMDR as any other therapy approach.
Justin Havens MBACP (Accred)
REFERENCE
1. Chen Y-R, Hung K-W, Tsai J-C, Chu H,
Chung M-H et al. Efficacy of eye-movement
desensitization and reprocessing for patients
with postraumatic-stress disorder: a meta-analysis
of randomized controlled trials. PLoS ONE 2014;
9(8): e103676. doi:10.1371/journal.pone.0103676
THERAPY TODAY
19
MAY 2017
SPEAKING UP FOR
INTERPRETERS
As a therapist who manages a team working
with refugees, asylum seekers and vulnerable
migrants, I enjoyed reading John Pasture’s
‘No one can help me’ (March 2017), about
working with his Kurdish client. However,
one short sentence leapt out at me: that was
the first interpreter (admittedly of the wrong
language) leaving with/before the client.
While all clients who need to work with an
interpreter should have the opportunity to
meet with the therapist without the interpreter
from time to time, the interpreter should never
leave with the client. In fact, the interpreter
should have time with the therapist before
and after each therapeutic session – 15 minutes
either side is ideal. This is for several reasons.
The bonds of language and culture can be a
lot stronger than the therapeutic alliance, and
you do not need clients and interpreters to
go out for coffee together after the session,
or for one to put pressure on the other. The
interpreter can pick up issues the therapist has
Work with an interpreter is
triadic: there are three people
in the room… not two people
plus a language machine
missed, or have valuable insight to contribute.
And, if the work is very distressing or hard, the
interpreter is the one whom everything goes
through and who gets the initial impact of
whatever is communicated.
Interpreters tend not to be given enough
support, but are expected to keep all that
they translate confidential; they have all of the
words and no voice of their own. Work with
an interpreter is triadic: there are three people
in the room, with all the attendant dynamics –
not two people plus a language machine.
Sushila Dhall
Therapeutic Services Manager,
Refugee Resource
THERAPY TODAY
20
MAY 2017
Counselling changes lives
WAITING
FOR THE
SOUTHSEA
BUS
Finding meaning in our life is no less
important just because we are nearing
its end, says Helen Kewell
ALAMY
T
om* was one of the first clients I
worked with during my training – a
95-year-old man who was referred
to me by a nurse in his residential
care home because he was struggling to adjust
to life alone after the death of his wife. I was
terrified. What could I possibly do to alleviate
the distress of a man at the very end of his life?
As I went to the care home for our first session,
I felt inescapably young and impotent before
the tidal wave of grief, ill health, powerlessness
and distress that I imagined I would meet.
Tom died, suddenly, after we’d had just
six sessions together. But, in those six weeks,
he turned each of my presuppositions on
their head. I learned a lot about myself, what
I wanted to do in my counselling career, and
what it means to experience love and loss in the
therapeutic encounter. Above all, he changed the
way I view life, ageing and death, and, crucially,
how to work therapeutically with people who
are approaching the end of their lives.
I believe that counselling is an emancipatory
and political act: by engaging in it, we can
liberate ourselves to be all that we can be. I
often feel, in my role as a counsellor, that I am
mounting a tiny insurgence against a world that
celebrates certainty and puts people in social
and cultural boxes. Society tends to objectify
and isolate the elderly; to regard everyone over
a certain age as an amorphous mass, rather
than a collection of unique individuals with
rich, unique stories.1 Often, older people find
themselves excluded from psychotherapy
services, unable to access them due to poverty
or physical disability, and seek support instead
from non-profit organisations.2 Depression
affects around 22% of men and 28% of women
aged 65 years and over, yet it is estimated that
85% of older people with depression receive
no help at all from the NHS.3 Society seems
to expect a certain amount of depression in
people over 65; it goes with the territory, as it
were. Is this OK?
Writing during her own advancing years,
Simone de Beauvoir proposed that we
experience our old age through other people’s
reactions to us, but this often conflicts with how
we truly feel inside.4 My wonderful, perpetually
cheerful grandmother, on her 90th birthday,
giggled as she exclaimed: ‘Ninety! But I don’t
feel old! Inside, I still feel like I’m in my 20s!’
This disconnect of personal experience of self
with societal perceptions and the physical
THERAPY TODAY
21
MAY 2017
manifestations of advancing age can be
psychologically difficult to bear.
Freud believed that older people were
not able to make effective use of therapy.2
Erikson only added the final life stage to his
developmental theory as he approached his
own old age. He argued that this final stage is
about integrating past, present and future to
find acceptance of the life that has been lived.1
Rogers, in developing the idea of the human
being’s natural tendency to growth, proposed
that change can only occur when we are
able to fully accept who we are.5 I would
argue that, even in very old age, it is still
possible, indeed crucial, to challenge longheld life narratives and to dare to write new
ones. One excellent way of facilitating this
is through counselling.
As counsellors, our role is to recognise,
encourage and celebrate the unique
individuality of our clients and to explore their
reality. When I first came to this work with
older people, in the conceit of youth, I believed
that self-actualisation was not feasible in the
last stage of life and the best I might hope to
offer my clients was the alleviation of their
distress. The work has profoundly challenged
my preconceptions.
Rewriting narratives
We all recognise the stereotype of the elderly
person telling and retelling stories of when
they were young to anyone who will listen.
However, as with any content that is brought to
counselling, the stories give clues to a client’s
process, how they are in the world and what
might be healing and helpful for them; they
are not to be overlooked.
Bill was an 80-year-old man I worked with
over six months, following the death of his
wife. They had been married for 55 years.
Glaswegian, talkative and hard of hearing, Bill
greeted me at his home each week wearing
a flat cap and an ancient pair of silk pyjamas
under his clothes to keep out the cold. The
story of his life, as it unfolded, was one of
poverty, adversity, bloody-mindedness and
sheer hard work. He retold it from many
angles, week after week, always casting himself
as a bad man making poor choices and not
deserving love. His grief was held back by his
belief that he didn’t deserve the love of his wife
in life, and therefore didn’t deserve to grieve for
her after her death.
As with any client, a counsellor’s role is to
interrupt established patterns of relating and
refuse to play along.6 I was struck by how caring
and charming Bill was in our sessions and in his
actions towards others, and the contrast with
his narrative, in which he was a hard, bad man,
who had done some awful things in his life.
This carried so much authenticity that at first
I felt I should be afraid of him, despite feeling
the warmth in our sessions. When I brought
this disparity to his attention, he brushed me
off, unable to entertain the idea that he might
be a good person. However, my persistence in
challenging his narrative eventually took us
on a journey together, back 75 years to early
abuse at the hands of a domineering ‘monster’
of a mother and to a realisation, which came
dramatically and suddenly in the dusty silence
of his sitting room, that he wasn’t to blame.
In Bill’s words, he could never forgive his
mother, but he slowly began to forgive
himself, to see himself as someone whose
trust had been broken, and who had been
traumatised by events in his childhood. He
found self-compassion and began to rewrite
the story of his life from this new perspective
– a narrative with greater authenticity than
the one that cast him in the role of reluctant
patriarch to his large family.
Had I taken his story at face value, I might
have viewed the development of self as
pointless for someone in poor health who
himself told me he was ‘not long for this
world’. The theory of gerotranscendance is
helpful here, as it conceptualises a circular
self that uses present reflection on the past to
constantly redefine experience and therefore
transcend boundaries and limits of age.7 This
aligns with the humanistic belief that everyone
has potential for growth and that this is enabled
through moment-to-moment interrelatedness
with others, as with Bill.
Entering their world
It can be confusing and concerning when the
elderly or profoundly old who are cognitively
impaired don’t recognise loved ones, cannot
remember information about their own lives
or seem to withdraw into a world that is quite
different to our reality. Counselling is all about
exploring the client’s worldview, and, for older
people who are losing cognition, this can be
a powerful antidote in a society that isolates
those who don’t conform to the received
view of what is ‘real’ and ‘right’. Imagine how
frightening it must be to lose your grasp on
Tom’s dementia afforded us, ironically,
an opportunity to bring our domains
together in a uniquely different place.
He often talked as though he were
somewhere else. Intuitively, I did not
correct him or ground him in my reality; it
seemed important to fully be in his world
memory, knowledge and your location, and to
have this reinforced by those around you.
A therapeutic encounter, seen through the
Buberian paradigm,8 is a point of connection
between two domains of existence, not the
dominance of one domain over another. Tom,
although he was in reasonably good health
for his 95 years, had been diagnosed with
dementia. I met him weekly, initially in his
room, although we subsequently became more
flexible about our encounters. Due to his poor
hearing and cantankerous nature, many of
our sessions had the outward appearance of
irritable bickering, despite moments of strong
connection and depth. Here was a man who,
despite his confusion, was fiercely authentic;
he did not hide himself from himself, or from
others. His refusal to abide by social niceties
and his strong desire to be wandering free
dominated our dialogues and his frequent
flights of imagination. He corrected me,
disputed with me and vehemently rejected
any platitudes or my eager trainee suggestions
that looking at old photos or listening to the
radio might be of comfort. To him, the rest of
the world was engaged in inauthentic nonsense
and he defiantly wanted his independence and,
desperately, the final void of death.
Had someone told me that this, frankly,
downright rude man would engender such
affection in me, I wouldn’t have believed it. His
sense of isolation, now that everyone dear to
him had died and he was locked away from his
previous life, dominated the narrative of our
sessions. Initially I was frustrated. He would
repeatedly say to me, ‘Why you are here? What
can you do for me?’ I had originally attributed
this to a generational critique of counselling,
but on reflection it felt more like an attempt
to shut everyone and anyone out. This was
THERAPY TODAY
22
MAY 2017
exacerbated by the fact that, due to his failing
memory, it took time each week to re-establish
contact and trust. As my regard for him grew,
on more than one occasion I responded that
he mattered to me, and that I wanted to spend
time with him. He found this difficult to hear,
but I persisted, and he eventually conceded
reluctantly that he liked me coming. The
truth is that Tom mattered to me greatly, and
I genuinely felt compassion for him. While he
emphatically pushed me away, I always asked if
I could return, and he always consented.
Finding meaning
Our first sessions were quite superficial, as
I naively assumed that I should keep things
light and avoid anything that might cause him
distress. Common sense, as well as research,
should tell us surely that this type of approach
can cause further distress and isolation for
elderly people.9 Indeed, when I braved a more
existential standpoint and began challenging
his narrative, finding meaning in his life, and
addressing his imaginings about dying head
on, we were finally able to meet at depth.
These moments sometimes occurred in
the corridor of his nursing home, waiting for
what he expected to be the bus to Southsea
(where he had planned to retire), or as we sat
in silence while he held his head or wept, or
when he openly discussed his hope for death
and explored the different ways he imagined
he could bring this about. In these moments, I
made no attempt to move him on to cheerier
thoughts or to ground him with my version of
reality. What happened felt like an important
process of validating his own unique reality and
lived experience, of joining him there, instead
of isolating him further. He began to recognise
me, and to wait by the lifts when I was due to
Counselling changes lives
visit, instead of sitting, as usual, confused and
dozing, in the communal lounge.
Tom’s dementia afforded us, ironically, an
opportunity to bring our domains together in
a uniquely different place. He often talked as
though he were somewhere else. Intuitively,
I did not correct him or ground him in my
reality; it seemed important to fully be in
his world. Once, he announced in a hushed
whisper that he was in France, trying to find
the nearest port to get home. The following
week he talked animatedly about locating
some friends in Italy so he could tread grapes.
Tom could be lucid and expressive in certain
moments, but at other times he was almost
pre-expressive, sitting or standing in absorbed
silence. Slowly he began to cast me in roles in
his imaginings, inviting me into his world. They
were compelling and I felt it was important to
honour them by reflecting them back to him
and staying in his context: ‘You are waiting for
a bus to Southsea. If we move to sit here with
a clear view of the door, then you won’t miss
it if it comes’ (in fact, I wanted us to sit down
together in his room, rather than linger in the
corridor). At other times, I encouraged deeper
exploration through body and sensation, such
as asking, ‘What do the grapes feel like when
you tread them?’
I was still a trainee when I met Tom; I knew
little about theoretical frameworks, but what
happened between us felt like pre-therapy.
I was trying to offer my humanity and make
contact within his reality to minimise the
anxiety and isolation he was feeling.10 My hope
was that he experienced his true self with me,
rather than simply a reflection of a received
understanding of what ‘old’ or ‘dementia’ or
‘grieving’ means. In his rambling accounts, I
noticed that Tom would begin to recall and
reveal more about his life, such as places he’d
been or people that were important to him,
and that making contact with those memories
seemed to bring a noticeable therapeutic
release. While his socially constructed,
corporeal self was incarcerated in the care
home, his real self was wandering wonderfully
free, and I felt liberated to be wandering with
him. In her novel about Alzheimer’s disease,
The Wilderness, Samantha Harvey’s protagonist
asks angrily why he can’t say things that aren’t
true and asks if ‘there is no freedom in words
and thoughts, then where is freedom?’11 The
scenes we explored represented Tom as having
freedom, authority, experience and power, and
felt like an expression of his true self.
Love and loss
Grieving for a client is, of course, much more
likely when you are working with profoundly
old clients, and this should be actively explored
in supervision. But it should never prevent
us from having a strong regard for our older
clients, or, indeed, from loving them. I believe
that, as death approaches, we can experience
a reversal of Lacan’s mirror:12 as newborns,
we resolve our sense of fragmentation by
seeing our wholeness reflected in those who
care for us; so too, in profoundly old age,
the close attention and regard of another
helps to counteract the fragmentation of self
and confusion that can be experienced, by
validating and integrating the meaning of the
life lived with the experiences of the present.
I believe counselling the elderly should
be approached without fear of loss, and with
hearts that are ready to meet people, even if
they are not yet able to meet us. Tom’s death
affected me deeply. His gift to me was learning
how to be with someone in despair without
feeling the need to make it better, how to sit
patiently with silences and confusion, and how
to talk about death frankly.
I was unable in the end to attend his funeral
but I later found a way to make contact with my
own loss, by sitting on the beach at Southsea
and saying goodbye to him there.
*Details of the elderly people described here have
been changed so that none are identifiable.
While his socially constructed, corporeal self
was incarcerated in the care home, his real
self was wandering wonderfully free, and I
felt liberated to be wandering with him
THERAPY TODAY
23
MAY 2017
Helen Kewell
About the
author
Helen Kewell
gained her
PG diploma
in humanistic
counselling
from the University of Brighton.
She works in private practice
in Sussex and has a particular
interest in working with the
elderly, chronic illness and
grief. She also volunteers with
Cruse Bereavement Care (www.
crusebereavementcare.org.uk).
www.helenkewell.co.uk
REFERENCES
1. Erikson JM, Erikson EH. The
life cycle completed: a review.
New York: WW Norton &
Company; 1977.
2. Pilgrim D. Psychotherapy
and society. London: Sage
Publications; 1997.
3. Health and Social Care Information
Centre. Health survey for England,
2005: health of older people.
[Online.] Leeds: HSCIC; 2007. www.
hscic.gov.uk/pubs/hse05olderpeople
(accessed 14 September 2015).
4. De Beauvoir S. Old age. (Trans
Patrick O’Brian.) Penguin Modern
Classics. London: Penguin; 1977.
5. Rogers CR. On becoming a person.
London: Constable; 1961.
6. Bott D, Howard P. The therapeutic
encounter: a cross-modality approach.
London: Sage Publications; 2012.
7. Tornstam L. Gerotranscendence:
the contemplative dimension of
aging. Journal of Aging Studies
1997; 11(2): 143–154.
8. Morgan-Williams S. All real living
is meeting. Journal of the Society for
Existential Practice 1996; 6(2): 76–96.
9. Dodds P. Pre-therapy and
dementia: an action research project. Post-doctoral thesis. Brighton:
University of Brighton; 2008.
10. Prouty GF, Portner M, Van Werde
D. Pre-therapy: reaching contact
impaired clients. Ross-on-Wye: PCCS
Books; 2002.
11. Harvey S. The wilderness: a novel.
New York: Anchor Books; 2010.
12. Lacan J. Ecrits: a selection. (Trans
Alan Sheridan.) London: Tavistock
Publications; 1977.
Women at the edge
Sophie Livingstone describes the intensity of relational
work with women confronting their sexually compulsive behaviours
L
auren came to see me last year, describing
sexually compulsive behaviour that had begun
seven years previously, when she was 17 and
became aware she was attractive to men. She
had a long-term boyfriend, but she was not faithful. Her
drinking and drug-taking were excessive. Three to four
times a week, she picked up young men in pubs and
clubs and had sex with them, in alleyways, cars, toilets,
and in her bedroom at home. There was nothing in the
experience of sex itself that was pleasurable for her; there
was simply a powerful compulsion to get a man into bed.
She would awake hungover the next day, filled with feelings
of repulsion and contamination, and distressed that she
had done it again. She could make no sense of these
behaviours; she desperately wanted to stop, but could not.
Lauren is a composite portrait, typical of many of the
clients I have seen with similar problems.
Controversy surrounds the idea of sex ‘addiction’.
The influential American Association of Sex Educators,
Counsellors and Therapists (AASECT) does not recognise
sex addiction or porn addiction as a disorder. It states
that ‘linking problems related to sexual urges, thoughts
or behaviors to a porn/sexual addiction process cannot
be advanced… as a standard of practice for sexuality
education delivery, counseling or therapy.’1 I have
taken to using the words ‘addiction’ and ‘compulsion’
interchangeably, although I favour the latter term. There is
no doubt for me that some men and women struggle with
compulsive sexual behaviours. These behaviours are, in
my view, distinct from consensual, informed, consciously
undertaken sexual activities, or infidelity, or having a high
sex drive. The sexually compulsive person feels driven to
have sex, or look at porn, or seduce someone (anyone),
usually in response to difficult feeling states. They are
preoccupied with sex, or seduction, and can experience
states of intense sexual arousal in anticipation. The sex
itself, however, does not make them feel good about
themselves. It does not meet their needs in the way their
anticipation and fantasies suggest it might. Over time, these
behaviours can become hugely destructive to emotional
wellbeing and, in the case of the women I have worked
with, physically dangerous too. Contrary to what people
may believe, sex addiction really is not that sexy.
While there is plenty of literature addressing the
presentation in men (see, for example, Patrick Carnes
and Rob Weiss in the US; and Thaddeus Birchard and
Paula Hall in the UK), there is far less focus on sexually
compulsive women. In the US, Alex Katehakis and Marnee
Ferree have written specifically about women. Here in
the UK, Paula Hall has called for more home-grown
exploration of sexual compulsivity and addiction. I have
found that the research of Manpreet Dhuffar2 and Fiona
McKinney3 offers a sensitive and cogent insight into women
struggling with these behaviours, and the issues that can
arise in the work with them.
Women and sexual compulsivity
The sexually compulsive person feels
driven to have sex, or look at porn, or
seduce someone (anyone), usually in
response to difficult feeling states
THERAPY TODAY
24
Women’s stories of problematic sexual behaviours are
hidden, obscured by dominant narratives about female
sexuality that conceptualise them in derogative ways: a
mess, ‘fucked up’, damaged and dangerous. When a woman
appears out of control in a social situation, uses alcohol and
drugs, and/or disappears to have unsafe sex with strangers,
the idea that there is a sexually compulsive behaviour
going on is probably not considered.
I feel a fierce resonance with women who struggle
with compulsive, out-of-control sexual behaviours, in
part because I recognise something of myself in them, but
also because I believe their conflicts reflect the profound
difficulties women can face in trying to ‘realise’ themselves
in a complex, contradictory, patriarchal social system.
Dominance and submission play out in sexuality in myriad
ways, both positively and negatively, and are often a theme
in the sexual encounters craved by the women I see. As
Michael Bader writes:4 ‘The answer to the question of how
patriarchal gender roles create adults who derive intense
sexual gratification from acting out [dominance and
submission] in bed lies in the complicated ways our minds
internalise social expectations and make them our own.’
Compulsive behaviour is the consequence of impulsive
attempts to deal with uncomfortable and painful feelings.
MAY 2017
Presenting issues
GETTY
The planning is often the most
pleasurable part of the process.
The sex itself is often mechanical,
functional and disappointing; if
euphoria is present, it is shortlived. Self-loathing and shame
resurface as the arousal chemicals
subside in the brain
If a ‘sex addict’ is feeling sad, or lonely, or bored, or in
emotional pain and despair, planning – often in a very
ritualised way – and then carrying out the preferred sexual
behaviour will temporarily alleviate it. The planning is
often the most pleasurable part of the process. The sex
itself is often mechanical, functional and disappointing;
if euphoria is present, it is short-lived. Self-loathing and
shame resurface as the arousal chemicals subside in the
brain. Mark Lewis, a cognitive neuroscientist in recovery
from substance addiction, argues that this is because
dopamine, thought to be a major protagonist in the
drama of addiction, is the neurochemical of desire, not
pleasure. It creates the feeling of wanting; the thought of
not therefore having is unbearable.5 This drives us to seek
an intense experience, but it does not deliver the euphoria
of a job well done. Over time this process cements itself
THERAPY TODAY
into the neural pathways of the dorsal striatum, which is
responsible for compulsive activities – activities requiring
no thought or reflection, just compulsion. It is powerful,
and it is not pleasurable. ‘Addicts’ are enslaved by this
neurological process. There is a ‘deadness’ to compulsion,
a lack of vitality.
Psychoanalytic theory can illuminate the self-harm
apparent in acting-out behaviours. Marcus West describes
a primitive ‘collapse and submit response’, in which
the individual ‘becomes in thrall to the experience of
death, which they cannot bear, yet from which they find
it extremely difficult to escape’.6 In submitting, a woman
hands herself over to the other ‘as a capitulation, as a
surrender to their fate’, no longer able to struggle against
the other’s overwhelming power. West suggests this
pattern can become incorporated into the personality as
‘submission in the hope for protection and care’, which
leads to a disavowal of ego-functioning, reinforcing
the exposure or vulnerability, and leaving the woman
powerless and trapped. This torment is nonetheless
preferable to the dangers of abandonment.
Betty Joseph describes such ‘patients’ as having
suffered early relational trauma – a lack of ‘warm contact
and real understanding’, or a violent parent, emotionally
or physically.7 ‘In the transference one gets the feeling
of being driven up to the edge of things… potentially
depressive experiences have been felt by them in infancy
as terrible pain that goes over into torment [and] they
have tried to obviate this by taking over the torment, the
inflicting of mental pain onto themselves, and building it
into a world of perverse excitement, and this necessarily
militates against any real progress towards the depressive
position… It is very hard for our patients to find it possible
to abandon such terrible delights for the uncertain
pleasures of real relationships.’
Lauren’s story
The women I have worked with have all had an immense
impact on me. They stay with me outside of sessions.
They make me feel about them. They are powerful and
vivid, but also intensely vulnerable. Each has described
a need to ‘push’ something when they have engaged in
risky sexual encounters, and this often takes the form of
violent, submissive sex with strangers or with partners
they know are harmful to their wellbeing. This is not the
negotiated, consensual power exchange of BDSM,* but
25
MAY 2017
Presenting issues
exposing themselves to coercion and danger. It is as if they
can only ‘find’ themselves through turbulent states of mind.
Often there is identifiable trauma – childhood chaos and
relational trauma, unnamed abuse or sexual assault – and
significant problems with emotional regulation. Powerful
feelings escalate fast and the only option appears to be an
equally intense acting-out behaviour. I perceive in this a
need to be embraced, to come alive, to find their shape. As
Jessica Benjamin writes:8 ‘The desire to inflict or receive
pain, even as it seeks to break through boundaries, is also
an effort to find them.’
Lauren’s family history was chaotic and fractured
by addiction and multiple, open parental infidelities.
Her relationship with her mother was fraught, volatile,
sometimes violent, and enmeshed. Her father watched
pornography with her and brought women home for
sex on a regular basis, with no discretion or sensitivity to
how Lauren might feel. Her parents separated when she
was nine. Lauren reported feeling unbearable emotional
pain throughout this period, but, on the instruction of her
mother, she told no one what was going on. This created a
sense of deep shame about ‘having feelings’.
At the age of 14, at a party, she felt unable to say no when
a man of 25 demanded oral sex. Afterwards, he offered her
money, which she refused. She felt ‘indescribable’ revulsion
and showered obsessively for days. At the age of 19, she
charged a man for sex for the first time. She felt she had
sunk to a new low and tried to get her act together. She
found herself a job in an office, but would show up late,
wretched and hungover, or drink too much and behave
badly at work social events. Her boss, a man 20 years older
than her, appeared to be taking her under his wing, but
was in effect grooming her. She developed a powerful
infatuation with him, during which she experienced
episodes of arousal so strong it felt unbearable. She began
an abusive relationship with him. He was overbearing and
controlling, and would hurt her when they had sex. Lauren
experienced this as annihilating to her spirit and soul, but it
also felt in some way ‘right’. She told me she knew he would
‘destroy’ her, but that there was an inexorable sense of
destiny to this relationship.
McKinney argues that sexual compulsivity in women
shares ‘features of addiction, deliberate self-harm,
Sophie
Livingstone
About the author
Sophie Livingstone
is a psychotherapist
and supervisor in
private practice,
and a psychosexual
and relationship
therapist at
Innisfree Therapy,
a sex-addiction
treatment centre
in central London.
Working relationally
There is an intensity to relational
work that demands an ability to stay
with the strong affect and sometimes
disturbing and distressing material – a
sense of volatility and unpredictability
THERAPY TODAY
borderline personality disorder and trauma’.3 It is a potent
combination and, clinically speaking, working with these
clients is not for the faint of heart. I found it very hard
indeed to listen to Lauren’s story.
She described being triggered into overpowering
arousal by obsessive attachments to dysfunctional men,
and experienced violent sexual nightmares if she could
not act on her sexual compulsions. She was bright, funny,
attractive and had so much going for her. However, she
could not hold onto any sense of self-worth. She was lost
and vulnerable. She made bold statements that she only
had sex with men she hated. Sex was about hatred – of
herself, of the men she could seduce so easily, of the sexual
double standards to which women are subject. Being
sexually predatory and objectifying men made her feel
powerful, for a time. This complex combination of feelings
perhaps reflects the complexity of factors influencing this
particular form of self-destructive behaviour: the cultural
construction of ‘male’ and ‘female’ sexuality and gender
power relations (the sociopolitical context); relational
trauma in her family, and the impact of that on her ability
to regulate her feelings and connect with others, and the
shame produced by both.
26
My core training is in integrative psychotherapy. I tend to
work ‘relationally’: that is, I subscribe to ideas around the
co-regulation inherent in the therapeutic relationship – that
we are mutually influencing and co-create the relational
space, and that my material interacts with the client’s. I
tend to be very attuned and empathic. I have undertaken
training and personal work that enables me to connect
therapeutically with others.
McKinney comes from a background in addiction
treatment and found in her research that ‘treatment’
in the addiction field was often ‘limited to formulaic,
task-focused cognitive and behavioural interventions, a
top-down, directive approach’.3 The relational aspect of
the work is less elaborated in the more behavioural models.
I feel I can see why. There is an intensity to relational work
that demands an ability to stay with the strong affect and
sometimes disturbing and distressing material – a sense
of volatility and unpredictability. ‘These are not difficult
clients, but difficult treatment dyads,’ McKinney writes.3
Working from a more relational, integrative or humanistic
stance, it can feel very hard to contain the volatile and
potent affect triggered by close interpersonal contact.
I also noticed that attempts to ground the affect by working
with the body can also be derailed by what feels like
the client’s hypervigilant sensitivity to having her body
‘controlled’ by an empathic other (as opposed to an
abusive other).
Lauren could feel invaded by these interventions and
become shy and reticent, or uncomfortable and snappy.
She feared her body would betray her, and she would
become overwhelmingly aroused. It was difficult for her
MAY 2017
We may be eroticised or
sexualised by the client, or
find ourselves becoming
aroused. Almost all my
clients have described
being seductive without
realising it
to bear intimacy. She was accustomed to intensity, which
is, as we know, not the same thing.
We may be eroticised or sexualised by the client, or
find ourselves becoming aroused. Almost all my clients
have described being seductive without realising it. It’s
a procedural memory, suggesting sexualisation of the
attachment system. I try, with varying degrees of success,
to stay vigilant to enactments and collusions. The erotic
transference that may enliven therapeutic alliances
with clients who are not sexually compulsive becomes
complicated in the relationship with a sexually compulsive
woman – and, in my experience, more so than with a
sexually compulsive man.
Conscious collaboration
I found with Lauren that it was empowering to work
collaboratively to help her ‘think’ more about what
was going on internally when she was triggered. At the
clinic where I work, we use a containing framework for
understanding behaviours and establishing bottom
lines early in the therapy process, such as Hall’s ‘Cycle
of Addiction’.9 Hall’s work is clear and instructive, and is
enormously useful in terms of psychoeducation. I think
working this way mediates the affect so it is more tolerable.
When I have asked my female clients what they found
most useful in helping them to stop on previous occasions,
the answer has been ‘strict boundaries’. They do not want
tenderness and empathy; they want something ‘strict’,
something to ‘come up against’. This, in a way, echoes the
‘pushing’ of compulsive sex – Benjamin’s ‘effort to find their
boundaries’,8 but it also, perhaps, expresses a disavowed
longing to be held emotionally. They perhaps also feel their
‘locus of accountability and responsibility’ must be outside
themselves, at least to start with. There is a need for the
therapist to function almost as an auxiliary ego for a while,
and fulfil a robust containing function. Arguably, the task of
therapy is to help the client internalise this locus, so they
can look after and regulate themselves, for themselves.
Early recovery is often fragile. With Lauren, over time,
we began noticing that the energy and charge of her
sexual activities was lessening. The behaviour patterns
became ego-dystonic, and her increasing awareness of her
emotional process made ‘acting out’ a far less attractive
option. She began to empathise with others’ experiences
of her when she was at her most florid, and to deal more
directly with her shame. She began to grieve the loss of
the bright hyper-reality of compulsive sexuality, but also
to grieve more deeply for the confused and lonely child
and adolescent she had been. Her relationship with herself
began to change.
Escape from the ordinary
She also began to see how much she ran away from
‘ordinariness’ and the ‘everyday’. She was having to
tolerate some boredom, without trying to ‘enliven’ herself
with destructive or dramatic behaviours. Slowly, as the
behaviours lost their grip, more of life became available
to her – a moment of noticing sunlight sparkling on water,
a feeling of hopefulness as she walked down the street,
the pleasure of hanging out with new female friends.
According to Lewis,5 new neural pathways associated
with reward are building, while the pathways associated
with compulsive sex are beginning to lose their power.10
In relational terms, she also learned that she defensively
objectified herself and men when her pain got too great,
and that she could call on the help of a growing circle of
friends, or find other ways to soothe herself. Sometimes
this worked and sometimes not, but we were moving in
the right direction.
Esther Perel writes that ‘loving another without
losing ourselves is the central dilemma of intimacy’.11 To
truly engage sexually, we need to have a stable sense of
self, so that we can let go of it for a while, and have enough
trust in the relationship to be able to tolerate our partner
letting go of us – so we do not need to ‘mask our ravenous
appetites and conceal our fleeting need to objectify the
one we love’.
I think the activity of therapy can be akin to the activity
of having sex. We pay attention to all those signals that
our clients hide or that escape their awareness, note
what we feel in our bodies or observe in theirs, and sense
whether they will allow us in or surrender to intimacy, or
if they surrender too easily, or resist, or try to penetrate
us instead. We notice the rhythms of interaction, where
there is tension and where there is flow. Therapy, like sex,
is profoundly exposing and profoundly intimate, and
sometimes a bit messy (if you’re doing it right). Where
there is mutual trust and respect, and the capacity for
recognition, both activities can be vital and restorative.
The bedrock of a positive, rewarding sexuality is a
good-enough relationship with a partner but, more
cogently, also with one’s self, and I believe there is much we
can do to help ourselves, and our clients, achieve this.
*The term BDSM includes bondage and discipline,
dominance and submission, and sadism and masochism.
THERAPY TODAY
27
MAY 2017
REFERENCES
1. AASECT. AASECT
position on sex
addiction. [Online.]
Washington DC:
AASECT; 2016. www.
aasect.org/positionsex-addiction (accessed
16 February 2017).
2. Dhuffar M, Griffiths
MD. Understanding
conceptualisations of
female sex addiction
and recovery using
interpretative
phenomenological
analysis. Psychology
Review 2015; 5(10):
585–603.
3. McKinney F. A
relational model of
therapists’ experience
of affect regulation
in psychological
therapy with female
sex addiction.
Doctoral dissertation.
[Online.] London:
Middlesex University;
2014. Eprints.mdx.
ac.uk/14413/1/
FMcKinneyThesis.pdf
(accessed 15
February 2017).
4. Bader M. Arousal.
New York: Thomas
Dunne Books; 2002.
5. Lewis M. The
biology of desire.
Melbourne: Scribe
Publication; 2016.
6. West M. Into the
darkest places: early
relational trauma
and borderline states
of mind. London:
Karnac Books; 2016.
7. Joseph B. Addiction
to near-death.
International Journal
of Psychoanalysis
1982; 63: 449–456.
8. Benjamin J. The
bonds of love:
psychoanalysis,
feminism, and
the problems of
domination. New York:
Pantheon Books; 1988.
9. Hall P. Understanding
and treating sex
addiction. London:
Routledge; 2013.
10. Naked Truth.
Road to Brighton.
[Video.] Manchester:
Visible Ministries
(undated). http://
visibleministries.com/
road-to-brighton
(accessed 15
February 2017).
11. Perel E.
Mating in captivity.
London: Hodder
& Staunton; 2007.
Mental health
Rethinking
human
suffering
Stephen Joseph argues that person-centred theory provides a robust
framework for understanding and working with severe mental distress
O
ver recent decades, the person-centred
approach has become a major force in the
world of counselling and psychotherapy. Yet
the person-centred approach to understanding
distress and dysfunction has commonly been overlooked
in mainstream mental health services. This is, perhaps,
due to the mistaken belief among many psychologists and
psychiatrists that person-centred therapy is a good idea for
the ‘worried well’, but that serious mental health problems
should be left to the ‘proper professionals’. This becomes,
of course, a self-fulfilling prophecy. As the person-centred
approach becomes marginalised in the NHS because
of these beliefs, training courses find it hard to provide
placements and supervision for trainees to work with
clients with more severe forms of mental distress, and so
person-centred practitioners emerge from their training
ill-equipped to work with anyone but the worried well, at
least in the eyes of these other professionals.
Clash of paradigms
But a deeper look at the theory that underlies personcentred practice shows it does have great potential for
helping people who would otherwise be considered to
have serious mental health problems. The main problem
is communication, as we are essentially dealing with a
clash of paradigms: the potentiality model of the personcentred approach on the one hand, and the medical
model on the other.
The person-centred approach to helping is based on the
assumption that human beings have an inherent tendency
towards growth and development: movement towards
becoming fully functioning will happen automatically
when people encounter an empathic, genuine and
unconditional relationship in which they feel valued
and understood. However, it is recognised that such
THERAPY TODAY
relationships are rare; the inherent tendency towards
becoming fully functioning is more frequently thwarted
and usurped, leading instead to psychological distress and
dysfunction.1 For the person-centred therapist, the power
and direction for change comes from within the client;
their task is solely to provide the new relationship that
allows the person to flourish.
The medical model is based on the assumption that
there exist specific disorders requiring specific treatments
– an assumption embodied in the Diagnostic and Statistical
Manual of Mental Disorders (DSM), now in its fifth edition.2
DSM-5 is a voluminous work, running to many hundreds of
pages, which describes the range of psychiatric disorders
and the detailed procedure for the diagnosis of each.
Whether or not they adhere strictly to the DSM, many
mental health professionals take for granted that there
is a need for specific treatments for specific conditions;
alternative ways of thinking are rarely acknowledged. The
person-centred approach emphasises developmental
processes and the actualising tendency of the individual;
there is no need for diagnosis, because problems in living
all have the same essential cause and the approach to
therapy is always the same. Person-centred therapy is a
relationship in which the client is able to grow and selfright in such a way that they move away from façade, from
pleasing others, and towards self-direction, openness to
experience, acceptance of others, and trust of their self.3
As a consequence, the person-centred approach uses
different terminology to describe mental health.
Explaining disorder
Rogers wrote that, in his experience, whatever their
problem, whether it was to do with distressing feelings or
troubling interpersonal relations, all clients are struggling
with the same existential question: how to be themselves.
28
MAY 2017
For the person-centred
therapist, the power and
direction for change comes
from within the client; their
task is solely to provide the
new relationship that allows
the person to flourish
THERAPY TODAY
29
MAY 2017
Our research may not always show us what
we expect or want to find. There may be
conditions that really are not well-suited
to person-centred therapy, but I think we
can safely assume that the majority of
conditions for which people currently
seek help can be addressed through the
person-centred approach
But to what extent can person-centred personality theory
account for the range of psychopathology that is described
in the DSM?
There are three defining features of the medical model:
1 the focus is on the individual – the origins of distress and
dysfunction are seen as within the person
2 the practitioner is seen as the expert on what the
patient needs, who knows what is best for the patient
3 the emphasis is on distress and dysfunction, and what is
weak and defective about people.
Ultimately, the challenge posed by the person-centred
approach is to rethink the nature of human suffering.
Rogers’ person-centred theory offers a meta-theoretical
perspective on human nature founded on the assumption
that human beings have an inherent tendency toward
growth, development and optimal functioning.1,3,4
Unpacking the implications of this for practice, the
person-centred approach is in direct opposition to
these three features of the medical model:
1 person-centred therapists are concerned with the social
systems of family and community and how external
forces act on the person, leading to the development
of conditions of worth, which in turn affect their
processing style
2 person-centred therapists see the client as the expert
on what is best for them and seek to form collaborative
relationships in which the client directs the therapeutic
process. The therapist is non-directive because the
direction comes from the client, hence the term
‘client-centred’
3 person-centred therapists are interested in the
constructive and healthy potential of people and
their movement towards becoming fully functioning,
consistent with the aims of positive psychology.
Various individuals and professional groups may
seize on one of these three points of opposition to
define themselves, but still hold fast to the other features
of the medical model. They may perceive themselves as
standing against the medical model but, in fact, continue
to promote others of its features. Only the person-centred
approach offers an alternative to the medical model in all
three ways – by looking to health and wellness, seeking
to understand the social processes, and taking the stance
that people are the best experts on themselves.
At least, that is the theoretical stance of the
person-centred approach. In reality, these ideas
may not always have been put into practice so well.
The approach has been most successful at promoting
the idea that people are their own best experts, but less so
in the promotion of health and wellness. In my view, many
person-centred therapists have themselves forgotten their
theoretical roots, so immersed and besotted have they
become with the medical model and its notions of deficit
and dysfunction. Person-centred therapists have become
so accustomed to using the language and terminology
of psychiatry that they have forgotten that theirs is a
potentiality model. In looking to the future, we need to
ensure that all three aspects of person-centred theory are
now given equal attention.
Evidencing the argument
Stephen Joseph
About the author
Stephen Joseph
PhD is Professor of
Psychology, Health
and Social Care at
the University of
Nottingham, where
he is convenor of
the counselling
and psychotherapy
teaching cluster. He
will be a keynote
speaker at the
BACP Research
Conference on
19–20 May.
This is an extract
from his latest book,
The Handbook of
Person-Centred
Therapy and Mental
Health: theory,
research and
practice, edited
by Stephen and
published by
PCCS Books.
THERAPY TODAY
30
It will seem self-evident to many that the person-centred
approach offers a more ethical and effective way of
helping, but that is not enough. It must be shown to be so.
There is already substantial evidence for the therapeutic
role of relationships,5 but there is a long way to go yet if
the person-centred approach is to gain credibility in the
current mental health system. If that is ever to happen,
we need to take research more seriously and get new
evidence that shows the person-centred approach
really is an alternative that makes a difference in our
understanding of how problems arise and how people
can be helped.
Furthermore, we need to do more than convince
ourselves. The person-centred approach is not widely
represented in our universities, where such research often
takes place. Awareness of it among other professionals
is minimal. If we want the approach to be taken more
seriously, we also need to communicate the research
beyond the person-centred community. As I see it, future
research developments are needed in a number of areas.
First, we need to see new research that accommodates
the ideas of evidence-based practice as they are framed
through the lens of the medical model. Such research
would develop person-centred conceptualisations of the
various diagnostic categories and test the effectiveness
of person-centred therapy for specific conditions – not
to provide a justification for the medical model, but to
show that there are other, more humane ways of thinking
about and working with people who have a diagnosis. We
need research that meets the standards of professional
psychology and psychiatry journals and speaks directly to
these audiences in ways that they understand, so that the
person-centred approach gets taken more seriously within
the wider mental health arena. However, in doing this
research, we must be open to testing and discovering the
strengths and the limitations of person-centred therapy.
Our research may not always show us what we expect or
MAY 2017
Mental health
What makes the personcentred approach a unique
form of positive psychology
is its underlying stance
that human beings are
organismically motivated
towards developing to
their full potential
theoretical aspects. Such research need not compromise
the principles of the person-centred approach, but
simply take it to new and influential audiences that will
be receptive to its ideas and values. In promoting social
justice, we would do well to look to the profession of social
work, which shares our concern about the societal causes
of distress and dysfunction and their prevention. In terms
of health and wellness, recent years have seen much
interest in positive psychology.
Towards full potential
want to find. There may be conditions that really are not
well-suited to person-centred therapy, but I think we can
safely assume that the majority of conditions for which
people currently seek help can be addressed through the
person-centred approach.
In terms of therapy for specific conditions, the most
significant development of recent years has been the
Counselling for Depression (CfD) programme.6 Some may
see this as compromising the principles of the personcentred approach, insofar as it adopts the language of the
medical model. For example, CfD by definition involves
the diagnosis of depression. On the other hand, those
involved in CfD may see this as a necessary compromise
that has meant the person-centred approach is taken
seriously in the NHS and by funding bodies.
Second, for those whose stance is to reject any
involvement with the medical model, other research and
scholarship is needed. Our own understandings of the
person-centred approach from its own frame of reference
cannot stand still. We need to continue to define our
assessment procedures. We need to describe our own use
of models of dysfunction. We need an understanding of
social and cultural forces. Research that develops personcentred theory in its own right, not as a compromise to
other positions, is vital if the approach is to maintain and
develop its own distinct stance to mental health. Such
research can continue to build in the specialist humanistic
and person-centred journals.
Third, rather than remain isolated, person-centred
practitioners should also align themselves with other
professionals who hold similar views on some of the same
It seems self-evident to me that the person-centred
approach is a positive psychology.7 Positive psychologists
are concerned with understanding what makes life worth
living, which ought to sound familiar to the person-centred
psychologist, counsellor or psychotherapist.8 After
all, it was Rogers who introduced the idea of the fully
functioning person. But this is not to say that all positive
psychology is person-centred. What makes the personcentred approach a unique form of positive psychology is
its underlying meta-theoretical stance that human beings
are organismically motivated towards developing to their
full potential. Research will benefit from a broader positive
psychological conceptualisation of measurement that
embraces a theoretically consistent approach. We need
new research that can show that mental health problems
are better understood as expressions of thwarted
potential, and that person-centred therapy leads to
increases in people becoming more fully functioning, not
simply to reductions in distress and dysfunction. Imagine
that, instead of diagnostic assessment, we had a new
system that was based on these ideas, and that therapists
no longer thought about symptom reduction, but about
the promotion of a person’s potential.
In these three ways – first, by researching personcentred therapy in medical model contexts and using
person-centred theory to understand psychiatric
concepts; second, by building strong theory and
scholarship within the person-centred approach, and,
third, by aligning the person-centred approach with
contemporary developments such as positive psychology
– we can begin to advance new evidence for the personcentred approach to mental health. Ultimately, the
challenge posed by the person-centred approach is to
rethink the nature of human suffering.
We need new research that can show that
mental health problems are better understood
as expressions of thwarted potential, and that
person-centred therapy leads to increases in people
becoming more fully functioning, not simply to
reductions in distress and dysfunction
THERAPY TODAY
31
MAY 2017
REFERENCES
1. Rogers CR. A theory
of therapy, personality,
and interpersonal
relationships as
developed in the
client-centred
framework. In: S Koch
(ed). Psychology: a
study of a science. Vol
3: Formulations of the
person and the social
context. New York:
McGraw-Hill; 1959
(pp184–256).
2. American Psychiatric
Association. Diagnostic
and statistical manual
of mental disorders
(5th ed). Washington,
DC: American
Psychiatric Press; 2013.
3. Rogers CR. On
becoming a person.
Boston, MA: Houghton
Mifflin; 1961.
4. Rogers CR. Freedom
to learn. Columbus,
OH: Merrill; 1969.
5. Cooper M, Joseph
S. Psychological
foundations
for humanistic
psychotherapeutic
practice. In: Cain DJ,
Keenan K, Rubin S
(eds). Humanistic
psychotherapies:
handbook of research
and practice (2nd
ed). Washington,
DC: American
Psychological
Association; 2016
(pp11–46).
6. Sanders P, Hill
A. Counselling for
depression. London:
Sage; 2014.
7. Joseph S. Positive
therapy: building
bridges between
positive psychology
and person-centred
psychotherapy.
London: Routledge;
2015.
8. Maddux JE, Lopez
SJ. Toward a positive
clinical psychology:
deconstructing the
illness ideology
and constructing an
ideology of human
strengths and potential
in clinical psychology.
In: Joseph S (ed).
Positive psychology in
practice: promoting
human flourishing
in work, health,
education, and
everyday life (2nd ed).
New York: John Wiley;
2015 (pp411–427).
I write,
therefore
I think
Executive coach Liz Cox explains how
reflective writing can boost our personal
and professional development
GETTY IMAGES
M
any of us can relate to the Socratic saying:
‘The unexamined life is not worth living.’
As coaches and counsellors, we believe our
lives are enriched by self-examination. We
learn from our mistakes, challenge our behaviours and
grow in our personal and professional endeavours by
exploring our assumptions about the world. In the words
of coach, supervisor, transactional analyst and author of
Reflective Practice and Supervision for Coaches, Julie Hay,
‘The point of reflection is to enhance capability.’1
Although some readers may groan at the thought of
any sort of writing activity, it can be an invaluable tool for
reflective thinking. For many of us, writing has become a
formulaic process of capturing data and facts in the form
of notes, reports, emails, client correspondence and so on.
Some of us may remember childhood as a time when we
enjoyed the creative process of storytelling; others may
only remember – with dread – schoolwork returned with
endless spelling and grammar corrections.
But here is a new thought: rather than being tethered to
the rules and restrictions of the writing discipline, what if
we could use this medium to free up our thinking? What
if it could become a creative platform for new insights
and take us on exciting journeys of self-discovery? This
THERAPY TODAY
32
MAY 2017
Writing
becomes possible when we see the process of writing
as thinking. As Kaufman says, ‘One cannot engage in the
process of writing without simultaneously engaging in
thinking… scribo ergo cogito.’2
From a neuroscientific perspective, this is the process
that Kaufman describes as ‘reduced activation of the
Executive Attention Network and increased activation of
the Imagination and Salience Networks’.3 Unpacked, this
means allowing the brain to access the more creative and
emotional territories contained within the limbic system,
while reducing the interplay of the prefrontal cortex, with
its rule-bound executive function – the part of our brain
that wants us to write in complete sentences, preferably
with correct spelling and punctuation.
Still sceptical? I was, too – but then I found myself
undertaking a creative writing task as part of my MSc in
coaching and behavioural change at Henley Business
School. After a six-minute ‘free-writing’ exercise, we were
asked to spend a further 30 minutes writing about a
subject of our choice. The pieces that people wrote and
shared with the rest of the group were extraordinary
glimpses into personal histories and emotional territories
that were often as illuminating to the writer as they were
to others in the group. Rich detail of life-changing events,
personal relationships and domestic detail poured forth,
carried in the authentic voice of their authors. Freedom
from the restrictions of ‘proper writing’ had tapped a vein
of creativity and emotional authenticity.
This was a light-bulb moment for me. Through writing,
we had been pushed into revealing previously hidden
levels of thought and depths of emotion. By producing
a piece of written work, rich material was now at our
disposal for further exploration and reflection. The
writing exercise had brought to the surface our stories,
and had enabled us to shine a new light on our internal
narrative. As one fellow student said to me: ‘It’s like finding
the key to a secret doorway.’
Note-taking
This more liberated writing technique doesn’t just apply
to the personal, creative territories. Our professional
The writing exercise had brought
to the surface our stories, and had
enabled us to shine a new light on
our internal narrative. As a fellow
student said to me: ‘It’s like finding
the key to a secret doorway.’
THERAPY TODAY
33
MAY 2017
UNABLE TO SAY NO
afterwards play an invaluable role in highlighting the key
aspects that resonated with you, at some level, during
the session, which you can then reflect on further. It also
allows for that element of creative thinking and additional
insight that comes from the process of writing as thinking.
James wanted to improve his timemanagement skills. I suggested he
keep a diary of his working week – both
a factual record of dates and activities,
and an emotional narrative describing
how he felt about these events. This was
highly revealing. A key theme emerged
around James’s inability to refuse work
demands, no matter how unreasonable.
This opened up new territory around
self-esteem and personal development,
and ultimately enabled him to make
meaningful change in how he managed
his time and the demands placed on him.
Keeping a journal
In Oscar Wilde’s play, The Importance of Being Earnest,
Gwendolen exclaims, ‘I never travel without my diary.
One should always have something sensational to read
on a train.’4 I couldn’t agree with her more. A learning
journal is where the more free-flow approach to writing
adds another dimension of insight and depth to the
learning experience, allowing you to ask, not just what
you did, but also how you felt about it at the time and
how you feel it impacted on the coachee. Treating this
as a subjective arena and a piece of written material for
your eyes only gives you permission to really interrogate
the learning issues and reflect deeply on how you can
develop and take things forward. As Holly describes it,
this is an invaluable writing forum for reflective practice,
as it is one where ‘you are both the learner and the one
who teaches’.5
In my case, I also keep a personal diary. I find it
invaluable for keeping track of where I am professionally
as well as personally. I now regret not writing a diary
earlier in my life, as I realise what a powerful medium
it is for capturing thoughts and feelings as life unfolds,
be they minor domestic moments or life-changing
events. While my diary may not be a ‘sensational’ read,
I genuinely find it fascinating to look back and see my
internal processing on a day-to-day basis. It is another
valuable means of self-reflection.
The liberating force of writing as thinking has played
a big part in encouraging me to keep up a diary. In the
writing tasks – for example, note-taking – can also benefit
from a more freestyle approach. Rather than imposing
a logical, structured format on your client notes, Hay
recommends that you write a ‘stream of consciousness’
directly after the client session.1 She suggests you divide
your paper into three columns. In the first column, you
note what was said by the client. In column two, you
record your responses to what the client said, alongside
or below any client interaction. In the third column, you
write down any questions or insights that occurred to you
at the time. In this way, you create a set of thoughts and
observations that can provide fertile material for further
analysis and reflection.
Stream-of-consciousness notes
I have found this more free-flowing approach to notetaking extremely helpful in allowing me to capture the
thoughts and feelings that emerge at the time, which
I can then go back to with a more analytical focus at a
later date. For coaching assignments of any length, the
series of notes you make along the way lend themselves
to a meta-analysis of themes and issues that can help
progress the conversation further. Just recently, I found
that an emotionally charged coaching session, which was
especially challenging at the time, became much clearer
to me once I had gone through this note-taking process.
My stream-of-consciousness notes revealed to me new
areas of language, tone of voice and use of metaphor, as
well as the shape and flow of the conversation, which
brought new insights.
Of course, some may say that recording the conversation
would serve the same purpose. But I wonder if this
is true? A recording is a helpful way to go back over
a coaching conversation and a great tool for learning
and development. But I think that the notes you make
RESISTANCE TO WRITING
Susan was referred to me by her company with a very specific
work challenge. She was regarded as extremely able in faceto-face contexts, but her written presentations were felt to lack
coherence, depth and supporting evidence. Given that this
was a writing issue, we agreed to try a creative-writing exercise.
Susan wrote a story about her childhood. Her relationship
with her mother was crucial to the story, and a strong theme
was her mother saying, ‘It’s easier to do it yourself.’ We talked
this through, and Susan suddenly saw the connection with her
business reports, and an underlying resistance to ‘explaining’
the issues clearly on paper. This insight helped her identify
more helpful strategies to improve her writing. It also opened
up new awareness of some of the unconscious drivers
informing her relationships with her more ‘needy’ clients.
THERAPY TODAY
34
MAY 2017
Writing
THE SIX-MINUTE WRITE
Think of this as a ‘warm-up’ to the main event, like stretching before a gym session.
It helps to loosen up the writing muscles and opens the creative floodgates.
• Write whatever is
in your head, making
sure that you are not
censoring yourself.
• Write without stopping
for six minutes.
• Don’t stop to think or
be critical, even if you
doubt its ‘quality’.
• Allow it to flow without
worrying about spelling,
grammar or proper form.
• Give yourself permission
to write anything. You do
not even need to reread it.
• Whatever you write is
right; it is yours, and no
one else need read it.
This article was first
published in the
January 2017 issue
of Coaching Today.
bacpcoaching.
co.uk/coachingtoday
Following the six-minute write, plunge into your writing task. You will be amazed at
how much easier it has become, and how fluently the words flow onto the paper.
(This exercise is adapted from Bolton G. Reflective Practice. London: Sage; 2014.)
past, a major deterrent would have been self-criticism
about the quality of my output. But this is not about
producing a literary work to rival Jane Austen or Virginia
Woolf; it’s about using the writing medium to unearth my
inner thoughts. Viewing it as such liberates you from the
unhelpful inner critic. To use Gallwey’s phrase, it allows us
to win the ‘inner game’ against self-doubt.6 Another factor
for me is technology. Being able to type up my diary – and
other forms of writing – on my laptop, security-protected
in electronic files, makes me feel much more inclined to
commit my thoughts and ideas to ‘paper’. It is easier and
safer, and keeps them well away from prying eyes.
However, a word of warning. There are several issues
to consider in relation to storing any original material on
a laptop, especially sensitive client data: the risk both of
losing data (not backing it up, theft, laptop malfunction
etc) and of others gaining access to it. For example,
client notes can be required by a court of law in a legal
case where they are considered relevant. It is important
to consider ways of protecting the anonymity and
confidentiality of your clients when storing any notes.
Narrative for self-reflection
An important role of the coaching process is to build the
self-awareness of our clients. Equipping them with the
means for self-reflection helps to create a pathway to that
goal. As Kets de Vries says, ‘To coach people successfully, it
is essential for both the coach and coachee to understand
what is going on underneath the surface.’7 I have found
narrative, in the form of personal stories and diaries, to be
a powerful way for clients to access hitherto unconscious
patterns of behaviour and belief systems, and introducing
them to the concept of writing as thinking can be helpful
in overcoming any initial scepticism and resistance to
undertaking these writing tasks.
Jean-Paul Sartre wrote: ‘A man is always a teller of
tales, he lives surrounded by his stories and the stories
of others, he sees everything that happens to him
through them.’8 In this sense, coaching could be
described as helping people to make sense of their
stories. And reflective writing can play a key role in
accessing those stories.
A final thought
Here’s an ancient Buddhist story. A man comes galloping
into town on his horse. A passer-by calls out to him,
‘Where are you going?’ The man replies, ‘I don’t know –
ask the horse.’
Reflective writing invites you to go on a journey of
exploration, to let go of your inhibitions and to allow the
process to take you to new places. It can be a thrilling
ride of self-discovery. For coaches, it is one of the most
powerful tools at our disposal for enabling our own
personal and professional development, and for helping
our clients to make significant shifts. According to van
Nieuwerburgh, reflective writing is one of the most
helpful ways of developing a coaching ‘way of being’.9
It simply requires a different mindset that sees writing
not as requiring thinking, but as thinking itself.
Liz Cox
About the author
Liz Cox is an executive coach and
consultant, previously ran a market
research company, Directions, and
is also a non-executive director
on the board of The Big Picture,
a global design research agency.
[email protected]
THERAPY TODAY
35
MAY 2017
REFERENCES
1. Hay J. Reflective
practice and
supervision for coaches.
Maidenhead: Open
University Press; 2007.
2. Kaufman P.
Scribo ergo cogito:
reflexivity through
writing. Teaching
Sociology 2013;
41(1): 70–81. 3. Kaufman SB.
Beautiful minds: the
real neuroscience of
creativity. Scientific
American 2013; 19
August. [Online.] https://
blogs.scientificamerican.
com/beautiful-minds/
the-real-neuroscience-ofcreativity (accessed 28
March, 2017).
4. Wilde O. The
importance of being
earnest and other
plays. Oxford: Oxford
University Press; 2008.
5. Holly M. Writing
to grow: keeping a
personal/professional
journal. Portsmouth, NH:
Heinemann; 1989.
6. Gallwey T. The inner
game of tennis. London:
Pan Macmillan; 1986.
7. Kets de Vries M.
Mindful leadership
coaching. Basingstoke:
Palgrave Macmillan;
2014.
8. Sartre J-P. Nausea.
London: Penguin; 2000.
9. Van Nieuwerburgh C.
Introduction to coaching
skills: a practical guide.
London: Sage; 2014.
FROM VISUAL TO
VERBAL DISCLOSURE
Liddy Carver delves into a paper on use of creative
activities to help people with severe depression put
their feelings and experiences into words
T
his month, Research
into Practice asks
whether visual arts
can help counsellors
work with clients with
severe depression.
A paper by Lee, Mustaffa
and Tan reports how
counselling approaches
can be enhanced by
visual art-making
activities. It explains how
they produce valuable
observational data that
throws light on what is
going on for the client
when they might otherwise
struggle to articulate
experiences and feelings.
A
t first glance, it is difficult to
see the relevance of this
research to UK-based, personcentred, experiential counsellors
and cognitive behavioural
therapists with extensive
experience of working with
severely depressed clients.
However, when a problem keeps
manifesting in relationships, you
need to resolve it, and that begins
by putting it into words.
Visual arts – traditionally
used with children – may, as the
researchers claim, help clients who
struggle to verbally communicate
existential crises. The study was
conducted as part of Lee’s doctoral
dissertation, and used qualitative
and quantitative research methods
Three case studies
show the use of visual
art-based activities
alongside person-centred
counselling in a psychiatric
outpatient setting. Amy,
44 and married with a
teenage daughter, was
diagnosed with major
depression five years ago.
Shawn, 47, divorced with
two teenage daughters,
was diagnosed with major
depression eight years
ago. Potter, a 34-year-old
man, was diagnosed with
dysthymic disorder six
years ago.
According to the
study, for each of these
emotionally imprisoned
clients, revisiting painful
events via creative
methods, such as painting
and collages, enabled
them to crystallise
negative emotions, which
could then be worked out.
• Lee KL, Mustaffa MS, Tan SY. Visual arts in counselling
adults with depressive disorders. British Journal of
Guidance and Counselling 2017; 45(1): 56-71. doi:
10.1080/03069885.2015.1130797
to explore the benefits of visual
arts activities for three clients
attending the counselling unit at
a Malaysian psychiatric hospital.
The data collection and analysis
included observations of six
counselling sessions with each
client and of their artwork,
evaluation questionnaires from
each session, interviews with
the clients, visual diaries and
a research journal. The study
focused on four questions:
• How do adult clients feel when
they are creating and talking
about their artwork in the
counselling process?
• Do they think that their artwork
has helped them to express their
feelings about their problem?
• In what ways has their artwork
helped them to face or manage
their problem?
• What do they believe is the
best way to use visual arts in
the counselling process?
Visual arts – traditionally used with
children – may, as the researchers claim,
help clients who struggle to verbally
communicate existential crises
THERAPY TODAY
36
MAY 2017
In this way, the clients were
invited to become co-researchers
into their own malaise and how
best to approach it.
Setting aside disagreements
about the most appropriate
psychological intervention for
depression, visual arts-based
therapy applied in this way can
sit comfortably alongside most
established models devised to
address its emotional toll. So,
while at first sight this paper
might seem to offer little
to a sophisticated audience,
its insights may benefit
therapists’ practice with adults
diagnosed with major depressive
disorders who find it difficult
to articulate, or even be aware
of, their affective response to
past experiences.
The three participants were
each asked to complete four
art-making activities. The first
was to choose art materials and
colours, and do some simple,
freeline drawing. They were then
introduced to the notion of using
art as a communication tool, and
encouraged to try out different
kinds of materials to find those
they liked best. In the second
activity, they were asked to draw a
picture of their current self-image
and make a collage of everything
they had and what they felt they
needed, and through this to
explore their feelings, thoughts
and behaviour. In the third stage,
they were asked to create a future
self-image. Finally, they were
asked to draw and write down
their feelings in a visual diary at
home, which they could share
with the counsellor.
The counsellor concentrated
on empathic listening while
observing clients’ responses and
artwork. The participants were
guided towards the research
questions, and each activity
was carefully introduced in a
stepped-up process, with the
aim of helping them value their
efforts and achievements.
Research into practice
FINDINGS
The researchers have collected
a striking amount of data
under six themes: ‘feelings
of unfamiliarity’, ‘feelings
of satisfaction’, ‘expressing
emotions’, ‘facing problems’,
‘facilitating deeper selfunderstanding’ and ‘making
progress in counselling’.
For instance, Potter struggles to
express his feelings, and explains:
‘When I drew, I went back to my
childhood drawing style, which
is the part I don’t want to face…’
Drawing helped him feel ‘… a bit
cheerful when I went home’.
However, ambivalence persists
about confronting previously
well-hidden issues: ‘I don’t have
the courage to face myself. When
I drew, I could face my problems,
but I was a bit avoiding.’ But,
ultimately: ‘Through my artwork,
I discovered things that I’ve not
thought of before… I could go into
my inner self at a deeper level
through drawing. Yes, I feel it did
help. For example, I dared not
face facts, face my own self, but I
could understand myself more
clearly through drawing.’
Likewise, although Amy
initially finds the process ‘a bit
embarrassing because I am a
perfectionist that cannot draw
very well’, she engages in the
art-making activities and her
counselling: ‘I followed the
guideline to draw what I wanted
to express, and I felt that would
be realistic… So my wondering
became engaging, focused and
free, like following my mind.
Then I felt very comfortable,
and was interested in knowing
the outcome or purpose of the
counselling process.’ For Amy,
the two are complementary.
First: ‘Maybe previously, I never
faced and thought about my
negative emotions deeply…
Through the thinking processes,
I can understand better about
my weaknesses.’ Second: ‘I
can understand better the
meaningfulness behind the
drawings, and then I know what
my problems are, since all the
issues have been brought to the
surface.’ This gives confidence:
‘I can visualise what I want and
hope for my future.’
Less articulate, Shawn finds
drawing: ‘… is not so tensed,
like the ordinary counselling
session… I feel that when the
person is more relaxed, and is
given the freedom to draw, a lot
of expression will come out.’
Although Shawn is not entirely
clear about the objectives, he
‘Through my
artwork, I
discovered things
that I’ve not
thought of before…
I could go into
my inner self at
a deeper level
through drawing’
says: ‘The times when I shared
it was a relief… From the art
activities, I discover… the reality
of problems I am facing and
what steps I can take to
overcome them.’ Despite his
initial hesitancy, the emphasis
on expressing emotions in the
making and sharing of his
artwork helps Shawn share
his feelings of helplessness.
By the end of the study, all
three participants are showing
clear changes in their mood
and their ability to engage with
counselling. According to the
study, these changes demonstrate
how art enabled them to move
‘from the personal visual
disclosure to verbal disclosure…
express their real feelings, focus
on exploring those issues they
were concerned with, face their
problems more directly, and
understand themselves at a
deeper level’.
Indeed, one of the participants,
Amy, reportedly told the
researcher that ‘research studies
such as this could develop more
helpful therapeutic methods
than merely taking medication
in helping the patients with
depressive disorders’.
WHAT CAN WE LEARN?
• Creative arts can be applied in counselling
alongside more orthodox talking therapies.
• Counsellors can assimilate the material to
address clients’ practical problems and help
them unscramble how depression affects
them and their relationships.
This approach can also:
• safely contain clients’ ambivalence about
disclosure of feelings, without relying on verbal
language to share narratives. In conjunction
with traditional counselling approaches,
creative arts can give voice to clients’ powerful
emotions, thoughts and memories when
words are difficult or seem insufficient
• alleviate fear by using imagination to
convey visual representations of clients’
THERAPY TODAY
37
MAY 2017
Liddy Carver
About the author
Liddy Carver is a BACPaccredited counsellor
currently completing
her doctoral research on
counselling training. She
worked as a counselling
trainer for several years,
volunteers at a student
counselling service,
and is Managing Editor
of Counselling and
Psychotherapy Research.
Get in touch
Is there a recent research
paper you’d like Liddy to
report? Email research@
thinkpublishing.co.uk
experiences, providing a first step towards a
therapeutic alliance
• build resilience in terms of clients’ coping
mechanisms and ability to recover from stress
• support clients to make choices, problemsolve, make meaning and safely express
complex reactions
• offer clients new ways of seeing ‘self’ and
actively engaging in their path to recovery.
For clients who find social interactions difficult,
creative-arts activities may initially be more
acceptable than other forms of psychosocial
support. If counsellors do choose to go down
this route, it would be a good idea to explain
to their clients the aims, procedures and
benefits of this approach.
THIS MONTH’S
DILEMMA:
Must I show my client what I’ve written in my notes?
M
atias, an accredited
counsellor in private
practice, keeps handwritten
notes of the main issues
discussed in client sessions.
He anonymises them by
filing them under the
client’s initials and stores
clients’ contact details in
his smartphone.
His notes also include
a full case history, his
hypothesis about clients’
psychopathology, if relevant,
and his strategy for working
with them. He also uses
his notes to process his
own countertransference
responses, and finds this
particularly helpful if he
is experiencing a strong
negative response to a client.
He has heard about the
Data Protection Act, and is
aware that some therapists
in private practice register
with the Information
Commissioner’s Office. But,
because he doesn’t keep
identifiable client records
electronically, he doesn’t
think this is relevant to him.
Matias has been working
with a client whom he
experiences as critical of him
and of therapy in general. The
client also voices his anger
towards work colleagues –
who he thinks talk about him
behind his back – and his
difficulty trusting people.
Following a particularly
challenging session, after
which Matias has written
about how hard he finds it
to empathise with, or find
anything to like about this
client, the client asks him
if he keeps notes of the
sessions and, if so, whether
he can see them.
WHAT WOULD YOU DO IN MATIAS’S POSITION?
Please note that the opinions expressed in these responses are those of the writers alone and
not necessarily those of the column editor, Therapy Today or BACP.
SERIOUS
BREACHES
Peter Jenkins
Author of Professional
Practice in Counselling and
Psychotherapy: ethics and
the law (Sage, 2017)
U
nfortunately, Matias’s private
practice has serious failings
at a number of different levels. In
legal terms, he may be in breach
of the Data Protection Act (DPA)
1998, by failing to register with
the Information Commissioner’s
Office (ICO).1 In professional and
ethical terms, he may also be
in breach of the BACP Ethical
Framework, section 14(f ), which
requires him to keep up to date
with the law and regulations.
In therapeutic terms, Matias
may well feel the need to process
his countertransference towards
the client. However, it may be that
the very detailed kind of narrative
process records he keeps is
‘excessive’ in DPA terms. He
could, for example, still process
his own emotional responses
to the client without writing in
such detail. At the very least,
he could make brief Post-it
notes, to be destroyed after
use in supervision, rather than
retained, potentially as part of
the permanent client record.
Matias seems ill-informed
about his obligations under the
DPA 1998. In all probability, his
storing of client personal data in
electronic format on his phone
means that he should register
with the ICO, whether or not
THERAPY TODAY
he also keeps manual records
of therapy and manual process
notes. If he’s in any doubt, there is
a very simple checklist available
on the ICO website, which should
quickly resolve any uncertainty
on this issue (ico.org.uk/fororganisations/register).
Assuming Matias does need to
register with the ICO, the client
has a general right of ‘data subject
access’ to his or her own files.
Another, more technical issue
here is whether the client can
access Matias’s handwritten client
and process notes. This depends
on whether these are filed in a
highly systematic way, consistent
with what is defined as a ‘relevant
filing system’ (see ico.org.uk/
for-organisations/guide-to-dataprotection/key-definitions for
the criteria). By not keeping
up to date with standard data
protection requirements, Matias
risks a fine from the ICO of several
hundred pounds, a professional
complaint by his client to BACP,
and the need to respond to the
aggrieved client under the ‘duty
of candour’, as required by the
BACP Ethical Framework.
HOW WILL
IT HELP?
Mark Redwood
Humanistic gestalt counsellor
in private practice
F
irst, Matias is wrong in his
belief that he doesn’t have
to register with the ICO. He is
keeping information about his
clients on his smartphone, which
most definitely means he should
register. In addition to registration,
Matias also needs to consider
whether keeping his clients’
contact details on his smartphone
is secure enough.
Second, the client seems not to
know whether Matias keeps notes
on their sessions. I feel this is an
important part of the contract
between therapist and client: the
client needs to know how their
information will be used, and who
will see it. For example, Matias’s
notes might be subpoenaed.
‘Matias may well feel the need to process
his countertransference towards the
client. However, it may be that the very
detailed kind of narrative process records
he keeps is “excessive” in DPA terms’
38
MAY 2017
Dilemmas
‘This request
provides Matias
with an opportunity
to confront his
client’s fears about
what he thinks
people conceal
from him and
why they do so’
In dealing with this request,
there is a very big unanswered
question: what does the client
hope to get from reading the
notes? In this dilemma, this seems
to be the most important question
to attend to, rather than whether
Matias should release the notes.
Exploring this question with the
client would help Matias and his
client decide what to release
and how.
In my own practice, I have read
out my notes while my client took
their own notes, because they
wanted to capture the important
turning points. Knowing this
enabled me to pick what to read
and how. For me, a decision about
releasing notes is always about
therapy. The question I am really
trying to answer is: how will this
help my client?
ADDRESS ISSUES
OF BETRAYAL
Sue Lyons
BACP-accredited
psychodynamic counsellor
in private practice
I
t appears that this client has
pursued therapy because he
has difficulty trusting people.
He believes that people are not
straightforward with him, and
that they discuss his undesirable
qualities behind his back. He is
clearly angry and hurt, and his
apparent criticism of therapy is
an indication that he is already
experiencing his therapist as
yet another person who may be
concealing negative feelings
about him.
As part of our commitment
to ethical practice, we are
encouraged to do everything we
can to develop and protect our
clients’ trust, and to maintain high
standards of honesty in our work.
I believe Matias has no option
but to disclose the fact that he
keeps notes. However, this request
to produce his notes on their
sessions would provide Matias
with an opportunity to confront
his client’s fears about what he
thinks people conceal from him
and why they do so. If Matias is
able to contain his client’s anxiety
and address head-on the issues
of trust and betrayal that his nondisclosure raises, he may well be
able to repair any damage caused
to the therapeutic relationship.
Countertransference reactions
are an important part of
understanding the unconscious
worlds of our clients, but, if
our countertransference is
overwhelmingly negative, we
have to ensure that we work it
through in supervision. Ongoing
negative countertransference can
have a cumulatively damaging
impact on a client’s unconscious
experience of the therapist and,
if not addressed and worked
through, will almost certainly
undermine the therapeutic
experience for the client.
The development of trust and
a relationship of integrity and
respect are fundamental parts of
our work with clients. If Matias
continues to struggle with his
countertransference with this
particular client, even after taking
it to his supervisor, he may want to
consider whether he can continue
ethically to work with him; it might
be advisable for him to refer the
client to another therapist.
Finally, this incident should
prompt Matias to change
the content of the notes he
keeps on his client sessions.
Countertransference musings can
be kept elsewhere, separate from
client notes, and ideally should be
destroyed once they have been
thought about in supervision.
Matias should also inform his
clients during the contracting
process that he keeps brief,
limited notes of sessions, as it is
important that clients are fully
aware of the information that is
being kept about them.
Finally, Matias would be wise
not to keep clients’ contact details
on his smartphone. Smartphones
are particularly vulnerable to theft
or loss, but a desktop computer
may also be hacked or stolen.
Therapists need to be highly
vigilant about data security,
whether data is stored manually
or electronically.
Registration with the ICO is a
complex topic that Peter Jenkins
covers in detail in his article
on ‘Data protection in private
practice’ in the Winter 2012 issue
of Private Practice journal.1
REFERENCES
1. Jenkins P. Data protection
in private practice. Private
Practice 2012; Winter:
24–27. tinyurl.com/lg2cmqc
(accessed 10 April 2017).
September’s dilemma:
Lee is 32 and comes to
Portia for therapy following
a relationship breakdown.
Brought up in foster care
from the age of eight, he
is desperately unhappy,
terrified of being rejected
and has developed a
strong need to please,
which masks deep feelings
of worthlessness.
Portia is in her early
40s and in an unfulfilling
marriage. She has felt deep
compassion for Lee since
the first session and, as their
therapeutic relationship has
deepened, has found herself
looking forward to their
weekly meetings and
THERAPY TODAY
39
often thinking about him
know that he is lovable
between sessions.
and desirable. She finally
In one session, Lee
decides she needs to come
shares a dream he has
clean in supervision about
had recently in which they
what’s happened.
are lying together and
Portia is cradling him. He
tells her he wishes she could
hold him in that way for real.
IF YOU
In a rush of excitement
WERE PORTIA’S
and fear, Portia says,
SUPERVISOR, HOW
‘If I weren’t your
WOULD YOU RESPOND?
therapist, I probably
Please email your responses
would.’
(300 words max) to dilemmas@
She feels guilty
thinkpublishing.co.uk by 18 July.
after the session, and
The editor reserves the right to edit
wishes she could take
contributions. Readers’ suggestions
back what she said,
for dilemmas are welcome
although she also thinks
but will not be answered
it is therapeutic for Lee to
personally.
MAY 2017
Screen-to-screen
Picking up on the theme in this month’s news
feature, we asked counsellors for their views about
working online and by phone or email
Jo Lucas
Integrative psychotherapist in
private practice, Cambridge
I use Skype, but only when
people ask for it, and to date only
with people with whom I already
have a therapeutic relationship.
When I started using it, I was
surprised at how effective it was.
I expected the screen to be a
real barrier to the relationship,
and to experience much
more performance anxiety. It
helped that I knew the clients
well already. But my screen is
reasonably big, so the client’s
face is almost life-size and I
can see when expressions flow
across their face, and respond.
What I do find limiting is that I
can’t reach out physically in the
same way as I do when the client
is in the room – the element of
presence is different. I also find
I have to work harder to stay in
contact with the person on the
screen, especially if I’m using
my iPad. It’s like the difference
between a television and a
cinema screen – I feel somehow
less connected, which makes me
realise I need to always use the
larger screen, especially if other
things are getting in the way.
I’m surprised that I don’t find
physical presence essential. If
a client said they only wanted
to work online, I’d give it a go.
It’s certainly a real boon to
people for whom travel is an
issue – in that respect, new
technology does open up a
realm that would otherwise
be closed to some people.
If you’d like to join
our Talking Point panel,
email therapytoday@
thinkpublishing.co.uk
Adrian Francis
Person-centred counsellor, based in Bridport
I’m profoundly deaf and work primarily with people
who have hearing loss. Online therapy doesn’t work
so well with signing clients, because it’s a very physical
language: you have to see the whole body to get the
whole picture. When you’re both in the same room,
you can pick up on everything, pass a box of tissues,
engage in creative therapy, or show clients books and
resources. It’s especially difficult if clients want to use
their mobile phone, as you can only see them from the
neck up. Online therapy isn’t an option for clients with
Usher syndrome, because they have restricted vision. I
also think it’s important for a client to go outside their
home for counselling, so they can leave their issues in
that safe space and walk away. With Skype, the session
is terminated by the press of a button, which may leave
clients feeling alone at home with their problems.
Karl Pegg
Person-centred counsellor in Colwyn Bay
I worked for many years with Samaritans
and did a lot of email counselling then.
I think it can help people to make the
transition from never having spoken to
anyone about their problems to being
able to trust and engage with faceto-face therapy. However, there are
important elements you can’t access
through the written word, like tone of
voice and expression.
THERAPY TODAY
40
MAY 2017
Telephone is probably for me the best
non-face-to-face option: I can get a feel
for the person and there’s a lot more to
work with in terms of all those signals
you can pick up from the spoken word,
even if you can’t see the face.
I don’t much like Skype. I find it takes
more time to get into the counselling
session, just because there is that
physical detachment. I don’t feel I can
Talking point
Soha Daru
Integrative counsellor, based in Leeds
I’ve used online therapy ever since I qualified, even though a lot of the tutors on my course
were not in favour of it. I just thought about the benefits it offers. If you look at the primary
components of person-centred therapy – empathy, unconditional positive regard, creating a
warm, safe, accepting environment, congruence, honesty and openness – you don’t have to be
in the same room to create that environment. People say there are things you can miss online,
but you can see the person quite clearly. If you’re not picking up so readily on non-verbal
clues, it can make you more acutely alert to other forms of expression.
There are important differences – I have clients all over the globe, and that can be quite
challenging with regard to the different terms and conditions for providing therapy, such as
confidentiality issues. Clients need to know the risks; if a client is feeling suicidal, it may not be
so easy to locate someone to contact in an emergency. The contract is slightly different, too –
clients are in their own homes, so we need to contract for that to ensure they find a place where
they are on their own, with no distractions.
I find it helpful to use headphones and I
encourage clients to do the same. There
can be problems with connectivity, so you
have to be prepared for that.
But, if all the above is in place, we can
reach out to so many people who might
not otherwise access our support.
NICK LOWNDES/IKON IMAGES
Niki Reeves
Attachment-based psychoanalytic
psychotherapist and supervisor,
based in Southampton
tune into my clients’ feelings so well, in
the way that you can feel in your own
body something that comes from a client
who is physically present. I feel I have to
work harder for less of a connection.
That said, I’d sooner offer Skype if it
meant someone could have counselling.
But I worry that the therapy world is
having to bend itself to new technology
and we are losing something important
in the process.
Practitioners often say that online work
is not as good as face-to-face, but that’s
because they often come to online work
thinking it’s just the same, or approach it
like Skyping a friend. You need to learn
the skills to do this properly, and you need
to prepare clients for it. I use VSee, which
gives a bigger picture, and I insist the
client uses a desktop computer with a big
screen and sits back so we can both see
each other from head to waist, as though
we are sitting in front of each other.
Relational depth depends very much
on the client. I have been in the room
with a client and never got the emotional
connection and closeness that I have with
others online. Some people would never
come to face-to-face therapy because it’s
too close and too intimate. I have clients
with agoraphobia and clients who are
carers who would not be able to have
therapy if they couldn’t do it online. In
eight years, I’ve only had two clients who
said it wasn’t working for them.
THERAPY TODAY
41
MAY 2017
Chloe Langan
Humanistic counsellor
and supervisor, based
in Inverness
When I moved up to
Scotland from Kent, a
number of my clients
suggested we continue
on Skype, which is how
I started to use it. I now
use it a lot, partly because
it’s not easy to find a
counsellor in the Highlands
and islands. Some of my
clients would have to travel
miles to see me – for some,
it would be a boat trip or
flight to the mainland.
For me, the primary
difference is in the
contracting. Before the
first session, I have a
conversation with the
client about things like
making sure that their iPad
is fully charged, that I have
a telephone number in
case the connection goes
down, and that they are
in a private space, with no
interruptions. Online, you
are working in someone
else’s home, and you need
to state those baseline
boundaries very clearly
at the start.
I use headphones, even
if I’m the only person in
the house. I’ve noticed
I lose focus more easily
online, and wearing the
headphones seems to
help. Once, I wouldn’t
have considered changing
how I worked, but moving
here has opened up a
space to consider different
possibilities. If it means
I can provide a service
to someone who would
not otherwise be able to
access counselling, then I
am very glad to be able
to do so.
Self-care
HOW DO YOU
TAKE CARE
OF YOURSELF?
Forced by ill health to cut
her counselling hours,
Figen Murray pours
her therapeutic skills and
energy into handicrafts
It all came about because I suddenly lost
much of my hearing and got tinnitus in my left
ear. I had to reduce my counselling workload,
as listening is more effort when you’ve got
poor hearing. I was quite down, but then I
remembered the advice I often give to clients –
that tapping into their creativity is good for the
soul – and so I started making craft gifts, such
as patchwork hearts, knitted monster mitts and
teddy bears. I made so many that my daughter
set up an online shop for me and, thanks to my
son tweeting about it, it went viral.
The knitted bears are for adults, because
they often forget how to play. I took to writing
a little story about each of them to go on
the website with their photos and, as I’m a
counsellor, I gave them personal problems
– Claudia who struggles with her work/life
balance, Collette who has weight issues,
Owen who can’t manage his anger, Trevor
who self-harms…
Whenever someone bought a bear, I’d put
a short update to their story in the package.
In response, my customers started sending
me their own stories, and telling me how they
could identify with the characters I’d created.
I’ve sold the bears worldwide, and donated a
lot of the proceeds to charity. There’s a longdistance truck driver somewhere in America
with one of my bears for company.
‘For me, it was an emotional and headspacecleansing process. I feel playfulness has
come back into my life now it’s done’
Just recently I decided to turn the stories
into a book, which I wrote in about six weeks
and self-published. The words just poured
onto the paper. I’ve been a counsellor, coach
and supervisor for 20 years, and have a head
full of people’s stories, as well as my own trials
and tribulations as a mother raising a family of
five children. For me, it was an emotional and
headspace-cleansing process. I feel playfulness
has come back into my life now it’s done.
You can find Figen’s
bears at www.depop.
com/imperfecthearts
Her book Bears Have
Issues Too is available
from Amazon.
How do you take care of yourself? Email [email protected]
THERAPY TODAY
42
MAY 2017
From the Chair
‘Our VPs are all outstanding women with the
influence to bring about real change, and I am
delighted they are willing to work with BACP for
counselling and psychotherapy’
CHARLIE BEST
B
ACP President David Weaver and I have had the pleasure in recent weeks
of meeting our vice presidents (VPs). Not everyone in the membership will
realise that we have VPs, or why. It is quite simple: they bring an immense
depth of experience and influence to the association and they support our
work to lobby and challenge at a national policy level.
I am writing this on my way to meet Professor Dame Sue Bailey, formerly President
of the Royal College of Psychiatrists, a specialist in child mental health and a powerful
presence in advocating for the highest standards of mental health practice.
Recently, we met Julia Samuel, psychotherapist, founder of Child Bereavement UK
and author – as readers will know from her article in last month’s issue, her first book,
Grief Works, is an outstanding read. Julia is also very skilled in communicating about
therapy in the media, and her ability to speak about the experience of bereavement
in a way that touches many is an example of public engagement at its most inspiring.
We were also delighted to meet Luciana Berger MP, former Shadow Minister for
Mental Health, who has agreed to become a VP. Luciana has long been a strong
advocate for change in the way mental health services are funded and organised.
She is notable for her commitment to speak with and learn from people who are
themselves receiving mental health support and delivering care on the frontline.
We also receive support from Kim Hollis QC, a former winner of the Society
of Asian Lawyers’ award for Most Successful Lawyer, and Juliet Lyon,
whose outstanding work over many years with the Prison Reform Trust
has contributed to significant change in the penal system.
I am often contacted by members asking, rightly, what steps BACP is
taking to influence policy, inform stakeholders and commissioners about
the value of counselling, and raise the profile of the counselling professions
in the public realm. Our VPs, alongside our President, are essential to that
work. They can reach audiences in a way that we could not otherwise. Our
strategy is based on principles of social justice – our VPs are all outstanding
women with the influence to bring about real change, and I am delighted
they are willing to work with BACP for counselling and psychotherapy.
email
[email protected]
Twitter
@Reeves_Therapy
@BACP
BACP board and officers
Chair Andrew Reeves President David Weaver Governors Natalie Bailey, Eddie Carden, Sophie-Grace Chappell, Myira Khan, Andrew Kinder,
Caryl Sibbett, Vanessa Stirum, Mhairi Thurston Chief Executive Hadyn Williams Deputy Chief Executives Cris Holmes, Nancy Rowland
THERAPY TODAY
43
MAY 2017
BACP round–up
Our monthly digest of BACP news, updates and events
New look for BACP
Our association exists for one simple
reason: counselling changes lives. This
core principle is so fundamental to
us that we’re incorporating it into our
new logo, placing the message that
counselling changes lives at the very
heart of our identity. You will start seeing
this logo in the summer, on the letters,
emails and documents we send you, as
well as on our new website. As the year
progresses, our new look will gradually
replace the current one, and will
continue to evolve as we develop over
time and incorporate your feedback.
The new logo will also be available
from the summer to Registered
Members, Accredited Members, Senior
Accredited Members, Accredited
Services and Accredited Courses to use
to promote your own work to the public.
To see how the BACP brand has
evolved over our 40-year history, and
to find out more about our refreshed
visual identity and what it means for
you, visit
www.bacp.co.uk/about_bacp/newlook.php
We’ll be introducing you to other
elements of our refreshed visual identity
over the next few months. We’ll update
you via the BACP round-up pages, your
monthly news e-bulletin, our Twitter
feed and our website.
Membership survey
– thank you
We had almost 8,000 responses
to the Membership Engagement
Survey in February. Thank you –
we really appreciate your feedback
and support. The results will help
us focus on what’s most important
to you as we shape the services
and benefits we offer.
We would also like to send
our congratulations to the
five winners of the one-year
free BACP memberships:
Carole Leech, Caroline Nottage,
Linda Baxter, Marilyn Finch and
Wendy Padley. Well done – we
hope you enjoy your prizes!
We’ll be reporting the results
of the survey back to you later
this year.
Commission on loneliness
BACP is among the organisations supporting the Jo Cox Commission
on Loneliness. The cross-party campaign, launched in January in
memory of murdered MP Jo Cox, encourages communities to tackle
loneliness. Older people are a key strategic priority for BACP’s work,
and we have supported the commission’s campaign through a series
of dedicated tweets aimed at increasing public awareness of the
issues and encouraging people to take time out to talk to each other.
Loneliness is often called the silent killer. Research shows that
it can increase the risk of premature death by up to 25%. It also
affects self-esteem and recovery after illness, and is linked with
depression and suicide.
THERAPY TODAY
44
MAY 2017
Public
engagement
roundtable
Counselling for
women prisoners
The Independent Advisory Panel (IAP) on Deaths in Custody has backed BACP’s
call for counselling to be available to all women prisoners. IAP has published a
working paper on ‘Preventing the Deaths of Women in Prison’, with interim findings
and recommendations from a rapid information-gathering consultation at the
beginning of the year. This was launched after 12 women took their own lives in
prison in 2016, the highest recorded number since 2004. BACP responded to the
consultation, as did IAP stakeholders and members of the Ministerial Council on
Deaths in Custody and the Advisory Board on Female Offenders.
Several of BACP’s other recommendations have also been highlighted in the
report, such as mandatory mental health awareness training for prison staff.
Nancy Rowland, BACP Deputy Chief Executive, said: ‘We hope that the information
in the report will lead to significant practice change in policing, prisons, health and
housing services, leading to real policy change for this vulnerable group.’
Other recommendations include focusing the whole prison environment on
promoting the mental and physical health of all prisoners, and providing a greater
range of mental health and substance misuse treatments in the community,
including counselling services and talking therapies.
For more information, please visit bit.ly/2ouuNFi
ALAMY; FIONA HANSON/PA ARCHIVE/PA IMAGES
BACP PhD bursary
Congratulations to BACP member
Dr Michael Minn, who has recently
completed his PhD. Dr Minn was a
recipient of the BACP PhD membershipfee-waiver scheme for two years of his
study, which he found very helpful.
BACP makes funds available for
members who are studying for a doctorate
in counselling or psychotherapy. There
are 12 bursaries available. They cover the
full cost of a year’s BACP membership
(excluding accreditation fees). The bursary
is for one year’s membership only, but
members can apply for and receive it up
to three times.
Applicants must be current members of
BACP and must already be registered on
their PhD/doctoral course.
The deadline for applications is 5pm
on 23 June 2017. Successful applicants
will be informed by 30 June 2017, and
the bursary will take effect from their next
membership renewal date.
For details, visit www.bacp.co.uk/
research/resources/Membership%20
fee%20waiver%20scheme.php
THERAPY TODAY
45
MAY 2017
In March, BACP held a
roundtable discussion with a
range of external stakeholders
to look at the feasibility of
developing a client panel or
focus group, and the best
ways of engaging with hardto-reach communities.
The meeting was chaired by
BACP’s new president, David
Weaver. Guest participants
included people with experience
of service-user research and
service-user involvement in
mainstream organisations, and
representatives from the BMA
Patient Liaison Group and
Mind’s engagement team.
A number of themes emerged
from the discussion. Part of
BACP’s engagement with
hard-to-reach communities
was seen to be about looking
at how counselling training
has become an exclusively
middle-class activity, as there
is no subsidised training. It was
also felt that BACP needed to
collaborate with a broader range
of organisations and networks
than it currently does.
The twin aims of public
engagement were identified
as working to change the
misinformation the public has
about what counselling is and
what it isn’t, and developing
some kind of structure to enable
clients or prospective clients
to feed their views back to
BACP so that the client voice
influences the development of
the profession.
BACP round–up
BACP accreditation
Newly accredited members, services and courses
We would like to congratulate the following
on achieving their BACP accredited status:
Counsellor/psychotherapist
Krupali Adathiruthi
Samantha Airey
Sophie Amoni
Alison Baily
Lorraine Baines
Lorraine Balaam
Yvonne Barham
Steve Barker
Phillip Birch
Ben Bourne
Julie Bowen
Annabelle Boyes
Dianne Breakwell
Jean Burden
David Buswell
John Carter
Lara Chitty
Julie Chivers
Tamsin Cullen
Supriya Dharmadhikari
Alison Doherty
Lucinda Drayton
Crissy Duff
Patsy Edmonds
Karen Elliott
Lesley Foulkes
Joanna Gibbons
Deborah Hamer
Samantha Handley
Alison Harris
Natalie Hawkins
Andrea Heaton
Sybille Henry
Emma Kingswood
Louise Lightfoot
Sue Lunn
Anne-Marie Lynn
Emma MacDonald
Juliet May
Margaret McCarthy
Teresa McFall
Sheena McKean
Kate Megase
Jo Anne Miller
Susan Morris
Josephine Myddelton
Ann Parker
Heather Pashley
Angela Plant
Shakeera Price
Christine Robinson
Janet Russell
Helen Rutherford
Chhaya Shah
Sameena Shakil
Anat Siani-Walker
Julie Smart
Maria Spyrou
Cheryl Stainer
Emma Stimson
Lesley Strabel
Rebecca Stremes
Alison Sutcliffe
Barbara Taccioli
Joanne Tan
Paola Tartaglia
Victoria Todd
Melanie Tucker
Charley Venables-Bland
Christina Waterhouse
Nicola Woods
Maria Yetman
Melanie Youngman
Cristina Zorat
Senior accredited
counsellor/psychotherapist
Rebecca Aharon
Senior accredited
counsellor/psychotherapist
for children and
young people
Celine Arnold
John Bradley
Debra McDonald-Webb
THERAPY TODAY
Senior accredited
counsellor/psychotherapist
for healthcare
Peter Leitch
Senior accredited
supervisor of individuals
Juliet Layton
For a full list of current accredited
services and courses, please visit
the accreditation webpages at
www.bacp.co.uk/accreditation
Members not renewing
accreditation
Counsellor/psychotherapist
Allison Armstrong
Michelle Attias
Joan Bagnall
Mina Blair
Jeanette Brazier
Wendy Burrows
Frances Coad
Florence Copley
Dominic Davies
Oriana Davies
Elizabeth Day
Angela Dickinson
Jack Doherty
Tara Evans
Janette Fawkes
Lorna Godwin
Anna Goff-Kai
Helen Greenall
Celia Hacking
Anna Hamilton
Edwina Hicks
Alison Hopkins
Anna Janmaat
Ruth Jordan
Melanie Lamb
Karen Langridge
Pauline Lessem
Elizabeth Lewis
Christine McGowan
May Morgan
46
MAY 2017
Lois Mummery
Christopher Murray
Teresa Nicholls
Sandra Nyakupinda
Robin Page
Josna Pankhania
Susan Rice
Sandra Rose
Lesley Rosen
Linda Sensicle
Josephine Sexton
Richard Simpson
Ella Soakell Haines
Maureen Staines
Nicola Sternhell
Jonathan Stoker
Kathryn Taktak
Caroline Tamman
Ian Taylor
Anne Thompson
Anne Towers
Julia Tye
Fiona Wagstaffe
Sarah Warhol
Rhona Webb
Isobel Webster
Accreditation reinstated
Christina Morris
Poilin Quinn
All of the details listed are correct
at time of going to print.
Disclaimer: please be aware that
BACP may have more than one
member with the same name.
To check whether someone is
a registered accredited member,
please visit the BACP Register
at www.bacpregister.org.uk/
check_register
CfD Practice
Research Network
The BACP Counselling for Depression
Practice Research Network (CfD PRN)
is a network of practitioners, trainees,
supervisors, trainers and researchers.
The CfD PRN aims to develop practicebased evidence for CfD, support the
commissioning of CfD, and secure the
position of counsellors working in the
Improving Access to Psychological
Therapies (IAPT) programme in England.
The network provides members
with the opportunity to communicate,
share information and resources, and
discuss topics of interest.
For more information or to join
the network, please visit
www.bacp.co.uk/research
CYP Practice
Research Network
The BACP Children and Young
People Practice Research Network
(CYP PRN) is a network of over
1,000 people who work with
children and young people as
counsellors, trainers, supervisors
or researchers.
The network is a great resource
for sharing information and best
practice, and for raising issues for
discussion. Topics that have recently
generated a lot of discussion
among members include how many
young people it is appropriate for a
secondary school-based counsellor
to see each week, and school-based
counselling contracts.
For more information and to
join the network, please visit
www.bacp.co.uk/research
Learning from
Scottish members
BACP was invited to lead a two-hour
seminar with members of the Glasgow
BACP Private Practice Network to introduce
our new Four Nations approach, share
details of our work to influence policy
and practice in Scotland, and discuss the
challenges Scottish members are facing on
the ground. This is one of a series of visits we
are making to each of the four UK countries
to inform our Four Nations approach.
Steve Mulligan, BACP Policy and
Engagement Lead, Four Nations, said: ‘It
was a fantastic opportunity to talk through
the work we are doing to strengthen
relationships with decision-makers from
across the political spectrum in Scotland,
and to listen to our members so we can
adapt our approach to best serve their
needs, as well as find opportunities
where we can work together to secure
positive change.’
Susan Knox, a private practitioner from
the Isle of Arran, who is a member of the
Glasgow BACP Private Practice Network,
said: ‘Given the distinct social and political
environment in Scotland, a “one size fits
all” approach was not working, and I was
pleased to hear more about BACP’s Four
Nations approach. After Steve’s visit, I felt
reconnected to BACP and reassured, and
I left the meeting feeling very positive.’
Scotland’s 10-year vision
BACP has warmly welcomed the new
Mental Health Strategy 2017–2027
published by the Scottish Government
late last month, following negative
responses to the draft plan last September.
The strategy includes a pledge to
review access to counselling and guidance
services in Scotland’s secondary schools.
BACP has campaigned for this for several
years. There is explicit recognition of
the importance of counselling and
psychotherapy throughout the strategy.
Dr Andrew Reeves, Chair of BACP, said:
‘We hope that this is the catalyst for
Scotland’s children to be given the same
emotional support enjoyed by their
peers in other parts of the UK. Talking
therapies have a critical role to play in
THERAPY TODAY
47
MAY 2017
health and wellbeing, and we hope that
the strategy’s commitment to increasing
the mental health workforce will include
vital investment into the provision of
evidence-based psychological therapies.
BACP is keen to work with the Scottish
Government to ensure its implementation
delivers the transformative impact
Scotland needs.’
School-based
counselling in Wales
The Welsh Government’s latest statistics
on the performance of its independent
school counselling services show its
important benefits for schoolchildren.
YP Core scores for psychological
distress among young people before
and after they received counselling fell
from 19.2 to 11.6. In addition, 88% of
children and young people who had
counselling did not need onward referral.
Welcoming the data, BACP Chair
Dr Andrew Reeves said: ‘The cost of five
sessions of counselling is equivalent to
just one contact with child and adolescent
mental health services [CAMHS]. Investing
a fraction of the mental health budget on
school-based counselling services helps
to keep children in school and avoid
unnecessary and often stigmatising mental
health diagnoses, as well as reducing the
burden on the already stretched and costly
CAMHS services.
‘Currently, only Wales and Northern
Ireland have statutory school-based
counselling. We will continue to campaign
to ensure all children and young people
across the UK have equal access to help
and support.’
BACP round–up
Meet the BACP Board of Governors
Sophie-Grace Chappell
Andrew Reeves
Who? Senior Counsellor at the
University of Liverpool, Senior
Lecturer at the University of
Chester, Project Director with
the Charlie Waller Memorial
Trust, independent practitioner
and author.
Why join the Board? For me,
BACP should be an organisation
that is about relationships first,
not business first. I wanted
to play a part in bringing the
philosophy of counselling and
psychotherapy back to the
heart of the association.
Your vision? Short term, for
BACP to continue to work
collaboratively to create a
culture in which we can create a
stronger voice for the profession.
Mid-term, for clearer training
standards and points of entry
into the profession, clearer
career structures, more paid
employment opportunities for
counsellors, and for counsellors
to be paid a proper wage for
their skills. Ultimately, for clients
to be able to access a choice of
counselling services when they
need to and how they decide
to do so, and for services to be
freely accessible for all.
Wisest advice you’ve ever
been given? ‘Give it time.’ Quick
change is not always sustainable,
even though it can look good in
the short term.
Who? Professor of Philosophy at the Open University.
Why join the Board? Because counselling has
been enormously helpful to me, and because I
believe I have something to contribute to BACP
as a professional ethicist.
Your vision? Untackled, individual unhappiness and
psychological malaise is not only a profoundly bad
thing in itself; it is also a significant drag on economic
and social efficiency. Counselling and psychotherapy
are key tools for freeing people
from their inner traumas and
dysfunctions, and unsatisfactory
relationships, and letting them
live in a way that realises their
real potential. I would like to see
a government and a counselling
profession that are united in
their understanding of this,
and in their aspiration to make
it happen.
Wisest advice you’ve ever
been given? ‘The greatest thing
you’ll ever learn is just to love
and be loved in return.’
Mhairi Thurston
Who? Lecturer in counselling at Abertay University
in Dundee and Programme Leader for the MSc
counselling course.
Why join the Board? I’m nearing the end of my second
term of office and I’ll be standing again
this year. BACP and its Board have
never been in better shape. It feels
so important to keep continuity and
stability so that key strategic intentions
can be developed and progressed.
Your vision? Employability is high
on my wish list. I would love to
see a proper career structure
developed for the counselling
professions, where employees
are valued and paid a
decent wage.
Wisest advice you’ve ever
been given? ‘You can’t
change the cards you’re
dealt, but you can change
how you play the hand.’
THERAPY TODAY
48
MAY 2017
Natalie Bailey
Who? A counsellor/
psychotherapist/supervisor
working with 16– to 19-year-old
students on the apprenticeship
scheme at a further education
college in east London. I also
work in private practice in
London’s Canary Wharf, and
supervise trainee and newly
qualified counsellors.
Why join the Board?
I wanted to make a contribution
to change in areas I am
passionate about – access to
counselling for young people,
parents and carers of children
with special educational needs
and disabilities, and for hard-toreach communities.
Your vision? In five years: that
there are trained counsellors
in all school settings, and the
necessary funding to pay them
for their work; and more support
for parents/carers of children with
disabilities. In 10 years: that the
public can have confidence in the
quality of counselling; we have
cracked the issue of stigma; and
that there is universal recognition
of the relevance of counselling in
our everyday lives.
Wisest advice you’ve ever
been given? ‘Never eat burnt
toast.’ It reminds me of the
importance of self-care, both
personally and professionally.
Vanessa Stirum
Andrew Kinder
Who? Chartered counselling
and chartered occupational
psychologist, registered
coach, Associate Fellow of
the British Psychological
Society, registered practitioner
psychologist, and senior
accredited BACP counsellor.
Why join the Board? To
make a difference within
the counselling professions
and, in particular, to highlight
the issues of employability
of counsellors.
Your vision? The counselling
professions need to be flexible,
innovative and forward-looking.
BACP’s strategy highlights the
importance of positioning our
Who? A divorce mediator
Why join the Board? Because, as
a non-member, I wanted to make
a contribution at board level to the
future of the organisation.
Your vision? For BACP to be a leader in the delivery of
counselling and psychotherapy, and to be recognised as
a key influencer in defining the future of talking therapies.
Wisest advice you’ve ever been given? ‘Take
responsibility for yourself and your actions.’
Caryl Sibbett
Who? A senior accredited counsellor/psychotherapist,
art psychotherapist, supervisor, lecturer and
researcher. I offer these services through my
own consultancy business.
Why join the Board? Because I believe in the
values and work of BACP. I also want to promote
the work of the counselling professions in the UK,
and particularly in Northern Ireland.
Your vision? That BACP will extend access to
counselling for more clients. I am passionately
committed to developing more paid work for
practitioners, with appropriate working conditions
and pay rates that are professional, fair and constructive. In
the longer term, to continue to develop and champion the
value of counselling and the counselling professions.
Wisest advice you’ve ever been given? ‘Don’t let the
sun go down on your wrath.’
Eddie Carden
services to commissioners and
employers so that many more
people can benefit from the
counselling professions. But
we need to avoid being purist
and at the same time ensure
we highlight best practice. In
essence, BACP has a crucial
role to meet the needs of its
members better, especially
around employability.
Wisest advice you’ve ever
been given? ‘The purpose of
life is not to be happy. It is to be
useful, to be honourable, to be
compassionate, to have it make
some difference that you have
lived and lived well.’ (Ralph
Waldo Emerson, poet.)
Who? Chief Executive of Renew Counselling, a BACPaccredited charitable counselling agency in Essex.
Why join the Board? I felt that, as an organisational
and individual member of BACP, I have experience
and insights that would enable BACP
to better understand and meet
members’ needs and champion
our profession.
Your vision? More collaboration
between the professional bodies
in our field, to give a strong,
united voice on the significance
of our work. Personally, I would
like to see statutory regulation for
our profession, as I consider that
voluntary regulation leaves us in
a no-man’s land.
Wisest advice you’ve ever been
given? ‘If a job’s worth doing, it’s
worth doing properly.’
THERAPY TODAY
49
MAY 2017
Myira Khan
Who? Accredited counsellor and
qualified supervisor in full-time
private practice, Associate Tutor
at the University of Leicester,
and founder of the Muslim
Counsellor and Psychotherapist
Network (MCAPN).
Why join the Board? I believe
I can represent and reflect the
diversity within the counselling
profession and networks, as well
as promote counselling to black
and minority ethnic and Muslim
communities. I wanted to be able
to contribute to and pay back
the organisation that has been
so supportive to my work and
to MCAPN.
Your vision? I would like to
see the profession genuinely
represent the vast diversity of
the clients and client groups we
work with. We need to encourage
and support people from a
greater diversity of ethnicities,
cultures and religions to train as
counsellors or psychotherapists,
take up clinical and teaching/
training roles, and work in our
professional bodies. Short term,
I would like to see the BACP
Register become the industry
standard for counselling training
and qualifications, and eligibility
to apply for jobs.
Wisest advice you’ve ever been
given? The best thing is to be
kind – to treat everyone, including
myself, from a place of love and
care. My dad told me that. He
taught me about self-care before
I even heard the term.
BACP round–up
PROFESSIONAL CONDUCT NOTICES
EVENTS CALENDAR
Hearing findings, decision and sanction
Laura Elizabeth Francis
Reference No: 541348
Swansea SA3
The complaint against the above individual
member/registrant was heard under BACP’s
Professional Conduct Procedure, and the
Professional Conduct Panel considered
the alleged breaches of the BACP Ethical
Framework for Good Practice in Counselling
and Psychotherapy.
The Panel made a number of findings
and was unanimous in its decision that
these findings amounted to professional
malpractice on the grounds of incompetence
and the provision of inadequate professional
services, in that the service for which Ms
Francis was responsible fell below the
standards that would reasonably be expected
of a practitioner exercising reasonable care
and skill. The Panel found no evidence of
mitigation and imposed a sanction.
Frances Karen Taylor
Reference No: 754006
Kent BR8
The complaint against the above
individual member/registrant was
heard under BACP’s Professional
Conduct Procedure, and the
Professional Conduct Panel considered
the alleged breaches of the BACP
Ethical Framework for Good Practice
in Counselling and Psychotherapy.
The Panel made a number of findings
and was unanimous in its decision
that these findings amounted to
professional misconduct in that
Ms Taylor’s behaviour contravened the
ethical and behavioural standards that
should reasonably be expected of a
member/registrant of this profession.
The Panel found some evidence of
mitigation and imposed a sanction.
For full details of these decisions, visit www.bacp.co.uk/prof_conduct/notices/hearings.php
Withdrawal of membership
Susan Atkin
Reference No: 562259
Dumfries and Galloway DG13
A sanction was imposed on Ms Atkin
following a professional conduct hearing.
Ms Atkin failed to comply with the sanction
and her membership of BACP was withdrawn.
CPD opportunities
The BACP professional
development day (PDD)
programme comprises a
number of titles delivered
across the UK.
The days have been
designed to deliver
CPD opportunities with
clearly defined learning
outcomes that will develop
Any future application for membership of
BACP will be considered under Article 12.3
of the Articles of the Association.
Full details of all professional conduct
decisions can be found at www.bacp.co.uk
/prof_conduct/notices/termination.php
7 July
Professional
development day
Working with erotic
transference and
countertransference,
with Sally Openshaw
London
8 July
Professional
development day
Bridging the gap: working
with unprepared clients,
with Trish Blundell
Norwich
4 September
Professional
development day
Supervision: relationship,
authority and ethics,
with Steve Page
Edinburgh
28 September
Professional
development day
Working safely and
therapeutically with domestic
abuse, with Gary Williams
Bristol
11 October
Professional
development day
Integrating artwork into
your counselling practice,
with Pauline Andrew
Newcastle upon Tyne
21 October
practitioner skills in the
specified areas.
The days are interactive
to enable every delegate to
get the maximum individual
benefit from attending. To
achieve this, expert tutors
have been selected to
deliver the programmes
and delegate places at
THERAPY TODAY
each event are limited to
a maximum of 25.
For a full list of PDD titles,
please see the events
listing on these pages. For
a full list and to book, go to
www.bacp.co.uk/events/
conferences.php or email
[email protected]
50
MAY 2017
Professional
development day
Bridging the gap: working
with unprepared clients,
with Trish Blundell
Manchester
27 October
Professional
development day
Suicide and suicidal ideation,
with Kirsten Amis Cardiff
Where I work
me
Analyse
I
Cluttered, cosy,
calm or clinical?
What do our
therapy rooms say
about us and how
we work? Elaine
Davies describes
her workspace
work from a converted garage. It’s
an integral part of the house, and it
wasn’t getting much use as a garage,
so I turned it into my counselling
room. I put in the biggest window
possible, and I thought a lot about
the décor. I’ve chosen some very
nice artificial lighting – uplighters
and a standard lamp – and the
colour scheme is lilac and cream.
Snuggle chair
It’s a dedicated counselling room –
I like that it’s the clients’ space and
that I can pull the door closed on
it when I finish work for the day.
There’s a two-seater settee and a
square snuggle armchair, both in
lilac. I let the client choose which
they want to sit in. They tend to stick
with the seat they first choose, which
can be an opener for interesting
conversations about looking at
things from different perspectives.
Something green
There’s a big plant – I think it’s a
castor oil plant – but I’m not greenfingered at all; I just thought it would
be nice to have something green
in the room, a bit of screening. I do
look after it – it’s not dead yet. I’ll
sometimes bring in a vase of fresh
flowers, but I’m always mindful that
scents and smells can be a trigger
for some clients, particularly in
trauma work.
Winter warmth
I’ve got an electric fire, fixed on
the wall. It’s one of those fires with
artificial flames. You need the heat
in the winter months, but I feel
the flames also give out a sense
of warmth. If people feel safe and
cared for, they’re going to feel more
able to talk about difficult stuff.
Certificate
On the wall above the bookcase
is a big print of an iris. I keep my
framed BACP registration certificate
on the bookshelf below it. That
was a conscious decision I made
a few years ago when I joined the
Register. I feel it’s all part of helping
clients feel safe. On the shelf there’s a
selection of self-help books on topics
like coping with panic and anxiety
– books that I might recommend to
clients. I’ve also got a portable wipe
board for my CBT work. I haven’t got
around to putting one on the wall.
Treadmill
The only other thing in the room is
my treadmill. My sons got it for me
a couple of years ago, because my
work is so sedentary and I need to
lose a bit of weight. It’s very heavy,
and there just wasn’t anywhere
else to put it. I do use it a couple of
times a week. It’s also given me more
empathy with clients who find it
hard to motivate themselves. But it’s
been a good topic of conversation,
particularly with clients who want to
get more active, to lose weight or to
help manage depression. I’m actually
discussing with my supervisor how I
could use it in sessions with clients.
About Elaine
Now: a CBT therapist,
counsellor and
supervisor, based
in South Wales
Also: Clinical Lead
Manager for an IAPT
service in Hereford
Was: and still is,
occasionally, a
CBT lecturer
First paid job: GP
receptionist, which
was where she first
realised the link
between physical
and mental health
I have a lilac rug, to go with the lilac
theme, and wood flooring. I chose
that because I didn’t want clients to be
worried about walking mud all over the
carpet. I want them just to be able to
stomp in as they are, in their
work boots if need be
What does your counselling room say about you and how you work? If you’d like to
describe your workspace here, email [email protected]
THERAPY TODAY
74
MAY 2017