FEBRUARY 2017 | VOLUME 28 | ISSUE 1
THERAPY TODAY
New look
New content
New ideas
The voice of the counselling and psychotherapy profession
Counselling women
offenders on
short-term sentences
FEBRUARY 2017, VOLUME 28, ISSUE 1
Working with chronic pain // Culture, race and context // Escaping the drama triangle
Student placements gone awry // Changing lives in the classroom // What’s on clients’ minds?
Contents February 2017
Here and now
News
News feature
The month
Letters
The big issues
Back onside
Gary Bloom applies his sports-journalism
skills in the classroom
Chronic pain: a neurosomatic approach
Judith Maizels and Fiona Adamson attend to the
emotional core of chronic pain
Culture and context
Rose Cameron argues that context is all-important
when working with diversity
Escaping the drama triangle
Mark Head explores the games clients play and
how to defuse them
18
Regulars
This much I don’t know
Life-changing learning
Cautionary tales
Susan Dale launches our regular feature unpacking
ethical problems in everyday counselling practice
Research into practice
Clare Symons encourages more communication
between researchers and practitioners
Dilemmas
Readers wrestle with this month’s testing scenario
Talking point
What’s on your clients’ minds?
Self-care
You tell us how you unwind
Analyse me
What does your counselling room say about you?
‘You communicated with us on an
adult level, unlike the teachers.
You didn’t raise your voice or be
disrespectful… When the teachers are
shouting, it’s hard to respect them, but,
when you treated us like adults, we
respected what you had to say’
A GCSE student explains why Gary Bloom’s approach got through to him
FEBRUARY 2017 | VOLUME
28 | ISSUE 1
THERAPY TODAY
New look
New content
New ideas
The voice of the counsellin
g and psychotherapy profession
Your association
On the cover..
Through the gate
From the Chair
BACP round-up
Classified
Mini ads
Recruitment
CPD
Counselling women
offenders on
short-term sentence
s
FEBRUARY 2017, VOLUME
28, ISSUE 1
Catherine Jackson visits
HMP Styal, where a pioneering
counselling service has
developed new ways of
working with offenders on
short-term sentences
Page 8
Working with chronic
pain // Culture, race and
context // Escaping the
Student placements gone
drama triangle
awry // Changing lives
in the classroom // What’s
on clients’ minds?
COVER_BLUE+SPIN
E.indd 1
01/02/2017 16:19
This is your journal. We want to hear from you. [email protected]
THERAPY TODAY
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Welcome
If there’s a theme this
issue, it’s change. As
therapists, promoting
and enabling change is
central to what we do.
It can take time, but
counselling can and does
change lives for the better,
and this is what makes
our work so fulfilling.
Editor’s note
Welcome to the first issue of our
redesigned, relaunched Therapy Today.
And a warm welcome, too, to Rachel
Shattock Dawson, who has joined the
team as consultant editor. Rachel is an
experienced women’s magazine journalist
and editor, and now a full-time practising
psychotherapist. Her knowledge of
magazine publishing and her views from
the front line of clinical practice have
helped shape the new journal, and will
continue to do so.
Therapy Today last had a redesign in
2009. That design was a classic, admired and imitated widely. But,
when BACP asked Think to take on the publication of the journal,
it was a perfect opportunity to refresh it.
I see Therapy Today as the beating heart of the counselling
professions – its purpose is to feed your thinking and practice with the
oxygen of high-quality articles on clinical and professional issues in
whatever sphere you work.
Our aim with the refresh has been to build on all that was good and
highly valued about the journal – its depth and breadth of professional
content, its invitations to readers to engage with the subject matter
and with each other, and its balance of practice, research, politics
and debate. We have sought to lighten and brighten it a bit, by
introducing more illustration and offering some shorter, more
accessible sections and articles that you can dip into and to which,
we hope, you will contribute.
Email me your thoughts; we really do want to know what works
for you and what doesn’t. This is a process, not the end goal.
CHARLIE BEST
Last summer, a group of us gathered round
a big table to talk about changing Therapy
Today. How could it be improved? What
needed refreshing? Was every page earning
its keep? Was there a good balance between
theory and practice, and was there something
for everyone, from student
to practitioner to manager
to professor?
Many months later and a
renewed and reinvigorated
Therapy Today is born.
As a former editor turned
therapist, I’m proud that
Therapy Today has always
stood out as a class act
among its peers. We hope that you now
find it more useful, engaging and thoughtprovoking. Of course, we’d love to hear what
you think, good and bad. We’ll be listening.
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
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
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
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.
Case studies All case studies in this
journal, unless otherwise stated, are
permissioned, disguised, adapted or
composites, to protect confidentiality.
5
FEBRUARY 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
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the terms of licences issued by the Copyright
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by the publisher to administer reprographic
reproduction rights. Individual and organisational
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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)
In the news
Our monthly digest of news, updates and events
Research funder bias
Trials directly comparing
antidepressants with
psychotherapy consistently
produce better results
for drug treatments
when they are funded by
pharmaceutical companies,
a new study has found.
The meta-analysis,
published in the January
issue of the British Journal
of Psychiatry, looked into 45
randomised controlled trials
New investment
in mental health
comparing drug treatment
with talking therapy. In
the 20 studies funded by
pharmaceutical companies,
the drug treatment was
significantly more effective
than psychotherapy; in
trials with no such financial
support, there were no
differences in outcomes.
There was a small but
not statistically significant
difference in favour of drugs
Mental health first-aid training for at least
one member of staff in every secondary
school in England and a £67.7 million
investment to accelerate the use of digital
technologies are among the commitments
to improve England’s mental health
services announced in January by Prime
Minister Theresa May.
The funds for digital technologies
will mostly be channelled to six NHS
trusts that are already pioneering new
approaches, but will include £3 million
to pilot digitally assisted CBT in IAPT
services, and £500,000 to develop new
digital tools for children and young
people with mental health problems.
For people in crisis, £15 million is being
allocated to setting up alternatives to
hospital A&E admissions, such as crisis
cafes and community clinics.
The Prime Minister also promised a
major review of child and adolescent
mental health services across the country,
led by the Care Quality Commission,
and a new green paper setting out plans
to improve mental health services for
children and young people in schools
and universities, and for families.
bit.ly/2iv6c1d
when drug companies only
supplied free medication.
The researchers stress that
the results do not show that
funding by pharmaceutical
companies, or any financial
conflict of interest on the part
of the authors, is responsible
for the more favourable
outcomes for drug treatments
in these trials; simply that
they ‘raise a doubt that there
might be such a bias at play...
77%
of IAPT high-intensity therapies are
delivered face to face, and 21%
by telephone, IAPT data show.
Some 44.5% of guided self-help is
delivered by phone, and 36% face
to face. bit.ly/2k3UPSa
76.9%
of referrals for psychological
therapies in Scotland were seen
within the 18-week limit. In the
quarter ending September 2016,
11,138 people started treatment,
fewer than in the previous two
quarters and down from 13,077 in
the same period in 2015.
bit.ly/2iQFQJF
Couple therapy ‘effective’
Psychodynamic couple therapy really does work, a
study by the charity Tavistock Relationships shows.
The research, the largest prospective naturalistic
study of couple therapy, involved 877 adults (508
women and 369 men) who attended the charity’s
two London clinics for at least two sessions and
completed self-report measures.
The findings prove that psychodynamic
couple therapy is ‘as effective for individual and
relationship distress as any other couple therapy
that has ever been tested for effectiveness’, said
Andrew Balfour, Chief Executive of Tavistock
Relationships. bit.ly/2jwARiq
19,000
children and young people in
England and Wales were admitted
to hospital for self-harm last year, up
14% in the past three years. Childline
delivered 18,471 counselling
sessions about self-harm. It was one
of the most common issues raised
by callers. bit.ly/2j8RUDw
THERAPY TODAY
6
painfully pointing to the
pervasiveness of industry
influences on treatment
outcome research’.
bit.ly/2jZzYv4
FEBRUARY 2017
Stress and
heart attacks
Malta bans
gay ‘cure’
Malta has become the first
European country to ban
reparative (conversion)
therapy, which seeks
to change gay people’s
sexual orientation.
Under Malta’s new
Affirmation of Sexual
Orientation, Gender Identity
and Gender Expression
Act, any health professional
found guilty of prescribing
or delivering treatment that
seeks to ‘change, repress
or eliminate a person’s
sexual orientation, gender
identity and/or gender
expression’ could be fined
up to €10,000 or receive a
one-year prison sentence.
In the UK, all the main
psychotherapy and
counselling bodies say it is
unethical for members to
offer reparative therapy, and,
with the NHS, have signed
up to a memorandum of
understanding stating that it
is harmful, but that practising
it is not illegal.
ALAMY
Loneliness toll
Gambling costs
The Government should
do more to tackle problem
gambling, a new report from
the Institute for Public Policy
Research (IPPR) says. The
report, Cards on the Table,
calculates that problem
gambling removes up to
£1.16 billion a year from
the UK economy, in health,
welfare, employment and
other public services costs.
IPPR says between 0.4
and 1.1% of the UK adult
population are problem
gamblers, and 4% are at-risk
gamblers. Men are five times
more likely than women
to be problem gamblers.
More than half the UK population (52%) are at
the very least sometimes lonely; just 20% say that
they have never felt alone, a new report from the
Co-op and the British Red Cross has found.
The report, Trapped in a Bubble, is based on a
survey of over 2,500 people. It identifies several
key triggers for loneliness, including separation
or divorce (reported by 33%), long-term health
conditions (32%), mobility problems (30%)
and bereavement (19%). Some 73% of those
surveyed reported at least one of these triggers.
Young people are the least
likely to gamble, but are the
most likely to be problem
gamblers. Problem gambling
is more prevalent among
people on lower incomes and
among some ethnic minority
groups – people of Asian/
Asian British origin and black/
black British origin (2.8% and
1.5% of the adult populations,
respectively) especially.
The Government should
recognise problem gambling
as a major public health
issue, IPPR says, and create a
strategy to improve access to
treatment and reduce public
risk. bit.ly/2gCMYJU
Difficulty accessing statutory services and
support, the loss of social spaces and inadequate
transport infrastructure all make it harder for
people to escape loneliness and find support,
the report says.
The British Red Cross has launched a twoyear programme to provide person-centred
psychosocial support in the homes of 12,500
people who are experiencing loneliness or
social isolation across the four UK nations.
bit.ly/2h487f2
THERAPY TODAY
7
FEBRUARY 2017
Researchers have identified
what links chronic stress with
heart attacks and strokes.
It has long been known
that chronic anxiety and
stress are linked with a higher
risk of cardiac problems.
New research, published
in The Lancet, has now
established that the link is
heightened activity in the
amygdala, the part of the
brain that controls the body’s
response to threat. It tells the
bone marrow to temporarily
produce more white blood
cells, in preparation to fight
infection and repair damage.
In today’s world, chronic
stress can lead to the
overproduction of white
blood cells, which can form
plaques in the arteries and
lead to heart disease, this
new research confirms.
‘This raises the possibility
that reducing stress could
produce benefits that extend
beyond an improved sense
of psychological wellbeing,’
lead author Dr Ahmed
Tawakol said. bit.ly/2jmeSrf
4,820
people are recorded as having
died by suicide in England in
2015 – 10.1 in100,000 deaths.
The House of Commons
Health Committee is calling for
government action, including
tougher penalties for irresponsible
media reporting of suicide. Media
guidelines are being ‘widely
ignored’, it says, and restrictions
may also be needed on access to
potentially harmful internet sites
and content.
bit.ly/2hzaMOl
News
feature
Through the gate
Catherine Jackson visits HMP Styal, where a pioneering
counselling service has developed new ways of working
with offenders on short-term sentences
'H
ope is something
you can’t have
without putting in
the hours for it. I
got out in May and relapsed
and came back in. In the past
four months with Room to
Talk, I have made changes
that I feel I can sustain when
I get out again. It’s made me
focus 110 per cent on what
I want, what I need and how
to get it – and I have got that
from these wise women in
here. I have grown more in
the past four months than
I ever did before.’
This is Alex, one of the 472
women offenders currently
serving their sentence in
HMP Styal, Cheshire, one of
the 12 women’s prisons in
England. She is at high risk of
becoming a ‘revolving-door
offender’. Half of women
offenders are reconvicted
within a year of their release,
and the proportion goes up
with the number of times they
return to prison. We used to
talk about ‘revolving-door
psychiatric patients’; with
these statistics, and others
telling us that nearly half
(46%) of women offenders
have suffered domestic
violence, 53 per cent have
experienced physical,
emotional or sexual abuse
in childhood, and 56 per
cent witnessed violence in
the home in childhood,1 the
distinction between the two
populations is becoming
increasingly blurred.
Yet, other than at Styal,
there is no organised,
established counselling
provision in England’s
female prison estate.
Alex is one of the lucky
ones, in that she has had
access to Room to Talk, a
voluntary-sector counselling
service set up six years ago
in Styal by two women,
Michelle (‘Shelly’) Cardona
and Eileen Whittaker. They
met when they were doing
their counselling training and
found they shared a sense
of dismay at the absence of
access to counselling among
women prisoners. Styal’s then
governor, John Hewitson,
welcomed them with open
arms, but no funding. They
launched the service with
just three counsellors,
working from the dining
room in one of the Victorian
villas that accommodate
most of the prisoners at Styal,
and now have a team of 25
– some volunteers and some
on placement. The service
is open three days a week,
offering 45–50 counselling
sessions to the prisoners and
prison staff from its own small,
but lovingly decorated (by
clients), hut.
THERAPY TODAY
‘Women bring everything,’
says Eileen. ‘Most have
underlying trauma, and
histories of child sexual
abuse and rape, torture or
trafficking. A lot are living
with quite difficult existing
disorders and depression.
Bereavement, miscarriage,
addictions – it’s all here.’
Giving time
Room to Talk has received
no external funding, other
than a £4,000 grant from
Lloyds Bank to set up a
website. Both Shelly and
Eileen have counselling
jobs that subsidise the three
days a week they devote to
Room to Talk. But they have
received the full backing of
the prison and the prison
governor, Mahala McGuffie.
‘We are massively grateful
for the support Mahala has
given Room to Talk, which
has meant we can make a
difference to women’s lives
here,’ says Eileen.
Purists may say it’s not
possible, and it’s potentially
8
even harmful, to try to offer
talking therapy in such an
environment, where clients
face numerous obstacles,
practical and emotional,
to engaging with therapy.
Women may be moved
without notice to another
prison, or be required to
attend a course during their
therapy hour; most have
had a lifetime of abuse and
exploitation, and may find it
hard to trust the service. They
may be in prison for such a
short sentence that they can’t
benefit from the counselling.
Shelly has no time for such
naysayers: ‘Prison is nothing
like the community,’ she
says. ‘I say to them: “Come
here and see how much
difference you can make.” To
me, it’s what person-centred
counselling is all about –
giving time to women. No
one has ever done that for
these women before. Even
holding them for one session
can make such a difference,
when they’ve had bad news
from home, for example,
‘To me, it’s what person-centred
counselling is all about – giving time to
women. No one has ever done that for
these women before. Even... one session
can make such a difference’
FEBRUARY 2017
and they can’t fix it because
they’re in here and they
feel helpless and hopeless.
Purists may doubt that one
hour of your time can help,
but we disagree.’
Anastasia Selby, Head of
Reducing Reoffending at
Styal, is unequivocal about
the benefits that Room to
Talk brings to the prison,
the women and the staff.
‘So many of the women
have underlying issues from
their past, and that is where
Room to Talk comes in. It’s
confidential, it’s individual,
it’s outside the prison system,
and it’s there for the women
when the time is right for
them, and I think that is of
enormous benefit,’ she says.
‘Almost every other
intervention here is
compulsory; it’s timetabled,
and it isn’t confidential. There
is very little here that they
can choose for themselves.
With Room to Talk, it’s their
decision to attend. A lot of
the women who have gone
through counselling with
Room to Talk have said how
much it has helped move
them on in life in terms of
their attitude and behaviour
in here.’
Counselling is ‘part of
the rehabilitative culture
that enables change to take
place’, Anastasia says, and
‘There is very little here that they can
choose for themselves. With Room to
Talk, it’s their decision to attend. A lot
of the women have said how much it
has helped move them on in life’
Room to Talk is seen as very
much part of the support and
care that the prison provides,
alongside the mental health
and substance-abuse service,
and the education and
other programmes aimed at
reducing reoffending. But it
is not something the prison
itself can fund, because there
is no evidence that it directly
contributes to reducing
reoffending. And it works well
precisely because there is
that clear separation between
it and the statutory prison
service, Anastasia believes.
FIRST programme
As is common throughout the
women’s prison service, many
of the women in Styal are
serving very short sentences –
around a quarter are there for
just 14 days, and the average
sentence is just 10 weeks. For
these women, who are also at
the highest risk of becoming
THERAPY TODAY
repeat offenders, there
has been little that Room
to Talk can offer. However,
now, thanks to a £200,000,
three-year grant from the
Big Lottery, Shelly and Eileen
have been able to launch
the FIRST programme.
FIRST (the Foundation
for Inspired Rehabilitation
with Skills and Tools) is
an intensive groupwork
programme that runs over
three to four weeks, two days
a week, and is designed
specifically to address the
lack of self-esteem and selfworth that is endemic in the
women’s prison population.
Shelly and Eileen believe
that, if the women value
themselves more, they will
make different, better choices
when they are released
back into the community,
and make more use of the
support services that are out
there for them.
9
FEBRUARY 2017
‘Women serving shortterm sentences are often
too chaotic to engage with
counselling, or not here
long enough to feel safe to
open up in counselling, so
we are trying to give them
something they can engage
with,’ says Shelly. ‘We don’t
tell them not to reoffend.
There’s enough people telling
them about the mistakes
they’ve made in their lives.
We are trying to help them
value themselves. Because,
if they don’t feel that, where
is the drive and inspiration
to change?’
The groups are for a
maximum of 12 women,
and are facilitated by two
counsellors, supported by
peer mentors who have
already completed the
programme. It is available to
all women who come into the
prison who have at least six to
eight weeks of their sentence
to serve, unless they have
evident psychosis or need
first to detox. The programme
comprises eight sessions (see
box overleaf) and mainly uses
creative arts techniques to
help women open up about
their emotional health needs.
For example, the women
are all given an empty rag
doll – just a cotton shape –
and throughout the week
they gradually fill her out in
News
feature
FIRST programme
their image: hair, clothes,
identifying marks (scars from
self-harm, or tattoos, for
example). When the doll is
finished, they can give it to
anyone they want. Some give
their doll to their children, so
they have something of their
mother at home while she is
still in prison. Breakdown of
family relationships and loss
of contact with their children
are major issues for many
women in prison. ‘Something
so small can be so powerful,’
Shelly says.
Guilt and shame
Another very powerful
exercise is to write a letter to
a loved one, telling them how
they want to be remembered.
In another session, each
woman is given a paper
flower to pass around the
group, and everyone writes
something positive about her
on each petal. ‘They feel such
guilt and shame about being
in prison. They can’t see the
positives about themselves.
It’s much easier to hear
the bad things than accept
compliments and see the
good,’ says Shelly.
The FIRST programme also
offers a ‘through the gate’
follow-up service; women can
Session one:
BUILDING TRUST
Getting to know each
other, expectations,
confidentiality and
setting boundaries.
Session two:
MAKING SENSE
OF MY WORLD
Understanding emotions,
safe expression, impact
on self/family/children,
healthier coping
mechanisms, stress and
anxiety management.
Domestic violence.
Session three:
ADDICTIVE AND
RISKY BEHAVIOUR
Understanding addiction
and its effects, reframing
unhelpful beliefs, asking
for help. How thoughts,
feelings and beliefs affect
behaviour and inform
come for counselling with
Room to Talk in one of the
houses outside the security
fence for up to three months
post-release, and Room to
Talk ensures they are linked
in with their local women’s
centre, where they can get
further help and support.
Thanks to the Big Lottery,
the FIRST programme is
being evaluated to measure
‘Everyone is there, on the floor, making
things, and people can explore what is
going on with themselves, and it’s so
relaxed that they’re more likely to share
and open up more with the counsellors’
THERAPY TODAY
choice. Sex workers
and trafficking.
Session four:
WHERE DO I BELONG
AND WHAT AM I WORTH?
Enabling recognition of
personal strengths and
drawing on them in times
of vulnerability.
Session five:
COMMUNICATING WITH
PEOPLE I CARE ABOUT
Identifying different
styles of communication,
expressing difficult feelings
safely and appropriately,
learning to be assertive.
Session six:
FEELINGS ABOUT MYSELF
What is self-esteem,
efficacy and resilience,
and why do they
matter? Challenging
maladaptive thoughts
and raising self-worth.
Improving confidence and
recognising personal value.
Session seven:
MY FUTURE PLAN
Planning for good
and bad times and
promoting personal
safety. Acknowledging
personal needs, giving
‘self’ permission to accept
ongoing help. Where help
can be accessed. Building
a pro-social identity.
Session eight:
HOW DO I DEAL
WITH ENDINGS?
Understanding the
importance of positive
closure; reinforcing
resilience and
acknowledging potential
for change. Positive
affirmations and hope
for the future.
changes in the women’s
mental health and mood.
Reoffending rates are also
being tracked, to assess
its impact.
‘It softens you’
For Alex, taking part in the
FIRST programme provided
a space where she learned to
trust other people enough to
open up: ‘Everyone is there,
on the floor, making things,
and people can explore what
is going on with themselves,
and it’s so relaxed that they’re
more likely to share and open
up more with the counsellors.
If you are one of those people
who feel you don’t fit in, you
lose that – it softens you.’
10
FEBRUARY 2017
REFERENCES
1. See www.
womensbreakout.
org.uk/about-us/
key-facts
New approaches
Are you
pioneering
new ways of
working? Email
therapytoday@
thinkpublishing.
co.uk
To contact Room
to Talk, email
info@roomtotalk
cic.co.uk
The month
What’s new on the bookshelves – and the classics that shaped us
Unforbidden pleasures
Book group
Read a new book
we should list?
Email reviews@
thinkpublishing.
co.uk
Must
read
Critical and experiential:
dimensions in gender
and sexual diversity
Adam Phillips (Penguin, 2016; £9.99)
We spend our lives chasing illicit
pleasures, but who pays much attention
to all the ‘unforbidden’ pleasures freely
available to us every day? Could we be
gaining just as much reward from these
unnoticed, permitted indulgences as we
do from the more glorified forbidden
ones – or more? Starting with Oscar
Wilde, Phillips unfolds the
meanings and significances
of the unforbidden, drawing
from sources from the
Book of Genesis to Freud
and his contemporaries to
explore the philosophical,
psychological and social
complexities that govern
human desire and shape
our reality.
Previn Karian (ed) (Resonance
Publications, 2016; £42.50)
This collection from the emerging
field of gender and sexual diversity
(GSD) explores non-normative gender
and sexual lifestyles rarely included in
mainstream literature. Contributors
from clinical
psychology,
psychotherapy,
sociology, cultural
studies, political
activism and the legal
profession explore
a wide range of
personal experiences
and theoretical
perspectives.
Psychodynamicinterpersonal therapy:
a conversational model
Great psychologists as parents:
does knowing the theory
make you an expert?
Michael Barkham, Else Guthrie,
Gillian E Hardy and Frank
Margison (Sage, 2016;
£24.99) Drawing on 40 years of
research, teaching and practice,
Barkham and colleagues present,
for the first time, a practical manual
for psychodynamicinterpersonal therapy (PIT).
PIT is built on ‘knowing
a person’, rather than
knowing about a person,
and, in combination with
a strong therapeutic
alliance, supports clients
to find solutions to
problems in the context
of a ‘conversation’.
David Cohen (Routledge, 2016;
£29.99) Using letters, diaries,
autobiographies, biographies and
interview material, Cohen explores what
the historical pioneers in theories of
child development said about raising
children and how they raised their own.
Chapters on Darwin,
Freud, Jung, Klein and
the founding figures
in developmental
psychology, such as
Piaget, Bowlby and
Spock, offer insight
into their family lives
and the impact of their
parenting on their
own children.
First lines
‘“I was invisible,” says “Barry”, his voice little more than a
whisper. “No one saw me when I was growing up. There
were so many of us I think my mam forgot about me a
lot of the time. Apart from him. He saw me alright.”’
From Psychotherapy with male survivors of sexual abuse: the invisible men by
Alan Corbett (Karnac, 2016; £24.99)
THERAPY TODAY
11
FEBRUARY 2017
Sex now, talk later
Estela V Welldon (Karnac, 2016;
£9.99) Why do we police what we
see as ‘normal’ sexual behaviour?
And what do we gain by doing
so? In this thoughtful, humorous,
challenging book, Welldon argues
that disapproval of others’ or our own
sexual behaviours closes our eyes to
a deeper understanding of human
nature. Using clinical
vignettes and her
own life experiences,
Welldon confronts us
with unusual sexual
behaviours that
almost always elicit
judgmental reactions
that hinder our deeper
understanding of
human relationships.
A book that shaped me
Moominsummer madness
Tove Jansson (Puffin, £6.99) I was
enchanted by the Moomin books
as a child, and this, the fourth in
the series, remains my favourite.
Jansson evokes a world in which
the Moomin family approach life
with an optimism that annoys those
with a more cynical perspective,
like Misabel and Little My; a world
in which good is always good
and bad things can be turned into
something good. Jansson offers
an inspirational
philosophy: don’t
worry about things
that can’t be changed
– embrace the
adventure. Everambivalent myself,
I remain, in roughly
equal measure, part
Moomintroll and
part Misabel.
John Daniel
What book contributed
to making you into the
person you are?
Email a few sentences to
[email protected]
The month
Our monthly round-up of film, theatre, the media and events
Theatre/film
Go fathom
Editor’s
choice
What would you make of a client like
Hedda Gabler? A woman yearning
to be true to herself yet finding her
spirit crushed by a restrictive society
– bored, manipulative and suicidal.
Ibsen wrote this play about the same
time that Freud began publishing
his psychoanalytic theories around
inner conflicts and how and why we
are driven to using people. Hedda,
played by Ruth Wilson, illustrates this
complexity beautifully in her refusal
to conform. In an interview with the
Sunday Times, Wilson suggests:
‘Maybe the point is that there are
some people you meet in life who are
really complicated and mystifying and
frightening, because you can’t crack
them open.’ Freud couldn’t have put it
better himself. Hedda Gabler plays at
the National Theatre, London, until
21 March and will be broadcast live
in cinemas nationwide on 9 March.
bit.ly/2j0qQav
‘Once again, people with deep psychological
wounds get miscast as the perpetrators,
instead of, more realistically, victims of
violence... This movie makes people with
dissociative identity disorder the next in
a long line of cultural scapegoats.’ Blogger
Iain C previews M Night Shyamalan’s new
psychological horror movie Split. bit.ly/2jUIGuE
Event
For both client and counsellor, a
diagnosis of a mental disorder
– be it bipolar, borderline
personality disorder or any other
from the expanding catalogue
of labels from the biomedical
world – presents a number of
challenges. Psychotherapist Jo
Watson and clinical psychologist
Lucy Johnstone challenge the
assumption that emotional
distress is best understood as a
disease. Their one-day event, A
Disorder for Everyone, is a mix
of talks, debate and poetry that
explores the impact this is having
on therapeutic practice. The next
event in a nationwide tour is on
3 March in Bristol.
bit.ly/2jK6rIH
LEA NIELSEN
Podcast
Post-Brexit referendum and with
Donald Trump in the White House,
a question hangs in the air: ‘What
is our national identity?’ For
many people, the ambiguity of
belonging to a place and
yet sensing that you are not
accepted there will be familiar.
A joint project between
Must
the Pentabus Rural Theatre
listen
Company and leading blackled touring company Eclipse
has produced White Open Spaces,
a series of podcasts about
race and racism in the
countryside. Provocative, sharp
and moving, six voices give their
perspectives on our nation today.
Ambridge it ain’t.
bit.ly/2gNp510
THERAPY TODAY
12
FEBRUARY 2017
Film
YALOM’S CURE
For those who still feel there’s more to
know about Irvin Yalom (although he
isn’t one to shy away from self-disclosure
in his many books), this biographical
documentary offers more insight into
the psychotherapist’s life. The film
travels between footage of his group
work during the 1960s to his personal
observations on his own relationships.
Much room is given to Yalom’s 60-year
marriage to Marilyn. The intervening
shots of nature make for a somewhat
meditative experience. Yalom’s Cure
is available on DVD.
yalomscure.com/en
49% of @Counselling_UK followers cuddle a pet to cheer themselves up (26% see friends or family)
If you only have two minutes…
Video
IT’S NOT
ABOUT THE NAIL
Must
watch
Got an event that
would interest
Therapy Today
readers?
Email media@
thinkpublishing.
co.uk
This video short by Jason Headley, available
on YouTube, touches the heart and the funny bone.
A wonderful demonstration of how the strong
urge to rescue rather than empathise can lead
to miscommunication.
bit.ly/MnyfOZ
Radio
ROBERT DAY
Theatre
‘I know you want what everyone else
wants. A family. A home. But you’ll
never have it. ’Cos of what’s inside you.’
Poignant and darkly funny, All the Little
Lights tells the story of three teenage
girls who slip through the cracks.
Written with the help of the charity Safe
and Sound, it is a story of child sexual
exploitation and what happens when
society turns a blind eye. Fifth Word
is taking the play on a full UK tour this
spring, with a London run planned for
later this year.
www.fifthword.co.uk
THERAPY TODAY
Film
The pain in silence
Amid the glitz of this year’s Oscars, Manchester
by the Sea stood out, and it is predicted to be the
most affecting film of 2017. Written and directed
by Kenneth Lonergan and starring Casey Affleck,
it is about an uncle (Affleck) who looks after his
teenage nephew after the boy’s father dies. It is
a story of grief and trauma but also something
rarely portrayed in film: the silence of pain and the
pain in that silence, and how the death of a loved
one brings to the surface the losses of the past.
Occasionally funny, its depiction of the spirit of
endurance stays with you long after you’ve left
the cinema. Catch it at your local indie cinema.
Must
see
CLAIRE FOLGER, COURTESY OF AMAZON STUDIOS AND ROADSIDE ATTRACTIONS
ALL THE
LITTLE LIGHTS
Is psychoanalysis in need of
resuscitation? If you missed
Daniel Pick’s fascinating Radio 4
programme Freud for Our Times
last month, you may wonder what
could be gained from a Freudian
revival, given the quantum leaps
in theory and methodology since
his death almost 80 years ago.
Pick, a historian and psychoanalyst,
peppers a series of interviews with
rare, albeit crackly, recordings of
Freud to explore the strength of
an approach that has lost status
in today’s neo-liberal society,
where quicker, cheaper solutions
are favoured. Augmented by
surprising research findings from
the Tavistock & Portman NHS
Foundation Trust, Pick offers a
persuasive counter-argument.
Freud for Our Times can still be
heard on BBC iPlayer.
bbc.in/2h4joJC
13
FEBRUARY 2017
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]
WORKING WITH
NON-BINARY CLIENTS
After such a wonderful article on looking
beyond the binary gender (‘Look beyond the
binary’, November 2016), I was disappointed
to see that Therapy Today had chosen to
publish responses (in December’s letters
pages) featuring inflammatory headlines
and misgendering, and false statistics.
From my own experiences, as well as
discussion with my friends and peers, it
seems that it is all too common for nonbinary people to have negative experiences
in the counselling world – this is true for
students and professionals, as well as for
clients. I would like to provide some balance
to this by presenting some questions for
counsellors considering working with nonbinary clients, as a resource to assess their
suitability for working with this client group.
l Do you take responsibility for informing
yourself about the language and culture of
those identifying outside the gender binary?
l Does your paperwork include options for
non-binary titles, genders and pronouns?
Have you reflected on your reasons for asking
for a client’s gender?
l Do your counselling rooms have
gender-neutral toilet facilities?
l Is your counselling service in an area safe
for gender-non-conforming clients to access?
l Do you assume your client’s gender or
pronoun based on appearance?
l Do you hold views that many non-binary
people view as offensive (for example, that
being trans or gender-non-conforming is
dysfunctional, a trend, anti-feminist or a
symptom of immature development, or that
trans people should not have access to singlegender spaces, such as bathrooms or refuges?)
l Do you have non-binary people in your
personal life? If not, why? Does only seeing nonbinary people professionally affect your work?
l How would you feel about dating a nonbinary person, or having a non-binary person
as a family member? Would you have
a preference for them to be cisgender?
l What work have you done to explore
your own transphobia?
l What have you done to explore your
own gender identity?
l Are there any aspects of your own identity
that break gender norms? How do you feel
about these parts of yourself? How may this
affect your client work?
l Are you aware of cross-cultural and
intersectional issues that may affect your
clients’ identity?
l Are you informed about structural
discrimination against non-binary people?
How might this be reflected in the power
dynamics of your counselling relationships?
What are you doing to remedy this?
Steve Jasmine Tomkinson MBACP
Person-centred counsellor, Manchester.
www.stevejasminecounselling.com
PUTTING THE RECORD
STRAIGHT ON TRANS ISSUES
I read with dismay the two letters published
in December’s Therapy Today in response
to Kaete Robinson’s excellent piece ‘Look
beyond the binary’ (November 2016). I have
been reflecting on whether such prejudice
would have been published if it were related
to another minority group, although it is
of course impossible to draw comparisons
between the struggles of different
marginalised minorities.
Bev Gold compares gender dysphoria
with anorexia, and with negative self-beliefs
that lead someone to be ‘uncomfortable in
their own skin’. But we have recently heard
conclusive evidence from a Lancet study that
gender dysphoria is indeed not a form of
mental illness, but a legitimate phenomenon
that needs not to be pathologised.1 She talks
about the mental distress of trans people but
ignores the sizeable body of evidence that
suggests any mental health issues are created
by stigma, negative attitudes and barriers to
transition,1 with studies demonstrating that
support in transition and acceptance alleviate
THERAPY TODAY
14
FEBRUARY 2017
this distress,2 while efforts at reparative
therapy only do harm.
As someone who is a member of both
trans and LGB communities, I experience a
disparity between a growing intolerance of
anti-LGB ideologies and an abiding tolerance
and dissemination of anti-trans ideas.
In addition, Bev Gold makes the frustrating
conflation that accepting someone as
transgender will necessitate them having
surgical transformations. Many trans people
do not have medical treatment. For those
who do, it has been proven to be inordinately
successful in alleviating dysphoria, with very
low evidence of regret. Bev Gold infers the
opposite, that this is somehow a dangerous
and tragic path.
Ultimately, trans identities need to be
accepted and validated, whether or not
someone has made medical changes. The
underpinning message of Bev Gold’s letter
is that, if a client enters the room and states
their name and pronouns and how they
experience themselves, we should cast
doubt on this, pathologise it and force them
to explore it, whether or not that is what
they are asking for in their therapy. This
is profoundly unacceptable and contrary
to the principle of autonomy in the BACP
Ethical Framework.
The second letter, from Stephanie DaviesArai, trots out some well-worn anti-trans
myths: that detransition is common (it is rare);
that the fact that detransition occasionally
happens means that transition is overall
harmful (strong evidence refutes this); and
that 80 per cent of trans children ‘desist’ – this
is evidenced in many places as a conflation of
Conclusive evidence shows
that gender dysphoria is
indeed not a form of mental
illness, but a legitimate
phenomenon that needs
not to be pathologised
To the editor
RESPECT FOR CLIENTS’ GENDER IDENTITIES
As a counsellor who supports clients
in the area of gender diversity, I was
very saddened to come across the
letters ‘Unstoppable bandwagon’ and
‘Too quick to jump to transition’ in the
December 2016 issue of Therapy Today.
Many of the clients I support face a
daily battle to be seen and respected
for the gender identity they know
themselves to be. A quick glance at the
mental health statistics shows just how
damaging micro-aggressions such as
misgendering and rejecting someone’s
self-identification are to people who
are trans and/or questioning their
gender identity. In 2014 the charity
PACE found that almost half (48%) of
trans youth under 26 had attempted
suicide and we know trans people of all
ages are massively overrepresented in
mental health statistics.
More people are coming out, and
the visibility of trans lives has increased
greatly in the past few years. As our
awareness of the diversity of gender
identity and expression has grown as
a society, sadly the backlash has also
grown. We are only too familiar with
how hate speech can turn to hate crime
(particularly in the current political
context) and have seen a rise in attacks
on trans people. So it’s very saddening
to come across these two letters, which
both appear to argue that we should
not accept a client’s identification as
the truth (and perhaps that we are the
trans and gender-non-conforming children. In
fact, studies have shown that genuinely gender
dysphoric children have gender identities
that are as consistent as those of cisgender
children. In other words, if we talk about not
allowing trans children to express their gender
through pronouns, clothes and gendered
names, then we should equally be concerned
about gendering cisgender children in the
same manner.
She talks about ‘sudden onset’ of
symptoms, apparently having no knowledge
or understanding of the lengths of time
involved in obtaining a diagnosis of, and
treatment for, gender dysphoria, or that
experts in their gender identity). I’d like
to ask: is this really ever acceptable?
If a client said they were lesbian, gay
or bisexual, would it be acceptable to
question their sexual identity?
The BACP ethical guidelines promote
principles such as autonomy, justice and
non-maleficence. Thus, we are asked to
treat all clients with fairness, to respect
clients’ rights to be self-governing,
and not to cause clients harm. BACP
has also expressed a clear stance on
reparative therapy through the 2016
Memorandum of Understanding on
reparative therapy, stating that ‘BACP
is utterly opposed to any misuse
of counselling or psychotherapy to
attempt to change a person’s sexual
orientation or gender identification’. If
we are refusing to accept clients’ selfidentification in terms of their gender
identity, how much of a leap is it to say
that we are seeking to change their
gender identity?
It is vital that counsellors abide
by the BACP ethical standards, that
they (and educators) acknowledge
when they need further learning
and training, and that they listen to
the voices of trans people both as
educators and as clients.
Debbie Clements MBACP
Counsellor, psychotherapist
and trainer.
counsellingserviceleeds.co.uk
clinicians will be looking for a consistent
pattern, and enduring and stable gender
identity. Evidence demonstrates most trans
people identify their dysphoria from a young
age, and that any ‘sudden onset’ symptoms
would not lead to treatment in anything
less than years. Meanwhile, this child will
be subject to relentless doubt, questioning,
bullying and attack. It is far more plausible
that trans children are dissuaded from
transitioning by this stigmatising and hostile
world than that we live in a culture where
being trans is over-enabled.
Stephanie Davies-Arai talks about
‘transgender indoctrination’ as if it is possible
THERAPY TODAY
15
FEBRUARY 2017
A quick glance at the mental
health statistics shows just how
damaging micro-aggressions
such as misgendering are to
people who are trans
for our tiny community to outbalance the frombirth indoctrination of cissexism – that is, the
assumption that we should attach entire legal
and social structures, names, pronouns, toilet
arrangements and much more to the shape of
people’s genitals; not forgetting that intersex
children often endure normalising surgery
in infancy, and later sometimes hormonal
treatment, to artificially fit this binary – an issue
that incites considerably less outrage than the
treatment of trans children in adolescence with
entirely reversible puberty blockers.
The treatment of transgender children and
adults is, contrary to these letters, slow-paced,
conservative, well-studied over nearly a
century, and very well clinically evidenced.
While there are intersections between
the gay and trans communities, to suggest
that trans people are simply confused gay
people or that being trans is somehow more
accepted and supported than being gay is a
deeply regressive attitude that does not merit
sharing in the pages of a professional journal.
My own article, referenced below, 3 contains
links to many of the studies referenced in this
letter, and further information is available in
the resources section of my website.4
Sam Hope MBACP (Accred)
REFERENCES
1. www.thelancet.com/journals/lanpsy/article/
PIIS2215-0366(16)30165-1/abstract
2. bmcpublichealth.biomedcentral.com/
articles/10.1186/s12889-015-1867-2
3. hopecounsellingandtraining.wordpress.com/
research-papers/
4. hopecounsellingandtraining.wordpress.
com/2016/11/17/it-is-vital-we-talk-about-thewelfare-of-trans-kids/
To the editor
US AND THEM
REGISTER AUDIT
We’ve had several letters and some
tweets about our recent Register audit
consultation, and we are genuinely
sorry that we messed up.
We weren’t planning to introduce
blanket change here, but sought to
gather opinion and inspire debate.
We recognise that we haven’t been at
all clear on this point and that this has
caused some members considerable
concern. We’re very sorry that we
weren’t clear from the outset.
As many of you will be aware,
we have a new strategy and we are
working hard to bring about culture
change at BACP. Importantly, this
means we are committed to being
more transparent and consultative with
you. We won’t always get things right,
as on this occasion, but your honest
feedback is invaluable and helps us
improve the way we work with you.
We would like to thank all of you
who completed the survey; we’ve had
over 3,000 responses and we hope
to publish the headline findings this
spring, before further consultation.
Thanks too, to you all, for being part
of our ever-changing association.
Below are some of the points raised in letters sent to Therapy Today.
CONTROLLING,
NOT PROTECTING
... Protecting the public is a laudable aim,
but I’m not sure that this is the way to do
it. Asking members to justify at least five
CPD choices, ‘mystery shopping’, suggesting
that supervisors report concerns about
supervisees to BACP? It sounds very
controlling and quite out of keeping with
the spirit of the Ethical Framework. I’m
profoundly uncomfortable with the notion
of BACP policing the profession in a manner
that suggests it has no trust in its members.
There is concern about the methodology
used to introduce these ideas, too. Through
a short online survey (which was given very
little publicity, given its implications for
members), BACP is seeking to introduce
some fundamental changes on a par with the
revisions to the Ethical Framework, but with
far less rigour.
Fiona Morrison MBACP (Accred)
INCOHERENT PROPOSALS
... Taken together, the proposals represent
an incoherent array of ideas without any
specific, clear and well-argued objectives
to which they might be linked. Some of
these ideas, if adopted individually or in
combination, would mark profound changes
in the roles, responsibilities and relationships
that underpin our professions, and in the
way in which the Ethical Framework is
applied in practice.
Adoption of any of these ideas risks
inconsistency with principles that underpin
BACP’s existing approach to the maintenance
of standards and safety. As a result, the very
existence of this survey, bereft as it is of any
clear context, rationale or open discussion,
leaves me concerned about the management
and leadership of the organisation, and
questioning my allegiance.
The Professional Standards Authority is
currently in the process of re-accrediting the
BACP Register. It would be a deep irony if this
fact has been a driver behind the decision
to conduct the survey. Nothing could better
illustrate how such processes can have
unintended consequences: in this case, the
erosion of this member’s confidence in BACP
as an organisation capable of articulating
and championing a deep understanding and
appreciation of the needs of the counselling
professions and those we serve.
Phil Turner Registered
MBACP (Accred)
Counsellor and supervisor
THERAPY TODAY
16
FEBRUARY 2017
... I find myself recalling the early days of
BACP, when I joined in the 1980s, when there
was a body of diverse practitioners who
shared a vision of how the society we lived in
could benefit from the greater availability of
counselling and psychotherapy. We believed
that the counselling ethos, including the
importance of providing a safe space for
feeling and thinking, could offer the wider
culture something immensely valuable. There
was also belief in strong mutual support in
the work in which we were engaged, from
which the concept of supervision emerged.
Now we have a deepening sense of an ‘us
and them’ mentality in BACP, with proposals
of inspections and ‘mystery shoppers’, apeing
the worst aspects of regulatory regimes.
I have a sense that the proposals put forward
in the survey demonstrate that some at
the top of BACP have an increasing wish
to grab power and use it to exercise
and demonstrate their ‘muscle’, to the
government and other institutions.
Steve Decker CPsychol
BACP senior accredited
counsellor and supervisor
ABSENCE OF TRUST
... What is proposed isn’t business as
usual but, instead, a radical change to
the whole relationship between BACP
and its membership. It represents a shift
from a conventional audit of BACP’s internal
procedures to proposals for an Ofsted-style
external audit of the performance of the
individual members. To do this, the role of
supervisors is redefined so they can carry
out a managerial or policing function on
behalf of the organisation.
It beggars belief that such a fundamental
reformulation of relationships is being
presented via what is essentially a tick-box
survey. Moreover, BACP has effectively preempted any kind of proper consideration
of these proposals by imposing an absurdly
short timescale. To be blunt, is the Board
attempting to slip these proposals through
without giving them adequate airing? If
not, why is there no proper opportunity
for discussion and debate?
BACP’s attitude to trust lies at the heart
of this. During the review of the Ethical
Framework, it was emphasised time
We have had
and again that clients have to be able
to cut these letters
to trust BACP registrants. Indeed
to include the breadth
‘our commitment to clients’ places
of comments and views.
trustworthiness at the very heart of
If you would like to read
the Ethical Framework. Yet the
the full versions, please
impression from this consultation
email therapytoday@
survey is that BACP regards its members
thinkpublishing.co.uk
as inherently untrustworthy – so much
so that they are badly in need of monitoring
and surveillance.
These changes are likely to result in
lip service, compliance and defensive
practice; they certainly won’t deliver
unequivocal benefits. What they will
undoubtedly generate is a fundamentally
perverse climate that will eventually
permeate through all our work.
Arthur Musgrave
BACP senior accredited counsellor and
supervisor (groups and individuals),
Western Valleys, a member group of the
Independent Practitioners Network
THERAPY TODAY
17
FEBRUARY 2017
Counselling changes lives
Back
onside
Gary Bloom describes
how he won over a group
of school-resistant 16-year-old
boys with six sessions
of fantasy football
GETTY IMAGES
I
’m standing in a classroom in front of 11 unruly
16-year-old boys, with a safety officer for my
protection. Why? I’d agreed to help a comprehensive
school challenge these students’ beliefs and
prejudices, and at the same time try to improve their
flagging GCSE prospects. The time until the first exam?
Six weeks. No pressure then.
First, some background. The school had contacted me,
having exhausted just about every other possible avenue
first, to ask if I would consider working with a group of
football-mad boys who had consistently underachieved
in their GCSE studies and were displaying severe
behavioural problems. The outlook for these boys was
increasingly grim as the GCSE exams crept ever closer.
The school came to me because, before training as a
psychotherapist, I had a reasonably successful career
as a TV sports commentator, specialising in football. Up
until that moment, I’d never considered that my two
careers could be fused. Needless to say, I was delighted
to have the opportunity to mix football and working in
a therapeutic group with young enthusiasts in a school
environment. But just six weeks – what was I thinking?
One of the many pressing issues I was now facing
was understanding exactly what working with a school
group would be like. I reached desperately for the work
of Nick Luxmoore, an iconic school counsellor based in
Oxfordshire. Reading about his and a variety of others’
experiences, I knew that I had to devise a ‘cunning plan’
that would engage the boys quickly – many of them had
become disconnected from the school, their studies and
the world in general.
THERAPY TODAY
19
FEBRUARY 2017
Counselling changes lives
When I first met with the head teacher, he admitted the
school was ‘running out of ideas’ and was sceptical that
a middle-aged, middle-class white man could outwit a
group of streetwise kids.
To some degree, I felt the same, but I devised and
submitted a six-week programme that I felt could
challenge some of the group’s basic prejudices and create
some impetus for reminding the boys that they had a
future after all – they just had to do something about it
in the six weeks remaining before their exams.
Champions League Group
According to Nick Luxmoore, the first 60-minute session
would either create or destroy any chances of success
with the boys. So I set about trying to work out what to do.
I decided that the best way to engage the pupils was
to be different from the other authority figures they had
experienced so far: I would position myself as part of their
group, rather than a super-ego (parent/school) figure; I’d
allow them to see the boy in me.
The boundaries would be those I use with adults – no
one had to be there, they could go whenever they chose
(but couldn’t return), and (very clear and unambiguous) it
was not acceptable to talk among themselves or be rude
to anyone in the group. But the sessions had to be fun, so
I disguised the main themes in a number of games, based
on student drinking games, which I felt sure they’d enjoy.
The group would be called the Champions League
Group, the premise being that they were a football team,
and that their group success or failure was dependent
on their working as a team, not as individuals. An
added incentive was that, if the boys improved on their
grades and behaviour, I would swing it for them to be
allowed to play football on the school AstroTurf after
our final session – a privilege some had lost due to
past misdemeanours.
The teachers gave me armfuls of reports with current
and past performance statistics, all indicating that the
boys had done little or no revision or coursework,
and that they were expected to fall far short of their
potential. How could I encourage the boys to improve
their behaviour and begin trying to revise?
Fantasy football
I opted for playing a version of fantasy football, where
the boys picked an imaginary football team of current
Premier League players, and then pitted their own
behaviour and performance in school against that of the
real footballers on the pitch, using a points system.
A highlight for me was when the boys decided that
any bad behaviour by the group would warrant an even
higher number of penalty points than I had originally
proposed, which to me suggested that they wanted to
improve and wanted to establish the levels of acceptable
behaviour by which they would all need to abide.
Week by week, the fantasy league aspect of the group
faded away, mainly as their behaviour improved and the
I decided that the best way to
engage the pupils was to be
different from the other authority
figures they had experienced
so far: I would position myself
as part of their group, rather
than a super-ego (parent/school)
figure; I’d allow them to see the
boy in me
contest between the boys and their fantasy team became
something of a farce – the real Premier League players’
behaviour on the pitch was much worse than that of these
so-called naughty boys of the school. (For the football fans
out there, think Jamie Vardy and Dele Alli at the end of
last season.)
Slowly, reports came back to me from the teaching
staff describing improvements in general behaviour,
attendance and punctuality. The group showed up more
often at revision classes and, although there were some
isolated incidents of ‘red cards’, they were gradually
moving to a more positive mode. The number of ‘red flags’
recorded by the school to denote poor behaviour in the
group members was significantly down.
Discussions in the sessions were based on real events
that had happened in the football world the week before,
carefully interwoven with the boys’ own behaviours –
issues like cheating, bribery or lying – and looking at
these concepts in both a sporting and real-world context.
The boys were fascinated by nutrition and the effects
of recreational drugs on the developing brain.
We tackled psychology, ethics, love, sex and porn
(which soon morphed into a discussion about marriage
and religion), all the while ensuring the fun element of
the sessions remained. The ‘drinking games’ (using jelly
beans of every disgusting flavour, instead of alcohol)
helped tremendously.
How I broke the rules
The boys seemed fascinated by my experiences as a
commentator and also by my experiences as an adult
male, father and husband. I was extremely careful not
to dominate these discussions and to treat the boys as
adults, listening to their views and, where appropriate,
challenging some of their preconceptions. They tried
interesting and varied ways to embarrass me and test
my ability to stay cool under pressure. The temptation
to respond with witty put-downs was, at times, almost
THERAPY TODAY
20
FEBRUARY 2017
overwhelming. However, I realised that humiliating the
boys in front of the rest of the group was just what they’d
expect, and instead opted for elegant, respectful solutions
that left no one with a face covered with egg.
I found that if, as a group facilitator, I disclosed more
than I would have done in one-to-one psychotherapy or
counselling sessions, the boys tended to open up more
themselves, and by the end of the six weeks they were
confiding in me about aspects of their lives that they
would prefer the school didn’t know. One boy thought it
was funny to describe a scene of domestic violence, and
another giggled throughout when recalling the amount
of cannabis he was smoking. I took safeguarding issues to
my therapy supervisor.
I deliberately used props from my broadcast work to
widen the boys’ exposure to life outside the classroom
and their individual circumstances. Surprisingly few
actually wanted to touch the broadcast equipment, and
they all seemed very nervous about handling articles from
another world. At the end of the sessions, when I brought
in a replica of the Champions League trophy, a few of
the boys refused even to touch it. I put this down to their
inability to value themselves, even though I made it clear
I valued what they had achieved in the previous weeks.
So what changed?
Towards the end of the six sessions, the head teacher
reported his delight with the boys’ improved behaviour
and that some were taking their GCSEs seriously. This
latter effect was probably due to the fact that, from our
discussions, the boys had realised the seriousness of the
situation and their lack of preparation.
I surveyed the boys when the sessions began and again
after they had finished, with some surprising results. In
three key areas the boys reported:
• a drop in anxiety about their exams
• an increase in their enjoyment of school
• a decrease in the support they were getting from
their families.
Asked about their feelings about the sessions, the boys
were generally positive. For some, my arrival was clearly
a wake-up call. But why? Had they just stopped listening
to their parents and teachers, and when someone
different came in, it made them take more notice? One
boy summed up what made the difference for him: ‘[The
sessions] made me realise that I was letting myself down,
and I was letting the group down. It’s my grades that
count of course, but it’s not nice bringing everyone else’s
grades down [by misbehaving in class]… It made me stop
being so selfish… You communicated with us on an adult
level, unlike the teachers. You didn’t raise your voice or be
disrespectful… When the teachers are shouting, it’s hard
to respect them, but, when you treated us like adults, we
respected what you had to say.’
One of the common themes in the group was how
defensive the boys were about their parents and the role
of their families in their lives. By the end of week six, I
felt there was less defensiveness and more realism about
what was going on at home.
One of the most challenging members of the group,
who had refused point-blank to do any revision, was
among the most changed by the end of the programme.
He was spotted teaching biology to a year 8 class
before school lessons began, and was regularly to
be seen staying late at school to catch up on revision
classes. Another of the boys, who had worried the
school significantly in the past few years, had managed
to secure an interview for an apprenticeship just days
after the group finished.
Scattering seeds
In many respects, the interest in the football theme fell
away as we tackled more general issues. However, I don’t
think the group would have engaged so well with me if we
hadn’t had the football theme to start with. Certainly, their
fascination with me as a TV commentator proved to be
the springboard for many interesting discussions.
On the day the GCSE results were due, I waited
nervously in the school drama studio as some tearful
and some ashen-faced children tore open their brown
envelopes to learn their results. I’d love to report that all
the boys performed much better than expected, but that
wasn’t the case. Overall, I’d helped take the group from
below the school average to above it, but a few of the
boys, despite increased revision classes and upping their
grades, still fell short of a pass.
Maybe it’s a bit myopic to evaluate the success of this
intervention solely in terms of exam results. As one
supervisor said to me: ‘Maybe this is like scattering seeds.
You just don’t know where they are going to land and if
they’re going to grow.’
The school has invited me back to run the course in
2017, but for year 10s and year 8s (younger pupils), as
they felt it was too little too late for year 11 students so
close to taking their GCSEs. Asked to describe my own
performance, I’d say I’d fired an arrow at a wall and drawn
a bullseye around it. I think I’ve a much better idea where
to aim next time.
Gary Bloom
About the author
Gary Bloom is an
integrative therapist,
counsellor and sports
broadcaster, based
in Oxfordshire.
Gary specialises in
working with elite
sportsmen and women,
as well as in schools.
He has just launched a
counselling radio show,
‘On the Sporting Couch’,
on TalkSport.
Contact: gary.bloom@
btinternet.com
I’d love to report that all the
boys performed much better
than expected, but that wasn’t
the case... As one supervisor said
to me: ‘Maybe this is like scattering
seeds. You just don’t know where
they are going to land...’
THERAPY TODAY
21
FEBRUARY 2017
Presenting issues
CHRONIC
PAIN
A NEUROSOMATIC APPROACH
Judith Maizels and Fiona Adamson explain how a neurosomatic approach
to chronic unexplained pain can reach to the source of the problem
L
inda, a 56-year-old woman, had
suffered from fibromyalgia since she
was nine, when her parents divorced
and she was sent to live with her aunt.
She described to me ( JM) how distraught she
was when her father took her to her aunt’s
home, how no one seemed to notice or care
about her distress, and how, as she entered
the hallway of her aunt’s house, she felt a
tightening around her throat, as if she were
being strangled. When her father left her
and drove away, her neck seemed to seize
up, and a sharp pain swept through her
shoulders and down her back. Her aunt had
said, ‘Stop making such a fuss! You behave
yourself, or you’ll be sent to a much worse
place, I can tell you.’ Linda had remained
silent and in physical pain for over 45 years,
until she came to me, seeking help to manage
her pain.
There are many different approaches
to helping people deal with chronic pain,
ranging from pain management counselling1
to therapeutic methods for medically
unexplained chronic pain (MUCP) that
Linda’s
story
We repeated this
exercise several
times until Linda
was shaking her
fists, shouting her
anger and laughing
with relief, surprise
and pleasure...
W
aim to dispel the pain entirely.2 My own
experience of complete recovery from 25
years of chronic fatigue syndrome/myalgic
encephalopathy (CFS/ME), together with
our experience of working with clients with
fibromyalgia and CFS/ME, has taught us
that MUCP can perform several extremely
important functions. It can:
• protect us from having to bear deeply
buried and distressing emotional pain
• alert us to the need to explore and express
some of those suppressed painful emotions
– and the emotional energy that they hold
• guide us as to the specific actions we need
to take (and not take) in order to release and
dispel the pain.
Mind and body
Despite many years of conventional
psychotherapy, I only made a full and
permanent recovery in 2004 after a threemonth programme of a mind/body treatment
known as reverse therapy.3 Having trained in
reverse therapy, counselling skills, wellness
coaching and, later, CBT, I began working with
ith guidance,
Linda identified
what she had really felt
when her father left
her: a desperate urge
to run away, huge rage
about how she had
been treated, grief at
the loss of her parents
and home, fear of the
future, and shame that
‘it was her fault’ that
her parents split up.
We explored what
she had actually
said and done at her
aunt’s house – which
was nothing: she
had remained silent,
vulnerable and alone,
desperately trying
to hide her feelings.
Then we explored
what she wished
she could have said
and done in those
THERAPY TODAY
22
clients in 2009. It was in my very first session,
working with Linda, that I realised none of
the approaches I had learned were adequate
to address the origin of this woman’s chronic
pain and help her manage or lessen it. So
Fiona and I began to develop a new approach
for working with clients diagnosed with
fibromyalgia and/or CFS/ME.4
We have learned that clients’ MUCP is
rarely random, and the parts of their body
affected are rarely incidental. We have come
to realise that MUCP has a serious purpose
and is giving out a powerful message from
our non-conscious implicit memory that
can guide us and the client to the actions
necessary to dispel their chronic pain.
Our approach is based on the belief that
our psyche knows exactly what we need to do
to recover, if only we can overcome our fears
of our emotions and hear what our symptoms
are telling us. Recovery comes when clients
learn that, contrary to their previous
experience, they can protect themselves from
emotional harm most effectively when they
express themselves authentically.
moments. At first,
her responses were
timid: ‘I just wanted
to run away. I might
have said I didn’t want
to stay here.’ With
encouragement, she
gradually transformed
her anxious words
into more powerful
exclamations: ‘I don’t
want to stay here! I
hate you! Take me
FEBRUARY 2017
home, now! Listen
to what I want!’
Gradually, her posture
began to change to
match her new flood
of energy: her back
straightened, she held
her head high, her
voice became louder
and more strident, and
she clenched her fists.
Finally, we went
through an anger-
LEIGH WELLS/IKON IMAGES
Our approach is
based on the belief
that our psyche
knows exactly what
we need to do in
order to recover,
if only we can
overcome our fears
of our emotions
and hear what our
symptoms are
telling us
Gradually,
we were able
to help Linda find
new strategies
for voicing her
own feelings
with her teenage
children and
ex-partner
release exercise that
allowed her to affirm
that she was utterly
justified to feel the
huge anger she had
felt as a child, and that
she had had no choice
at the time but to keep
silent, and so had
carried this pain in
her body ever since.
Now that she had
started to release
her anger, and had
discovered how
energising it was to do
so, she could release
the physical pain that
had been masking
the emotional pain.
We repeated this
exercise several times
until she was shaking
her fists, shouting her
anger and laughing
with relief, surprise
THERAPY TODAY
23
and pleasure that
her pain had lifted
and her energy had
returned – and that
she had achieved this
transformation herself.
Using these new
insights, gradually she
was able to find new
strategies for voicing
her feelings with her
teenage children and
ex-partner. Although
FEBRUARY 2017
her recovery followed
many emotional and
physical ups and
downs, her pain levels
gradually subsided
with repetition of
the recall and angerrelease exercises.
After six months, she
reported that she only
had pain when she
was feeling particularly
anxious or stressed.
Presenting issues
These principles underlie our practice of
neurosomatic therapy, an approach itself
rooted in classical psychoanalytic theory
(specifically, Freud’s theory of conversion
disorder).5 We use the term ‘neurosomatic’
to describe somatoform disorders that arise
through the dysregulation in childhood of
neurobiological stress-response systems
as a result of trauma or chronic distress,
which leaves the person with a life-long
vulnerability to developing such disorders.4
In all the clients we see, there is a huge
part of the self – the intuitive, emotional,
spontaneous, authentic or ‘true’ self – that
the fearful, defensive survival mind (the
‘false self ’) has repressed for most of their
lives. We developed our neurosomatic
therapy on the principle that the physical
symptoms of MUCP and similar somatoform
disorders are the embodiment of the client’s
unresolved inner emotional conflict between
these two self-aspects. Their physical pain
is understandably defending them from
experiencing the unexpressed voice of their
true self, especially their repressed anger and
the energy that their repressed emotions
hold. Their primary defensive and protective
survival strategy has involved emotional
disconnection, fear-based withdrawal,
and self-silencing behaviours – strategies
that research shows are characteristic of
people with MUCP.6,7 As neuroaffective
psychotherapists Heller and LaPierre
explain,8 we learn to convert our ‘shameful’
traits into beliefs that give us the pride and
perceived strengths that help us survive our
traumas. But the downside of this strategy is
that we can grow up driven to prove we are
worthy and lovable by adopting behaviours
that are perfectionist, excessively selfsacrificing and over-caring of others.
Neurobiological origins of MUCP
The link between repressed emotions and
physical symptoms has, of course, been
the foundation of psychosomatic medicine
for many decades. But recent research
in developmental and interpersonal
neurobiology has provided a sound
foundation for the neurosomatic model
of medically unexplained symptoms that
underpins our approach.4 For example, the
single greatest risk factor for pain syndromes
in both children and adults is the damaging
impact of childhood trauma, abuse, and/
or disrupted attachment on a child’s
neurodevelopment – childhood abuse and
neglect are often the most reliable predictors
of chronic pain6 and illness in adulthood.
Schore,9 among many others, has also
demonstrated that adverse childhood
experiences can trigger the chronic ‘freeze’
stress response that leads children to
withdraw and emotionally shut down.
Numerous clinical studies now confirm
that people who habitually suppress their
emotions, and especially their anger (socalled anger-in states), do indeed experience
the highest levels of MUCP and sensitivity
to pain. According to Lumley, not only do
early traumatic experiences act to sensitise
the pain pathways, but the neural circuitry
involved in pain processing substantially
overlaps with the anxiety, fear and emotionprocessing circuitry.6 In addition, since
emotions are forms of energy in which
hormones and other neurochemicals move
round the body, habitual emotional inhibition
dysregulates neurochemical flows and blocks
emotional energy, directly contributing to
chronic fatigue and illness. Alongside, there
is an emerging body of evidence that people
who express their long-inhibited anger can
dispel their MUCP.2,4
All our clients with a neurosomatic
illness have experienced a period of acute
neurosomatic stress prior to onset of their
symptoms. This is the critical moment at
which our true self reaches the limit of our
emotional endurance, leaving us feeling
trapped and overwhelmed by unbearable
circumstances. Unable to see a way of
resolving our situation, we are driven to using
our old passive-withdrawal survival strategies.
‘Escape’ is effected by the body triggering
the neurosomatic process by ‘sending’ us our
symptoms, providing our fearful, defensive
survival mind with a socially acceptable
means of withdrawal. The onset of pain and
illness is the only way in which the client’s
true self can protect them from ‘having’ to
tolerate any further emotional suffering –
a state demanded by their survival mind.
Neurosomatic therapy
The chronically ill client feels hopeless,
helpless, confused, despairing, griefstricken, isolated, abandoned and consumed
with unacknowledged rage. As Driver, a
psychoanalyst, has observed,10 these are the
feelings that they experienced as children.
The feelings are rooted in neurosomatic
despair – painful emotional memories that
embody the unresolved emotional conflict
– leaving the stress-response cycle equally
unresolved. And, since physical pain and
emotions both originate in the same part of
the brain (namely, the limbic system), the
path to accessing the hidden emotional pain
is surely indicated by the one clear signal
that we already have – the physical pain
that has been generated by the body itself.
We therefore explain to clients the process
by which their chronic pain has arisen, and
we teach them to become mindful of the
emotional signals that their body is holding
as we enquire what message their pain is
desperately trying to impart to them. In this
respect, neurosomatic therapy has much in
common with other body psychotherapies.
However, recovery from chronic pain and
illness comes only when clients experience
new, positive forms of authentic action
(AA), having first increased their conscious
awareness (CA) of their once-silenced voice.
This combination of CA and AA is so crucial
for client recovery that we specifically teach
clients the skill of ‘neurosomatic intelligence’
(CA+AA). Using the client’s growing somatic
awareness, we also explore the deeper nature
of both their physical and emotional pain,
The chronically ill client feels
helpless, confused, despairing,
grief-stricken, isolated, abandoned
and consumed with unacknowledged
rage... these are feelings that they
experienced as children... rooted in
neurosomatic despair
THERAPY TODAY
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FEBRUARY 2017
address some of their fears, defences and
other emotions, and help them find healthier
ways to meet their own emotional needs.
We integrate this approach with a variety
of task-oriented assignments.
Using bodymind and somatic awareness
techniques, and only when the client feels
safe enough and ready, we focus mindfully
on their, and our own, sensate experiences in
relation to specific evocation states.11 These
represent situations or symptoms directly
associated with blocked emotions – emotions
that now become accessible to the client
through their re-experiencing and re-enacting
past and/or recent situations of their own
choosing. The purpose of these re-enactments
is for clients to ‘change the ending’ of the
original situation in which they had felt
so trapped, powerless and shamed. We
encourage them to express at last the exact
feelings that they had felt forced to silence at
the time. Each time a client overcomes some
of their fears of expressing their long-silenced
feelings, the emotional associations of
traumas or stressful relationships are diluted
and the memories become coupled with the
client’s current, self-empowering experience
of finally expressing their authentic self in the
present moment, and this brings them a new
sense of self-realisation.
Evidencing our approach
It is through these experiential exercises that
clients are finally able to express some of
their long-buried authentic emotions, which
often results in dramatic alleviation of their
chronic pain and other symptoms as they
begin to resolve their inner conflict. Typically,
clients will tell us, ‘I’m a real person again,’ or,
‘I’ve got my life back.’
Of course, the path is not without obstacles.
While the re-enactments are a powerful
first step, clients find that sustaining and
reinforcing their physical improvements
day-to-day can be challenging. We work with
them to address the non-conscious fears that
can block or sabotage their recovery, provide
longer-term support to help them sustain
their freedom from pain and explore with
them the deeper meaning of their illness
and journey to recovery.
At present, we can offer only case-based
evidence for the outcomes of this approach.
We have worked with 31 clients, all but one of
whom reported substantial or total recovery
from the pain and/or the CFS/ME that
dominated their lives. Two clients partially
Using bodymind and somatic awareness
techniques, and only when the client
feels safe enough and ready, we focus
mindfully on their, and our own,
sensate experiences in relation to
specific evocation states
Practise mindful body and sensory awareness
Evoke emotional experience from
three possible evocation states
(1)
Recall onset or
flare-up(s) of pain/
symptoms
Develop
conscious
awareness (CA)
Identify:
• neurosomatic stress
• symptom
message, and
• inner emotional
conflict between:
u survival mind
beliefs, rules and
expectations, and
u authentic
emotional needs
and wishes of
the true self
Practise
neurosomatic
intelligence
(CA+AA)
• Specific bodymind
and emotional-release
exercises
• Regular, daily
practice at home,
including
journaling
THERAPY TODAY
25
(2)
Recall other
self-silencing situations
(3)
Investigate current
pain/symptoms
Take authentic action (AA)
Create and experience a
‘new ending’ for situations in
which the client originally felt
powerless, through their:
• expressing their authentic
emotions and needs, and
• releasing blocked anger
and emotional energy
Develop conscious
awareness (CA)
• Describe, visualise
and create metaphors
for the pain/symptoms
• Visualise organic
changes
Experience transformation
and freedom from pain/
symptoms as the client:
• discovers that they have become
pain-free through their own efforts
• becomes more fully aware of
their own embodied experience
of their authentic emotions
• learns to recognise, nurture and
support their own emotional needs
• experiences hearing their own
voice speaking their own truth for
the first time, in the presence of a
safe, compassionate witness
• feels validation for their newly
experienced emotions, and
• with joy, self-belief and renewed
energy, celebrates the emergence
of their authentic voice, vitality and
self-empowerment, at last feeling
open to new possibilities in life
FEBRUARY 2017
Discover
the unconscious
message of the
pain/symptoms
KEY ELEMENTS IN
NEUROSOMATIC
THERAPY FOR
MEDICALLY
UNEXPLAINED
CHRONIC
PAIN/SYMPTOMS
Presenting issues
Judith Maizels
About the author
Judith Maizels is a
neurosomatic therapist
in private practice
since 2009.
She works exclusively
with clients with
fibromyalgia
and/or CFS/ME.
www.proactiveneurosomatictherapy.com
relapsed after a year, which might be because
they had to terminate the work too soon, for
financial reasons.
We have published two volumes on our
work:4 a comprehensive literature review of
research into the emotional roots of chronic
pain in medically unexplained conditions,
and (still at press) a description of the
recovery programme and detailed casework.
We recognise that this approach potentially
takes us into very sensitive territory; we are
all too familiar with the stigma and shame
that people feel when told that their pain is
‘all in the mind’. Having had ME for 25 years, I
know exactly what that hostility and disbelief
feels like. The pain is utterly genuine, and
neurobiological and epigenetic in origin.
Wellbeing depends on learning to be more
fully emotionally authentic and the ability
to protect our deeper emotional needs
from old, conditioned (self-)expectations.
Clients discover that, if they are empowered
to act authentically, their body no longer
‘needs to send’ them their symptoms. Neural
networks and brain neurochemistry become
normalised as the client’s new behavioural
patterns become automatic, reducing the
likelihood of any future relapse. We believe
that this neurosomatic approach, integrated
into an established pain-management
programme, could also help alleviate
medically explained chronic pain.
REFERENCES
What’s your
experience?
Write to us at
therapytoday
@thinkpublishing.
co.uk
1. Patel K. Chronic pain and the self. Therapy Today
2016; 10: 10-15.
2. Sarno J. The mindbody prescription. Healing the
body, healing the pain. New York: Hachette Book
Group; 1998.
3. Eaton J. ME, chronic fatigue syndrome and
fibromyalgia: the reverse therapy approach.
London: New Generation Publishing; 2005.
4. Maizels J, with Adamson FPC. Breakthrough for
chronic fatigue syndrome, ME and fibromyalgia:
how neurobiology and epigenetics point the way
to recovery. Volume 1: Chronic neurosomatic
illness. Bushey, UK: Wellwise Press; 2015.
(Volume 2: Recovery from chronic neurosomatic
illness is currently at press, 2017)
5. Breuer J, Freud S. On the psychotherapy of
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trauma. Berkeley, CA: North Atlantic Books; 2012.
9. Schore AN. Right-brain affect regulation: an
essential mechanism of development, trauma,
dissociation, and psychotherapy. In: Fosha D,
Siegel DJ, Solomon MF (eds). The healing power of
emotion. New York: WW Norton & Co; 2009.
10. Driver C. An under-active or over-active
internal world? An exploration of parallel dynamics
within psyche and soma, and the difficulty of
internal regulation, in patients with chronic fatigue
syndrome and myalgic encephalomyelitis. Journal
of Analytical Psychology 2005; 50: 155–173.
11. Kurtz R. Body-centred psychotherapy: the
Hakomi method. Mendocino, CA: LifeRhythm
Books; 2015.
GIVING ANGER
A VOICE
This is a short summary of an anger-release exercise from our neurosomatic recovery
programme. The therapist can modify the protocol to suit the client and situation.
Fiona Adamson
About the author
Fiona Adamson is
an executive coach
supervisor, and
transpersonal and
gestalt psychotherapist
in private practice for
over 30 years.
www.fionaadamson.com
• Stay in your bodymind throughout this task,
noticing any physical sensations and symptoms.
• Complete your bodyscan, and then repeat
aloud the following affirmation: ‘I am safe to be
who I truly am.’
• Recall a current, recent or past event when
you remember not speaking up; describe that
event, and your thoughts, feelings and actions
and any pain or other symptoms that arose.
• If you kept silent and hid your feelings,
what stopped you from speaking up (your
‘survival mind’)?
• ‘Change the ending.’ Now is the time to stop
keeping silent and start expressing your true
THERAPY TODAY
26
feelings (your true self) about those events.
Use as much physical and emotional energy
as feels comfortable.
• Validate and celebrate releasing your anger.
Focus on ‘What do I need for myself right now?’
• Come out of your bodymind. Notice how your
actions have affected your pain, energy and any
other symptoms. Write about your experience
in your reflective journal.
• Your symptom message may tell you: ‘My pain
is here to tell me to STOP hiding my feelings
and START speaking up about how I truly feel
and what I truly need – NOW!’
• Apply your symptom message daily.
FEBRUARY 2017
This much I don’t know
My supervisor said to me: ‘Silence is a
process and, if you stick with it, if you don’t
put any demands on the client to say
anything, something will come out of it.’
I
was coming to the end of my
person-centred psychotherapy training, and
I’d got a placement with an NHS counselling
service. I remember one client I worked with,
a woman with very severe anxiety. She came
for the first session, sat down in the chair
opposite me and didn’t say a word. I was
supposed to be assessing her and, no matter
what I said, she just sat there in silence, tears
streaming from her eyes. The second session
was exactly the same: she sat in the chair
and wept.
For me, at the time, as a trainee
psychotherapist, that was a very unsettling
experience. I had all these thoughts going
through my head: ‘I don’t know what to do…
I don’t know what to say… I don’t think I can
do this... I’m not good enough… I’m supposed
to be assessing her and I haven’t written
down a thing… Maybe I’m a failure at this.’
At that point my inclination was to say to
her: ‘I don’t know that you are right for
therapy.’ Thankfully, I didn’t.
I took it to my supervisor, and he told me
a story about a very well-known personcentred counsellor, psychotherapist and
writer who had once had a job in a military
institution, working with veterans. His
colleagues had told him not to bother seeing
one of the veterans. They told him the man
was totally unresponsive; he wouldn’t get
anything out of him; there just wasn’t any
point. The therapist ignored their advice. He
sat with this man once a week, every week,
for several weeks, and the man said nothing;
it was as if he was completely catatonic.
Then, one day, the therapist said to the
man words to the effect that, although he
couldn’t know what had happened in his
life, he was sure it was really traumatic. He
went on to say that he was sure too that the
man would have had other, very different life
experiences – for example, he might have
had a family or a valued relationship. At that
point, the man picked up his cup of coffee
and threw it at him. Something had shifted.
My supervisor said to me: ‘Silence
is a process and, if you stick with it, if you
don’t put any demands on the client to say
anything, something will come out of it.’
He encouraged me to sit with the silence
or, if that was too hard, to stay congruent
and authentic and, when appropriate, to
communicate an observation – with this
client, for example, just to say: ‘I notice we
are both sitting in silence and there are tears
running down your cheeks.’ So, at the third
session, that is exactly what I did, and she
replied: ‘Thank you for giving me this space
and just sitting with me.’ Something here too
had shifted.
Dr Divine Charura is a chartered psychologist and senior
lecturer in psychotherapy in the School of Health and
Community Studies at Leeds Beckett University
THERAPY TODAY
27
FEBRUARY 2017
That experience has stayed with
me through all my working career. It
fundamentally changed how I work with
clients. It taught me the value of silence and
what can emerge from it when there’s no
pressure on the client to speak. Not all clients
are able to tolerate silence and use it. But, for
those who are, the ability to sit with oneself
in silence is such a strength. And, for the
psychotherapist, it’s a good discipline and a
good test of your ability to stay focused and
connected, contain the client’s process, and
not let your mind wander off.
That was over 15 years ago, but just this
year I happened to bump into the client in
town. We nodded to each other and that was
it. But she looked well, and she was with some
people who seemed to be her family.
Cautionary tales
WHEN
STUDENT
PLACEMENTS
GO WRONG
This month’s cautionary tale
tackles student placements –
do they meet the course and
BACP’s requirements, and
is the student competent
to work there?
By Susan Dale, BACP Good Practice Manager
THE STUDENT’S
STORY
I
’m Aimee, a student
counsellor, and a student
member of BACP. I’m in my
second year of an integrative
counselling diploma.
The course used to be
accredited by BACP but, since
I started, although the college’s
website still has links to the
BACP Ethical Framework, it has
changed affiliation to another
counselling body, which has its
own ethical code of practice.
I’m currently on placement
with a small charity that supports
children and young people
aged 12 to 18. The charity gave
me a couple of days’ induction
training when I started, and I
was a teaching assistant before
retraining as a counsellor, so
my course tutor at the time
considered me competent to do
the work.
Last year, the placement went
well – the counsellor at the school
where I am based assessed all the
referrals first and allocated me
clients she considered to be ‘low
risk’. I could refer clients back to
her if I thought there might be a
safeguarding issue.
On my own
Then the school counsellor
left, so I am having to do the
assessments myself, with no
back-up. My college tutor and
college supervisor have also both
left, and I have been allocated
a different, external supervisor.
As there’s no longer a school
counsellor here, I’m now working
with young clients who are much
ETHICS IN ACTION
LEIGH WELLS/IKON IMAGES
The Ethical Framework for
the Counselling Professions
states very clearly that
practitioners need to
work to professional
standards and ‘within
their competence’
(see Commitment 2a).
This includes trainee
practitioners. As
therapeutic practice,
safeguarding and law are
very different in relation to
children and young people,
normally this would mean
that practitioners and
trainees should have had
further, specialist training.
Competence
The key issue is a shared
understanding between
How to go forward?
Have you got an ethical problem you would like to share? Email a
brief outline to [email protected]. The Ethics in
Action Helpdesk is here to support your ethical decision-making, at
[email protected] or call 01455 883300. Clients with concerns should
contact ‘Ask Kathleen’ at [email protected] or call 01455 883300
THERAPY TODAY
28
FEBRUARY 2017
course and placement
providers, supervisors
and students about what
‘competence to practise’
with this particular client
group means.
BACP guidance1 for
accredited courses on
placements in children
and young people’s
settings makes clear
that students on generic
(adult) counselling training
courses can work with
children and young
people on placement,
and these placements
will count towards the
clinical placement hours
required by the course, and
towards BACP registration
and accreditation, if the
THE SUPERVISOR’S
STORY
more vulnerable, and there have
been a couple of safeguarding
issues, which I think I have dealt
with quite well. But my new
supervisor is saying that, under
the BACP Ethical Framework,
I am not working within my
competence with this client
group, and that the college needs
to ensure that my placement
still counts towards my practice
hours. But the college says
this is the responsibility of
my supervisor.
Who to believe?
Who is right? I am very worried
that all the hours I have worked
on this placement may not
count towards completing my
counselling course or for BACP
membership and registration.
W
hen Aimee came to
me for supervision,
she was, I realised, working
in a very different situation.
Previously, the children and
young people she worked with
had already been assessed by
a senior counsellor. However,
this had changed and she told
me she was now expected to
do her own assessments, that
the school counsellor was no
longer employed at the school,
and that she was now working
with a more vulnerable young
client group.
I advised her to speak to her
course tutors, as, in my view, they
are responsible for ensuring that
student placements are suitable.
She didn’t want to find another
placement, as she only had
another 20 hours of counselling
to complete. I didn’t want to say
to the college that she was not
working within her competence
with this client group, as she is a
very good counsellor, but in my
professional opinion she is just
not experienced enough to work
with the very vulnerable clients
she is seeing.
Further
information
You’ll find BACP’s
suite of Good
Practice in Action
resources and the
Ethical Framework
on the BACP
website at
www.bacp.co.uk/
ethical_framework
‘ ... she is a very good
counsellor, but in my
professional opinion she
is just not experienced
enough to work with the
very vulnerable clients
she is seeing’
REFERENCES
training provider and/or the
placement service provider
ensures that the student has
the basic competences to
practise safely and ethically
with this age group. Aimee
and her supervisor may find
the competence framework
for working with children
and young people aged 11
to 18 helpful in identifying
what competence may
look like in terms of training
and experience.2
Accreditation
While Aimee’s course was
accredited by BACP, she
was deemed competent to
work with this client group
when a senior practitioner
was assessing clients before
they were allocated to her,
and so the placement,
and the hours she worked,
could be counted towards
her BACP registration.
Those conditions no longer
apply. However, many nonaccredited courses do try
to emulate good practice,
and, if they are a member
of another professional
body, they will be subject
to their own ethical code
or framework.
Aimee’s new supervisor
is right to question
whether this placement is
now suitable. As a BACP
student member, Aimee is
bound by the BACP Ethical
Framework. Commitment
1a states that we make our
THERAPY TODAY
clients our primary concern
while we are working with
them: this is about what is
best for Aimee’s clients, not
best for her.
It is of course the
supervisor’s responsibility
to ensure that the work
of a trainee ‘satisfies
professional standards’
(see good practice point
56 in the BACP Ethical
Framework). As Aimee is
close to completing her
basic training, however,
we hope she and her
supervisor will be able to
find any additional support
and training she may need
to ensure she is competent
to complete her placement
with the charity.
29
FEBRUARY 2017
1. BACP. Revised
statement on
students working
with children and
young people (CYP).
[Online.] Lutterworth:
BACP; 14 June 2016.
www.bacp.co.uk/
media/?newsId=3953
(accessed 4 December
2016).
2. BACP. Competences
for humanistic
counselling with
young people (11-18
years). Lutterworth:
BACP; 2014.
www.bacp.co.uk/
ethics/competences_
and_curricula/
cyp_competences.php
(accessed 4 December
2016).
Culture and context
Counsellors need to be mindful of context, as well as race and
culture, when working with diversity, writes Rose Cameron
A
round this time last year, I wrote two new
chapters for the third edition of Skills in
Person-centred Counselling & Psychotherapy.1
The chapters look at how social injustice is
constructed and perpetuated, and invite the reader to
reflect on how they enact in the therapy room their
membership of various social groups.
In the months since then, we have seen the election to
the US presidency of someone who has openly mocked
people with disabilities, publicly expressed racist attitudes
and been broadcast boasting about using his celebrity
to perpetrate sexual assault. When Donald Trump was
elected, the Ku Klux Klan marched in celebration, and
fellow Americans were attacked, physically and verbally,
for being African-American, Latino, Jewish, Muslim, gay
or trans.2
Similarly, here in the UK there was a huge increase in
hate crime following the Brexit referendum,3 and hate
crimes against lesbian, gay, bisexual and transgender
people also increased by 147 per cent during July, August
and September 2016, compared with the same period the
previous year.4 Convictions for rape, sexual assault and
domestic abuse have also reached record levels.5
My chapters about social inequality are, sadly, more
urgent and relevant than ever. If we, as therapists, trainers
and trainees, are to be part of the resistance to this
current wave of hate, and if we are to create therapeutic
spaces that really are safe for those who are under threat
from this hatred, we have to have a solid understanding of
how social injustice is constructed and perpetuated.
Rose Cameron
About the author
Rose Cameron began
training as a counsellor
in 1989 and worked in
the NHS and private
practice in Manchester
from 1993 to 2009,
when she relocated her
practice to Edinburgh
and Fife.
She has been training
counsellors and
psychotherapists since
1996 and is currently a
teaching fellow at the
University of Edinburgh.
www.rosecameron.org
Social context
Social groups come into being when perceived differences
are given social significance. Difference in itself does not
create a social grouping – some people have wide feet,
and others have narrow feet, but wide-footed people and
narrow-footed people do not constitute social groups
because there is no social significance attached to the
width of our feet. Social significance is attached to our
genitalia, skin colour, sexuality, physical impairments, age,
income, job, religion and whether we have a permanent
home, and this profoundly affects almost all aspects of
our lives.
Social groups are marginalised when the shared
experience that forms their group membership is one
THERAPY TODAY
30
of being ignored and overlooked, of not being invited
in, welcomed or valued. Disability is a particularly clear
example of this because it involves overt, physical
exclusion. Despite legislation, disabled people are still
prevented from physically including themselves; their
experience is too often one of being stared at and
belittled and patronised. Such hostilities – and more –
are also expressed, sometimes more subtly, on the basis
of race, ethnicity, class, gender, sexuality, religion and
homelessness. Many people are members of more than one
marginalised social group and so experience overlapping
and interdependent discrimination or disadvantage.6
Social privileges
Most of us, whether clients or therapists, are both granted
and denied social power by virtue of belonging to a
multiplicity of social groups. Reflecting on how we enact
our social positions in the therapy room can give us
insight into how we might be read by a client.
Those of us who enjoy social privilege often do so
without awareness. We are not forced to be aware that
someone else is being denied what we take for granted. As
a recent newspaper article put it: ‘Most of the time, being
white is an absence of problems. The police don’t bother
you so you don’t notice the police not bothering you. You
get the job so you don’t notice not getting it. Your children
are not confused with criminals.’7
Our clients’ experience of the world may be very
different to our own. ‘Whites who are effective seem to
learn two attitudes,’ writes Carl Rogers. ‘The first is the
realization and ownership of the fact that “I think white”.
For men trying to deal with women’s rage, it might be
helpful for the man to recognize “I think male”.’8 Privilege
is the water we swim in when we have structural power,
and so we are often unaware of its presence in our lives.
We can’t assume that a client whose social position is
different to our own lives in the same world that we do
– or that we are familiar with their world.
Realistic fears
Counselling and psychotherapy have rightly been
criticised for failing to take a broader, sociological
view of distress.9,10 Even approaches that consider the
environment as a – or even the – origin of psychological
distress rarely consider more than the immediate family
FEBRUARY 2017
Diversity
THERAPY TODAY
31
Cultural competence
TRINA DALZIEL/IKON IMAGES
Social significance is attached
to our genitalia, skin colour,
sexuality, physical impairments,
age, income, job, religion and
whether we have a permanent
home, and this profoundly affects
almost all aspects of our lives
environment. To imagine that our clients are unaffected
by the wider social environment is to deny its reality.
The recent wave of hostility and violence has come as a
shock to many, yet those who are socially disempowered
know that, although the expression of hostility, in
some instances, had become more subtle, it never
stopped. Being angry when confronted with prejudice
is an appropriate response. Being anxious in a hostile
environment is also an appropriate response: it keeps you
vigilant, which helps to keep you safe.
Depending on your theoretical orientation, prejudice
and hate can be usefully understood as stemming from
irrational beliefs, as a defensive self-structure, or as
projection (there is also some understanding of racism
as a psychiatric issue – the beta-blocker propranolol has
been shown to potentially reduce implicit racial bias).11
The prejudice and hate of those with social and political
power are as potentially harmful to our clients as their
own psychopathology, and may determine, among many
other things, whether our client is attacked in the street,
whether they get the job they are qualified to do, and
whether they are offered psychological therapies rather
than admitted to a psychiatric ward. Prejudice in those
with social power cannot be shrugged off.
We can do harm, both psychologically and politically,
by pathologising or discounting our clients’ experience
of the world. However, it is also important to remember
that clients come to therapy because they are seeking
psychological help, not to witness a display of their
therapist’s political awareness. We are there to provide
therapeutic help. Hopefully, we will also take social and
political action outside the therapy room but, when inside
the therapy room, our job is to help our client find a way
to deal with their anxiety in a life-enhancing, not lifelimiting, way.
Cultural practices happen in a cultural, social and
historical context, and so their meaning changes. Judging
the niqab, hijab and burkini as oppressive, for instance,
is currently a national pastime in the UK and several
other European countries. Various forms of veiling
have, in different places and times, been used as tools of
sexual oppression, and in some instances still are but, for
many women in the UK today, choosing to be covered
FEBRUARY 2017
is a positive statement of Muslim identity in the face of
Islamophobia. Of course, a positive Muslim identity is
exactly what some people object to – it would be pretty
hard to read as pro-feminist last summer’s news footage
of armed police in France forcing a woman to remove her
tunic on a public beach. As individuals, we have the right
to our own opinions on particular values and cultural
practices, but our job as therapists is almost always to
understand what these values and practices mean to
our clients.
There are numerous texts about transcultural or
multicultural counselling that aim to foster ‘cultural
competence’ and enable the reader to understand clients
from cultures other than their own. While there is much
in these texts that is very useful indeed, I would suggest
that the idea of ‘culture’ should be approached with
extreme caution.
The tyranny of culture
The classic definition of culture (there are a great many)
comes from the founder of cultural anthropology, Sir
Edward Burnett Tylor (1832–1917): ‘… that complex whole
which includes knowledge, belief, art, morals, law, custom,
and any other capabilities and habits acquired by man
[sic] as a member of society.’12 It is widely accepted that
members of a social group, whether national, ethnic or a
group that comes into being through shared experience
of, for example, sexuality, share common practices and
values. However, culture has become a contentious
concept in anthropology. Critics, such as the feminist
anthropologist Lila Abu-Lughod, see the concept of culture
as serving to oversimplify and stereotype the other, and as
‘the essential tool for making other’ that helps ‘construct,
produce, and maintain cultural difference’ as much as it
helps us explain and understand it.13
Abu-Lughod argues that, in daily life, we respond to
specific situations in their relational context, and that
our responses are informed, but not dictated, by cultural
expectations. Arthur Kleinman,14 another anthropologist,
elaborates on this by arguing that people are often
placed in very difficult situations where adhering to
Aisha’s
story
Aisha started
crying as soon
as the meeting
started, while
her relatives
discussed her as if
she wasn’t there
I
was working
in residential
care when I first
began training as a
counsellor. Aisha was
not a counselling
client, but she was
someone to whom
I was endeavouring
to offer warmth,
respect, empathic
understanding and
a culturally endorsed course of action may simply cause
too much suffering.
The social contexts in which we live are not
homogeneous and coherent: they are subject to change,
and are always understood and experienced from a
particular perspective. I have never found knowing,
let alone understanding, supposed ‘facts’ about other
cultures particularly helpful when working with clients.
Like me, all the clients I have worked with have lived in a
multiplicity of social groups, with all their related cultures,
and, like me, have had complex and often ambivalent
relationships with these groups and cultures.
Real people live within a complex of many cultures and
subcultures. They both embody and struggle with and
against their cultural values. Cultural narratives influence,
but do not dictate, personal narratives.
What I do find helpful as a background in working with
clients from different cultures (and this would include
cultures that arise from social groups, such as blind, deaf
or gay cultures) are my friendships with people whose
social identity is different from mine. I form and maintain
friendships because I like my friends, not to educate
myself. These friendships do not inform my therapeutic
practice directly, but they do provide me with a general
familiarity that potentially enriches my practice.
I find fiction and films by writers and directors
from other places and other social groups helpful in
a similar way. I had, for example, extreme difficulty in
understanding an Albanian client who told me that,
if his family’s application for asylum in the UK was
unsuccessful, he would have to kill his daughter. She
had been raped, in front of him, by Serbian soldiers in
Kosovo, and had become pregnant. He had fled with her
to the UK, where his grandson was born. (For reasons
of confidentiality, this client is a composite, not a real,
identifiable individual.)
I was not unfamiliar with honour killings in other
communities, and I knew that Albanian culture views
rape as worse than death for the victim, and as intensely
shaming to the whole family. Yet my client confounded all
my expectations. He was very clear that he did not see his
a safe relationship in
which she could make
her own decisions.
She had been very
keen for me to attend
a meeting that her
family were having to
discuss a difficulty that
she had. I was, in the
interests of keeping
clear boundaries,
initially reluctant but,
THERAPY TODAY
32
after discussion with
my manager, agreed.
The first hour was
excruciating. Aisha
started crying as soon
as the meeting started.
She sat quietly in
the corner while her
relatives discussed
her as if she wasn’t
there. I awkwardly
interjected with
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various comments
about the importance
of expressing feelings
and being heard. No
one took any notice.
After about
an hour of this, I
mentally shrugged
my shoulders and
joined in. I was very
sure that, if any of my
counselling trainers
Diversity
REFERENCES
The social contexts in which we live
are not homogeneous and coherent:
they are subject to change, and are
always understood and experienced
from a particular perspective
1. Tolan J with Cameron R. Skills in person-centred
counselling & psychotherapy (3rd ed). London:
Sage; 2017.
2. Dearden L. Donald Trump’s victory followed by wave
of hate crime attacks against minorities across US – led
by his supporters. [Online.] The Independent; 2016:
10 November. www.independent.co.uk/news/world/
americas/us-elections/donald-trump-president-supportersattack-muslims-hijab-hispanics-lgbt-hate-crime-wave-uselection-a7410166.html (accessed 3 December 2016).
3. Travis A. Lasting rise in hate crime after EU referendum,
figures show. [Online.] The Guardian; 2016: 7 September.
www.theguardian.com/society/2016/sep/07/hate-surgedafter-eu-referendum-police-figures-show (accessed 3
December 2016).
4. Townsend M. Homophobic attacks in UK rose 147% in
three months after Brexit vote. [Online.] The Observer;
2016: 8 October. www.theguardian.com/society/2016/
oct/08/homophobic-attacks-double-after-brexit-vote
(accessed 3 December 2016).
5. Crown Prosecution Service. Violence against women and
girls: crime report 2015-16. London: CPS; 2016.
6. Cameron R. Politics, prejudice, power and privilege.
In: Tolan J with Cameron R. Skills in person-centred
counselling & psychotherapy. London: Sage; 2017
(pp125–138).
7. Marche S. The white man pathology: inside the fandom
of Sanders and Trump. [Online.] The Guardian; 2016:
10 January. www.theguardian.com/us-news/2016/jan/10/
white-man-pathology-bernie-sanders-donald-trump
(accessed 3 December 2016).
8. Rogers C. Carl Rogers on personal power. London:
Constable; 1978.
9. Baluch SP, Pieterse AL, Bolden MA. Counseling
psychology and social justice: Houston... we have a
problem. Counseling Psychologist 2004; 32: 89–98.
10. Greenleaf AT, Williams JM. Supporting social justice
advocacy: a paradigm shift towards an ecological
perspective. Journal for Social Action in Counseling
and Psychology 2009; 2(1): 1–14.
11. Terbeck S, Kahane G, McTavish S et al. Propranolol
reduces implicit negative racial bias. Psychopharmacology
2012; 222(3): 419–424.
12. Tylor EB. Primitive culture: researches into the
development of mythology, philosophy, religion,
language, art, and custom. Volume 1. London: John
Murray; 1920 [1871].
13. Abu-Lughod L. Writing against culture. In: Fox RG (ed).
Recapturing anthropology: working in the present. Santa
Fe, NM: School of American Research Press; 1991.
14. Kleinman A. Writing at the margin: discourse between
anthropology and medicine. Berkeley, CA: University of
California Press; 1995.
15. Kadare I. Broken April. New York: Vintage; 1978.
daughter as being in any way responsible for her rape. He
clearly loved both her and his grandson very dearly. He
was distraught, tormented and desperate.
I did some research in an effort to understand. I read
newspaper reports about the Kanun, the Albanian
traditional code of conduct, which in some parts of
Albania is seen to sanction honour killings. But it was only
when I happened to read a novel, Ismail Kadare’s Broken
April,15 that I understood my client’s situation. Broken
April, which is set long before the atrocities in which my
client and his daughter were caught up, does not mention
rape, but it enabled me to understand the degree to
which killing is a social obligation that has nothing to
do with what the killer feels or wants.
My client was in the situation identified by Kleinman in
which adhering to the course of action expected of him
was too painful to contemplate. He was on the point of
marrying his daughter to a British citizen whom he both
disliked and distrusted, as his only way to save her, when
they were both deported by the UK authorities.
I would very much like to hope that, over the coming
years, the UK becomes a more inclusive place, where
everyone is valued. But the signs are not good. Should the
current wave of hostility continue, my remaining hope
is that the counselling profession will make a concerted
effort to create a sanctuary for those who find themselves
at the sharp end.
or fellow trainees had
heard what was going
on, I would have been
excommunicated.
When we eventually
emerged from the
meeting, Aisha said:
‘That’s the first time
I’ve felt that you really
cared or understood.’
We talked about
why that was. She
said that I never
gave her advice – or
even asked many
questions. It was true.
Both my counselling
course and the
organisation I worked
for emphasised
the importance of
respecting clients’
autonomy. I had
learned not to ask
I had been
experiencing
one of those
thrilling periods
when a trainee
finds that what
they are doing
is ‘working’. But
it hadn’t been
working for Aisha
THERAPY TODAY
33
direct questions, and
to listen, rather than
try to solve my clients’
problems. In fact, I had
been experiencing
one of those rather
thrilling periods when
a trainee finds that
what they are doing
is ‘working’.
But it hadn’t been
working for Aisha.
FEBRUARY 2017
The problem lay in my
failure to recognise
and understand
difference. Aisha was
used to collective
problem-solving. She
felt rejected when
I failed to give her
the guidance she
expected. To her,
advice-giving was an
expression of care.
Theory in practice
Escaping the
drama triangle
Mark Head explains a simple technique to defuse the games clients play
T
MATT KENYON/IKON IMAGES
he drama triangle1 is perhaps one of the most
widely used pieces of transactional analysis
(TA) theory. It can be used to understand the
dynamics of relationships in any setting, whether
in organisations, schools, couples or in the counselling
room. It is an easily accessible tool for understanding how
psychological games2 are played out between people. In
this article, as well as looking at some typical games that
may be played in counselling, I will look at ways we can
either avoid or manage games when we find ourselves
drawn into them.
Eric Berne first introduced the idea of psychological
games in Games People Play. In general, we can think of
a game as a process of unconscious, mutual influence,
involving two or more individuals, that makes their
interactions predictable. It involves a moment of surprise,
and usually ends in all parties feeling bad in some way.
Berne argued that, because of the predictable nature of
games, we will all play them to a greater or lesser extent,
no matter how great our level of personal awareness.
Therefore, one of the aims of TA is to facilitate people
to play fewer games, and of a less destructive nature.
Berne described three degrees of destructiveness
related to games:
• first degree: uncomfortable – has an outcome that
the player will share with their social circle
• second degree: embarrassing (or shame-worthy) –
a game with an outcome that the player will not make
public within their social circle, but may share with those
with whom they are most intimate
• third degree: life-changing – a game ‘which is played
for keeps, and which ends in the surgery, courtroom, or
the morgue’.2
Drama triangle
In Games People Play, Berne described some different
ways of analysing games, but it was Karpman, with the
development of the drama triangle, who created what
is probably the most widely used method. Karpman
THERAPY TODAY
suggested that, when we engage in playing games, we take
up one of three particular roles. The ‘persecutor’ takes a
one-up position in relation to the other game player, and
blames them for the situation. The ‘rescuer’ similarly takes
a one-up position in relation to the other game player but,
rather than blaming them, tries to look after or do things
for them. Finally, the ‘victim’ takes a one-down position
in relation to the other game player, and looks for them
to solve any problems. As the game unfolds, the game
players (whether as individuals or groups) will move
around the different positions on the drama triangle.
The only rule of the game is that the players cannot be
in the same position on the drama triangle at the same
time. For example, even in a game of ‘uproar’, where both
parties are having an argument and competing for the
higher moral ground, the players will oscillate between
persecutor and victim as they seek to score points off
each other.
To demonstrate the drama triangle, we can look at
some of the games commonly played in the counselling
room. In one such game, the counsellor takes the rescuer
position and the client the victim position. This is a
Even in a game of ‘uproar’,
where both parties are having an
argument and competing for the
higher moral ground, the players
will oscillate between persecutor
and victim as they seek to score
points off each other
34
FEBRUARY 2017
THERAPY TODAY
35
FEBRUARY 2017
All three positions on the drama
triangle are unhelpful in managing our
relationships. Some people are drawn
to the rescuer position as the least
stigmatising. However, this position,
like the other two, still involves our
minimising or ignoring either our
own capability or that of the other
person to manage the situation
Mark Head
About the author
Mark Head MSc is a
certified transactional
analyst (CTA), a training
and supervising
transactional analyst
(TSTA) in psychotherapy
and a UKCP-registered
psychotherapist, as well
as being a mindfulness
instructor. He is one
of the founders and
co-directors of the Link
Centre, a TA training
centre in East Sussex.
He has over 10 years’
experience of training
and supervising people
in TA.
common counselling game, not least because many
people train to be counsellors because they want to help
people, making them susceptible to rescuing. Berne gave
colloquial names to games, and these types of games he
called ‘Do me something’ or ‘Why don’t you… Yes, but’.
In counselling practice, a client might say, ‘I have come
to you to sort out my problem’, ‘I want your advice’ or
(a very familiar scenario to most counsellors), when the
counsellor asks a client what they want from a session,
‘I don’t know’. If we aren’t alert to this, it is easy to find
ourselves working hard to solve the other person’s
problem, offering advice or trying to do the client’s
thinking for them.
As the game unfolds, different possibilities occur. It
might be that the client comes to counselling one day
and says, ‘This isn’t really working for me; I’m thinking of
finishing.’ Here the client shifts from victim to persecutor,
and the counsellor from rescuer to victim. Alternatively,
the counsellor may offer their ‘helpful’ suggestions, but
the client always seems to find reasons not to follow any
of them through (here the client is subtly moving between
victim and persecutor, and the counsellor between
rescuer and victim). If the client doesn’t leave first (as in
the previous example), the counsellor may eventually
become so frustrated that they switch to persecutor and
become overly confrontational, or find a way of getting
rid of the client.
Kick me
The second common type of game is often played
around the boundaries of counselling. Berne referred
to this game as ‘Kick me’. Here, the client may make a
number of demands or requests of the counsellor (for
example, asking for a reduced fee) or continually turn
up late. In this instance, the client is unconsciously
THERAPY TODAY
36
taking up the persecutor position, and the counsellor
unconsciously (maybe for the sake of building the
therapeutic relationship) rescues the client by not sharing
their discomfort with what is going on. As the client
continues to make demands or push the boundaries
of the counselling, the counsellor begins to feel more
frustrated. This culminates in the counsellor delivering
a psychological kick, perhaps in the form of an overly
robust confrontation where they offload their stored-up
frustrations on the client.
A third game that most counsellors experience is when
a client initially idealises their counsellor, only to later
regard them as inadequate or even dangerous. Berne
referred to this game as ‘Now I’ve got you, son of a bitch’
(NIGYSOB). Here, the client begins by heaping praise on
the counsellor, and puts themselves down in comparison.
While this may not be at first apparent, the counsellor
takes the rescuer role by not confronting or questioning
this initial idealisation. Unfortunately, counsellors, like
all human beings, make mistakes. When this occurs, the
client switches into the persecutor role and may leave
therapy (possibly giving no reason), or find ways to let
the counsellor know they have got it wrong for them and
why this makes them a bad counsellor.
Winner’s triangle
Obviously, awareness of games can really help us as
counsellors because it provides us with opportunities
to think about ways we can manage situations where
we think we are getting involved in a game, or we find
ourselves in the middle of a game, or we realise we have
been playing a game. However, this does not always help
counsellors know what they can actually do in such
situations. Here, a model developed by Choy, called the
‘winner’s triangle’, can help.3
All three positions on the drama triangle are unhelpful
in managing our relationships. Some people are
drawn to the rescuer position as the least stigmatising.
However, this position, like the other two, still involves
our minimising or ignoring either our own capability or
that of the other person to manage the situation. Choy
identified three positive alternatives to the positions
on the drama triangle by recognising that each has a
positive component. She calls these ‘assertive’, ‘caring’
and ‘vulnerable’. The assertive position is concerned with
expression of our own interests and needs. Rather than
persecuting and blaming the other person, assertiveness
involves setting appropriate boundaries, providing
feedback and clearly stating what is wanted. The caring
position is about showing concern for people who are
vulnerable in a way that seeks to empower them. Rather
than rescuing and ‘doing for’ the other person, caring
involves checking out if our help is wanted, and if it is
something we are happy to give without putting a price
on the service, and doing our share of whatever is agreed.
FEBRUARY 2017
Theory in practice
Persecutor
Rescuer
Drama triangle
Assertive
Caring
Winner’s triangle
Victim
Vulnerable
THE DRAMA AND WINNER’S TRIANGLES
The vulnerable position is not about being a victim; it’s
about genuinely acknowledging suffering, or potential
suffering, and expressing feelings.
Changing triangles
If we become aware that we are in the middle of a game
with someone, we can shift off the drama triangle and
onto the winner’s triangle. So, instead of persecuting,
we are assertive; instead of rescuing, we are caring,
and, instead of being a victim, we are vulnerable. As
counsellors in the ‘Do me something’ game, we may
want to focus on caring, and consider how we avoid
over-providing for our clients and facilitate their doing
their share of the thinking – in short, look to empower
them. In the second and third games (‘Kick me’ and
‘NIGYSOB’), we may want to focus on assertiveness to
bring awareness of the process into the work. We can then
negotiate and agree with the client how we will manage
the boundaries of the therapy, or what happens when we
get it wrong for our client. In situations where we do get
it wrong for our client, or where we are affected by our
client’s suffering, the most useful intervention may be to
show our vulnerability, through either a heartfelt apology
or an expression of feeling, without getting defensive or
trying to make things OK for the client.
Is there a position on the drama triangle that you tend
to avoid when you are involved in such games? If so, you
probably need to develop the positive alternative on the
winner’s triangle. For example, many therapists (but not
all) avoid the persecutor position and then find it difficult
to use assertiveness in their work, and may mistake
assertiveness for persecution. Yet it is assertiveness that
they need to develop in order to manage the games in
which they are likely to find themselves.
This article was first published in the winter 2016 issue of
Private Practice journal. bacppp.org.uk
THERAPY TODAY
37
FEBRUARY 2017
REFERENCES
1. Karpman S. Fairy
tales and script drama
analysis. Transactional
Analysis Bulletin 1968;
7(26): 39–43.
2. Berne E. Games
people play. London:
Penguin; 1964.
3. Choy A. The winner’s
triangle. Transactional
Analysis Journal 1990;
20(1): 40–46.
Research into practice
Bridging the gap
Practitioners and researchers need to find ways to talk to each other,
says BACP’s new Joint Head of Research, Clare Symons
J
ohn McLeod’s vision
when launching
the BACP research
journal Counselling &
Psychotherapy Research (CPR,
now published for BACP by
Wiley) back in 2000 was to create
a journal that explicitly linked
research with practice. ‘The
vision itself came out of research
showing that counselling
practitioners didn’t really
consider research to be relevant
to them and their practice,’ says
Clare Symons, who has edited
CPR for the past three years and
has just moved to take up the
post of Joint Head of Research at
BACP. That vision remains, she
emphasises: to provide a forum
for practice-focused research and
ensure practitioner members of
BACP have access to high-quality
research in their specialist fields.
Practice research networks
With regard to the first aim, both
CPR and BACP are taking steps
to build stronger links between
research and practice. Says Clare:
‘It’s very difficult to bridge that
gap if practitioners aren’t talking
to researchers, and vice versa.’
One solution, which is proving
very effective, is practice-based
research networks (PRNs),
such as the Children and Young
People PRN, which draws
together practitioners from
across children’s health and
social-care services to collect
evidence of good practice that
can then be used to improve
services. ‘Linking research and
practice is a process, an ongoing
dialogue between the two,’ Clare
believes. ‘My hope for the future
is that, in the next 10 years, we
will see more practice-based
research and there’ll be more
interaction between practitioners
and researchers, drawing on
this big body of evidence. I
would love to see a PRN for
private practitioners. Think of
the evidence base they could
create if they were gathering data
collectively. The BACP Research
department is planning to put
support in place so practitioners
can be part of relevant PRNs to
contribute to the evidence base
and support their own practice.
I think members want this.’
From research to practice
Another challenge is to improve
practitioners’ ability to understand
and apply research findings. ‘A
lot of practitioners don’t have
the knowledge about research to
evaluate what they are reading
and to understand and make
judgments about its quality
and whether a particular article
should influence their practice,’
Clare says. ‘BACP is reviewing
what members need to help
them critically evaluate
research and make better
use of it in practice, such as
training modules.’
CPR is also making more
use of video and audio abstracts
to explain papers and draw
readers in. ‘These are all ways
to break down the barriers for
those who find research papers
dry and difficult to engage
with, and connect them with
the human face of research in
counselling and psychotherapy,’
Clare says.
But CPR is aware that the
research it publishes needs to be
more relevant and accessible to
practitioners. The journal does
publish quantitative, statistical
analyses, but its readiness to
promote qualitative research is
an increasingly unique strength,
Clare believes. This year, CPR
will be publishing two special
sections (issues), in March
and June, on ‘Use of personal
experience in research’, edited
by Jeannie Wright (University
of Malta) and Jonathan Wyatt
(University of Edinburgh). The
special sections will feature
research using a range of
qualitative methodologies.
‘I think a lot of practitioners
who are less comfortable with
positivist research will find these
papers more relevant to their
A LIBRARY IN
YOUR POCKET
This time a year ago, CPR set a
precedent for BACP’s journals and
went online-only.
CPR was costing BACP a fortune in
printing and mailing costs, and creating
a vast carbon footprint, while too many
members simply weren’t reading it.
Clare Symons oversaw the transition.
‘Many of our members, unless they
are training or work in an academic
institution, have very little access to
good-quality research,’ she says. ‘My aim
as editor was to enable and improve that
access. With CPR online, BACP members
have instant access to a whole library of
articles specifically on counselling and
THERAPY TODAY
38
FEBRUARY 2017
psychotherapy that are very relevant to
their day-to-day work with clients.’
All BACP members have free online
access to the full archive of CPR articles
via the BACP website. Just sign in using
your BACP membership log-in details at
www.bacp.co.uk/research/publications/
CPR.php
In addition, CPR now has a free app
that allows BACP members to access
the archive wherever and whenever they
want. The app is currently only available
for iPhones, but an Android version is
coming soon.
You can download the app from
bit.ly/2inhsie
Panos Vostanis
P
VELLEKOOP LEON/IKON IMAGES
‘My bottom
line is that, as a
practitioner, I want
to know how to
work better with
the client in the
room, and I think
CPR is a key tool
for equipping
members in that’
practice,’ Clare says. ‘CPR has
always tried to be pluralist in
the different approaches and
methodologies it acknowledges.
It is one of its strengths that it is
open to this breadth.’
CPR is also ready to engage
with the wider sociopolitical
world. In early 2018, Jaime
Delgadillo (University of York)
will be guest-editing a special
issue on social inequality, and a
special section on counselling
and the LGBTQ community is
also in the pipeline.
Professor Panos Vostanis was
recently appointed to replace
Clare as editor of CPR. He points
out that a major challenge for the
journal is the lack of high-quality
research in the field in general.
‘Ultimately, there hasn’t been a
lot of counselling research out
there, and counselling struggles
to get the funding necessary to
conduct these large-scale trials
that produce the “hard” evidence
for effectiveness,’ he says.
Small is beautiful
CPR is competing for papers
with journals that carry much
greater academic weight in the
international academic ranking
system. It has two options: it can
(and does) publish ‘offspring’
papers from the large-scale trials,
and it can (and does) encourage
new researchers to publish their
work, however small-scale it is.
‘You can do very small
pieces of research that, while
their samples aren’t huge, still
produce good results. There’s a
lot of master’s research that has
never been published. There
should be a place where these
researchers can publish their
findings. There’s nothing wrong
with small-scale, so long as the
researcher is aware of and honest
about the research’s limitations,’
THERAPY TODAY
Panos says. ‘They are all adding
to the building blocks that
together make up a robust
body of counselling and
psychotherapy research.’
‘CPR is still in its infancy in
research-journal terms,’ says Clare.
‘We’ve seen a gradual increase
in the quality of our articles
over its lifetime.’ She believes
the journal is well on its way
towards achieving what she calls
‘a delicate balancing act’ between
attracting high-quality new work
by researchers and practitioners
in counselling services and
providing a platform for
fledgling researchers.
‘For me, research is
another tool in our
members’ skills sets.
There are plenty of
practitioners
who feel really
put off by research,
for understandable
reasons. Researchers
are not always very good at
communicating their research or
why it is important. My bottom
line is that, as a practitioner, I want
to know how to work better with
the client in the room, and I think
CPR is a key tool for equipping
practitioners and members in
that. It’s whether people feel able
to use that tool, and I think there
is more we can do to help them.’
39
anos Vostanis, the new
editor of CPR, has
worked in child psychiatry
for nearly 30 years. He is
Professor of Child Mental
Health at the University
of Leicester, a visiting
professor at University
College London and a
tutor with the Anna Freud
Centre in London. He
has extensive training in
child, adult and family
psychotherapies and
has published widely on
children’s mental health,
particularly the impact
of trauma on children,
including those living in
war zones. He recently
returned from a trip across
six continents with the
World Awareness
for Children in
Trauma project,
to promote a
sustainable
model of
intervention
to help
children who
have experienced
adversity and trauma.
He was editor of the journal
Child and Adolescent
Mental Health for six years
and is a member of the
BACP Research Committee.
‘For me,’ he says, ‘the
challenge is to get a
good balance between
counselling, psychotherapy
and research.’
Coming next month
Next month we will be launching a new, monthly section
on Research into Practice, in which Liddy Carver, formerly
Programme Leader for Counselling Skills at the University
of Chester, will review new research and explain its
relevance to everyday clinical practice.
FEBRUARY 2017
CONFIDENTIALITY
IN TRAINING
MISTAKES
ARE PART OF
LEARNING
This month’s dilemma
S
amuel and Faduma are trainees in
their first year of a postgraduate
diploma in integrative counselling.
One evening, Samuel offers Faduma
a lift home after the course. On the way,
Faduma chats about her first client in
her first counselling placement. By the
end of the journey, she has revealed the
client’s first name, age, where they live
and work, and that they’re battling with
a cocaine habit, among other details.
Samuel is concerned that so much
has been revealed to him in such an
unboundaried way. As an occasional
recreational drug user himself, he also
feels uncomfortable about Faduma’s
judgmental attitude towards her client’s
NIP GOSSIP
IN THE BUD
Adam Knowles
BACP student member
A
s a trainee, I empathise: this
situation comes up more
often than I’d like. Faduma has
much to learn about professional
ethics. But, then, nobody wants to
start their career with an ethical
complaint against them. Nor,
I assume, would Samuel want
to escalate the complaint if it
could be avoided: it would make
the second year of his course
rather awkward.
Perhaps Samuel’s best course
of action would have been to have
interrupted Faduma earlier in the
conversation, when he began to
feel uncomfortable, and to have
said: ‘Best not tell me their name.
Confidentiality and all that.’ That
cocaine use, but does not want to
challenge her about this, as he’s anxious
she might judge him too, and he has
his own worries about whether his drug
use is compatible with his becoming
a counsellor.
He is not sure whether to report
Faduma to the course leader for
breaching client confidentiality, or to her
placement manager, or even to BACP.
WHAT WOULD YOU DO
IN SAMUEL’S POSITION?
Please note that the opinions expressed
in these responses are those of the
writers and not necessarily those of the
column editor, Therapy Today or BACP.
ship has sailed, but that’s what I
try to do when these situations
arise – nip them in the bud.
On my course, we are
encouraged to discuss suitably
anonymised cases in class in
the context of the theory we are
learning, so I pondered what the
difference is here. It is, in a word,
‘gossip’. Intention is everything.
Discussing a client in order
to help them, or to become a
better therapist, is a legitimate
intention; unreflective venting
and judging are not.
Samuel needs to work out a
more confident position on his
use of drugs in relation to his
becoming a counsellor, but this
is a separate issue.
The question is whether
Faduma’s attitudes and
behaviours will be challenged –
let’s even say ‘corrected’ – by her
supervisors and the training in
due course. If so, I would give her
the benefit of the doubt; if not, I’d
be inclined to take proportionate
action. Certainly, were a similar
situation to arise in future, and
not only with Faduma, Samuel
could voice his own commitment
to confidentiality and question
the appropriateness of the
discussion, to avoid being put
in this difficult position again.
‘Discussing a client in order to help
them, or to become a better therapist, is a legitimate intention; unreflective
venting and judging are not’
THERAPY TODAY
40
FEBRUARY 2017
Sarah Van Gogh
Counsellor in private practice
and for Survivors UK, and a
tutor at Re-Vision
I
would hope Samuel’s strong
reaction to the conversation
with Faduma would encourage
him to realise that something
important has been stirred up
in him and that he could take
it to his personal therapy. For
example, he might use his own
therapy to look at how anxious
he is about being judged, how
lacking in confidence he is about
what to do if he perceives a peer
is behaving unethically, and what
his own drug use means to him.
In good counselling training,
there are groups devoted to
facilitating authentic exchanges
between trainees on sensitive
interpersonal issues like these.
Such a group would provide
a space where Samuel could
open up about what he has
been thinking and feeling about
this discussion with Faduma.
There should also be space in
supervision groups for trainees
to look at ethical dilemmas,
where Samuel could discuss what
to do when informal exchanges
tip into oversharing client
material or intimate information
about peers.
If counselling trainees have
good modelling from their
therapists and trainers on how
to be deeply accepting of the
‘core’ self while remaining able
to rigorously challenge certain
‘personal’ behaviours, they can
learn by example to be similarly
accepting and challenging in
their interactions with others.
I hope Samuel is supported
and challenged enough in his
therapy and training to be able to
raise directly with Faduma what
Dilemmas
his reactions were to the way
she spoke about her client, while
remaining mindful that he too is
an imperfect being who is on a
learning journey.
TIME FOR SELFREFLECTION
Sophia Prevezenou
Psychosynthesis
psychotherapist,
supervisor and trainer
W
hat struck me about this
dilemma was the power
of judgment and fear, and their
role in any decision-making.
Faduma judges her client for
taking drugs. Samuel judges
Faduma for having revealed
confidential information to
him, and for judging her client.
Samuel fears being judged by
his training organisation and
possibly judges himself for his
occasional drug use.
Samuel is unwittingly faced
with a disclosure that puts him
in a position of having to take
some action and consider his
duty of care and the extent of his
responsibility in this situation.
What complicates matters is his
own fear that, if he speaks to
anyone about this, his future
as a counsellor might be at risk.
What’s important here is to
distinguish the aspects that
relate to a potential breach of
the BACP Ethical Framework
and require action, in order to
safeguard Faduma’s client, from
those that relate to superego
activity, and intrapersonal and
interpersonal dynamics, which
should be explored in therapy
and supervision.
In the first instance, Samuel
might want to reflect in his own
therapy on the dynamics of
his relationship with Faduma
that make it difficult for him
to confront her, and how he
might find it easier to report
her to the relevant authorities.
If I were Samuel, I would talk
to Faduma, remind her that
keeping professional boundaries
is of paramount importance,
and encourage her to take this
to her therapy and supervision,
where she can reflect on her
reasons for casually discussing
her client with a colleague, and
her judgmental attitude. For
Samuel (and Faduma), this is
about self-reflection, rather than
taking action motivated by fear
and anxiety.
‘If this is a one-off
breach, Samuel’s
pointing this out
to Faduma may be
enough to make
her more careful
in future’
HE SHOULD TALK
TO HER FIRST
Heather Dale
BACP senior accredited
counsellor and
psychotherapist, and
senior lecturer at the
University of Huddersfield
T
here are several dilemmas
here. First, there are the
confidential details that Faduma
has revealed to Samuel. She
may think that, as they are
both trainees and bound by
the same ethical code, she can
allow herself a certain amount
of freedom. Even so, she has
disclosed a lot of information,
and Samuel is right to take
this seriously.
Samuel should put himself in
Faduma’s shoes: what if he was
the one who might be considered
to be oversharing? My guess is
that he would want Faduma to
discuss it with him before taking
any action, which is the right
course. If this is a one-off breach,
Samuel’s pointing this out to
Faduma may be enough to make
her more careful in future. He
should only take it further if he is
convinced that she is not aware
of the seriousness of breaching
confidentiality, and then only
after having told her what he is
going to do.
Second, there is Samuel’s
concern about Faduma’s
‘judgmental attitude’. Her client
hasn’t stopped coming to see her,
so perhaps Samuel’s discomfort
is more to do with his own fears
about his drug use.
Last, there is Samuel’s concern
about his own drug use and
whether that is compatible with
his becoming a counsellor. Only
Samuel knows the answer to that
question, and he needs to find a
safe place, perhaps in personal
therapy, to consider and talk
through the issues.
May’s dilemma:
Matias, an accredited
counsellor in private practice,
keeps handwritten notes on
his clients, where he records
the main issues discussed
in sessions. He anonymises
his notes 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 how
to work 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.
THERAPY TODAY
41
He has heard about the
difficulty trusting people in
Data Protection Act, and is
general. After a particularly
aware that some therapists
challenging session, after
in private practice have
which Matias has written
registered with something
about how hard he finds it to
called the Information
empathise with this client, the
Commissioner’s Office, but,
client asks him if he keeps
because he does not keep
notes of the sessions and, if
identifiable client records
so, whether he can see them.
electronically, has not
thought this relevant to him.
Matias has been working
WHAT SHOULD
for some months with a client
MATIAS DO?
whom he experiences as
Please email your responses
critical of him, and of
(300 words maximum) to John
therapy in general. The
Daniel at dilemmas@thinkpublishing.
client also voices his
co.uk by 20 March. The editor reserves
anger towards work
the right to cut and edit contributions.
colleagues, who he
Readers are welcome to send in
thinks don’t like him
suggestions for dilemmas to be
and talk about him
considered for publication, but
behind his back, and his
they will not be answered
personally.
FEBRUARY 2017
GETTY IMAGES
FAMILY TENSIONS
AND RELATIONSHIPS
Talking point
Each
month we’ll be
asking readers across
the UK for their views
on topical issues. To start
the year, we asked for a
snapshot of what clients
are bringing to
counselling right
now
Last year was one of massive national and international turbulence:
the UK voted to leave the European Union, Donald Trump was
elected US President, terror attacks brought death to ordinary citizens
going about their daily lives, and further disclosures of historic child
sexual abuse rocked the world of sport. Often, the issues our clients
present in counselling mirror what’s happening in the world at large.
When a tragedy hits the headlines, buried material can break into
consciousness, or it can trigger new distress. Either way, therapists
are often the first to hear about it. We wondered: what are clients
bringing to therapy at the moment? Interviews by Nadine Woogara
ANXIETY AND TERRORISM
‘The main issue that our young clients are
bringing to counselling is anxiety. Anxiety
was the highest presenting problem every
month of last year. Children as young as five
are presenting with general anxiety disorder,
social anxiety disorder, anxiety around
trauma and specific phobias. It used to be the
case that, if you were having issues outside of
home, home was a safe place. But now, with
social media, there’s a lot more unfiltered
information coming to young people. Today
they’re exposed to so much more. Right now,
it’s the terror attacks that are causing anxiety.
Children are presenting with: “What if that
happened here?” Transgenerationally, we see
a lot of suppressed anxiety within parents
that is revisited in the population of young
children. Our practice is in Northern Ireland,
so for us anxiety is a way of life.’
Edith Bell
Child and adolescent specialist,
Northern Ireland
THERAPY TODAY
42
FEBRUARY 2017
‘Nine out of 10 of my clients are Asian or
Muslim. They see my photo or my name
and think: “Oh, you’ll understand.” They’re
bringing marriage issues – separation and
divorce. Or they’re getting to a place where
things aren’t working out and there’s conflict.
Equally, it’s healthy relationships. They may
not want to split up, but they’re unhappy.
It usually involves the extended family
and their in-laws. A lot of my work is about
helping couples recognise that their marriage
doesn’t exist in a bubble, or recognising that
there is a bubble when too many people are
involved. Over the last year, I’ve consistently
seen a generational shift in how marriage
is viewed. The younger generation’s idea of
what it is to be married is to have their own
place, while the older generation think the
couple should move in with the husband’s
family. So conflict comes up with the dual
role of the husband – son and husband. Right
now, a lot of my work is about managing
these other relationships.’
Myira Khan
Specialist in counselling BME and
Muslim client groups, Leicestershire
EXPECTATIONS AND VALUES
‘What I’m seeing is clients coming
with the issue of not quite fitting in.
People feeling undervalued, so they
put themselves under a lot of pressure,
which then makes them anxious and
depressed because they’re not living up
to expectations at work or at home, say.
As a consequence, they see themselves
as not good enough, and this translates
into other areas of their lives. With my
background in working with people
with disabilities and long-term health
conditions, the idea that you should be
a certain way, that there’s one acceptable
way of being, is very present. People are
trying to be what they think they should
be. And, when it’s not possible to be that
person, their self-esteem suffers. And
I think we have come to value things
more than each other, and ultimately
that makes us unhappy – it’s a case of
perpetuated misdirection.’
Rachel Waddington
Disability and long-term health condition
specialist, South Yorkshire
What’s on their minds?
NUMBING THE PAIN
‘There’s a lot of historical child sexual abuse coming up
with the female clients I work with. A lot of shame that
they’re working through, along with self-esteem issues,
and trust and relationship difficulties. A lot of my clients
might be numbing their pain through drugs and alcohol
as it’s started to get the better of them. When I look at
all my clients, they are all feeling some sort of emotional
pain, and they are no longer managing it on their own.
Thinking about it, what all these issues have in common is
that they highlight the complexity of people’s lives today.’
Helen George
Women’s issues specialist, Middlesex
NEW YEAR, NEW START
‘As we’re just over the Christmas
break, I’ve mainly been getting calls
asking for what I call “cabin-fever
counselling”. People have been with
their family for days, and probably
for more hours than they bargained
for, and it’s brought up issues in their
relationships. Also, with the new year,
it’s a new beginning, and people are
looking at their lives and asking: “Do I
want to continue this way?” I’ve had a
stream of emails and calls from people
who want a change, saying: “I hate my
life.” Calls are also starting to come in
from people about childhood sexual
abuse, following the football scandal.
When the whole thing hit the fan in
November, I predicted then that there
might be a peak in people bringing
abuse. Sure enough, that is what
has happened.’
James Alexander
Specialist in child sexual abuse and
relationships, Glasgow, Scotland
Talking Point
If you’d like to join our Talking Point panel,
email [email protected]
POLITICAL FALL-OUT
‘I’ve definitely seen a rise in anxiety,
especially among European clients. If you
monitored the level of anxiety through this
year, you’d see peaks around the Brexit vote
and the US election. If I notice an increase
in anxiety, I ask my clients about the world
around them. I ask open questions to
explore triggers. I give them space to talk
about Brexit without asking directly. Many
European clients had quite catastrophic
thinking after the referendum. It was a
reflection of what they saw in the world.
Similarly, I’ve seen a lot of issues about
work. Not necessarily bullying, but it’s linked
to the political changes. And I’ve been
working a lot with obsessive compulsive
disorder. It was quite hidden and underdiagnosed. Now there’s a lot more open
discussion about it. Role models in the media
have helped people to understand what it is.
I’m not completely convinced by the internet,
but online forums can help people to spot
THERAPY TODAY
43
FEBRUARY 2017
STRESS AND SEX
‘I’m seeing a lot of anxiety
and stress. That’s something
that young people are
experiencing a lot of right
now. It’s exacerbated
because I work in a very
academic school, with high
expectations. Stress impacts
on sleep, so I see a lot of
boys with sleep issues. I see
some boys with depression
and a few with self-harm, but
that is unusual here. I’ve been
in this job for three years
now, so boys are starting to
bring relationships to me,
and questions about sex.
Issues around sex at this
age are very interesting and
quite a difficult area to work
in. It’s an all-boys school, so
they may not be very used to
relating to girls. In the top of
the school, I have young men
who are sexually active and
it may not be going well.
In the middle, I have boys
who want to talk to girls
and are finding that really
scary. Right at the bottom of
the school, I have little boys
asking: “What is sex?” It’s
interesting where the line
between counselling and sex
education lies. Talking about
sex often seems to come out
of talking about something
else, like a family break-up.’
Meg Harper
Child and adolescent
specialist, Warwickshire
symptoms and think: “That could be me.”
I think people are more open now to
coming to counselling and saying: “I think
I have this.” But Facebook and Twitter are
obsessive rituals themselves. I’ve seen
clients called in by their manager for being
on their phone too much at work. Some
people have to check it in the morning
before they even get out of bed.’
Elaine Davies
CBT specialist, Wales
Self-care
HOW DO YOU TAKE CARE OF YOURSELF?
Tell us how you guard against the stresses of your work and what you
do to refresh and restore your energies and empathy. Here, counsellor
GARY WILLIAMS kicks off our new series
GETTY IMAGES
A
ll through my working life, first
in the military, then in the police
service and now as a counsellor, I have
worked with people at the sharp end
of trauma.
Self-care has always been essential
for me – to protect myself both
physically and mentally.
I spent four years in the Royal Navy
in the late 1970s, and then joined the
police service and worked my way
up from a uniformed policeman on
the beat in Liverpool city centre to,
25 years later, a detective inspector
investigating family crime.
That was when I trained as a personcentred counsellor – I thought I could
use my experiences in the police and
navy to work with people through their
traumatic experiences. I’ve helped to
establish perpetrator programmes and
survivor groups – very rewarding work
that really does save lives.
I retired early from the police force
and quickly established myself as a
counsellor, specialising in working with
domestic abuse and running training
workshops for therapists.
I have two supervisors who support
and challenge me in my life and my
work. For me, that’s essential.
And I maintain a good level of
fitness. I train regularly and participate
in triathlons, which demand high
levels of both physical and mental
endurance. I’m not a competitive
person – for me, the hours of
swimming, cycling and running in
THERAPY TODAY
44
FEBRUARY 2017
triathlons are all about physical and
mental focus, which I find helps me to
manage my own emotions in my work.
To me, self-care is quite simply about
ensuring I am fit enough to provide
professional therapeutic support
to others.
Gary Williams is a
BACP-registered counsellor
and workshop facilitator,
based in Merseyside
How do you take
care of yourself?
Email therapytoday@
thinkpublishing.co.uk
From the Chair
‘Is this work sexy, with immediate, visible impact for the
membership? No, it isn’t. Is it critical for what we do, how
we do it and why we do it at all? You bet your life it is’
CHARLIE BEST
A
t our AGM in November 2016, I used a metaphor that I will shamelessly
re-use here. It was about moving into a new house. You have lots of
plans for change: decorating, new carpets, perhaps a new extension.
Then you move in and find all sorts of structural problems, of which
you were blissfully unaware, have to be sorted out first. You realise, with a tinge of
disappointment, that the makeover is pointless until the structural problems have
been attended to. Welcome to my experience at BACP.
This has been at the heart of my first two years as Chair, working alongside the
other board members, the CEO and his team, and the wider staff team. Is this work
sexy, with immediate, visible impact for the membership? No, it isn’t. Is it critical
for what we do, how we do it and why we do it at all? You bet your life it is.
You will be pleased to know there has been considerable progress on
many fronts. We have a new IT structure in place that will soon enable
major changes to our website. We have a whole new strategy, including
children, young people and families, older people and the Four
Nations. New branding will soon be rolled out across the whole
association and, as you will have noticed this month, we have a
new-look Therapy Today.
It doesn’t stop there. We now have excellent working relationships
with the UK Council for Psychotherapy (UKCP) and the British
Psychoanalytic Council (BPC), and a new strategic partnership
with the Irish Association for Counselling and Psychotherapy
(IACP), as well as Relate. As I write, we are talking to other
organisations too. We are in regular dialogue with politicians,
commissioners and other stakeholders to advocate for the
counselling professions, and are working to bring the service
users’ perspective into BACP to help inform and challenge our
thinking. Our core position that ‘counselling changes lives’ is at
the heart of all that we now do.
I’m delighted to announce that the house is now in much
better shape, and I hope 2017 will bring the changes you would
wish for your association.
email
andrew.reeves@
bacp.co.uk
Twitter
@Reeves_Therapy
@BACP
BACP board and officers
Chair Andrew Reeves Deputy Chair Fiona Ballantine Dykes President David Weaver
Governors Natalie Bailey, Eddie Carden, Sophie-Grace Chappell, Myira Khan, Caryl Sibbett, Vanessa Stirum, Mhairi Thurston
Chief Executive Hadyn Williams Deputy Chief Executives Cris Holmes, Nancy Rowland
THERAPY TODAY
45
FEBRUARY 2017
BACP round–up
Our monthly digest of BACP news, updates and events
An evening with
Susie Orbach
BACP members are invited to join us online for ‘An Evening with Susie Orbach’,
from 7.30pm on 16 March 2017, at the Barbican Centre in London.
The event is already fully booked but it will be webcast live on the night, so
BACP members can take part, for free, from the comfort of their own homes.
Susie Orbach is a psychotherapist, psychoanalyst, writer and social critic.
She founded the Women’s Therapy Centre in 1976 and is the author of
Fat Is a Feminist Issue and Bodies. Her most recent book, In Therapy, is
based on the Radio 4 series of the same name.
This promises to be an unforgettable evening with one of the UK’s top
psychotherapists. To book for the webcast, go to www.bacp.co.uk/webinar
If you would like to put a question to Susie on the evening, please email it
to [email protected] or tweet us at #BACPEveningWith17
Find out more at www.bacp.co.uk/events
Spokesperson
network
Would you like to join BACP’s
spokesperson network and help
promote the counselling professions?
BACP’s External Communications
team is putting out a call for members
who would be willing to help us respond
to enquiries from journalists, event
organisers (speaker requests), media
production companies and researchers.
We’ll also be calling on the
network to help inform our campaigns
and generate proactive media
coverage to promote counselling
and psychotherapy, BACP’s strategy
and membership and the benefits
of counselling to the public.
If you would like to know more,
please email [email protected]
with information about your areas
of expertise and your contact details.
THERAPY TODAY
46
FEBRUARY 2017
2
studentships worth £7,500
each are being offered by
BACP in 2017 to support PhD
research on topics related to
BACP’s strategic aims. To apply
and for more information, email
[email protected]
23
Booking is now open for BACP’s
23rd Annual Research Conference
on 19–20 May, co-hosted with the
University of Chester. The theme is
‘Research and effective practice for
the counselling professions’. Email
[email protected]
Counselling
for Depression
Clients find Counselling
for Depression (CfD)
helpful but hard work,
a study published in the
BACP journal Counselling
& Psychotherapy Research
(CPR) suggests.1
CfD is a manualised
form of counselling that
is approved by NICE
and offered through
the primary-care IAPT
programme in England.
The researchers behind
the study used interpretative
phenomenological analysis
to examine data from 12
clients who completed the
Helpful Aspects of Therapy
questionnaire and 10 who
took part in post-counselling
semi-structured interviews.
The results showed that
clients experienced CfD as
helpful, and felt understood
by their counsellors and
able to work through issues
within a safe therapeutic
relationship. But they said
they found the counselling
‘hard work’ and they didn’t
like the limit on how many
sessions they could have
(CfD is recommended for
eight to 10 sessions).
28
28 February is the final deadline
for members using BACP’s
online accreditation system.
We’re closing down the system
so we can modernise it and
make it more user-friendly.
If you’re using it to log your
training, practice, CPD or
supervision, you should print
off your completed records
before the deadline. If you’ve
already started your online
accreditation application, you’ll
need to complete it in full and
submit it before the deadline.
If you need help, email the
BACP Accreditation team at
[email protected] or
go to bit.ly/2iuYd4c
ALAMY; CHARLIE BEST
CPR is free online to BACP
members. Log in at
www.bacp.co.uk/research
1. Goldman S, Brettle A, McAndrew
S. A client focused perspective of
the effectiveness of Counselling for
Depression (CfD). CPR 2016; 16(4):
288–297.
BACP welcomes
schools pledge
BACP has warmly welcomed Prime Minister Theresa May’s
commitment to improve mental health support in schools.
The Prime Minister’s announcement on mental health
in January covered several issues that BACP has been
campaigning on. BACP has particularly welcomed the offer
of mental health first-aid training for every secondary school
in England. ‘It’s important that teachers and school staff can
identify problems and offer emotional first aid to children, and
it’s a crucial first step in ensuring children and young people
are signposted to appropriate psychological support
when needed. BACP has long campaigned for a
trained counsellor in every school in England, as
there is in Wales and Northern Ireland,’ BACP
Chair Andrew Reeves (left) said.
BACP also welcomed the emphasis
on improving mental health in workplaces,
new funding for digital mental health services,
and the renewed commitment to parity of
esteem for mental health services. ‘There
have been few visible improvements
since parity for mental health
services was enshrined in law,
and it remains a priority for us,’
Reeves said.
Find out more at bit.ly/2jra2cA
THERAPY TODAY
47
FEBRUARY 2017
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
Jameel Abbas
Heather Adams
Nigel Armstrong
Laura Baines-Ball
Walkiria Bass
Michael Batkin
Chris Berry
Susan Bird
Kirstie Bratton
Ron Bushyager
Lisa Charlton
Edita Chodoseviciute
Mark Colhoun
Nileema Conlon Vaswani
Delia Cooke
Martha Copsey
Hannah Cowan
Amanda Croft
Evelyn Dickinson
Jonathan Dyson
Joan Elliot
Robert Finch
Sharon Fitzpatrick
Angela Forrester
Philip Gatter
Sheila Goddard
Susanne Gosling
William Gray
Simon Hardy
Neil Hargreaves
Amanda Hawking
Sandra Hewett
Matt Hewitt
Angela Heyes
Candice Hone
Linda Hoyle
Vivienne Huckerby
Helen Hunt
Joanna James
Mahtab Kafi
Angela Keane
Maxine Kelsey
Graham Kennish
Tracey Knight
Susan Lacey
Deborah Langdon
Clint Larcombe
Geraldine Linley
Eileen Mason
Stuart Matheson
Hazel McCartney
Glenda McCormick
Jenny McCracken
Steve McFadden
Sarah McWhirter
Deborah Miller
Meena Modhvadia
Dimitrios Monochristou
Debra Nash
Joanne Newstead
Katie Neylan
Jay O’Connor
Fiona O’Donnell
Lenora Olivier-Lovett
Paula Palmer
Sara Pomfret
Nicola Potter
Kim Powell
Carmel Proctor
Charlotte Roberts
Gwyneth Robinson
Gillian Rushbrook
Eleni Savvides
Rosa Sefi
Benjamin Selby
Sherry Singh Panchal
Richard Stephenson
Susan Theaker
Ann Todd
Elspeth Treacy
Christina Tringi
Daniel Tudhope
Victoria Vallender
Eva Van Eeghen
Jill Wales
Rebecca Wells
David Whistance
THERAPY TODAY
IACP/BACP recognition
of accreditation
counsellor/psychotherapist
Patricia McDermott
Senior accredited
counsellor/psychotherapist
Donna McKeever
Laura Morris
Mona Noblett
Amanda Webbon
Senior accredited
supervisor of individuals
Alison Smyth
Maria Steer
Carla Thompson
Organisations with
new/renewed service
accreditations
Care To Listen
Hounslow Youth
Counselling Service
Time To Talk West Berkshire
Members not
renewing accreditation:
Counsellor/
psychotherapist
Caroline Aslen
Anne Baker
Linda Barbour
Rowena Bennett
Bidi Broderick
Sandra Brudenall
Eimear Chambers
Mariette Clare
Kathleen Corrigan
Paulina Dabrowska
Carole Emmett
Elise Godier
Bernice Green
Janet Grove
Ann Hildebrand
Stephen Howell
Jennifer Jones
Ruth Jones
Maria Kol
Elizabeth Lewis
Kathleen Madigan
Susan Mobberley
Christina Morris
David O’Shea
Patricia Page
Jennifer Parker
Geoffrey Pelham
Linda Quigley
Jane Roberts
Philip Roberts
Lynne Spencer
Christine Stanley
Marion Swailes
Susan Waller
Jacqueline Warren
Naik Whittall
Patsy Wilson
Accreditation
reinstated:
Morag Borszcz
Susan Clayton
Robert Durkin
Ian Semel
Laura Tarsia
Sharon Wedgbury
All the details listed are correct at time of going to print. For full
details of all accredited individuals, courses and services, please
visit the BACP website at www.bacp.co.uk/accreditation
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
48
FEBRUARY 2017
GETTY IMAGES
New BACP
Joint Heads
of Research
Dementia and
counselling
February’s research enquiry of the month asks: ‘Is there any
research into person-centred approaches to working with
clients diagnosed with dementia?’
We searched Google Scholar (scholar.google.co.uk)
using the search terms ‘humanistic’, ‘person-centred’,
‘dementia’ and ‘client’. Two papers in particular offer
much food for thought.
Bryden1 describes a person-orientated approach
to counselling people with a diagnosis of early-stage
dementia. She suggests that interventions such as grief
counselling, non-directive counselling, long-term supportive
psychodynamic psychotherapy, cognitive behavioural
therapy and rehabilitation may be most appropriate.
Spalding and Khalsa2 explored therapists’ views of the
helpful and unhelpful components of humanistic and
transpersonal approaches when working with older clients
with dementia. The therapists they interviewed felt that the
most helpful factor was ‘trusting the process’, defined as
‘openness to not knowing, paired with a growing trust in
the unfolding process of therapy’. They also felt counselling
helped to empower clients by supporting their independence
and right to make choices, and acknowledging clients as the
‘experts’ in making meaning of their experiences.
Send your research questions to [email protected]
THERAPY TODAY
1. Bryden C. A personcentred approach
to counselling,
psychotherapy and
rehabilitation of
people diagnosed with
dementia in the early
stages. Dementia 2002;
1(2): 141–156.
2. Spalding M,
Khalsa P. Aging
matters: humanistic
and transpersonal
approaches to
psychotherapy with
elders with dementia.
Journal of Humanistic
Psychology 2010;
50(2): 142–174.
Clare
Symons
(left) and
Naomi
Moller
49
FEBRUARY 2017
A warm welcome to Dr Clare
Symons and Dr Naomi Moller,
who have joined BACP as the
new Joint Heads of Research,
on a job-share basis. Clare is a BACP senior
accredited and registered
counsellor and trainer. She
also edited the Counselling
& Psychotherapy Research
journal for the past three
years. Her research interests
are ethics and standards and
the relevance and application
of research to practice. Naomi
is a counselling psychologist
by training and a lecturer
in psychology at the Open
University. Her primary
research interests are in
psychotherapy research
and training.
BACP round–up
Training workshops on preventing FGM
Register at bit.ly/2iPkKbT
EVENTS CALENDAR
25 February
BACP student event
Bridging the gap
London
28 February
Professional development day
Working with partners of
trans-identified people
Newcastle upon Tyne
3 March
One-day event
Working with survivors of
childhood sexual abuse
Belfast
GETTY IMAGES
The Department of Health’s FGM Prevention
Programme is running a series of free workshops
on tackling female genital mutilation (FGM)
for counsellors, psychologists, community
workers and mental health practitioners.
A BACP survey last November found
a clear demand for specialist training
among members.
The training covers understanding
FGM; good practice in the care of women,
girls and families affected by FGM, and
NHS trusts’ FGM responsibilities. Workshops
will run in Leeds (22 February), Taunton
(1 March), Birmingham (15 March) and
London (22 March), with online webinars
scheduled for 6, 14 and 24 March.
16 March
Live webcast
An evening with Susie Orbach
PROFESSIONAL CONDUCT NOTICES
Sanction compliance
16 March
Professional development day
Societal rape: myths and traumatic
reactions
Southampton
Sharon Davies
Reference No:
613744
Somerset TA2
Angela O’Connor
Reference No:
553313
Cheshire CH43
Michael Worrall
Reference No:
510405
London W13
BACP was satisfied
that the requirements
of the sanction have
been met. As such, the
sanction reported in
the July 2016 edition
of the journal has
been lifted. The case
is now closed.
This report is made
under clause 5.2
of the Professional
Conduct Procedure.
BACP was satisfied
that the requirements
of the sanction have
been met. As such, the
sanction reported in
the September 2016
edition of the journal
has been lifted. The
case is now closed.
This report is made
under clause 5.2
of the Professional
Conduct Procedure.
BACP was satisfied
that the requirements
of the sanction have
been met. As such,
the sanction reported
in the March 2016
edition of the journal
has been lifted. The
case is now closed.
This report is made
under clause 5.2
of the Professional
Conduct Procedure.
For full details of all professional conduct notices, please
go the Professional Conduct pages on the BACP website
at www.bacp.co.uk/prof_conduct/notices
THERAPY TODAY
50
FEBRUARY 2017
30 March
Professional development day
Working with partners of
trans-identified people
London
19–20 May
23rd BACP Annual
Research Conference
Research and reflective practice
for the counselling professions
Chester
For more details and bookings,
please visit: www.bacp.co.uk/
events/conferences.php
Where I work
me
Analyse
Cluttered, cosy,
calm or clinical?
What do our
therapy rooms
say about us and
how we work?
Rachel Shattock
Dawson describes
her space
CHARLIE BEST
I
’d say the scheme of my room
is clinically cosy. It’s plain cream
and white, with touches of black,
and natural wood floors and
furniture. I seat clients opposite
tall French windows, which look
out onto a private courtyard filled
with terracotta pots and plants, and
a large expanse of sky above.
Pebbles and shells White orchids
I came across the notion of a
therapeutic use for pebbles in my
first placement at an addiction
counselling agency. I now have a
tray of pebbles, shells, crystals, and
various bits and bobs I’ve collected
over the years. They are my little
people – my props, which clients use
to describe the people around them
and the nature of their relationships.
Who’s got the hard, dark edge?
Who chimes with a twisted shell
or the smiley face? Who seems like
a crystal-clear quartz?
Picasso’s doodles
There’s nothing gloomier than the
half-dead spider plants you typically
find in NHS rooms. Healthy plants
and blooming flowers make a space
feel healthier too, and help to give a
warm welcome. I like orchids, and
I like how they work in a therapy
room, as they can be delicate and
intricate, or large and blowsy. I stick
to white so they don’t tip over the
line into being a distraction.
The tissue issue
A picture is never just a picture in a
therapy room. It’s remarkable how
many clients seem to use my prints of
Picasso’s line sketches unconsciously.
I can see their eyes linger on them,
and sometimes they later grab a pen
to draw their own stick characters in
a story they’re retelling.
Giant boxes of so-called man-size
tissues seem to cry out ‘tears’ as
soon as clients walk in. Little tissues
in bright dainty cubes catch the
eye, don’t last the course and send
a mixed message about a need to
prettify a good long sob. Finally,
I’ve found the answer. Kleenex put
their big, strong tissues in a small,
low-lying box. I’m sold.
Cream leather chairs I reckon that IKEA’s Poäng chairs
are probably the most-seen therapy
chairs in the world. Mine are in
cream leather, on a nearly black
wood base. They don’t dominate the
room too much, as some more tanklike chairs or sofas do, and I like that
they have generous armrests and a
slight rocking action.
Play clay I always have a tub of colourful Play-Doh
in my room. I might suggest clients use it to
represent someone they’re talking about, or to help
describe their family or perhaps themselves as a child.
Working with modelling clay has helped my clients
get to places that talking alone hasn’t reached.
What does your counselling room say about you and how you work? If you’d like to contribute
to our new, regular back-page feature, email [email protected]
THERAPY TODAY
74
FEBRUARY 2017
About Rachel
Now: integrative
psychotherapist
and counsellor, in
private practice
Where: a dedicated
therapy room sited
next to the front door
at home in Surrey
Once was: a glossymagazine editor First proper job:
psychologist working
in a ‘human factors’
research and
consultancy group at
Loughborough Uni
First-ever job:
Saturday girl in a care
home for the elderly