BACP Therapy Today July 2020

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Too young JULY 2020, VOLUME 31, ISSUE 6

to understand?

Overcoming age discrimination in counselling :RUNLQJ ZLWK PRWKHU GDXJKWHU FRQŴLFW ,V LW WLPH WR ŴH[ RXU ERXQGDULHV" +HOSLQJ FOLHQWV ƓQG QHZ ODQJXDJHV IRU ORVV // 7KH FDVH IRU VLQJOH VHVVLRQ FRXQVHOOLQJ

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JULY 2020 | VOLUME 31 | ISSUE 6

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Contents July 2020

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Upfront

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Welcome News round-up CPD and events Spotlight Reactions The month

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Main features

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Gillian Bridge (‘Why feelings are overrated’, pages 32-34)

Turning point It changed my life Talking point The bookshelf Dilemmas Analyse me

On the cover..

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35 40 46 48 50 74

Opportunities

Playing the numbers game Our profession needs more younger counsellors to stay relevant, says Ali Xavier (pages 18-21)

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Regulars

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‘Revisiting, rehearsing and revising very bleak or very disproportionate emotions of any kind is likely to be more harmful than beneficial’

The big issue Are younger counsellors at a disadvantage? By Ali Xavier In practice Getting the best from continuing professional development The big interview Windy Dryden makes a case for single-session counselling The mother-daughter puzzle Rosjke Hasseldine shines a light on IHPDOH LQWHUJHQHUDWLRQDO FRQÅ´LFW Why feelings are overrated Is talking about how they feel always what clients need? asks Gillian Bridge The Therapy Square Anthony Prendergast explains his model for working with blocked potential Finding new languages for loss Sasha Bates explores how we can help bereaved clients express the inexpressible

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Contact us by emailing: therapytoday@thinkpublishing.co.uk

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Editor’s letter

FROM THE CHAIR

herapy Today has always explored a broad spectrum of models and theories. There is no one-size-fits-all approach to therapy, and I know that you welcome new ideas to challenge and expand your thinking. One model explored in this issue is single-session counselling (SSC), in ‘The big interview’ with Windy Dryden (page 24). Having trained in SSC some years ago, it’s now an offer that sits alongside my longer-term work and appeals to clients who need to tackle a crucial issue quickly. It’s intense work, but often extremely rewarding. Dryden has, of course, a long history of teaching and writing, but do you always need an academic background to come up with a new approach to working? I know that many practitioners have found that their own ‘model’ has naturally evolved out of extensive client work. ‘The Therapy Square’ (page 36) is a good example – Anthony Prendergast’s simple, client-friendly solution to the challenge of explaining and working with the impact of inhibiting messages and emotions. Rosjke Hasseldine, meanwhile, has developed a model for understanding mother-and-daughter conflict through the lens of societal and cultural expectations. She explores what happens to mothers and daughters when values clash in her case history-led article on page 28. Therapy Today is also a platform for debate and opinion, and two articles this month are designed to challenge our perceptions about our profession. In ‘The big issue’ (page 18), Millennial counsellor Ali Xavier hears from younger counsellors who have felt judged on their perceived lack of life experience during their training. It can be painful to acknowledge that even our profession, which is built on a foundation of self-reflection, non-judgment and a belief in equality, still has major barriers to entry that include race and class as well as age. We will be exploring race in relation to training in an upcoming issue. I know many practitioners will disagree with Gillian Bridge’s opinion piece, ‘Why feelings are overrated’, on page 32. But by being willing to truly listen and consider opinions that directly challenge our own, we remain responsive to growth. The ‘Reactions’ page is your platform for entering the debate.

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I’m writing at a time of incredible social and emotional plight. It may seem that we have turned a corner in the pandemic, but the anger, pain and loss caused by inequality, injustice and hatred, which pervade humanity, are very much felt across the world. Throughout this anguish and upheaval, the work of BACP has continued in supporting members to support the public. The Trustees of the Board of Governors have been resolute in delivering on the strategic focus of membership engagement. Their involvement in committees and Board meetings, and in representing the organisation in a variety of ways, centres on matters that are of prime importance, such as professional standards and promoting paid opportunities for our members. We are at a unique moment in the Board’s cycle where a number of Trustees will step down at the next AGM. As with any loss, there is the opportunity for change and growth and, ZKLOH WKLV ORVV LV VLJQLƓFDQW LW DOVR JLYHV WKH chance for new Trustees to join. My call for members to stand for election as Trustees is now more pertinent WKDQ HYHU IRU \RX WR LQŴXHQFH the strategic direction of our Association at this turning point, and for you to use your vote to choose who you would want to represent your views on the Board.

Natalie Bailey BACP Chair

Sally Brown Editor

Editor Sally Brown e: sally.brown@thinkpublishing.co.uk Consultant Editor Rachel Shattock Dawson Reviews Editor Jeanine Connor e: reviews@thinkpublishing.co.uk Media Editor Nadine Moore e: media@thinkpublishing.co.uk Art Director George Walker Chief Sub-editor Marion Thompson Sub-editor Catherine Jackson

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Production Director Justin Masters Group Account Director Rachel Walder Executive Director Jackie Scully Sales Executive Sonal Mistry d: 020 3771 7247 e: sonal.mistry@thinkpublishing.co.uk

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: Walstead Bicester, Chaucer Business Park, Launton Rd, Bicester OX26 4QZ 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: bacp@bacp.co.uk Changed your address? Email bacp@bacp.co.uk BACP BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire LE17 4HB t: 01455 883300 e: bacp@bacp.co.uk w: www.bacp.co.uk

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Disclaimer Views expressed in the journal and signed by a writer are the views of the writer, not necessarily those of Think, BACP or WKH FRQWULEXWRUĹ?V HPSOR\HU XQOHVV VSHFLĆ“FDOO\ 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 FRPSRVLWHV WR SURWHFW FRQĆ“GHQWLDOLW\

Copyright Apart from fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright, Designs and Patents Act 1998, no part of this publication may be reproduced, stored or transmitted in any form by any means without the prior permission in writing of the publisher, or in accordance with the terms of licences issued by the Copyright Clearance Centre (CCC), the Copyright Licensing Agency (CLA), and other organisations authorised by the publisher to administer reprographic reproduction rights. Individual and organisational members of BACP may make photocopies for teaching purposes free of charge, provided these copies are not for resale. Š British Association for Counselling and Psychotherapy

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Welcome, 1

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News round-up

Our monthly digest of news, updates and events REPRO OP SUBS

FROM THE CEO

Update on SCoPEd

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Back in May, we provided an update on the status of the SCoPEd project via our monthly eBulletin and explained the reasons for the delay in releasing the next iteration. We’re pleased to let you know that we’ve almost completed work on the next draft framework and are hoping to release it this month. The involvement of our members in this process is hugely important, we’ve listened to the concerns you had – which were raised in the consultation process – and we hope that the new draft will go a long way in addressing those anxieties. We want to reassure you, however, that your involvement need not stop here, and we’re keen to hear your thoughts on the next iteration when it’s released. We’re looking at several ways in which we can garner your feedback on the next draft of the framework and will communicate WKRVH ZLWK \RX ZKHQ WKH\ōUH FRQƓUPHG We’ll take any feedback we receive into consideration when reviewing this version of the draft framework later in the year. The purpose of SCoPEd is to produce a framework that will become D UHDO EHQHƓW WR RXU PHPEHUV E\ promoting your skills and experience, so your involvement in helping us to get the work right is invaluable.

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You will soon be given the opportunity to make a real difference to our Association by getting involved in our Annual General Meeting (AGM) process. We’ll be inviting you to submit resolutions and motions to be considered at our AGM, which is set to take place in December. Over the past few years, we’ve worked really hard WR UDLVH WKH SURƓOH RI WKH AGM and the value it brings to the discussion around what’s important for counselling and psychotherapy and for all our members. Resolutions and motions are your opportunity to have your voice heard by the

Association, our Governors and fellow members. One of the many things that makes me so proud of BACP is the commitment to the development of the counselling professions demonstrated by so many of our members. It is through your willingness to express your views that we will continue to grow and be a dynamic and forwardthinking profession with the needs of our clients at the heart of all we do. Please get involved to make your voice heard and to ensure that you’ve had a part in shaping what happens in the future. Hadyn Williams BACP CEO

Join us on the Board From 1 July you will have the opportunity to put yourself into the heart of the action by nominating yourself for the BACP Board elections. From networking with members to making top-level strategic decisions, as a Board member, you can really get involved and KDYH D KXJH LQŴXHQFH RQ KRZ \RXU $VVRFLDWLRQ LV UXQ 7R KHDU more from our current Board members, go to the BACP website DQG VHDUFK Ō2IƓFHUV DQG *RYHUQRUVō

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JULY 2020

News, 1

THERAPY TODAY PODCAST

MEMBER BENEFITS ¢ Launch of new research digest Our new research digest gives you access to the latest research in counselling and psychotherapy on a regular basis. The digital digests will be published on the BACP website four times a year DQG \RX FDQ UHDG WKH Ć“UVW HGLWLRQ QRZ 7KH Ć“UVW HGLWLRQ IHDWXUHV DQ DUWLFOH IURP PHPEHU /\QVH\ Judge-Porter exploring perceptions of counselling people with dementia. There is also a post about a new YouTube channel run by a group of international therapists that focuses on psychotherapy research relevant to clinicians. Other research explored in the digest includes a systematic review of 15 studies focusing on the differences in interactions between in-person and telephone therapy. There is also a review of 249 studies from around the world that evaluates ethical issues in practising psychotherapy online, and a narrative review of the mental health challenges faced by healthcare workers during the Covid-19 pandemic. The next edition of the research digest will be available in $XJXVW :H KRSH \RX ZLOO Ć“QG LW D XVHIXO WRRO LQ NHHSLQJ \RX XS to date with the latest research in counselling and psychotherapy practice. We’d love to hear your feedback on whether you’re Ć“QGLQJ LW KHOSIXO RU ZKDW \RX WKLQN ZH FRXOG LPSURYH VR SOHDVH feel free to email us at research@bacp.co.uk. For the full digest, visit our website: www.bacp.co.uk/about-us/advancing-theprofession/research/research-digest-issue-1

¢ Free online counselling course There’s still time to take advantage of our online course, produced in partnership with The Open University. The course, ‘How to do counselling online: a coronavirus primer’, is free and will help you offer an effective and ethical online service. It’s available to all members by signing up to The Open University’s ‘Open Learn Create’ platform. More than 9,500 members have already participated in this course, with one member saying: ‘We were advised to take the course to prepare us for conducting ongoing practice sessions online and I found it invaluable.’ For full details, see www.bacp.co.uk/news/news-frombacp/2020/17-april-new-course-for-online-counselling

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Working by telephone Not all clients are comfortable with online work, and telephone FRXQVHOOLQJ RIIHUV D Ĺ´H[LEOH alternative. But there is more to effective telephone counselling than you might think. In this Therapy Today podcast you can listen to a discussion of the common pitfalls, what to consider when you recontract with clients to move to telephone work, and how to ensure you meet the competences for working this ZD\ -R %LUFK DQ H[SHULHQFHG counsellor, coach, supervisor and trainer who runs courses on telephone counselling, talks to Therapy Today editor Sally Brown. Other podcast highlights not to be missed include Catherine Jackson interviewing Rachel Freeth, the UK’s only person-centred counsellor and psychiatrist, and BACP therapist Wendy Bristow reading her article ‘High-tech heartbreak’, which H[SORUHV KRZ VRFLDO PHGLD LV impacting relationship break-ups. New podcasts are added every month, so don’t forget to check in and listen at www.bacp.co.uk/ bacp-journals/therapy-today/ therapy-today-podcast

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Members in the media

Coronavirus member survey

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Running to beat anxiety, binge-eating and lockdown anger are just a few of the subjects on which our members have shared their expertise in newspapers, on websites and on the radio.

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Thank you to everyone who completed our survey about how you’ve coped with moving your practice online during the pandemic. Your feedback has helped us understand what we can do to support you in your current ways of working, and the CPD and resources we can produce to help you through and beyond the current situation. The survey has now closed and we wanted to give you an update on some of the key themes that have emerged. We asked if you had been able to continue practising during the pandemic, and 87.7% said they have been able to continue providing counselling and psychotherapy since the Government‘s restrictions came into place earlier in the year. Your feedback on what you needed has helped us to identify resources to support you. This includes moving your practice online, with 37.7% of those who responded telling us they intend to undertake training in online counselling. However, 74.7% of those who completed the survey said they have seen a decrease in their client caseload, and 78.2% have reported a decrease in the number of referrals when compared with their usual circumstances. These results highlight the challenges many members have faced during this time and reinforce the need for us to continue to call on the Government to work with us to ensure there is a workforce to deliver a comprehensive mental health response to the crisis. Read more at www.bacp.co.uk/news/newsfrom-bacp/coronavirus/coronavirusupdates/preliminary-results-of-ourmember-survey

BACP President David Weaver and members Helen George, Yetunde Ade-Serrano and Eugene Ellis contributed to an article on how Covid-19 disproportionately affects BAME people for Mental Health Today. Louise Tyler was live for an hour on LBC radio talking to presenter Iain Dale and listeners about loneliness, in response to lockdown and the coronavirus pandemic. Catherine Gallacher spoke to Huff Post UK about how to deal with anger if it’s building up during lockdown. Rakhi Chand was featured on the 5HƓQHU\ website talking about depression and anger. William Pullen spoke to 5XQQHUōV :RUOG magazine about how running can help with anxiety in a post-lockdown world. On a similar subject, Sue Campbell was quoted in Happiful magazine on how exercise can help our minds, as well as our bodies. Harriet Frew shared her expert thoughts about binge-eating during lockdown for a piece on the 3RS6XJDU website. Jennie Cummings-Knight featured in Huff Post UK in an article headlined ‘How to break away from this emotional rollercoaster of a week’. Hilda Burke spoke to The Independent for an article about anxiety during lockdown. Also in The Independent, an article about how to access free and private therapy during lockdown featured BACP CEO Hadyn Williams, Deputy Chief Executive Fiona Ballantine Dykes, Workforce Lead Kris Ambler and Mark Fudge, Chair of BACP University and Colleges division. Fiona also featured in New Statesman, talking about online therapy. Our Four Nations Lead, Steve Mulligan, was on BBC South Today evening news talking about our campaign to maximise the role of counselling and psychotherapy in supporting the UK through the crisis. If you are interested in becoming a media spokesperson, email media@bacp.co.uk

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MEMBERS MAKING A DIFFERENCE

Working on your behalf BACP staff are working from home and, while we can’t get out and about right now, we are still campaigning on your behalf ¢ We’ve written to the Education Secretary urging him to allocate extra funding to counselling in schools and colleges. Our call to Gavin Williamson outlines how the Covid-19 pandemic is already having a serious impact on the mental health and wellbeing of the nation’s children and young people. It highlights that allocating resources to therapeutic support in schools and colleges in England is needed to ‘stem what will inevitably be a more severe crisis without urgent attention from the Government’. This letter is the latest activity in our campaigning work calling for a paid counsellor in every school in England. Last year our Children, Young People and Families Lead, Jo Holmes, met the Children’s Commissioner, a vocal and high-profile supporter of school counselling, and her team to discuss counselling in schools. During Covid-19, we’ve continued to work closely with the Scottish and Welsh Governments, advising on standards for school counselling. We’re also putting together a survey of our members who offer school counselling services to help inform our future work in this area. Read the full letter at www.bacp.co.uk/news/ news-from-bacp/2020/1-june-this-isa-critical-time-to-respond-to-risingmental-health-needs-of-children-andyoung-people

¢ We’ve welcomed a new action plan to improve mental health services in Northern Ireland. The plan aims to increase counselling provision in primary care and is in line with BACP’s own strategy. Four Nations Lead Steve Mulligan is ready to work with Health Minister Robin Swann (below) and his department to ensure counselling and psychotherapy play their role in the front line of mental health support. ‘The new Northern Ireland Mental Health Action Plan provides much needed impetus to urgently improve access to mental health support in Northern Ireland,’ says Steve. ‘We see this as an important staging post towards the development of a 10-year funded mental health strategy and we’re keen to work with the Health Minister, his department and the new Mental Health Champion to ensure the counselling and psychotherapy workforce is a key part of the front line of mental health support in Northern Ireland.’ Read the full story at www.bacp.co.uk/news/ news-from-bacp/2020/20-may-wewelcome-new-northern-irelandmental-health-action-plan

PROFESSIONAL CONDUCT BACP’s Professional Conduct Notices will no longer be published in Therapy Today. However, they can be found at www.bacp.co.uk/professional-conduct-notices

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Bereavement support BACP member Alex Church has helped set up a collaboration of counselling organisations to provide specialist bereavement support during the coronavirus crisis. The Bradford Counselling Collaboration is made up of more than 10 counselling agencies across the Bradford District and Craven area that employ our members. It’s been given funding by NHS Bradford District and Craven Clinical Commissioning Group to support those grieving the loss of family or friends as a result of the pandemic. The service also offers support for other types of loss, such as income or a job. The funding will pay for BACP members to deliver 1,000 hours of grief and loss counselling, as well as paying for training for 50 support volunteers and befrienders to help with signposting. Alex, who works in the mental health commissioning team for NHS Bradford District and Craven Clinical Commissioning Group, says: ‘Covid-19 has significantly increased the number of people across the district who will experience grief and loss. It’s important that we have qualified counsellors on hand to support communities in the district to deal with this. Having a collaborative means we have been able to mobilise quickly and work together to deliver this.’ Jo Holmes, BACP’s Children, Young People and Families Lead, says: ‘This is a great example of counselling networks coming together with a shared vision to look at gaps in current provision to best meet the needs of the local community.’ ¢ If you are a member who is making a difference in your community, share your story with us at media@bacp.co.uk

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BACP’s in-person events will resume from 1 September, provided it is safe to do so. One of the highlights is this year’s Private Practice Conference, ‘Communication: can you understand me?’, which is planned to take place on 26 September at Etc Venues County Hall. Questions that will be explored include how we communicate when conventional methods aren’t appropriate, whether we need to change our communication style when working with young people or older generations, and how we communicate when disability is present, such as loss of sight or hearing. Speakers include Helen Kewell on the challenges

BAME resources

of communication when working with the older generation, and Ani de la Prida on ‘A pluralistic approach to communication’. We are also running a live webcast of the event, which will include the opportunity to engage with keynote presentations and workshops by asking questions through our online webcast platform, in addition to using the secure chatroom to network with colleagues and send questions to our presenters when they visit the online studio for live Q&A. For further information, visit www.bacp.co.uk/events-andresources/bacp-events

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Become a social entrepreneur In a new online resource, Beverley Costa, psychotherapist, supervisor, trainer and founder of Mothertongue multi-ethnic counselling service, explores how therapists and counsellors can reach beyond our clients’ inner worlds and have a positive impact on their external environment. ‘As counsellors, we’re used to dealing with human distress daily,’ says Costa. ‘For some of the people who come to us for help with their distress, counselling or psychotherapy may be what they need. For others, the environment in which they live may be one of the main sources of their distress.’ This new resource, free for all members, explores the drive that is shared by many practitioners to do more about social injustice. It introduces a model for therapeutically framed social

entrepreneurism, The Social Response Cycle, as a possible response. At the heart of The Social Response Cycle is the premise that initiatives that are small DW ZRUOG OHYHO FDQ KDYH D VLJQLƓFDQW impact at an individual or community level. This resource, taught through a series of videos, audio recordings and online exercises, introduces a structure for piloting social enterprise projects, enabling you to apply it to your own ideas. Real-life examples from Costa’s two decades of experience of initiating, developing and delivering therapeutically framed social action and response projects are used throughout. For more information and to access the resource, go to www.bacp.co.uk/events-andresources/bacp-events/socialresponse-cycle-member-resource

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Many members have contacted us for support in working with clients affected by the recent George Floyd case, and in exploring their own unconscious bias in relation to race. In response, we have pulled together resources RQ UDFH DQG GLYHUVLW\ DQG Ĺ´DJJHG them on the website. The selection explores issues such as barriers for black, Asian and minority ethnic (BAME) communities in accessing therapy, working with BAME children and young people, and managing assumptions. • Presentation highlights include ‘Black minds matter’, by KimberlyAnne Evans for BACP’s Research Conference that took place earlier this year, and Dr Dwight Turner’s ‘Being the other: political correctness, intersectionality and the voices of the other’, which opened CPCAB and BACP’s joint diversity symposium in May 2019 (available for CPD Hub subscribers). • Among the articles, you will Ć“QG ĹŒ%ODFN VSDFHV EODFN IDFHVĹ? from Therapy Today, October 2019, which explores some of the ways black people are creating therapeutic spaces, and Isha McKenzie-Mavinga’s discussion of the powerful forces preventing race being discussed in therapy. Ĺ˜ <RX ZLOO DOVR Ć“QG *RRG 3UDFWLFH in Action resources, including ‘Equality, diversity and inclusion in the counselling professions’ (GPiA 056), which discusses published research relating to the Equality Act 2010. For all of the related resources, go to www.bacp.co.uk/eventsand-resources/race-anddiversity-resources

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‘We cannot continue to allow people to reach a point of crisis before they get help’

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Kerrie Jones tells Sally Brown about her clinic’s innovative approach to treating eating disorders

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errie Jones is a BACP-registered counsellor and the co-founder and clinical director of Orri, an innovative eating disorders service. Orri aims to fill two crucial gaps in treatment provision that became apparent to Kerrie over the course of her career in eating disorder treatment. ‘The first is early intervention. Research shows that treatment in the first three years of an eating disorder has the highest success rate,’ she says. ‘The second is treatment that allows patients to maintain their everyday life, whether that is going to uni or working, and living at home or independently.’ Two well-publicised reports1 have highlighted barriers to clients accessing services, with reports of waiting times of up to five and a half months for treatment and people with eating disorders being told they are ‘not ill enough’ to access NHS services, which is often interpreted as ‘Come back when you are thinner/more unwell’. ‘There can be a revolving door for patients with eating disorders,’ says Kerrie. ‘They are referred by their GP for treatment, but then are rejected by the eating disorder services, so they go back to their GP, and the process starts again.’ This is the point at which clients who can afford it often seek private treatment at clinics such as Orri, but those who can’t potentially fall through the net and get no treatment at all. ‘Obviously, it is a far from optimum situation. Our ultimate aim is to work with the NHS to provide funded places,’ Kerrie says. Orri offers ‘day-hab’ – an intensive treatment programme that allows clients to test-drive the insights and learnings from the clinic when they return home every evening. ‘A day-clinic place is far less expensive than an inpatient place, and it’s far less disruptive. Some clients are sent hundreds of miles away from their home to an inpatient unit, which in itself can be traumatic,’ says Kerrie. ‘The clinic is open from 8.30am to 7pm, and clients attend on a full-day, half-day or five-hour basis, to fit around work or study.’ Orri’s client base is predominantly young and female, although at the time of writing they also have male clients and older clients in their 50s. There is no minimum BMI threshold for admission. Although there is an emphasis on early intervention, the clinic has seen success with clients with a severe and enduring eating disorder (SEED) diagnosis. ‘Getting better is a subjective term, but we have

‘It seemed obvious to me that the treatment process came with an inbuilt barrier to patients’ recovery’

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seen clients who have had multiple inpatient admissions respond and maintain their physical health,’ says Kerrie. Before launching Orri, Kerrie worked at Priory Hospital Southampton, and then set up an inpatient clinic in Farnham. It was there that she began to think about solutions to the limitations of the inpatient model. ‘We would build up a deep attachment to patients and provide 24/7 care. Then, at the end of their stay, they would essentially be cut off from that, with little ongoing contact. It seemed obvious to me that the treatment process came with an inbuilt barrier to patients’ recovery. At Orri, our relationship is interwoven with a client’s everyday life,’ says Kerrie. Backing for Orri, which is based in a six-storey building in central London, comes from LGT Lightstone, a social impact investor. Central to its success, believes Kerrie, is the breadth of skills across its expert team. ‘Eating disorders filter into all aspects of a person’s life. The diverse team at Orri ensures that there is the experience to meet the client in each of these facets. This includes both body and talk-based therapists, dietitians, occupational therapists, registered mental health nurses and psychiatrists. We take a multidisciplinary approach because there’s no one way to have an eating disorder.’ Like other services, Orri had to rapidly transition to online after lockdown, but found that clients have adapted quickly. ‘We were in the process of researching online provision, so it has been fast-tracked,’ says Kerrie. ‘What we have found so far is that clients are amazingly resourceful. It also offers some extra advantages. We can work with clients in their own kitchens as they prepare food, for instance. We literally get into their cupboards!’ Kerrie’s personal motivation is driven by knowing there is much work to be done to properly meet the needs of this client group. ‘Some of it is about educating society in the diversity of eating disorders and how and why they continue to develop and thrive,’ she says. ‘But we cannot continue to allow people to reach a point of crisis before they get help.’ www.orri-uk.com For a longer version of this interview, listen to the Therapy Today podcast: www.bacp.co.uk/bacpjournals/therapy-today/therapy-today-podcast

1BEAT. LIVES AT RISK: THE STATE OF NHS ADULT COMMUNITY EATING DISORDER SERVICES IN ENGLAND. LONDON: BEAT; 2019.

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Meeting the threshold

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I was moved by Catherine Jackson’s interview with Rachel Freeth, psychiatrist and person-centred counsellor (‘Counsellors are seen as just for the worried well’, Therapy Today, May 2020). The title references a common term in mental health services, alongside phrases such as ‘it’s their choice’, and ‘it just doesn’t meet the threshold/criteria’, and worst of all, ‘treatment-resistant’. It’s a world where people can feel they are not eligible, mad, skinny, or off drugs enough to deserve care and support. , LGHQWLĆ“HG VR VWURQJO\ ZLWK 5DFKHO DV , KDG D YHU\ VLPLODU MRXUQH\ WUDLQLQJ DV a psychiatric nurse in the early 1980s, usually referred to now as mental health nursing. I am now also a practising integrative counsellor. I spent some years working in management of health and social care, where the use of the term ‘person-centred’ and a sprinkling of attachment theory is a world away from my counselling practice. The terminology is widely used in health and social care to indicate a policy of putting people at the centre of their own care and of working with their strengths and assets. However, as this is delivered without training and understanding in attachment and relational depth, it lacks a sense of the whole. Even within the arguably more psychosocial models of social care, everything is constrained by cost and time pressures and the various eligibility thresholds and criteria. Mental health NHS crisis teams can be acute care and bed gatekeepers, with a high percentage of people with mental illness who use drugs, including alcohol, excluded from support until an often totally separate organisation only dealing with a medical model of detox sorts out the addiction. These criteria and boxes, systems and models lack organic, creative, meaningful relationship but describe themselves as individualised or person-centred. It fragments the person. As the article highlights, in professionalising and UHJXODWLQJ FRXQVHOOLQJ WR Ć“W WKDW ZRUOG we could lose what makes it so impactful. Nicola Grieveson MBACP

Discovering client malware My thanks to Catherine Jackson for one of the most seminal pieces I have read in Therapy Today to date (‘Counsellors are seen as just for the worried well’, Therapy Today, May 2020). They have identified some of the most important issues we counsellors face. As a seriously enlightened psychiatrist, in her comprehensive book Psychiatry and Mental Health, Rachel Freeth is refreshingly critical of a large swathe of her profession. We know the medical model

does not work, Rachel concurs. But we are not defining a model that does. Whatever hardware issues a client might carry, it’s the software that they sense. That is what matters to the individual, and, indeed, to those with whom they interact. It’s not about how you and I define illness. It’s about how happy people are in themselves or with others. If we hear voices but are happy, then there is no problem to address. If we think we are always right but cause mayhem in society, there is something wrong.

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Addressing issues from a pathology textbook will consistently be wrong. The evidence is there. Psychiatric treatment cannot be as effective as physical treatment because it lacks the equivalent body of established knowledge to support it. While Rachel rightly criticises what seems pretty much the basis of psychiatry as taught and practised, we are left with a pathology vacuum. We need to accept that the route to peace and happiness lies within the client. Carl Rogers taught us that we all have within us the capacity to self-heal. My job is to enable my client to discover the malware in their onboard computer and allow the self-healing programme, so obvious in physical healing, to take hold and do its job. This is the process that works. If we spot some pathologies on the way through, so much the better and so much quicker the process. David Waite MBACP (Reg) It is truly heartening to read Catherine Jackson’s lively and informative interview with Rachel Freeth. There are so many pivotal issues raised by Freeth, one of the few authors/practitioners around in the unique position (as a psychiatrist and a person-centred counsellor) to be able to speak both compassionately and authoritatively (and beyond the realm of cosy platitudes) of genuine dialogue among ‘mental health’ professionals of different ilks and persuasions. The one point I want to raise has to do with the vagaries of professional ‘belonging’. Despite an inborn suspicion of psychiatry, I too believed, like Freeth, in open dialogue among tribes, until one incident shook that belief to the core. A client I had been working with for some time slowly descended into a full-blown psychosis, until one day they didn’t turn up for the session. I promptly phoned their GP, who informed me that the client had been referred to a psychiatrist, and gave me the latter’s contact details. My hope was that, through the sharing of information, we could help one another to better help the client. I left several voice messages and wrote a few emails. No reply. I eventually found out from the GP that, as I was not medically trained, the

We very much welcome your views, but please try to keep your letters shorter than 500 words – and we may sometimes need to FXW WKHP WR ƓW LQ DV many as we can

psychiatrist had no interest in talking to me, a mere counsellor. I want to think this had to do with the individual psychiatrist, not psychiatry per se. I am certain Freeth would never dole out the same treatment to a counsellor; in that, she is the invaluable exception that proves the rule. I was hurt by the experience, partly because I was open to learn, as I’m not certain that unconditional positive regard is quite enough with psychosis and there may be room for co-operation across disciplines. Both in my training as a person-centred counsellor and in my experience as a tutor in several person-centred courses over the years, I’ve often been confronted by tutors and students alike with the question whether an intervention, an idea, a way of thinking and practising was ‘truly’ person-centred. It seems to me that a concern for tribal belonging overrules any other concern, including soundness of practice, efficacy and competence, as well as, crucially, openness to experience and ideas. At the same time, bending over backwards to comply with the ‘protocol-bound, target-driven, diagnosis-based mental health culture we have now’ and that Freeth rightly decries potentially makes person-centred therapy one of the most conservative approaches to counselling, with the dubious dividend of being equipped with a mystifying veneer of effusive slogans. Counselling for Depression and the surreal attempts in counselling research to measure congruence, empathy and unconditional positive regard are in the same vein. Is there a moral to the story? I am not sure, but I think Audre Lorde was right in saying that you can’t use the master’s tool to dismantle the master’s house.1 Plus, theoretical frames are perhaps to be seen as secondary to an ethico-political commitment that refuses to comply with the neoliberal notion of mental health that dominates our profession today. Manu Bazzano MBACP (Reg) REFERENCE 1. Lorde A. The master’s tools will never destroy the master’s house. London: Penguin Classics; 2018.

As a seriously enlightened psychiatrist, in her comprehensive book Psychiatry and Mental Health, Rachel Freeth is refreshingly critical of a large swathe of her profession. We know the medical model does not work, Rachel concurs. But we are not defining a model that does

I was very grateful to come across Rachel Freeth’s honest and unflinching take on the current, risk-averse, focused approach to mental health in the public services. As a psychodynamic therapist, I find myself all too often feeling I have to compromise the underpinning principles of my understanding of mental health to fit the current climate. To hear a psychiatrist talk about ‘tolerating uncertainty and mystery’ is beyond refreshing. More people like Rachel are desperately needed at a time where we are so wedded to ideas of target-driven models and outcomes that we lose sight of the very thing that led so many of us to this profession: namely, the belief that the relational factors that led to mental distress need a form of relational healing that often doesn’t follow a linear timeline. I would hugely welcome more such candid conversations in Therapy Today in the future. Nevena Pecotic MBACP (Reg)

3URMHFWLYH LGHQWLĆ“FDWLRQ I’d like to thank Ingrid Schultz for her letter (‘Reactions’, Therapy Today, June 2020) in response to my article, ‘Meeting the challenge of therapist fatigue’. She asked why I did not raise the issue of projective identification and I would like to respond. I believe projective identification is commonly understood in the way Ingrid explains it, as ‘an unconscious communication by the client’. I believe this is always going on with every client, and the therapist will also unconsciously communicate with the client in a similar manner, creating a feedback loop in both directions. For this reason, I prefer Assagioli’s concept of ‘psychological osmosis’,1 which for me has the additional advantage of also encompassing the impact on the therapist (and client) of many of the other contents of the psychic environment at the same time. I don’t see a practical way to fully disentangle this rather messy version of countertransference, much as we of course will try to do so in service of our clients. I accept my preference is a result of the lens through which I understand our work and is at variance with traditional ways of

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understanding countertransference. I agree with Ingrid that understanding the nuances of countertransference is ‘a vital and important aspect of the therapeutic relationship’. I was trying to convey the necessity, when considering the phenomenon of therapeutic fatigue, of considering how we manage the impact of countertransference on the therapist. Chris Paul MBACP (Reg) REFERENCE 1. Assagioli R. Psychosynthesis. Amherst, MA: The Synthesis Centre Inc; 1965.

Hope springs While reading ‘The trouble with hope’ by Nicholas Willatt (Therapy Today, June 2020), I found myself thinking about a former client battling with a very complex and traumatising set of home circumstances. Every day was a struggle to exist. His fleeting hope was that things would eventually change. This got him through his studies and his circumstances did eventually change. Hope kept him going. It reminds me of the ‘Stockdale paradox’, named after James Stockdale, a Vietnam prisoner of war who survived for seven years, when many of his comrades died around him, before finally being released. He writes about managing to stop being tortured by hurting himself so badly that his captors had to get him medical assistance. Stockdale found a balance between remaining realistic about his outcomes and believing that things would eventually change, which gave him the will to survive. We are often side-by-side with clients who sit with relentless despair and their perception of what is better is usually very different to our own. I am certain there is a necessary place for exploring hope and the realms of its boundaries, if this is the client’s need, as pointed out in the author’s final paragraph. We must explore hopelessness without being sucked into the vacuum, and this is where our own hope can be a turning point. I often ask myself if I can imagine the client in a different place. This not only gets me thinking about how the client sees themself, and what’s holding them in their current state

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Reactions, 1

To the Editor

Reactions, 2

To the Editor VERSION

Reactions

The act of seeking counselling is itself an expression of hope and, while we must never presume to know what the other is thinking, there are times with clients when we need to acknowledge this hope and give voice to our deepest-held beliefs

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but also what motivates them to change. It also allows me to examine my own hopes for the client and how this can help or hinder the process. I agree with the author that, when exploring hope, it must be from the client’s perspective. Thank you for a very thoughtprovoking article. Vanessa Edworthy MBACP (Snr Accred)

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I want to say how much I agree with the highlighted comment ‘When it comes to hope, it is not our job to direct our clients’ in the ‘The trouble with hope’ (Therapy Today, June 2020), but I think something important was left out. Let me illustrate this with an experience. Many years ago I was confronted in a counselling organisation in which I worked by a client saying, ‘I have taken a fatal overdose and I intend to go to A&E when it’s too late to save me, but I want to spend my remaining time until then with you because of all the support and good times I have had in this building. I want to thank you all for what you have done for me and I certainly do not want to repay that by dying here.’ I had to think quickly about my response. In the end I said something like, ‘I cannot accept that what you are saying is the whole truth, but have to assume that the reason you walked in through that door and are saying this is because a part of you hopes that something will cause you to change your mind.’ I like to think this interaction may have been a fundamental turning point in this client’s life. What I know for certain is that what I said registered and he did go to A&E of his own volition (it was not far away). Our conversation was, of course, somewhat less succinct than the way I have summarised it and others have said I should have called an ambulance immediately, thereby protecting both myself and the reputation of the counselling service. However, I was concerned that the client would leave the building before it arrived and perhaps die a lonely and miserable death. Nicholas Willatt puts his finger on many of the pitfalls colleagues face when thinking about hope. However, worrying about them is

missing out on the support, access arrangements in public exams and medication that would make a significant difference to their lives. Sarah Carr MBACP (Accred)

Supporting teachers

a distraction and can get in the way of working in relational depth. I would like to challenge readers of Therapy Today to work from a deeper and more confident place within themselves. What is important, I believe – and not just in examples like this – is that the act of seeking counselling is itself an expression of hope and, while we must never presume to know what the other is thinking, there are times with our clients when we need to acknowledge this hope and give voice to our deepest-held beliefs. Arthur Musgrave MBACP (Snr Accred)

ADHD reaction Joanna House’s letter (‘Reactions’, Therapy Today, June 2020) on the ‘chicken or egg’ situation with regard to children with ADHD symptoms and their parents’ behaviour towards them struck a chord for me, but in relation to emotionally unstable personality disorder (EUPD), also known as borderline personality disorder. This condition is also often attributed to parental treatment of the child but, again, could it be true that the stresses and strains of having a child with EUPD are highly challenging for parents? Again, many adults with EUPD do not have siblings with mental health difficulties. Surely explaining children’s difficulties in terms of parental shortfalls does not encourage parents to pursue relevant assessments, for fear of judgment or even action against them? Children may thus be

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Catherine Jackson’s article ‘Filling the gap’ (Therapy Today, April 2020) resonated with me. The article mentioned the support that counsellors might be expected to give to classroom teachers who feel challenged or inadequate when children become upset. Pre-lockdown, I worked as a mobile play therapist in mainstream primary schools in North West England. Before school lessons began, I used to have a five-minute check-in with the class teacher of each child I was working with. This was an opportunity for teachers and teaching assistants to report back to me on any changes they had noticed in the child since I was last in school. Sometimes staff needed to offload about recent contact with the child’s parent. Often, they thanked me for that opportunity and said they felt better for it. Sometimes, teachers recognised that certain aspects of the child’s home life or personality traits forced them (the teacher) to reflect on their own coping strategies and childhood experiences. I felt they appreciated the opportunity to be heard without judgment before throwing themselves wholeheartedly into the busyness of the school day. In our current situation, I’ve been wondering about how primary school teachers are experiencing relationships with the parents of the children in their classes. I wonder about staff who might have given an email address or mobile phone number to offer some parents extra support with home schooling and the pressure of being with their child(ren) under these constrained conditions, without the opportunity of a ‘Can I have a quick word...’ in the playground at morning drop-off or afternoon pick-up. And I wonder who is supporting those teachers if they’re supporting parents in these or other ways? Yvonne Parr MBACP

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The month Mental wellbeing and the human experience in the arts, media and online

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LOCKDOWN STORIES Essay

Healing from a toxic childhood

CLIENT

Steven Gold, a professor at Nova Southeastern University’s Center for Psychological Studies in Florida, has developed a therapy for adults with developmental deprivation IURP SURORQJHG FKLOG DEXVH Contextual trauma therapy ƓUVW WHQGV WR WKH HIIHFWV RI lack of affection, attention and guidance through an extensive period of stabilisation, before exploring DQ\ WUDXPD *ROG VD\V WKLV prevents clients from reduced daily functioning, returning to addictive behaviours and breakdown that can otherwise EH EURXJKW RQ 7KLV HVVD\ offers a good introduction WR WKH UHVHDUFK DQG EHQHƓWV of this approach that Gold explores in detail in his IRUWKFRPLQJ ERRN www.aeon.co/essays/ contextual-trauma-therapycan-limit-the-impact-of-atoxic-childhood

The joys and pressures of family life during lockdown are explored in three short GUDPDV IURP WKH :HOVK FKDQQHO 6 & Ć“OPHG RQ ODSWRSV DQG SKRQHV ,Q :HOVK ZLWK subtitles, the Cyswllt (Lifelines) trilogy offers a chance to hear the language spoken LQ HYHU\GD\ FRQWH[WV PL[HG ZLWK D VPDWWHULQJ RI (QJOLVK VODQJ DQG VZHDULQJ Unprecedented LV DQRWKHU VHULHV RI VKRUW Ć“OPV E\ OHDGLQJ SOD\ZULJKWV FRPPLVVLRQHG DIWHU ORFNGRZQ DQG VKRZQ RQ %%& )RXU +LJKOLJKWV LQFOXGH Penny, an effective straight-to-camera monologue by a homeless man temporarily moved into a hotel, and Going Forward ZKLFK VXEWO\ H[SORUHV ZRUNSODFH EXOO\LQJ YLD D =RRP FDOO %RWK series are now available on BBC iPlayer

Books

Food for thought

Take your mind on a holiday with these thoughtprovoking reads. No travel required. Available by mail order from the publishers’ websites or Amazon. • Change the way you breathe and you change the body’s physiology, with a knock-on effect on \RXU VWDWH RI PLQG 7KLV LV the premise explored in Breath: the new science of a lost art 3HQJXLQ /LIH Author James Nestor’s personal experience of a transformational breathing workshop is a springboard for this deep-dive into the DUW RI EUHDWKLQJ (YHU\ chapter is a treasure trove of ancient traditions, modern science and maverick ‘pulmonauts’ eager to show how optimal breathing is the key to mental and SK\VLFDO ZHOOEHLQJ

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• The title of this memoir from journalist Michèle Roberts, Negative Capability: a diary of surviving (Sandstone), was inspired by a letter written by John Keats advising his brothers to be ‘capable of being in uncertainties, mysteries and doubts’ – a state familiar to all WKHUDSLVWV 5REHUWV FKDUWV her personal journey after experiencing rejection, both professionally and SHUVRQDOO\ :ULWWHQ SUH pandemic, this insightful exploration of resilience and growth after loss of identity could not be more pertinent WR WKH FXUUHQW WLPHV

JULY 2020

• Lockdown has made us all the more aware of the pressures on our medical profession, and these beautifully written stories really bring to life the pain and joy of working on the IURQW OLQH RI WKH KHDOWK VHUYLFH Breaking and Mending: a junior doctor’s stories of compassion and burnout (Wellcome Collection), now in paperback, is a memoir from best-selling novelist Joanna &DQQRQĹ?V HDUOLHU FDUHHU +HU passion for telling people’s stories and her interest in PHQWDO KHDOWK VKLQHV WKURXJK

Must -read

BBC4

BY ANUSH PHOTO BABAJANYAN/VII FOR UNICEF/REDUX/HEADPRESS

Television

The Month, 1 Art

Think about it!

THE BOTANICAL MIND

Radio

Black British women Podcast

On the Record The podcast industry has taken a hit since lockdown, with a downturn in commuters WXQLQJ LQ %XW LI ZH ORVH WKLV medium, we lose gems such as this one from The National $UFKLYHV (DFK HSLVRGH WHOOV D story behind a letter or record VWRUHG LQ WKH $UFKLYHV 7KH latest series, Love, tells stories gleaned from real love letters KHOG WKHUH 7KH\ LQFOXGH the tale of a medieval clerk’s unrequited love, two 18th-century women who ‘marry’ in secret, and covert passion at The Caravan Club, London’s most Bohemian venue in 1930s &RYHQW *DUGHQ $UFKLYLVWV act as detectives and, by unravelling each story through conversation and interviews, reveal much about the human QHHG WR ORYH DQG EH ORYHG On the Record at The National Archives is available from the usual podcast platforms and at https://media. nationalarchives.gov.uk

Listen to last year’s joint Booker Prize winner, Girl, Woman, Other by Bernardine Evaristo, brought to life in this BBC Radio 4 production voiced E\ 3LSSD %HQQHWW :DUQHU ,WĹ?V D FROOHFWLRQ RI OLQNHG stories, mostly about black British women from across the UK and across the generations, with themes including race, identity, IULHQGVKLS DQG IDPLO\ Each 14-minute episode (10 in all) focuses on one (or sometimes two) of Evaristo’s cast of characters, including Amma, a 50-something struggling SOD\ZULJKW ZKR Ć“QDOO\ JHWV KHU ELJ EUHDN +DWWLH DQG her mother Grace, who end up inheriting a farm in Northumberland, and Carole, who overcomes a rocky start to become a VXFFHVVIXO EDQNHU (YDULVWRĹ?V poetic, unpunctuated prose is both engaging and VRRWKLQJ ZKHQ UHDG DORXG Available now on the BBC Sounds DSS

THERAPY TODAY

The Botanical Mind LQYHVWLJDWHV WKH VLJQLĆ“FDQFH RI WKH SODQW NLQJGRP WR KXPDQ OLIH FRQVFLRXVQHVV DQG VSLULWXDOLW\ DFURVV FXOWXUHV DQG WKURXJK WLPH ,WV RSHQLQJ DW /RQGRQĹ?V &DPGHQ $UWV &HQWUH ZDV SUHYHQWHG E\ ORFNGRZQ DQG WKH H[KLELWLRQ KDV EHHQ DGDSWHG DQG ODXQFKHG DV DQ RQOLQH SURMHFW +LJKOLJKWV LQFOXGH &DUO -XQJĹ?V LOOXVWUDWLRQ The Tree of Life IURP The Red Book ZLWK LWV URRWV LQ KHOO DQG LWV EUDQFKHV LQ KHDYHQ 7KH ERRN ZDV ZULWWHQ LQ DQG LV GHVFULEHG DV -XQJĹ?V PRVW LPSRUWDQW ZRUN EXW LW ZDV RQO\ GLVFRYHUHG DQG SXEOLVKHG \HDUV DJR The Botanical Mind: art, mysticism and the cosmic tree LV IUHH WR YLHZ XQWLO -XO\ DW www.botanicalmind.online

Film

Pink wall 7KLV GHEXW IHDWXUH Ć“OP from actor-turned-director Tom Cullen offers six WLPH VKXIĹ´HG VFHQHV following couple Jenna and Leon, played by Tatiana Maslany (Orphan Black) and Jay Duplass (Transparent RYHU VL[ \HDUV With a semi-improvised script, you can expect

moments of intense connection and heartbreak as the relationship begins to IDOWHU $ FRXSOH QHYHU meant to be? Make up \RXU RZQ PLQG (LWKHU way, it’s bound to stay ZLWK \RX $YDLODEOH WR rent from BFI Player KWWSV SOD\HU EƓ RUJ XN

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Š PINK WALL (FILM) 2019

Please email details of new releases or events that would interest Therapy Today readers to therapytoday@ thinkpublishing.co.uk

Š THE ARTIST; PHOTO: Š TATE

Don’t miss

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Playing the numbers game If we don’t do more to bring young therapists into our profession, we risk becoming obsolete, says Ali Xavier

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‘Have we subconsciously identified with the disparaging “snowflake” image of us portrayed in the media?’ THERAPY TODAY

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THERAPY TODAY

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Life experience 7KHUH LV DQ DVVXPSWLRQ WKDW DJH LV D PHDVXUH RI OLIH H[SHULHQFH DQG WKDW ROGHU SHRSOH ZLOO KDYH PRUH H[SHULHQFH RI OLIH EH EHWWHU LQIRUPHG DQG VR EH PRUH VXLWHG WR WKHUDSHXWLF ZRUN %XW WKH LURQ\ LV WKDW DV D SURIHVVLRQ ZH GR QRW H[SOLFLWO\ VKDUH WKH ZLVGRP RI RXU H[SHULHQFH ZLWK RXU FOLHQWV PRVW PRGDOLWLHV WUDLQ XV QRW WR JLYH DGYLFH RU VHOI GLVFORVH :H DUH KRZHYHU HQFRXUDJHG WR OLVWHQ WR RXU FOLHQWVĹ? VWRULHV ZLWK D ĹŒEHJLQQHUĹ?V PLQGĹ? DQG WR JXDUG DJDLQVW DVVXPLQJ WKDW HYHQ LI ZH KDYH KDG D VLPLODU H[SHULHQFH WR D FOLHQW ZH NQRZ KRZ LW IHOW IRU WKHP 0RVW SUDFWLWLRQHUV HVSHFLDOO\ WKRVH WUDLQHG LQ KXPDQLVWLF DSSURDFKHV DFWLYHO\ GLVFRXUDJH WKH FOLHQW IURP VHHLQJ WKHP DV DQ H[SHUW 2QO\ WKH FOLHQW FDQ EH WKH ĹŒH[SHUWĹ? LQ ZKDW WKH\ DUH H[SHULHQFLQJ ,I LW

‘If we don’t make it easier for younger people to enter and stay in our profession, we risk becoming obsolete’ LV RXU UROH WR IDFLOLWDWH WKH FOLHQWĹ?V WKLQNLQJ SURFHVVHV WR HQDEOH WKHP WR PDNH WKHLU RZQ VHQVH RI DQ H[SHULHQFH RU HPRWLRQ WKHQ VXUHO\ HIIHFWLYHQHVV DV D WKHUDSLVW GHSHQGV RQ VNLOO RU SHUVRQDO SUHVHQFH UDWKHU WKDQ DJH" , DP ZULWLQJ WKLV ZLWK DQ DFXWH DZDUHQHVV RI P\ DXGLHQFH VRPH RI ZKRP PD\ KDYH EHHQ FRXQVHOORUV IRU ORQJHU WKDQ , KDYH EHHQ DOLYH %XW P\ KRSH LV WKDW UDLVLQJ WKH LVVXH RI DJH GLYHUVLW\ LQ FRXQVHOOLQJ DQG SV\FKRWKHUDS\ ZLOO VWLPXODWH WKRXJKW DQG SURYRNH GLVFXVVLRQ LQ D ZD\ WKDW GRHVQĹ?W DUURJDQWO\ GLVPLVV WKH ULFK ZLVGRP DQG H[SHULHQFH RI FROOHDJXHV EXW ORRNV SURGXFWLYHO\ WR WKH IXWXUH RI WKH SURIHVVLRQ , EHOLHYH RXU SURIHVVLRQ QHHGV PRUH \RXQJHU FRXQVHOORUV ERWK WR UHĹ´HFW WKH GLYHUVLW\ RI FOLHQWV ZKR UHTXLUH WKHUDSHXWLF ZRUN DQG WR VDIHJXDUG RXU IXWXUH ,I LQ WKH IXWXUH WKH LQFUHDVLQJ QXPEHUV RI \RXQJHU SHRSOH VHHNLQJ WKHUDSHXWLF VXSSRUW FDQĹ?W Ć“QG D FRXQVHOORU WKDW WKH\ FDQ UHODWH WR ZLOO WKH\ VLPSO\ WXUQ WR WKH WKRXVDQGV RI FRXQVHOOLQJ SV\FKRORJLVWV ZKR TXDOLI\ LQ WKHLU HDUO\ V" ,I ZH GRQĹ?W PDNH LW HDVLHU IRU \RXQJHU SHRSOH WR HQWHU DQG VWD\ LQ RXU SURIHVVLRQ ZH ULVN EHFRPLQJ REVROHWH &KDQJLQJ WKH GHPRJUDSKLF RI RXU SURIHVVLRQ LV OLNH WXUQLQJ D PRYLQJ FRQWDLQHU VKLS ĹŠ LWĹ?V QRW JRLQJ WR KDSSHQ IDVW EXW ZKHQ WKHUHĹ?V D SHUVLVWHQW IRUFH WRZDUGV VWHHULQJ DQRWKHU FRXUVH PRYHPHQW HYHQWXDOO\ KDV WR KDSSHQ 0\ IHHOLQJ LV WKDW WKH Ć“UVW VWHS LV FRPLQJ WRJHWKHU DQG FUHDWLQJ D ORXGHU YRLFH 7R WKDW HQG , ZRXOG OLNH WR VWDUW D QHWZRUNLQJ VXSSRUW DQG VWUDWHJ\ JURXS

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IRU WKHUDSLVWV XQGHU , XUJH \RX WR JHW LQ WRXFK LI \RX ZRXOG OLNH WR MRLQ RU VKDUH \RXU YLHZV You can contact Ali on Instagram @tiliatherapy or email her at tiliatherapy@ protonmail.com For an exploration of age at the other end of the spectrum, see this month’s ‘Turning point’ column on page 35.

About the author Ali Xavier LV DQ LQWHJUDWLYH FRXQVHOORU ZRUNLQJ LQ SULYDWH SUDFWLFH DQG D OHFWXUHU DW 7KH 2SHQ 8QLYHUVLW\ LQ PHQWDO KHDOWK DQG WKH FRPPXQLW\ DQG VXSSRUWLQJ ZHOOEHLQJ LQ FKLOGUHQ DQG \RXQJ SHRSOH 6KH OLYHV LQ VRXWK /RQGRQ ZLWK KHU KXVEDQG DQG WZR FKLOGUHQ

REFERENCES 1. Hill A. The quarterlife crisis: young, insecure and depressed. [Online.] The Guardian 2011; 4 May. www.theguardian. com/society/2011/may/05/quarterlifecrisis-young-insecure-depressed (accessed 2 June 2020). 2. Young E. Does it matter whether your therapist is similar to you? [Online.] BPS Research Digest 2018; 18 April. https://digest.bps.org. uk/2018/04/18/does-it-matter-whetheryour-therapist-is-similar-to-you (accessed 2 June 2020). 3. Cormack J. Counselling marginalised young people: a qualitative analysis of homeless young people’s views of counselling. Counselling and Psychotherapy Research 2009; 9(2): 71-77. 4. American Trends Panel Wave 10. Most Millennials resist the ‘Millennial’ label. Washington: Pew Research Center; 2015. 5. Lutrell R, McGrath K. The millennial mindset: unravelling fact from Ć“FWLRQ /RQGRQ 5RZPDQ DQG /LWWOHĆ“HOG Publishing, 2015. 6. British Psychological Society. BPS careers destinations (phase 3) survey: 2016 report. Leicester: BPS; 2016. www.bps.org.uk/sites/www.bps. RUJ XN Ć“OHV 1HZV 1HZV )LOHV &DUHHUV GHVWLQDWLRQ VXUYH\ SGI (accessed 7th May 2020).

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Getting the best from CPD SUBS

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hen you’ve finally qualified to work as a counsellor, you may have a sense of having at last arrived. And you have, but in many ways the learning has just begun. We therapists are required to continuously grow our skills and knowledge, both as practitioners and as people. Our ongoing continuing professional development (CPD) commitment may seem onerous or a frustrating expense, but if you love learning, it’s one of the bonuses of our profession; an excuse to invest in new courses, workshops or books! Good CPD can be a source of inspiration that may take you in a new direction, consolidate or grow your confidence in your work, or renew your energy and commitment to your practice. Experiential CPD in particular also has much to offer in terms of personal development by coaxing you out of your comfort zone. PreCovid, in-person CPD events were also a reliable way of meeting and spending time with other practitioners – something that most of us feel we don’t get enough of. But the primary purpose of CPD is, of course, client safety – ensuring we continue to work ethically and effectively and in our clients’ best interests. It’s in the Ethical Framework as part of our commitment to clients – we agree to work to professional standards by ‘keeping our skills and knowledge up to date’ (Our commitment to clients, point 2b).1 We can do this by ‘reading professional journals, books and/or reliable electronic sources; keeping ourselves informed of any relevant research and evidence-based guidance; discussions with colleagues working with similar issues, and regular continuing professional development to update knowledge and skills’ (Working to professional standards, point 14).

Keeping a record BACP-registered members must keep an upto-date and accurate record of a range of CPD activities relevant to current or future practice. Your records need to include how you have reflected, planned, actioned and evaluated your

It’s much broader than attending workshops, conferences and training courses (whether online or in-person). Did you know that giving talks or presentations, supervising or undertaking research, organising specialist groups and peer mentoring also count as CPD? According to a BACP Register resource,2 CPD is defined as ‘any learning experience that can be used for the systematic maintenance, improvement and broadening of competence, knowledge and skills to ensure that the practitioner has the capacity to practise safely, effectively and legally within their evolving scope of practice’, and it may include both ‘personal and professional development’. Sources of CPD may include peer support groups, reading books, journals or internet articles, writing articles or papers, tuning in to TV and radio programmes and work shadowing. Although good supervision forms a core part of our professional development, it doesn’t count towards your CPD hours, as it is a separate Register requirement. Personal therapy sessions do count, but they shouldn’t be your only form of CPD.

How much?

How to choose

The required minimum CPD for all BACPregistered members is 30 hours per year, but you may need or choose to do more than this, depending on where you are in your career or personal life. It makes sense to spread out your hours over the working year. You don’t need to be rigid about a monthly schedule, but if you work to a baseline of two and half hours a month (which adds up to 30 hours over 12 months), you will know you’re doing enough.

According to the BACP Register resource, CPD often involves a cyclical process. This starts with reflection on development needs, then moves on to identifying, prioritising and planning what CPD to look for, followed by action (undertaking the CPD) and, finally, reflection. Of course, learning can occur unexpectedly, and if you can reflect on the impact it has had on your professional development, it can also be counted as CPD. Sometimes a CPD event may simply pique our interest, or appeal because it’s by someone we have professional respect for or interest in. Sometimes, the deciding factor is that it’s convenient and affordable, and there is nothing wrong with that. By contrast, a knowledge gap creates a more urgent drive for CPD, as demonstrated by the demand for online and telephone counselling training earlier this year.

‘The primary purpose of CPD is, of course, client safety... It’s in the Ethical Framework as part of our commitment to clients’ THERAPY TODAY

BLACK YELLOW MAGENTA CYAN

What counts as CPD?

development needs and the impact on your practice. If you are audited, you will be asked to submit your CPD record using the mandatory template on the website, so it may be a good idea to use this as your CPD record. The template is divided into two sections: ‘Reflection and Planning’ and ‘Action and Evaluation’. In ‘Reflection and Planning’, there is space to fill in the following: What do you need to learn? How is the learning relevant to your practice? What might you do in order to achieve this learning? What will your success criteria be? You also add a target date for completion. In ‘Action and Evaluation’, you record the ‘when and what’ of the CPD, as well as what you have learned and how you intend to apply it to your practice. It may seem daunting but it is designed to aid the reflective process, both by identifying what CPD you may need and embedding the insights and learning into your practice. If that doesn’t work for you, you can use your own record system, such as a reflective journal, but you will still need to fill out the mandatory form should you be audited, so think about recording your thoughts under the subheads above.

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Sally Brown explores how we can make the most of the requirement for continuing professional development

In less extraordinary circumstances, it can often be taking on a new client, or a development in your work with an existing client that highlights a competence gap. If you are adding a new modality to the way you work, your CPD hours will be taken up by your core training course and the related reading and extra-curricular learning it may involve. If you are employed as a counsellor or volunteer for a service, there may be organisational input into what CPD you do and when you do it, and it may even be provided and paid for by your employer. However, you may also want to think about what CPD you personally want to do, for your own professional and personal development. A knowledge gap isn’t always filled by acquiring specific skills. Sometimes the need is learning about socio-political-cultural changes in society and our own responses to them, whether conscious or unconscious. As Hazel Johns writes in Personal Development in Counsellor Training: ‘The imperative for counsellors to surface and confront any of their own conscious or unaware hostilities or discomforts is stronger than ever. If prejudices are no longer sanctioned by society, more energy might be invested in keeping such views or feelings covert – yet another demonstration of the fundamental need for personal development and the striving for selfawareness and self-knowledge.’3

Fitting it in Finding time for CPD can be a challenge if you have a busy practice, as admin and pre- and postsession preparation can easily fill up the periods when we are not seeing clients. So, it can be safest to plan your CPD, rather than trust that you will do enough. Depending on what works best for you, that might mean ring-fencing time on a weekly, fortnightly or monthly basis specifically to devote to CPD. Prioritising time just for you and your personal development is not just a reflection of a professional approach to your work, it’s also a form of self-care and self-regard. With more workshops and conferences now available online, it’s possible to catch up with live events you have missed and make this type of learning a core component of your CPD. Online provision also gives us access to top practitioners that we would otherwise have had to travel long distances at significant cost to hear speak. On the BACP CPD Hub, for instance, we can see presentations by Bessel van der Kolk, Irvin Yalom and Emmy van Deurzen. The subscription

channel Wisemind offers courses in the newest trauma-informed therapies, with contributions from Pat Ogden, Janina Fisher and Iain McGilchrist, among others. PESI UK (subscription only) offers luminaries such as Gabor Maté, Louis Cozolino, Peter Levine and Sue Johnson. But signing up to a CPD Hub is one thing, and making the time to view the content another (I am not renewing my subscription to Wisemind for this reason, as I simply did not make the time to watch enough of it to make it worthwhile). You may also want screen-free ways to get CPD, if much of your working life is now spent on screen, so don’t overlook reading, whether it’s a new title or one from your bookshelf that warrants a re-read. And, of course, reading your copy of Therapy Today and the divisional journals, online versions of which are now available free for members, counts as CPD and can be a source of useful and thought-provoking content. Jotting down in a notebook your insights and reflections may help turn reading from a passive activity to one where you reflect on applying what you learn to your practice.

Getting experiential Exploring theory, adding to your knowledge base and keeping up to date with key thinking is, of course, a core aspect of CPD. But the other significant element is your personal development in relation to your practice – growing your selfknowledge and raising awareness of unconscious bias, fears, intolerances and limiting beliefs, as well as your strengths and untapped potential. Our relationship with ourselves has a direct influence on our relationship with our clients and, as we use ourselves as a tool in the therapy room, it makes sense to fully explore that tool’s capabilities and qualities, via self-awareness, selfknowledge, self-acceptance and personal growth. As Carl Rogers said, ‘The degree to which I can

BACP’s Registrants’ Guide to Continuing Professional Development for counsellors and psychotherapists is available here: www.bacp.co.uk/media/1475/ bacp-registered-member-cpdguide.pdf

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About the author Sally Brown is a counsellor and coach in private practice and the editor of Therapy Today.

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create relationships which facilitate the growth of others as separate persons is a measure of the growth I have achieved in myself.’3 Another reason why development needs to be personal as well as professional is that we are expected to aspire to certain ‘personal moral qualities’ under the Ethical Framework (Ethics, point 8): candour, care, courage, diligence, empathy, fairness, humility, identity, integrity, resilience, respect, sincerity and wisdom. Those qualities may come naturally for some, but for most of us, they take effort. Perhaps experience has taught you otherwise, but I wonder whether ‘Aha!’ moments of personal growth are less likely to happen through passive learning, such as reading or watching a pre-recorded talk, than they are by actively engaging in experiential CPD. I’m probably not alone in finding that half the learning I come away with after a workshop is gained from interactions with my fellow participants. At present, we don’t know when it will be considered safe to come together again in this way but, in the meantime, many providers are creating interactive online CPD, allowing us to contribute and work in break-out groups. Like many practitioners, I count my morning meditation practice as a core part of my personal and professional development. It fosters my selfawareness and self-acceptance in a way that I feel directly feeds into my ability to feel compassion and show up with courage in the therapy room. For others, self-exploration may happen through creative expression such as art, dance, music, improvisation or writing. Keep a reflective journal – a practice we are often encouraged to do during our training that is worth continuing throughout our professional life. As the self is ever-dynamic, there is no end point to self-exploration.

REFERENCES 1. Ethical Framework for the Counselling Professions. Lutterworth: BACP, 2018. 2. www.bacp.co.uk/membership/ registered-membership/guide-to-cpd/ 3. Johns, H. Personal Development in Counselor Training (2nd ed). London: Sage; 2012. 4. Rogers CR. On Becoming a Person. London: Constable, 1961.

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In practice - CPD, 1

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‘Not all clients need or want a deep relationship with their counsellors’

Catherine Jackson invites Windy Dryden to make his case for the power of single-session counselling to change lives

Catherine Jackson: Most readers will be familiar with the concept, but can you set the scene by describing in a nutshell what single-session counselling (SSC) is? Windy Dryden: I see SSC as a purposeful endeavour where both counsellor and client set out with the intention of helping the client in a single session, knowing that further sessions are available if the client needs them.

CJ: What are the theories underpinning it? WD: I’d like to shift the emphasis a little and first give a bit of the history of its development, and then outline a few of the important

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principles that underpin it. It isn’t new – Freud used one-off consultations, notably with the composer Gustav Mahler. Adler, Ellis and Erickson all gave public demonstrations that were, effectively, SSC. Carl Rogers did the same, including taking part in Everett Shostrum’s Gloria films with Perls and Ellis. But it was Moshe Talmon’s book, Single-Session Therapy,1 published in 1990, and his subsequent pioneering work with Michael Hoyt and Robert Rosenbaum that really put it on the map. They, between them, laid down the main principles of SSC. The first principle is the ‘power of now’. Since a counsellor does not know for certain that a client will return, it is important to

harness the power of the present encounter, but secure in the knowledge that more help can be available later on if needed. Michael Hoyt coined the term ‘one-at-a-time counselling’2 to describe how the counselling takes place one session at a time. The client is encouraged to reflect on what they have learned from the session, digest it, act on it and let some time pass before deciding whether or not to seek another session. In fact, Talmon, in his original description, included several ‘points of contact’ around the single counselling session – the initial contact to make the appointment, further telephone or questionnaire contact to explain the process, the face-to-face contact itself, and a follow-up. In my experience, in some cases, the person may get what they need from the pre-session contact alone. The second principle is that ‘even a brief encounter can be therapeutic’. We have probably all had the experience of being helped by someone in a short period of time and, as counsellors, we have probably all known occasions when we have helped someone in the assessment session, even if we aren’t aware of this at the time. It is possible to help someone in a single session, especially if both parties are open to this possibility. The point is to offer counselling at the point of need rather than at the point of availability. These are just the two primary principles; there are many others that I outline in my new book.

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CJ: How do you think it achieves what it achieves? What are its unique strengths (for counsellor and client)? What’s the evidence for its effectiveness? WD: I think that quite a bit of the power of SSC lies in the shared expectation that, if the counsellor and client work together to achieve something meaningful for the client, then this can happen. Its strengths are that the counsellor helps the client to focus on their most pressing concern and, in doing so, encourages the client to identify and harness their inner strengths and external resources to address that concern. There is an acknowledged lack of robust empirical evidence for the effectiveness of single-session therapies,3 although reviews show it does result in improvement in symptoms and it scores well for client satisfaction.4,5 However, this is all premised

‘I see SSC as a mindset towards counselling and a way of delivering counselling services. It’s about how the counsellor approaches the session’

on a conception of SSC as a model of therapy, when I and many others would argue that it is more of a delivery system or mindset, rather than a specific theoretical approach.

CJ: You are widely known as one of our foremost practitioners of cognitive behaviour therapy (CBT), and rational emotive behaviour therapy (REBT) in particular. How did you get from REBT to SSC? What are the common threads that led you to where you are today? WD: Like many counsellors, I saw the Gloria films. I was struck by how much Rogers, Perls and Ellis achieved in such a short period. Another influence was the ‘Friday Night Workshops’ run for many years by Albert Ellis, where he would help two volunteers from the audience with their emotional problems. Again, I was struck by what could be done in single sessions of counselling. Over the years, whenever I ran a workshop, I would offer to demonstrate my work with volunteers, and I both enjoyed this work and saw once again what could be achieved in a short period of time. In 2014, when I retired from my university post, I was looking for a new challenge. With the growing waiting lists for counselling in many contexts, I thought that SSC could help ease this situation. I decided to set about encouraging services to offer SSC and have been running training workshops on it ever since.

CJ: Your latest book is written for FRXQVHOORUV VSHFLƓFDOO\ 'R \RX WKLQN

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counsellors are missing a trick by not adding SSC to their toolboxes? WD: First, I am not wholly comfortable with the idea that SSC is a tool in a counsellor’s toolbox. As I said before, I see it as a mindset towards counselling and a way of delivering counselling services. It’s about how the counsellor approaches the session – as if it could be the last, irrespective of the client’s diagnosis or complexity of problems; setting an agreed meaningful goal for the session with the client; identifying and drawing on the client’s own inner and outer strengths and resources; ensuring the client takes away a meaningful solution from the session; ensuring they have a plan to implement the solution, and then bringing the session to a suitable conclusion, including clarifying future steps if the client needs more help. So yes, I think that, if counsellors are willing to adopt a single-session mindset some of the time and arrange some of their services so that help can be offered when clients need it, then they will benefit both their clients and themselves professionally. I want to be very clear that I am not saying that it should replace ongoing counselling or any other form of therapeutic engagement. SSC best stands alongside other forms of counselling delivery. It has much to offer as one of the choices available within an integrated service, which is where I’d like to see it.

CJ: What can SSC offer practising counsellors and counselling agencies – and, of course, their clients? How would you attempt to convince sceptical readers of Therapy Today? WD: I doubt that any counsellors came into the profession with the ambition to ‘help people who have waited three months for my help’. We want to help people at the point where they have come forward seeking it, perhaps after months or years of struggling on their own. When they finally seek counselling, they are ready to be helped, and what they don’t need is a triage interview and/ or to be placed on a waiting list for assessment and often then on another waiting list for actual counselling. Perhaps if we had sufficient employed/paid counsellors we could actualise our desire to help people at the point of their need, rather

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My single session with Megha was a demonstration session in Mumbai GXULQJ DQ 5(%7 WUDLQLQJ FRXUVH , ZDV JLYLQJ IRU TXDOLĆ“HG SUDFWLWLRQHUV 0HJKD ZDQWHG KHOS ZLWK GHFLGLQJ ZKHUH WR JLYH ELUWK WR KHU Ć“UVW child. She wanted to have a natural childbirth but was reluctant to tell her husband how important it was to her because she felt she was being demanding and unfair to him. I questioned these inferences and encouraged her to tell her husband what she really wanted. Here is a key part of the session, which lasted for 21 minutes and 27 seconds.

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Megha: 0D\EH LWĹ?V QRW WRR GHPDQGLQJ Windy: 0D\EH LWĹ?V QRW WRR GHPDQGLQJ" Megha: <HDK Windy: <HDK DQG PD\EH LWĹ?V SHUIHFWO\ SRVVLEOH WR KDYH VRPHWKLQJ ZKLFK LV UHDOO\ UHDOO\ UHDOO\ UHDOO\ UHDOO\ LPSRUWDQW WR \RX WKDWĹ?V QRW D GHPDQG $QG WKDW UHDOLVDWLRQ PDNHV \RX IHHO ZKDW"

than when a counsellor can be made available for them. But this is not today’s reality. If you want to help people when they need help, you have to develop a part of counselling delivery that can do this, and this is the strength of SSC. However, it is not an either/or situation – it’s both/and. Some people will need ongoing work, but quite a few others will find a single session of counselling helpful and sufficient, given their current circumstances. My point is that counsellors should be trained to do both single-session counselling and ongoing counselling. I would love to see SSC on the curriculum in all foundational counselling training, and I am hopeful that this will happen in the not too distant future. All the available data show that the modal (the most commonly occurring) number of counselling sessions clients receive from public and third-sector counselling agencies is one.6 Agencies need to face this fact and try to ensure that every single session, starting with the first, is as productive for the client as possible. Indeed, there is some evidence that even clients with complex issues benefit more from a single session of counselling at the point of need from a walk-in service than help provided at the point of availability.7 I would say to the sceptical, try it and see, but do so while embracing a single-session mindset. Trying it with an ongoing counselling mindset just won’t work.

CJ: How do you answer critics who say SSC can only ever be a stickingplaster solution as it doesn’t offer the continuity and relationship that is so fundamental to the common factors WKDW H[SODLQ ZK\ FRXQVHOOLQJ ZRUNV"

Megha: [Long pause@ $FFHSWDQFH PD\EH Windy: <HDK" 2. 1RZ FDQ \RX RIIHU WKDW DFFHSWDQFH WR \RXUVHOI" This is taken from a follow-up note I got from Megha seven months after the session: ĹŒ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Ĺ?

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‘Sometimes I think that the counselling profession is more concerned with what they think clients should want ... rather than what many clients seem to want’

WD: Well, first of all, a sticking plaster can be useful in promoting a healing process. And surely it is a fundamental principle of counselling to provide help when the person needs it, not just when it is available? I think that SSC adds to the therapeutic climate of an organisation rather than detracts from it. Sometimes I think that the counselling profession is more concerned with what they think clients should want (such as ongoing counselling at relational depth), rather than what many clients seem to want, as evidenced by their overall pattern of session attendance (such as help at the point of need, at relational promptness). Including SSC in the service offer does not mean that some clients won’t be best served by ongoing work. Rather, it recognises that not all clients need long-term work. As I’ve said, SSC is a mindset. I argue that counsellors are able to hold multiple mindsets and use the one that best serves the client in front of them. This, of course, requires a counsellor to be open-minded and flexible and see that different forms of counselling delivery may benefit different people. There are quite a few myths about SSC. One is that it is not counselling but an allied activity where the helper uses counselling skills. However, if you look at the BACP definition of counselling – ‘a specialised way of listening, responding and building relationships based on therapeutic theory and expertise that is used to help clients or enhance their wellbeing’8 – you will see that SSC falls within this definition. A second myth is that, as effective counselling is built on a therapeutic relationship that takes time to develop, singlesession counselling cannot be effective. I would say first, a good working alliance can be established quickly, and second, not all clients need or want a deep relationship with their counsellors.

CJ: SSC is widely used in university and college counselling to cut waiting lists in pressured services. How would you answer the inevitable accusations that this is cost-cutting and cheapening FRXQVHOOLQJ WR Æ“W EXGJHW FRQVWUDLQWV" WD: Ideally, both SSC and longer-term counselling should be available in university and college counselling services, with all students being offered SSC first. Then, those who need further help can be offered another session of SSC or longer-term counselling, as

appropriate. My response to the cost-cutting accusation is that this is not the main reason for introducing SSC. It if reduces costs, then so much the better, but this should not be the prime motivation for its introduction. Incidentally, wherever it has been introduced into university and college counselling services, it has markedly reduced waiting lists and has been appreciated by most of the students who have experienced it. They really value being seen quickly.

CJ: Perhaps the comparison between SSC and traditional counselling is invidious – should we rather be considering SSC for some people and some situations and traditional FRXQVHOOLQJ IRU RWKHUV" ,Q ZKLFK FDVH ZKLFK DQG ZKDW" WD: When I first got interested in SSC, my early work was preoccupied with this question. I developed a long list of inclusion criteria and an equally long list of exclusion criteria. Then I realised one interesting thing – I was developing a single-session approach to discovering who might benefit from single-session counselling! That struck me as preposterous and against the ethos of SSC, where counselling, not assessment, is provided from moment one. If one considers walk-in counselling, where people literally walk in and receive a session of counselling straight away, here there is no attempt to assess which type of counselling would best suit the person. The best way of determining whether a person will benefit from SSC is to give them a single session of counselling and see how they respond. If they need another session, this can be arranged, and if they need ongoing counselling or a block of sessions this can also be organised if a service offers a range of counselling service delivery options.

CJ: *LYHQ LWV VWURQJ FRVW HIIHFWLYHQHVV VKRXOG LW EH DYDLODEOH LQ ,$37" WD: It is interesting that you have asked this question. I’m currently involved in a trial of SSC at an IAPT service in Hampshire. So, watch this space. I am hopeful that, if this trial is successful, SSC may be made available in IAPT services across the board.

CJ: 9HU\ PDQ\ WKDQNV :LQG\ , H[SHFW this interview will spark a considerable response from readers!

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REFERENCES 1. Talmon M. Single session therapy: maximising WKH HIIHFW RI WKH Æ“UVW DQG RIWHQ RQO\ WKHUDSHXWLF HQFRXQWHU 6DQ )UDQFLVFR &$ -RVVH\ %DVV 2. +R\W 0) )RUHZRUG ,Q 6OLYH $ %REHOH 0 HGV :KHQ RQH KRXU LV DOO \RX KDYH HIIHFWLYH WKHUDS\ IRU ZDON LQ FOLHQWV 3KRHQL[ $= =HLJ 7XFNHU 7KHLVHQ SS[L[ [Y 3. +\PPHQ 3 6WDONHU &$ &DLW & $ 7KH FDVH IRU VLQJOH VHVVLRQ WKHUDS\ GRHV WKH HPSLULFDO HYLGHQFH VXSSRUW WKH LQFUHDVHG SUHYDOHQFH RI WKLV VHUYLFH GHOLYHU\ PRGHO" -RXUQDO RI 0HQWDO +HDOWK 4. 3LWW 7 7KRPDV 23 /LQGVD\ 3 HW DO 'RLQJ VSRUW SV\FKRORJ\ EULHÅ´\" $ FULWLFDO UHYLHZ RI VLQJOH VHVVLRQ WKHUDSHXWLF DSSURDFKHV DQG WKHLU UHOHYDQFH WR VSRUW SV\FKRORJ\ ,QWHUQDWLRQDO 5HYLHZ RI 6SRUW DQG ([HUFLVH 3V\FKRORJ\ ÅŠ 5. 'RRUQ $' 6ZHHQH\ . 7KH HIIHFWLYHQHVV RI LQLWLDO WKHUDS\ FRQWDFW D V\VWHPDWLF UHYLHZ >2QOLQH @ &OLQLFDO 3V\FKRORJ\ 5HYLHZ 6. +R\W 0) 7DOPRQ 0 :KDW WKH OLWHUDWXUH VD\V DQ DQQRWDWHG ELEOLRJUDSK\ ,Q +R\W 0) 7DOPRQ 0 HGV &DSWXULQJ WKH PRPHQW VLQJOH VHVVLRQ WKHUDS\ DQG ZDON LQ VHUYLFHV %HWKHO &7 &URZQ +RXVH 3XEOLVKLQJ SS 7. 5HLPHU 0 6WDONHU &$ 'LWWPHU / HW DO 7KH ZDON LQ FRXQVHOOLQJ PRGHO RI VHUYLFH GHOLYHU\ ZKR EHQHÆ“WV PRVW" &DQDGLDQ -RXUQDO RI &RPPXQLW\ 0HQWDO +HDOWK ÅŠ 8. %$&3 *ORVVDU\ %$&3 (WKLFDO )UDPHZRUN IRU WKH &RXQVHOOLQJ 3URIHVVLRQV /XWWHUZRUWK %$&3

$ERXW Windy Dryden Windy is Emeritus Professor of Psychotherapeutic Studies at Goldsmiths University of London, and one of the leading practitioners and trainers in the UK in cognitive behaviour therapy and rationalemotive cognitive behaviour therapy, a leading CBT approach. Windy has been ZRUNLQJ LQ WKH Æ“HOG RI FRXQVHOOLQJ DQG psychotherapy since 1975 and was one of WKH Æ“UVW SHRSOH LQ %ULWDLQ WR EH WUDLQHG LQ CBT. He has trained therapists all over the world, including in the US, South Africa, Turkey and Israel, and has published more than 200 books. His latest book, The SingleSession Counselling Primer: principles and practice, is published by PCCS Books (www.pccs-books.co.uk).

$ERXW WKH LQWHUYLHZHU Catherine Jackson is a freelance journalist specialising in counselling and mental health.

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motherdaughter puzzle

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n experienced counsellor recently admitted to me that she felt out of her depth when a mother and adult daughter both came to see her for help with their incessant DUJXLQJ 6KH VDLG WKDW VKH VWUXJJOHG to identify the core reasons for their arguments, and she knew that the communication skills and boundaries she tried to instil in them did not address the core reasons for their UHODWLRQVKLS GLIÆ“FXOWLHV 6DGO\ WKLV FRXQVHOORU LV QRW DORQH Colleagues frequently tell me that they feel unprepared when it comes to ZRUNLQJ ZLWK PRWKHUV DQG GDXJKWHUV They blame the absence of specialised WUDLQLQJ 7KLV ODFN RI IRFXV RQ WKH mother-daughter relationship creates unnecessary anxiety among counsellors and psychotherapists, and frustration IRU IHPDOH FOLHQWV )RU H[DPSOH LW ZDV only in 2016 that the Adult DaughterMother Relationship Questionnaire was GHYHORSHG E\ -XOLH &ZLNHO 1 And in my

RIÆ“FH DOO WRR RIWHQ , KHDU PRWKHUV DQG GDXJKWHUV YRLFH WKHLU IUXVWUDWLRQV DERXW WKH ODFN RI VSHFLDOLVHG KHOS In this article, I share two insights that will help counsellors understand the dynamics between a mother and GDXJKWHU RI DQ\ DJH 7KHVH LQVLJKWV come from the mother-daughter DWWDFKPHQW PRGHO , KDYH GHYHORSHG through my 20-plus years of listening to thousands of mothers and daughters of all ages from different countries DQG FXOWXUHV The model makes the complicated dynamics between mothers and daughters easy to understand, explains why mothers and daughters Æ“JKW DQG WHDFKHV KRZ PRWKHUV DQG daughters can build strong, emotionally FRQQHFWHG UHODWLRQVKLSV I chose to specialise in the motherdaughter relationship back in the 1990s because that relationship is central to ZRPHQ XQGHUVWDQGLQJ WKHPVHOYHV My relationship with my mother had

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shaped who I was, and when my daughter was born 30 years ago, I knew I had to change the harmful themes that were being passed down the JHQHUDWLRQV :KDW EHJDQ DV D SHUVRQDO TXHVW EHFDPH P\ SURIHVVLRQDO PLVVLRQ

0RWKHU GDXJKWHU FRQŴLFW Mothers and daughters frequently tell me that they feel ashamed about WKHLU UHODWLRQVKLS GLIƓFXOWLHV 7KH\ IHHO that they ‘should’ be able to get along because popular wisdom tells them that mothers and daughters are supposed WR EH FORVH 7KLV VRFLHWDO H[SHFWDWLRQ makes mothers and daughters EODPH WKHPVHOYHV IRU FDXVLQJ WKHLU UHODWLRQVKLS GLIƓFXOWLHV 7KH WUXWK LV LI P\ \HDUV RI H[SHULHQFH SURYLGLQJ therapy are any indication, many women currently experience motherGDXJKWHU UHODWLRQVKLS FRQŴLFW %DVHG RQ WKH HQTXLULHV , UHFHLYH from mothers and adult daughters IURP GLIIHUHQW FRXQWULHV , EHOLHYH

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Societal expectations routinely set mothers and daughters up for conflict, says Rosjke Hasseldine

that a larger, society-wide dynamic is contributing to their relationship FRQĹ´LFW 2IWHQ , KHDU ĹŒKRUPRQHVĹ? EHLQJ blamed as the cause for relationship problems, whether they are the teenage daughter’s hormones, the pregnant daughter’s, or the menopausal PRWKHUĹ?V $QRWKHU FRPPRQ UHDVRQ PRWKHUV DQG GDXJKWHUV JLYH WR H[SODLQ why they are not getting along is their differing (or similar) personality WUDLWV , KDYH QHYHU IRXQG KRUPRQHV RU personality traits to be the core reasons for mother-daughter relationship FRQĹ´LFW KRZHYHU 5DWKHU , KDYH concluded that society sets up mothers DQG GDXJKWHUV IRU FRQĹ´LFW ,Q WKH Ć“UVW LQVLJKW , VKRZ WKDW WKH mother-daughter relationship is QRW GLIĆ“FXOW WR XQGHUVWDQG RQFH ZH realise that mothers and daughters GR QRW UHODWH LQ D FXOWXUDO YDFXXP In recognising that mothers and daughters relate within a sociocultural DQG PXOWLJHQHUDWLRQDO HQYLURQPHQW the dynamics between them become HDVLHU WR JUDVS :H VHH KRZ OLIH HYHQWV UHVWULFWLYH JHQGHU UROHV XQUHDOLVHG career goals and the expectation that ZRPHQ VKRXOG VDFULĆ“FH WKHLU QHHGV LQ WKHLU FDUHJLYLQJ UROH DOO VKDSH KRZ PRWKHUV DQG GDXJKWHUV YLHZ WKHPVHOYHV DQG HDFK RWKHU DQG KRZ WKH\ FRPPXQLFDWH 7R LOOXVWUDWH WKLV dynamic, I share the story of my work ZLWK 6DQGHHS D \RXQJ FROOHJH VWXGHQW IURP WKH 8. In the second insight, I explain how patriarchy’s way of silencing and denying what women need is the root cause of most mother-daughter UHODWLRQVKLS FRQĹ´LFW DFURVV GLIIHUHQW FXOWXUHV DURXQG WKH ZRUOG 7R LOOXVWUDWH WKLV , VKDUH P\ ZRUN ZLWK 0LULDP D GRFWRU IURP 6ZHGHQ ZKR ZDV UDLVHG LQ D IHPLQLVW IDPLO\ 0LULDP DQG 6DQGHHS FRPH IURP different countries and cultural backgrounds, and their families are at opposite ends of the women’s rights continuum, yet their core relationship SUREOHP LV WKH VDPH %RWK 0LULDP DQG 6DQGHHS FRPH IURP IDPLOLHV LQ ZKLFK ZRPHQ KDYH QRW OHDUQHG KRZ WR DVN IRU ZKDW WKH\ QHHG

Insight 1: Mothers and daughters relate in a sociocultural environment As is the case with any couple, mothers DQG GDXJKWHUV UDUHO\ Ć“JKW RYHU ZKDW WKH\ VD\ WKH\ DUH DUJXLQJ RYHU 6DQGHHS and her mother were no exception to WKLV UXOH 6DQGHHS ZDV D \RXQJ FROOHJH VWXGHQW ZKR OLYHG DW KRPH +HU SDUHQWV immigrated to England from India EHIRUH 6DQGHHS ZDV ERUQ 6DQGHHS had three brothers, but she was the IDPLO\Ĺ?V RQO\ GDXJKWHU 6DQGHHS FDPH WR VHH PH EHFDXVH she was feeling depressed about KRZ FULWLFDO KHU PRWKHU ZDV 6KH ZDV struggling to juggle her college work with the housework her mother and IDPLO\ H[SHFWHG KHU WR GR 6KH VDLG KHU mother would accuse her of not being a good enough ‘housekeeper’ and not caring enough for her mother when she ZDV LOO ZKLFK ZDV RIWHQ 6DQGHHS KDG FRQVXOWHG D FRXQVHOORU before me, who had suggested that her mother might be suffering from D SHUVRQDOLW\ GLVRUGHU , QHYHU JRW WR PHHW 6DQGHHSĹ?V PRWKHU DQG ZRUN with her clinically, so I was unable to YDOLGDWH ZKHWKHU WKLV PLJKW EH WKH FDVH 5HJDUGOHVV HYHQ LI 6DQGHHSĹ?V PRWKHU GLG KDYH WKLV GLDJQRVLV LW GLG QRW SURYLGH 6DQGHHS ZLWK WKH DQVZHUV VKH QHHGHG 5DWKHU 6DQGHHS QHHGHG WR understand the multigenerational VRFLRFXOWXUDO HQYLURQPHQW LQ ZKLFK VKH DQG KHU PRWKHU OLYHG 6KH DOVR QHHGHG to understand what was going on in this HQYLURQPHQW WKDW DSSDUHQWO\ FDXVHG KHU mother to be so angry and critical, and ZK\ VKH DQG KHU PRWKHU EHOLHYHG WKDW LW ZDV 6DQGHHSĹ?V UHVSRQVLELOLW\ WR GR DOO WKH KRXVHNHHSLQJ

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:KHQ , VWDUW ZRUNLQJ ZLWK QHZ FOLHQWV , PDS WKHLU PRWKHU GDXJKWHU KLVWRU\ This is the primary exercise in the PRWKHU GDXJKWHU DWWDFKPHQW PRGHO It is an adaptation of the genogram H[HUFLVH WKDW IDPLO\ WKHUDSLVWV XVH 7KH maps focus on the three main women in the multigenerational family, which LQ 6DQGHHSĹ?V FDVH ZDV 6DQGHHS DV the daughter, and her mother and JUDQGPRWKHU , PDS WKH H[SHULHQFHV WKH WKUHH ZRPHQ KDYH KDG LQ WKHLU OLYHV LQFOXGLQJ WKH JHQGHU UROHV WKDW KDYH GHĆ“QHG WKHLU OLYHV DQG OLPLWHG WKHLU FKRLFHV DQG SRZHU , DOVR PDS KRZ WKH PHQ LQ WKH IDPLO\ WUHDW WKHLU ZLYHV DQG GDXJKWHUV 0RWKHU GDXJKWHU KLVWRU\ PDSV SURYLGH DQ LQ GHSWK DQDO\VLV RI the multigenerational sociocultural HQYLURQPHQW LQ ZKLFK WKH ZRPHQ LQ WKH IDPLO\ OLYH DQG ZKDW LV KDSSHQLQJ ZLWKLQ WKDW HQYLURQPHQW WR FDXVH PRWKHUV DQG daughters to argue, misunderstand HDFK RWKHU DQG GLVFRQQHFW HPRWLRQDOO\ (Detailed instructions on using this exercise with clients can be found in The Mother-Daughter Puzzle.2)

Patriarchal structure 6DQGHHS WDONHG DERXW KHU JUDQGPRWKHU DQG PRWKHUĹ?V OLYHV DQG DUUDQJHG PDUULDJHV DQG VKDUHG KRZ YHUEDOO\ DEXVLYH DQG FRQWUROOLQJ KHU IDWKHU DQG JUDQGIDWKHU ZHUH 6KH VDLG WKH PDOHV in the family were encouraged to go to college and build their careers, while the females were expected to VWD\ DW KRPH WR KHOS WKHLU PRWKHUV $V 6DQGHHS SURYLGHG WKHVH GHWDLOV KHU family’s patriarchal structure came into VKDUS IRFXV 6DQGHHS UHSUHVHQWHG WKH Ć“UVW ZRPDQ LQ KHU IDPLO\ JHQHUDWLRQ WR Ć“QLVK VFKRRO DQG JR WR FROOHJH 6DQGHHSĹ?V IDPLO\ EHOLHYHG LQ ZKDW , FDOO WKH FXOWXUH RI IHPDOH VHUYLFH ĹŠ D global patriarchal belief system that YLHZV ZRPHQ DV FDUHJLYHUV QRW FDUH UHFHLYHUV )DPLOLHV WKDW VXEVFULEH WR WKH FXOWXUH RI IHPDOH VHUYLFH H[SHFW PRWKHUV DQG GDXJKWHUV WR EH VHOĹ´HVV VHOI VDFULĆ“FLQJ VHOI QHJOHFWLQJ FDUHJLYHUV This belief system does not recognise ZRPHQ DV SHRSOH ZLWK WKHLU RZQ QHHGV $OWKRXJK , QHYHU PHW 6DQGHHSĹ?V mother, it was apparent to me (based

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on Sandeep’s descriptions) that she had internalised this family belief and did not know any other way of being. This meant that she did not understand Sandeep’s desire to go to college or her Ć“JKW IRU KHU LQGHSHQGHQFH , VXVSHFWHG that Sandeep’s independence felt threatening to her mother. Several reasons explain why Sandeep’s mother was so critical of her daughter and why she behaved in an emotionally manipulative manner – for example, by becoming ill just when Sandeep was busy with an assignment or exam. First, Sandeep wanted to live a different life to that of her mother and of her grandmother, and this might have made Sandeep’s mother feel alone and abandoned. For her, being female meant being a caregiver and ‘good daughter’, stepping into their mothers’ shoes and repeating their mothers’ lives. Sandeep’s mother had done that, her mother had done that, and she expected Sandeep to follow in that role. I suspect Sandeep’s wish for a different life and different relationships felt like a rejection to her mother. It made her feel that her daughter was criticising the life and values she believed in as a mother. Second, Sandeep’s mother could have been jealous of her daughter’s freedom and opportunities, even though she was probably unaware that her criticism and anger were rooted in jealousy. Sandeep’s freedom and opportunities might have been an uncomfortable mirror for her mother, reminding her of the freedom she never had and the dreams she had to relinquish. Third, the mother’s attempts to keep Sandeep from graduating and

‘Sandeep’s freedom and opportunities might have been an uncomfortable mirror for her mother’

leaving home could have been linked WR KHU RZQ Ć“JKW IRU HPRWLRQDO VXUYLYDO Sandeep reported to me that she was the only person who gave her mother love and care, so the thought of Sandeep leaving home must have been terrifying to her.

Navigating the pushback For mothers and daughters to build a strong, emotionally connected relationship, ideally both parties will engage in couples therapy. However, if one person is not able, or willing, to participate, healing is still possible. In Sandeep’s case, her mother did not want to participate in therapy. This did not prevent Sandeep from working on understanding and improving her relationship with her mother. When one person changes their behaviour, the relationship changes to incorporate the new behaviour. Of course, Sandeep and I had little control over how her mother would respond to the changes Sandeep needed in their relationship. My work with Sandeep involved teaching her how to listen to her own voice. Sandeep had become an expert in responding to what her mother needed and being a ‘dutiful daughter’, but she had little idea about what she ZDQWHG IRU KHUVHOI EH\RQG Ć“QLVKLQJ her degree. Sandeep did not know how to ask herself what she thought, felt and needed emotionally because that conversation was not spoken in her family. My role as a mother-daughter therapist was to help Sandeep uncover the sexism she had inherited from her mother and grandmother that had silenced her voice. I helped her understand the gender inequality her family and culture normalised, and I taught her how to claim her own ideas of who she wanted to be and what she needed in her relationship with her mother, and in all her relationships. I also helped Sandeep navigate the pushback she got from her mother and father when she stopped complying with their demands to be the family’s unpaid housekeeper. I helped her to understand her mother and father’s perspectives so that she had empathy

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for them, and I encouraged her to recognise that their anger and criticism weren’t as personal as they felt, and originated instead from their cultural beliefs. Alongside helping Sandeep come to a better understanding of her family’s sociocultural environment, I helped her recognise she was entitled to speak her mind, reject unreasonable demands and carve out her own life path. Sadly, Sandeep’s parents did not react well to her behaving differently to what they expected of a dutiful daughter. After Sandeep left home, her family’s anger and accusations that she had dishonoured the family became alarming, leading her to obtain a restraining order against her parents and siblings. Through her therapy, Sandeep learned the degree to which her family members did not tolerate any challenge to their long-held beliefs about what women can and cannot do and can and cannot wear. I had to help Sandeep stay safe and grieve the loss of her family, even as she gained her own voice and life.

Insight 2: Mothers and daughters ƓJKW RYHU WKHLU GHQLHG QHHGV My clients have taught me that the denial of what women need, especially when it comes to women’s emotional needs, ripples below most motherGDXJKWHU UHODWLRQVKLS FRQŴLFW $V , ZULWH in The Mother-Daughter Puzzle, when a family does not speak the language that enquires after what women feel and need, mothers and daughters are VHW XS IRU FRQŴLFW ,W FUHDWHV DQ HLWKHU or dynamic in which the mother and GDXJKWHU ƓJKW RYHU ZKR JHWV WR EH heard and emotionally supported in their relationship because they do not know how to create a normality in which both are heard and supported. In every mother-daughter history map I draw, I see how the silencing of women’s needs harms women’s emotional wellbeing, limits their ability to advocate for themselves in their relationships and workplaces and perpetuates gender inequality. I see how this dynamic makes women

invisible and how being invisible makes women hungry for attention. The inability to openly and honestly ask about what they need creates emotionally manipulative behaviour between mothers and daughters and sets daughters up to have to mindread their mother’s unspoken and unacknowledged needs. Miriam contacted me for help with her adolescent daughter. Miriam and her mother were doctors, and Miriam’s husband and father were extremely supportive of their careers. But, just like Sandeep and her mother, Miriam and her mother had internalised and normalised the culture of female service, and Miriam’s daughter was DQJU\ DERXW KHU PRWKHUĹ?V VHOĹ´HVVQHVV Miriam’s daughter felt that she had to mind-read what her mother really felt and wanted, and she was tired of it. She desired an emotionally honest relationship, to feel free to say what she felt and needed, and for her mother to speak her mind and stop the guessing games. Miriam’s daughter did not want to feel responsible for meeting her mother’s unvoiced and unacknowledged needs.

Emotionally silenced The silencing of women’s needs is an inter-generational dynamic that gets passed on from mother to daughter because the mother is not able to teach her daughter how to voice her needs openly and honestly. When the daughter is expected, often unconsciously, to listen for and meet her mother’s unvoiced and unacknowledged needs, the daughter is learning to become an expert on understanding what her mother needs, not on what she needs herself. This means that the daughter will grow up to be as emotionally mute as her mother, thus setting up her own daughter to try to learn to interpret and meet her unvoiced needs. In my experience, women’s generational experience of being emotionally silenced and emotionally neglected is a common theme between mothers and daughters.

Happily, I am seeing a huge shift in adult daughters in their 20s, 30s and 40s, who are waking up and wanting change. These daughters recognise that they have learned – from their mothers and from society in general – to be far too tolerant of being silent and selfneglecting. More daughters are asking their mothers to join them in therapy so that together they can change these inherited behavioural patterns. Mothers and daughters are teaming up and pioneering a ‘new normal’ in their families – a normal where women are speaking up and demanding to be heard. And they are passing on this new normal to the next generation of sons and daughters. When we understand that motherdaughter attachment disruption or FRQĹ´LFW WHOOV WKH VWRU\ RI KRZ VH[LVW beliefs and gender role stereotypes harm women’s voices and rights, the mother-daughter relationship becomes an unstoppable force for change at family and worldwide levels. Sadly, Sandeep’s mother was not DEOH WR MRLQ 6DQGHHS LQ KHU Ć“JKW WR challenge her family’s sexist cultural beliefs. I inferred that too much neglect made Sandeep’s mother emotionally unable to think her way out of her powerlessness. Miriam, having had a far more supportive and empowering upbringing, was able to join her GDXJKWHU WR Ć“QG D QHZ QRUPDO IRU women within their family. This mother and daughter team-coached each other as they decontaminated themselves from their internalised sexism and selfsilencing habits. The mother-daughter relationship has tremendous power to change women’s lives around the world. When mothers and daughters band together, they become a powerful force for change, creating an impenetrable wall of resistance against family members who are threatened by women claiming their rights. I have had the honour to work with many pioneering mothers and daughters who dared to dream of a reality in which mothers and daughters are no longer starving for attention and Ć“JKWLQJ IRU FUXPEV RI DIIHFWLRQ 7KHVH

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brave mothers and daughters have recognised the harm that patriarchy, VH[LVP DQG JHQGHU LQHTXDOLW\ LQĹ´LFW RQ women, and have decided that enough is enough. In essence, they are saying, ‘With us, it must end.’ â– 1DPHV DQG LGHQWLI\LQJ GHWDLOV KDYH been changed. 7KLV DUWLFOH Ć“UVW DSSHDUHG LQ Counseling Today WKH MRXUQDO RI WKH $PHULFDQ &RXQVHOLQJ $VVRFLDWLRQ

About the author 5RVMNH +DVVHOGLQH is a motherdaughter relationship therapist, author of The Silent Female Scream and The Mother-Daughter Puzzle: a new generational understanding of the motherdaughter relationship (both Women’s Bookshelf Publishing), and founder of Mother-Daughter Coaching International LLC (www. motherdaughtercoach.com), which offers online mother-daughter attachment training courses. Rosjke has presented her research at professional conferences, at the United Nations Commission on the Status of Women, and on TV. Rosjke will be teaching her motherdaughter attachment training course in the UK in June 2021. For more information, see her website, www.rosjke.com, or email URVMNHKDVVHOGLQH#JPDLO FRP

REFERENCES 1. Cwikel, J. Development and evaluation of the Adult Daughter-Mother Relationship Questionnaire (ADMRQ). The Family Journal 2016; 24(3). https://doi.org/10.1177/ 1066480716648701 2. Hasseldine, R. The mother-daughter puzzle. Durham, NH: Women’s Bookshelf Publishing; 2017.

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Is therapy really good for everyone, or just for people who ‘feel like us’? asks Gillian Bridge

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ike many people, I’m finding lockdown tricky. I’m OK with being on my own, fine with limitations on shopping and socialising (apart from with family), and much more than OK with the early morning quiet, the birdsong and the empty, lush, spring countryside I can now more easily run and cycle through. But what is irking me is the almost unchallenged assumption that this unusual situation must inevitably result in an even

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greater tsunami of mental health problems than we have already. Just before lockdown, I published a book focused on how and why we are not only getting the preexisting ‘tsunami’ out of all proportion, but potentially also making the situation worse, not better, by insisting that ‘talking about feelings’ is the solution to all mental health problems. And here we are again – the only way to stop everyone collapsing under the strain of lockdown is for us all to talk about our feelings!

ALICE MOLLON/IKON IMAGES

I am sure there will be those among you who would be prepared to agree with me if doing so (publicly anyway) didn’t risk opprobrium. I’m remembering the many counsellors and therapists who have sidled up to me after one of my conference talks to whisper, ‘I didn’t know we were allowed to think such things, never mind say them!’

Human realities As a teacher, lecturer, addiction therapist, executive coach, drug and alcohol worker (largely in prisons), therapist, counsellor, and writer (mostly on mental health-related matters), I have a wealth of experience in working directly with adolescents, addicts, criminals and people with ASD. And although I firmly believe that there’s no point whatsoever in therapy of any kind if it doesn’t take the individual human into account, I’m not so certain about the legitimacy of a comprehensive adoption of what is usually called ‘a person-centred’ (that is, a feelingsbiased) approach when it comes to therapy for a large proportion of clients. I often wonder whether therapy really is good for all, or just for people who ‘feel like us’? Sometimes the exposition of theory that I find in Therapy Today makes even me, a language professional, question whether we’re all truly trying to communicate with and make sense of real people. I wonder if, even when talking about person-centred ideologies, we are more fixated on concepts than on the very human realities of the ‘non-psychologically woke’ world. Do we, in fact, expect levels of awareness and psychological understanding in that vastly diverse outside world that quite simply aren’t there? Do we assume a universal ability to articulate feelings in a healthpromoting way? Do we, as a professional population, and particularly when axiomatically endorsing the pre-eminence of person-centred, feelings-biased ideologies, reflect our own essentially middle-class, Western-orientated origins? And does this mean we make too many assumptions about education and cultural beliefs, as well as expectations, goals, ambitions and intentions, and – my particular beef – the function and workings of language? Language and meaning Language is not a concrete thing and conveys no absolute meanings. Language and meaning

are a two-way affair; each begets the other. I believe that the way we talk about experience is as likely to form our reaction to it as the other way round. And that language, while not necessarily an honest guide to either subjective or objective ‘truth’, must be at least expressively functional and used within a shared cultural paradigm before it can really be helpful in a therapeutic context. As therapists, we have to be able to recognise the possible connotations, emotional or practical, when somebody uses words like ‘hurt’, ‘loving’ or ‘painful’, and that assumes a pre-existing shared lexicon. And clients must be expressively functional before we can carry out useful therapy with them, particularly if it is intended to be non-directive and non-judgmental. I have worked in prisons with clients whose primary emotional needs were best met by helping them to articulate and communicate their problems more effectively, rather than simply to express their feelings of raw and inchoate anger – which their crimes had usually done pretty well already. While expressing feelings might have resulted in short-term catharsis for them, it was unlikely to result in long-term selfmanagement strategies. In fact, I have serious reservations about the benefits to many damaged people of being encouraged to dwell on ‘feelings’ that may well be outside the range of sensations experienced by other, more ‘normal’ people. Revisiting, rehearsing and revising – reinforcing and probably setting in concrete, in fact – either very bleak or very disproportionate emotions of any kind are likely to be more harmful than beneficial. Take, for example, the sex offender who, having been made to undertake a prison course to tackle his thoughts and behaviour, was expected to revisit and talk about them with others and ended up saying, ‘I’ve never had so many deviant thoughts.’

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Good mental health It is time to consider the absolute value of the cultural givens (givens for certain sections of society, at least, but by no means all) that say first that feelings and subjective responses to life and events are as valid and valuable as analytical and objective ones, possibly more so, and second, that client-centric, non-judgmental, non-directive therapies are the most ethical and least authoritarian approaches to mental health treatment. The first, unquestioned solipsistic assumption that ‘me’ and ‘now’ are all that matters and that ‘my reality is the ultimate reality’ runs in direct contrast to evidence that good mental health is dependent on having a wide and diverse perspective and a true connection to things, times and people beyond the self. However, it is also one that links closely to that non-directional approach many therapies take, which leads me to question the primacy and universal usefulness of those therapies. While some people may go into therapy because they really do wish to explore their inner selves, and may truly be in it for the long haul, my experience lies more with people who are in distress over elements of their lives that they feel are either out of control in some way or are deeply dysfunctional. So, what are they looking for from therapy? Is it to talk (or often not talk) at length until they almost magically stumble over their own solutions either to the things that are out of control or to the distress they have been experiencing? Or is it largely to discover the tools/skill set/information/ whatever might be missing that may help them deal better with what life has flung at them? To return to the cohort I mentioned earlier – adolescents, addicts, criminals and people with ASD – to which I might add people with other cognitive and learning differences or very limited education – what are they bringing to therapy that might make their experience of it very different from those more likely to benefit from non-directive work? I’m sure most adolescents would bridle at being considered ‘under-resourced’, and yet I’m going to suggest they are. That is because, like many people in the above categories, they have fewer of the resources needed to make sense of the world, of experience and of themselves, not to mention fewer expressive skills necessary to articulate their responses to those things.

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Adolescents have limited stores of knowledge and experience, as well as brains in which self-knowledge lags behind selfsensitivity. The anterior cingulate, a key area of the brain for self-awareness, self-control and language production, works rather differently in adolescence. Addicts, criminals and people with ASD have a number of under-developed brain areas in common, but in particular the anterior cingulate cortex.1 And such key limitations suggest that these cohorts will experience difficulties with awareness of their own internal processes and also with communicating whatever it is that they may be experiencing, making an essentially feelings-related, talk-driven, non-directive therapeutic approach at best a very hit-andmiss affair when it comes to delivering helpful outcomes for those clients. And, as with people with ASD in particular, language is likely to be less a matter of a spontaneous outpouring in response to internal and external events and more a matter of learned, occasion-appropriate scripts. It is infinitely less likely to be reliably descriptive of what might be called ‘true’ internal states. And that can be a major factor in many relationship problems between people with ASD and ‘neurotypical’ people.

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Opinions and advice For instance, a client with Asperger’s tried very hard to please his wife but she just couldn’t get her head around his inability to demonstrate what she thought should be appropriate sympathy when her sister died. He did experience real concern for her, which was obvious in my sessions with him, but did not have that appropriate verbal/gestural template. They were only able to agree to continue their marriage once his wife had eventually given up on expecting ‘normal’ expressions of sympathy and accepted a more pragmatic relationship that recognised his limitations. I am pretty upfront with my clients, although I always remind them that ‘you know it’s not really in my remit...’ before I give them advice or a directive steer. I invite them to choose whether my style fits their needs and if they are looking for that advice/steer. And this is where some knowledge of how the brain works comes in useful, as I know that for many clients the chances of sudden flashes of selfawareness and moments of epiphany, or even

slow dawning realisation, are either relatively remote or wholly unlikely. So I offer them an option that sits between the ‘How does that make you feel?’ approach and one that asks, ‘Do you want my thoughts on this?’ Does it really breach a ‘proper’ therapeutic relationship when one long-standing client, who previously tried innumerable therapists, says he comes to me because I give him opinions and advice? That’s what he wants. The desired outcome for him is not revelations about himself but default ‘instructions’ that remove confusion in stressed moments and prevent him behaving in ways that have caused problems in his relationships in the past. I believe that is worthwhile therapy. I believe the same is true of the more interventionist approach I have taken with prisoners, addicts (who anyway can’t really be ‘worked with’ while they are still climbing the walls) and adolescents who come to me looking to make sense of their experiences but lack the overall experience to do so without some help. That, too, is therapy, in my opinion. Research from the relatively new area of epigenetics has the potential to send seismic shockwaves through the whole business of mental and psychological health anyway. It is likely to be of enormous, life-changing benefit to clients to discover that their anxieties, addictions and responses to stress are not simply outcomes of their past experiences or their parents’ inability to provide emotional succour, but may in fact be down to the ghosts of multiple previous generations lurking in their genes. And that, by tweaking lifestyle factors, rather than analysing themselves, they can influence the extent to which those ghosts can dictate their futures. So I will discuss with them the benefits of improved diet, exercise, good sleep hygiene and avoidance of psychotropic substances, and I firmly believe their mental health will benefit at least as much by that as by

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repeatedly going over their past distress – and probably much more so. And although we’re all likely to be underresourced when it comes to knowledge of the latest research, shouldn’t we be learning about it and open to using it in our practice? Will we really benefit ourselves or our clients by simply expecting such knowledge to materialise somehow through investigation of feelings? Feelings have had a good run, but now I think it’s time for therapy to broaden its thinking. Feelings may be the way to go for some; they may be irrelevant to others, and they could be actively harmful for many. So let us, as the caring profession we are, be certain that therapy is of benefit to more than people who ‘feel like us’.

REFERENCE 1. Bridge, G. Guilty by association – autism, addiction and criminality. Addiction Today 2009; 21(120): 31-33.

About the author Gillian Bridge is a psycholinguistic consultant working therapeutically with private and corporate clients and a speaker on the subject of resilience at schools, universities and conferences. She has previously worked as a teacher, addiction therapist, prison drug and alcohol worker and executive coach. She is the author of several articles and four books that investigate the ways in which EUDLQV PD\ ƓQG G\VIXQFWLRQDO thoughts and substances more attractive than healthful ones. Her latest book, Sweet Distress: how our love affair with feelings has fuelled the mental health crisis (and what we can do about it), is published by Crown House.

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‘My current work schedule is far healthier than the workaholic one I happily created, endured and inflicted on my family back in the 1980s’

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our years ago, I attended a BACP CPD day colloquially known as the ‘retirement course’. I wasn’t planning on imminent retirement or looking out for such a course; I just saw the ad and felt compelled to peer over the perimeter wall of the profession I had entered 37 years earlier and take a peek into retirement land. I was just 26 when I started out, back in 1977, as a trainee counsellor for what was then Marriage Guidance, now Relate. My first client couple were in their 50s and hesitated at the threshold. ‘Have we‌ got you?’ the woman asked, with seeming incredulity, once we were all ensconced. ‘Are you wondering,’ I tentatively enquired, ‘whether someone as young as me can possibly understand and appreciate all that’s brought you here?’ They both looked relieved the truth was out and opted to give me a chance. Much later, when I turned 50, I had an 89-yearold client (a retired professor). His opening words were, ‘I was thinking of seeing a prostitute, but I’m impotent, so I’ve come to see you instead!’ He gave a half-smile, as did I, but we both knew he wasn’t joking. At the start of each session, he would pass comment on my vase of lilies, informing me of their Latin name, or give his critique on some fascinating article gleaned from The Times, all to overcome his neediness and remind us both that he was still, albeit inside his decaying shell of a body, a man of substance, worthy of respect. One year later, he fell apart on my sofa. His long-time friend and ex-lover had died and his own body was now failing at such a rate that it would not be long before his own time was up. For the first time in my presence, his face creased up and this little old man began to shake, persistently and silently, to his very core. I moved to sit beside him and stretched out a fatherly arm and held him tight while he sobbed his little-boy heart out. Sometimes, as Wordsworth implied, age really is

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illusory, for that day the child (in us both) was father to the man. Now at 68, it’s my age, not my youth, youth, that that might make younger clients harbour doubts about me. I read of research suggesting most clients prefer to see a counsellor around their own age or a little older. But 40 years years older? older? I still have clients in their 20s who understand that their therapist was once that same age, albeit long ago. Of course, those were my 20s, not theirs, but the territory of youth is at least familiar to me; whereas anticipating my 80s and old age is an exercise of the imagination, and fearfully so. I have spent the past 32 years in private practice, where, over time, five days per week became four, four became three, and now I am down to just two-and-a-half days per week, no evenings and a new maximum of three appointments in a day. It suits me. These days, I’m tired by late afternoon and my evenings are for me, not my clients. And my current work schedule is far healthier than the workaholic one I happily created, endured and inflicted on my family back in the 1980s. These days most of us can expect to live a long life in retirement, hence the oft-heard advice to carry on working as long as we possibly can. BACP’s ‘retirement course’ was indeed very good, and yet it got retired before me! I don’t know when I shall vacate my therapist chair for the last time but I know I won’t carry on as long as I can, because then I would only stop when forced to do so by illness, infirmity or when my supervisor tells me I’m past it. Before long I shall plan a date well in advance and give good notice – two years perhaps. Meanwhile, I continue with the joys and challenges of this work, whittling down my counselling hours while I fill my life with other meaningful activities. It’s the way to go.

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Then...

...now About the author Kevin Chandler is a BACP senior accredited counsellor, psychotherapist and supervisor based in +ROPĆ“UWK :HVW <RUNVKLUH +H is the author of Listening In: a novel of therapy and real life $FFHQW 3UHVV

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Using this simple model can help clients understand and overcome inner conflict, and reach their full potential, says Anthony Prendergast belief that we are all born whole, with access to our full human potential. But, instead, many of us live a life of blocked potential, defensive, depressed and drained of energy by the conflict between the true self and the internalised parent. It starts with inhibiting messages in childhood that tell us something is wrong with us, that part of us is unacceptable to our primary carers or the wider community. In order to survive and not risk being cast out, we adapt to our environment and unconsciously deny or repress those parts.

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hat stops us from achieving our full potential in life? Why do sane, rational people not choose healthier options, and instead remain stuck in an unhealthy pattern of behaviour? What is the ‘invisible wall’ that stops us from moving forward? To answer these perennial questions that are often at the heart of our work, I have developed a model called The Therapy Square, to use collaboratively with clients in order to uncover internal conflict. Based on key concepts from psychodynamic theory, transactional analysis (TA) and behavioural theory, it builds an integrated and comprehensive picture of what causes a client’s ‘stuck places’ and how they can get beyond them. Concepts such as intra-psychic conflict, transference and repression can be difficult to explain to clients, so part of my motivation in developing the model was to find a simple way to introduce them. It is underpinned by the

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Social conditioning As we grow up, we learn through social conditioning which parts of us are unacceptable by experiencing an inhibiting emotion such as shame, guilt, fear or anxiety at the same time as an inhibiting message.1 Such social conditioning can come from many sources, including modelling by attachment figures, family scripting (including transgenerational), trauma, education, religion, peers and wider society. Biological and temperamental predispositions may modify how an individual is affected by the social conditioning. If we attempt to express the forbidden, we pay the price of disobedience by suffering the inhibiting emotion. Freud described this when he said that ‘anxiety signals the return of the repressed’.2 While shame, guilt, fear and anxiety are the inhibiting emotions commonly cited, it seems logical that any negative emotion, including contempt and disgust, could play a part.3 Inhibiting emotions and

their use for social conditioning are not unique to humans. Chimpanzees will cover their eyes with their hand when they have done something that is considered shameful. The capacity to feel shame predates homo sapiens. From an evolutionary point of view, we are dependent on our parents for years before we can survive on our own, so we need to adapt to them, which often comes with a cost attached. We are hardwired to be loyal to our parents or attachment figures and be whatever they say we should be: like them or not like them. This loyalty can be so ingrained that some clients resist seeing their parents’ faults, even if they were badly abused by them. Although social conditioning can have negative consequences (for example, leading to blocked potential that causes depression), social conditioning is also a part of being a human being and living in society. All societies have a general consensus on what they consider moral or ethical and have prohibitions on certain behaviours. Although these vary widely, there is

‘Inhibiting messages are the crucial missing element’

some behaviour that is universally accepted as immoral, such as murder, rape and theft. Inhibiting emotions are what enforces our social rules on acceptable behaviour. Although our work often involves reducing toxic levels of inhibiting emotions in our clients, on some occasions we may need to increase the inhibiting emotion of guilt – if, for example, a client has committed a crime but continues to deny the impact it has had on their victim’s life. And although the mechanism of social conditioning in humans described here involves negative emotions, positive emotions and other mechanisms are also likely to be involved.

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Inhibiting messages The Therapy Square describes how we were born with our full potential but due to social conditioning end up in blocked potential. Therapy helps us get back to our full human potential.

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Many short-term dynamic psychotherapies (STDPs) use Malan’s triangles as tools to understand core conflict.4, 5 The Therapy Square adds to Malan’s Triangle of Conflict the concepts of injunctions and impasse theory from the transactional analysis (TA) redecision school, to include inhibiting messages.6 Neither of Malan’s triangles includes the message that initially led to the core conflict. Inhibiting messages are the crucial missing element driving internal conflict because without such messages there would be no inhibiting emotion to enforce it and as a result, no blocked potential, internal conflict or transference.

Using The Therapy Square in sessions Depending on what the client is bringing, we may start at any of the four quadrants of The Therapy Square (see diagram). Using a laminated template with blank spaces, we aim to fill in each section according to the diagram. For example, if the client says, ‘I would like to be able to express anger,’ we start by recording this statement in the ‘human potential’ section, as the healthy expression of anger is missing. However, often the client will describe their presenting problem – for example, ‘People keep harassing me, and I can’t seem to tell them to stop it and it is beginning to get me down.’ We record this statement in the ‘blocked potential’ section, as it is repressed anger with the associated cost of depression. Alternatively, if what they bring revolves around an inhibiting emotion – for example, ‘I am being harassed and I know I have a right to say stop, but when I have done that in the past, I just felt so guilty about it’ – then we record ‘guilt’ in the ‘inhibiting emotion’ section. Or the client may say, ‘Father said, “Anger is not ladylike”,’ which is an inhibiting message, so we record it in that section. Of course, not all messages are given verbally. Father may have instead literally frowned upon any display of anger. One important category of common inhibiting messages is what I have termed ‘false equivalences’ – for example, that pride equals arrogance. So healthy pride becomes associated with arrogance and is therefore forbidden. By filling in all of the quadrants on the template, we can map out the nature, costs and source of the internal conflict. As shown in the examples above, sometimes the blocked potential is outside of the client’s awareness,

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such as repressed anger. However, other clients are conscious of some or all of the four elements. We aim to fill in all four quadrants in early sessions. Clients sometimes ask if they can take a photo of the completed square, or I might suggest it and ask them, for homework, to think about whether this conflict happens elsewhere in their life (introducing the idea of transference). If only three of the four quadrants have been identified, I might suggest that they think about the missing one. As the square is laminated, I can wipe it clean afterwards and reuse it with another client. Inhibiting messages are not limited to emotions. In TA, injunctions are parental prohibitions such as ‘don’t feel’, in relation to certain (or any) emotions, but they also include prohibitions of other things from the five areas of survival, attachment, identity, competence and security.7 For example, someone may have been given the injunction ‘Don’t be successful’ by a parent who was jealous of them. Hence, they learned to hold back from succeeding at anything, resulting in an instinctive negative reaction to competency. There are as many inhibiting messages that say ‘You should do X’ (counter injunctions in TA) as there are ones that say ‘Don’t do X’. Both are inhibiting messages because they inhibit the individual’s choices in life. Any inhibiting messages, whether they are coming from the external world or they are internally created by a child ego-state, will result in blocked potential.

Self-created inhibiting messages As Goulding and Goulding show, not all injunctions come from the outside world. Some of them originate as a result of a child misinterpreting adult behaviour. 8 I illustrate this to clients by telling them the story of Little Jonny: ‘Little Jonny was five years old and, like many little boys, he loved playing with his Lego. Being only five years old, he sometimes made a mess with it on his bedroom floor. Jonny’s mother was under some stress as the relationship between her and Jonny’s father was going through a very difficult patch. Occasionally Jonny’s mother would shout at him about the mess. ‘One day, following one of these occasions, Jonny’s father told him, “Come and sit down here, Jonny. We have something we need to tell you. Your mother and I are going to

‘Any inhibiting messages, whether from the external world or internally created, will result in blocked potential’ get a divorce and we are going to be living separately. We still love you deeply and are going to both see you separately. We don’t want you to think it is anything you have done wrong.” But Jonny doesn’t believe him. He thinks, “It must be because I was a bad boy. But what did I do wrong? Oh I know, I didn’t tidy up my Lego. Mum used to get angry and shout at me to tidy it up but I didn’t do it”.’ At this point I look at the client and say, ‘Now you know and I know that Little Jonny’s parents didn’t get divorced because he didn’t clear up his Lego a few times, but Little Jonny doesn’t know that. He is sure it is something he did that caused it and at that moment he makes a decision, “I must not make a mess and must get everything right in the future.” He becomes a perfectionist. “If I never make a mistake, nothing bad will ever happen again,” he tells himself. And even now, as an adult, he becomes anxious if he can’t get something absolutely perfect. He has adapted to what he thinks his parents want him to be.’ As I have been telling the story of Little Jonny, I have been inviting the client into a state of mild regression known as a child ego-state in TA, which helps him recall any childhood beliefs or decisions that he made

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about the world or himself. Many will be innocuous, but some may set his future direction in profound ways. Like Little Jonny, he may have inadvertently created an inhibiting message and chosen a path in life based on a childhood belief that was not true.

Breaking out of the LQWHUQDO FRQŴLFW Once we have figured out the cause of the conflict, we can look at how the client can break out of the internal conflict. The aim of therapy is for the client to move from the ‘blocked potential’ quadrant into the ‘human potential’ quadrant, by helping them to defy the inhibiting messages. One way I like to help clients achieve this comes from behavioural theory, and has been beautifully described by McCullough.3 Essentially, the core conflict is treated in the same way as a phobia can be treated, with progressive exposure therapy and anxiety regulation. In the example above, where the client has been told that ‘anger is not ladylike’, I would encourage her to progressively express her anger and I would positively validate any healthy examples of her doing so. I encourage clients to be mindful of their thoughts and emotions and I let them know that the inhibiting emotion will come up to try to stop them from expressing the forbidden emotion or behaviour. I tell them that, if they start to feel a bit of irrational guilt, for example, they will know they are going in the right direction. Often clients know the inhibiting emotion is irrational. In the example above, the client might say, ‘I know cognitively that it is OK to express my boundaries, but I still feel guilty afterwards when I do.’ In TA, this is known as the script backlash. The client has managed to defy their parental script but they are punished by the inhibiting emotion afterwards. Developing mindfulness of what is triggering the inhibiting emotion helps to regulate it, enabling the client to progressively tolerate what was previously forbidden, such as the expression of anger.

Regulating shame, guilt, fear and anxiety In my experience, progressive exposure to the forbidden emotion or behaviour will bring down the level of the inhibiting emotion over time. That which was initially feared eventually

becomes bearable, and then comfortable. I warn clients that, as they start to experience an emotion that was repressed, they may fear it. They may worry that they will get so angry that they ‘strangle the boss’. Or, if the feared emotion is sadness, they will ‘cry a river of tears’ and be unable to ever stop crying. I explain to them that, in the case of anger, ‘Although it felt so angry and scary, actually what you said was completely normal in that situation. It was a healthy expression of boundary setting. Just ask your friends; they will all tell you that objectively the level of anger you expressed was completely normal.’ This gives them permission to disobey the parental inhibiting message.9 Sometimes a client will be exhibiting a toxic level of an inhibiting emotion that does not, as Freud suggested, signal the return of the repressed. For example, if the client is feeling quite anxious about a serious health condition and is feeling overwhelmed, they are feeling traumatic anxiety rather than ‘signal’ anxiety. But, whether it is signal anxiety or traumatic anxiety, it will need to be regulated if it is toxic. As well as desensitising the inhibiting emotion, I use specific antidotes to counteract each of them. To counteract shame and the attendant loneliness, I use affirmation and encourage the opposite of shame – which is pride.10 For guilt, I encourage understanding, self-acceptance and forgiveness of one’s mistakes. Fear is counteracted by looking at the fears and fostering courage, and anxiety is addressed with grounding techniques, to create a sense of safety. Each inhibiting message is usually accompanied by a mix of inhibiting emotions, so we work with whichever is at the fore for the client at the moment.

Toxic shame Eric* was a client who suffered from a highly toxic level of shame and self-loathing. He had severe depression most of his adult life and a

‘For guilt, I encourage understanding, self-acceptance and forgiveness of one’s mistakes’

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childhood dominated by being bullied by other children. Home life was dysfunctional. He grew up on a deprived council estate where drug use was endemic. At our initial meeting, he began to talk about his upbringing and became increasingly distressed. I had the mental image of a runaway truck building up momentum that would shortly be unstoppable. So I shared the analogy with him and told him I was going to ‘apply the brake’ and slow him down.11 I suggested that his level of unregulated shame was far too high and might stop him from processing his experience. I introduced The Therapy Square in the third session to explain the links between the inhibiting messages he received about being ‘disgusting’ from the other children, the inhibiting emotion of shame, and his defence of trying to hide from the world (blocked potential). I challenged that hiding by asking him to maintain eye contact if the shame started to increase. On one occasion, his shame and distress suddenly increased to a high level, so I asked him to look at my face and tell me if he could see any sign that I thought he was disgusting. I knew he wouldn’t, because at that moment my eyes were filled with tears of love and compassion for his suffering. My intervention was designed to rapidly bring him back to the here and now with me, out of transference, thereby regulating his feelings of shame. It is my belief that therapy should be an open process for clients, and The Therapy Square allows me to introduce a simple map of internal conflict, based on psychodynamic and TA theory, that is accessible to clients.12 By adding progressive exposure therapy and applying specific antidotes to the inhibiting emotions, I can help clients to experience the part of the self that was previously forbidden. 1DPHV DQG LGHQWLĆ“DEOH GHWDLOV KDYH EHHQ FKDQJHG

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About the author Anthony Prendergast MSc is a BACP and UKCP registered FHUWLĆ“HG WUDQVDFWLRQDO DQDO\VW $('3 OHYHO WKHUDSLVW DQG D VXSHUYLVRU ZRUNLQJ LQ SULYDWH SUDFWLFH LQ &DPEULGJH DQG RQOLQH +H FDQ EH FRQWDFWHG DW anthony.prendergast@gmail.com

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n recent years, therapy has become a lifeline for me. Therapy has changed and shaped my life in ways that I could never have anticipated. At the time of writing, I have seen a therapist or been in therapy at various points for roughly half of my life. That’s 18 years of spilling my innermost thoughts to numerous strangers for bouts of various talking therapies for multiple reasons. If this were a marriage, it’d be our porcelain anniversary – a material known for both its toughness and also its fragility. Which I think is fitting, considering the context. But that’s not to suggest it has always been plain sailing. In fact, it has been anything but. I’ve seen several therapists over the years and it’s always been a unique and complex relationship. Some therapists have been great, some less so; sometimes I’ve been open to the help and support, other times I haven’t. And I’ll admit it’s not been until relatively recently that I’ve felt the real ‘magical’ effects of therapy. I definitely do not claim to understand how the magic of therapy works. All I know is something incredible happens when you open up to another human who you click with and who is trained to listen and support. As far as I am aware, though, no actual magic is involved in therapy, although at times I am utterly convinced that some kind of sorcery is at play in my therapist’s room. I’m frequently amazed by how much better I feel when my emotions and intellect are aligned, and how that alignment naturally occurs through the ongoing process of therapy. I think one of the things that has made the relationship with two recent therapists so positive is that they have both consistently shown me over time that they have got my back and that my wellness is their priority. They have been on ‘Team Jo’. They have acted as compassionate and thoughtful mirrors that I can look into without judgment or fear. And that is

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not to say they’ve always let me off lightly. They’ve been able to gently hold me accountable, allowing me to notice and correct my course when I’m repeating behaviours that have been harmful or unproductive in the past. Having weekly sessions with one therapist for almost three years and the other for just over a year now has meant they have been able to gently excavate my whole life history and can remind me of patterns, even when I’m not seeing them myself. Sometimes it almost feels like the relationship is the healing ointment, rather than the words said. I feel compelled not to understate how hard therapy can be. It’s hard to get the courage to go to therapy. It’s hard to find the right person who makes you feel safe, emotionally held and comfortable. It’s hard to trust the process when progress is slow. It’s hard when you doubt yourself, and it’s hard when you come away feeling worse than when you went in. It’s hard to sit in a small room with a relative stranger and tell them all your raw, uncensored stories – the ones you’ve never said aloud before, the ones you’ve never told anyone, maybe not even yourself. The imbalance of emotional exposure is hard to grapple with; they know almost all the worst bits about you, but you know next to nothing about them. Even when therapy is going great, you have a therapist you click with and you’re making great progress, it’s still bl**dy hard work. Joining the dots and noticing the patterns can be as exhausting as it is freeing. Taking the work from the cosy, safe vacuum of the therapist’s room into the harsh light of your real life can be confronting and difficult. Every second is worth it, of course, but boy, it’s still hard. There is no magic incantation to chant, no magical potion to drink so that all my problems will be fixed. But sometimes, I can’t help but feel that what happens in therapy really is magic.

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About the author Jo Love is a mental health advocate, speaker, writer, podcaster and winner of Smallish magazine’s Parenting Ambassador of the Year for Mental Health award in 2017. After spending much of her life silently suffering with mental ill health leading to a diagnosis of postnatal depression and PTSD after the birth RI KHU ƓUVW GDXJKWHU Jo realised she needed to make a change, speak out and help others know it is OK not to be OK. She uses her platform to break the silence on mental health issues through her 25k Instagram followers and the podcast, What I Wish I had Known with Lauren, Jess & Jo <RX FDQ ƓQG Jo on Instagram @jo_love_ and @therapyismagic

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Finding new languages for loss How can we help clients express the inexpressible in this time of coronavirus? By Sasha Bates

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can feel a familiar physical tightening in my chest, and a similarly familiar emotional fluttering making itself felt in the same region, only deeper. Flickering at the edge of my consciousness is a thought swimming its way to the surface. It takes a few seconds to get there; then I realise – I’ve been here before. This is grief, once again assailing me, and evoking the same overwhelming and seemingly inexpressible feelings I had when my husband, Bill, died. Like coronavirus, that cataclysmic event also came out of nowhere and devastated the world I knew. The traditional ‘stages’ of grief can be discerned among the ever-swirling vortex of emotions overwhelming many of us right now: denial, anger, depression, bargaining – maybe not yet acceptance. But I can also spot what I prefer to call the shapes or states or sensations of grief as I identify them in my book, Languages of Loss, written in the wake of Bill’s death. During those unbearable early months, I realised how inadequate words are when grief plunges us into a visceral, whole-body, whole-lifestyle, whole-existential identity crisis. I was not unaware of the irony that my twin professions of journalism and psychotherapy rely so heavily on the use of

language – something that was now eluding me. I felt embarrassed to think of all the grieving clients I’d seen over the years whom I’d misguidedly tried to help with such an inadequate tool as language at my disposal. As therapists, we are going to be seeing clients for whom loss figures hugely in the coming months, if not years. How are we to help them express something so inexpressible, particularly when we are ourselves gripped by our own losses? We don’t have to have lost a person to coronavirus – although many of us will have – to nevertheless be experiencing grief for the loss of our lifestyles, certainty, freedoms, friends, favourite coffee shops and restaurants and so much more – losses big and small. Many of us are even grieving the loss of our physical health, fitness and appearance,

and possibly even a sturdy grasp on our mental health, alongside the more concrete losses. We need to find ways to express this grief to ourselves before we can help our clients express their own. Because, of course, as therapists, we know only too well that grief does need to be expressed, allowed, given voice to, if it is not to fester and go underground, hidden deep beneath our usual defences – defences that coronavirus may well now be fortifying. But, given the inadequacies of language, given that we are now alongside our clients as never before in terms of feeling their pain, how can we address this? How can we help ourselves to express what we are feeling, and how then can we help them?

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In writing Languages of Loss, I realised that words are only one form of language. There are many others and in grief we need access to them all. There is the language of the body, of music, of art, of spirituality, of dreams. There is also the manipulation of language itself in order to communicate differently and more indirectly – manifesting as poetry, storytelling, visualisation, imagery, myth and metaphor.

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Languages of Loss became my way of making sense of senseless loss and expressing inexpressible emotions, although I didn’t realise it at the time. Looking back, it seems almost Kleinian in inception – a projectile vomiting out of the primeval, nameless, unbearable dread inside. I just had to get the ‘poison’ out at all costs and as quickly as possible and doing so onto a page was more acceptable than onto a person. A calmer way of saying this was that I was using the researchproved, useful grieving strategy of journalling to clarify my thoughts. Which is also true, but only with the benefit of hindsight. In the moment it definitely felt more like vomiting, with the bulimic desire to purge and so bring about the blessed relief of emptiness – the blank page my toilet bowl. To torture this metaphor further, you may well have to be that toilet bowl for your clients, if they are able to use you in such a way. But many can’t, so you can also offer them a blank canvas (literal, not Freudian, for once) if they are artistic; toys, playdough or sand if they are regressed; instruments if they are musical; movement if they tend more to the physical. Better still, offer all these together and more. I am not saying that we all have to turn ourselves – even if we could – into art or music or movement therapists, but what we can do is encourage clients to explore which modality, which ‘language’, best enables them to creatively express their grief. Words may not be their thing. For me, words actually are my thing, but they often eluded me in my moments of deep crisis. I turned to the grief theories for help – for a blueprint, a guideline, a map for how to ‘cope’. But there I was met with a barrage of unhelpful words. Words that felt cold, clinical, far removed from what I was feeling. Words like stage, task, journey, getting over, path,

’I turned to the grief theories for help – for D EOXHSULQW DQG ZDV met with a barrage of unhelpful words’

acceptance, resolution. These landed on stony ground. And then the ground itself came to my rescue. I started walking in nature – another tried-and-tested therapeutic suggestion that really did help – and from out of these twin pillars of support, the journalling and the nature walks, a different form of language started to emerge. Before training as a therapist, I was a filmmaker. My visually creative side had gone underground since my change of career, but I found it resurfacing. My swirling feelings started to take on a visual shape. I started to ‘see’ my grief in filmic, almost hallucinatory images. Taking refuge in symbolism and imagery, I was better able to express and therefore get a grip on the turbulence of my unruly feelings. ‘Stages’ and ‘tasks’ were replaced with more amorphous, unpindownable words like ‘shape’ and ‘state’. I used an ongoing visualisation of being tumbled in an ocean to convey the different states through which I continued to circle. This oceanic visualisation formed the backbone of my narrative and provided the chapter headings for the book – implosion, scattering, flailing, floating, balancing, sailing and swimming. Of course, it would have been neater to end that sequence with ‘landing’, but for me that suggested too much closure. I don’t think we do ever land. Apart from the initial unchangeable fact of Bill’s death – the implosion of chapter one – all my chapter headings are verbs. Grief is not static, not fixed like a noun. Grief is dynamic, constantly shifting, verb-like and alive and, like the ocean, never still. Once grief has upended our world and we have seen how laughable our attempts at control or certainty are, we never again reach dry land. We never regain a solid base. If we are lucky, we can create another nice big ship in which to take refuge, offering the sensation that life is safe again, but beneath us the ocean continues to churn. Life remains a balancing act, and we acknowledge the constant recalibration required to accommodate the ebb and flow of the swell beneath us.

6WD\LQJ DĹ´RDW We can focus on the wonderful joys that being on the ship has to offer, or we can focus on the storm always brewing, with its potential to dump us right back in the swirling darkness at

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’Grief is not static, not Ɠ[HG OLNH D QRXQ *ULHI is dynamic, constantly VKLIWLQJ YHUE OLNH DQG never still’

any point. Or we can keep both those truths alive simultaneously. We can enjoy the current stability of the ship while being aware that it is still just a ship and therefore only as strong as the next tempest. As therapists, we help our clients to juggle both perspectives and describe the view along the way. This will feel like second nature to most of you. Whatever the presenting issue and whatever your modality, I’m sure you are well used to holding two contrasting truths in mind, conveying that and more to your clients, and to using different approaches and languages to help them through. But I also know how all my clinical experience with clients and all my cognitive therapeutic knowledge fell short in preparing me for my own collision with grief, so I wanted to share how being more expansive and less literal in my ways of communicating helped me relate better to my grief, and to others. I am writing this during what I hope will be the final weeks of lockdown. With my sister and great-nephew currently in hospital, I imagine I’m not alone in feeling the ground snatched from beneath me by another series of powerful waves of grief right now. They still have the power to knock the wind out of me and render me shaky. I’m not currently practising as a therapist. I feel for those of you who have had to manage your own search for balance and perspective while being buffeted, all while seeing clients similarly agitated, and doing it all via videoconferencing. Just keeping your own ship afloat is probably exhausting you. Exhaustion is, of course, another symptom of grief and one that fogs the brain, making vocabulary even harder to grasp. So, if creativity is eluding you right now, perhaps I can tell you about some other, less exhausting ‘languages’ that helped me navigate my grief. You may or may not find

some of these useful, either in themselves or because they spark ideas for other ways you can escape the tyranny of literal words.

SHUTTERSTOCK

New languages First, the language of silence. Again, I’m going back to basics, but sometimes it’s worth reiterating because it was definitely what I needed more than anything, particularly in the early days. Not talking, and definitely not being talked to. Just sobbing, being heard and witnessed in my pain and having a companion in my sorrow. I wasn’t in therapy when Bill died, and initially I didn’t think that mattered. Many of my friends are trained therapists, so it wasn’t as if I didn’t have great support, but even so I felt the need to protect them, that there was a time limit on how much wailing I could do, how often I could go over the same old ground, how messy I could be. I ended up having 10 weeks of therapy with a previously unknown therapist I found online, which surprised me by its usefulness. There really is a place for just being alongside someone as they fall apart. Not trying to put them back together, not trying to analyse or interpret or offer psychoeducation. Just being there and saying out loud, or by your presence, ‘I see you, I see your pain.’ Second – use other people’s languages. Whether that be poetry, works of art, pieces of music, what you will. Offer your clients a way to tap into the creativity of others to help them express the pain they can’t yet form into thought themselves. I spent a lot of time wandering around art galleries, listening to music as I walked, responding viscerally to the things that somehow articulated something I couldn’t grasp intellectually. Clients may want to bring into the session the art, poetry, stories and music that has spoken to them in their grief. Or you could offer them something you may have yourself as a jumping off point. I keep a box of postcards and I often just upend it and spread the contents out on the floor for clients to see what they are drawn to. Third – movement. Again, research proves how useful this is for shifting stuck patterns and for addressing trauma, but I also found it useful as a means for expression – for representing pain in a way that words couldn’t do. Like art and music therapy, movement therapy is of course a specialised skill in itself, so I’m not suggesting

you attempt something you are not trained in. However, offering the client the option to explore that part of themselves, possibly outside your relationship, may be what they need right now.

Finding healing Having said all this, I do not underestimate the power of your ongoing relationships with long-term clients. We all know it is the relationship that heals, and your knowledge of your clients and your ability to provide them with the secure base they need right now, is of course invaluable. So, don’t take any of this as a suggestion to not do what you do best. But maybe you could explore your own grief and see what unusual things unfold. It might provide a way of understanding that your clients may also need something a bit different right now. I do not undervalue the wonderful grief theories out there. Dual process and continuing bonds theories were particularly resonant with me and reassured me that I was not going completely mad during the times when I really felt I was. And as for Kßbler-Ross, she repeatedly said that she didn’t intend her stages to be either linear or prescriptive, as they are often now understood. The tyranny of the publishing world and our innate need for a rulebook turned her words into a cause for controversy. Having just had my own book published, I can relate to that – books are by their nature linear and need both a narrative and an end point that is not too downbeat. So, I empathise and am not in any way criticising her groundbreaking work. I experienced all her five stages at times – they exist and, like millions of other grievers before me, it was comforting to know that I was not alone in feeling any of this. But in other ways her theory, whether she intended it or not, felt limiting – a far cry from the enormity of what I was going through. It barely touched the surface.

I needed to find my own language of loss and interpret my experience via other means. Writing my book, taking walks, doing yoga, looking at art, listening to music, spending time with friends, and engaging cognitively with the theories at times as well, all became my means of expression, and I encourage everyone to find their own. If you can feel into the grief our current situation has evoked, you may find a new language or medium that works for you, and that may inform how you help your clients find theirs. Languages of Loss (Yellow Kite) by Sasha Bates is available now in hardback, e-book and audio.

About the author

’Do not underestimate the power of your ongoing relationships with long-term clients’ THERAPY TODAY THERAPY TODAY

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Sasha Bates is a psychotherapist, journalist and former GRFXPHQWDU\ Ć“OPPDNHU $IWHU 18 years in the television industry, she retrained as an integrative psychotherapist at the Minster &HQWUH WKHQ ZRUNHG LQ WKH 1+6 and higher education before VHWWLQJ XS LQ SULYDWH SUDFWLFH

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‘Clients generally don’t want to push the boundaries’

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Flexing our boundaries

Is it helpful for us to change the way we work in extraordinary times? ART

‘Maintaining strict boundaries would just not work’

PRODUCTION CLIENT

Given the unusualness of the current situation, adapting boundaries is absolutely necessary. Getting a quiet space to talk can be problematic at the moment, so I’ve been more flexible in terms of payment and last-minute cancellations. Maintaining boundaries in a strict way right now would just not work for some of my clients. For those who have asked, I have certainly shared what is happening for me re Covid-19. I spoke to one client about how I had woken up at the beginning of the week feeling really flat and that this was OK. It felt important for me to let them know that I had also been struggling with my own mental health, being a very social animal. I then said what I was doing to try to keep my spirits up (mindfulness, exercise, talking with my husband and Zoom calls with friends). My sense is that sometimes clients think that we counsellors are completely sorted individuals who never struggle, and my experience as a therapist tells me that it can be useful to remind them that this isn’t the case. We are all struggling with isolation, boredom and distancing. Ben Amponsah, psychotherapist, EMDR therapist and trainee counselling psychologist

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Emma Page, integrative counsellor in private practice

‘I have maintained the structure but made other boundaries flexible’ In the interests of continuity, I have maintained the same structure (time and frequency) where possible but made other ERXQGDULHV PRUH Ĺ´H[LEOH ,I D \RXQJ FKLOG LV FODPRXULQJ DW WKH GRRU RI WKH FOLHQWĹ?V URRP GXULQJ RXU RQOLQH VHVVLRQ RU HYHQ DV KDV KDSSHQHG RQ PRUH WKDQ RQH RFFDVLRQ LV VFUHHQ ERPELQJ DQG ZDQWLQJ WR VD\ KHOOR WKHQ , UHVSRQG QDWXUDOO\ DQG VD\ KHOOR EDFN )RU D FOLHQW ZKRVH OLIH IHHOV D OLWWOH ORVW EHWZHHQ WKH GHPDQGV RI SDUHQWKRRG DQG ZRUNLQJ RQOLQH WKLV PRPHQW FDSWXUHV WKHLU VLWXDWLRQ H[DFWO\ 2QFH UHFRJQLVHG LW FDQ EH worked with therapeutically, like any other form of clinical PDWHULDO $ NH\ FKDQJH LV WKDW , QR ORQJHU FRQWURO WKH SK\VLFDO VSDFH ĹŠ HQVXULQJ ZDUPWK OLJKW FRPIRUW WLVVXHV DQG GULQNLQJ ZDWHU IRU H[DPSOH 7KHUH LV QRZ RQO\ D YLUWXDO VSDFH DQG ZKDW FDQQRW EH FRQWUROOHG DUH WKH WHFKQRORJLFDO JUHPOLQV WKDW RFFDVLRQDOO\ GLVUXSW D VHVVLRQ :KHQ LQ WKH FDVH RI RQH FOLHQW WKLV SURYHG IUXVWUDWLQJO\ GLVUXSWLYH LW GLG QRW VHHP UHDVRQDEOH WR FKDUJH IRU WKH VHVVLRQ /DWHU WKLV YRLGHG VHVVLRQ DQG LWV broken communication provided useful clinical material with EHDULQJ RQ WKH FOLHQWĹ?V IRUPDWLYH QDUUDWLYHV Roger Lippin, psychodynamic psychotherapist

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3URYLGLQJ VHFXUH ERXQGDULHV LQ RQOLQH FRXQVHOOLQJ QHHGV Ĺ´H[LELOLW\ WKDW FDQ VXVWDLQ UHODWHGQHVV DQG WKH ZRUNLQJ DOOLDQFH :KDWHYHU WDNHV SODFH LQ UHODWLRQ WR WKH ERXQGDULHV RI WKH FRXQVHOOLQJ UHODWLRQVKLS RQOLQH LV GHHSO\ PHDQLQJIXO DQG LW LV KROGLQJ WKLV LQ PLQG WKDW FDQ FUHDWH HIIHFWLYH WKHUDSHXWLF FRQWDLQPHQW 5HFHQWO\ IRU LQVWDQFH , PDGH WKH GHFLVLRQ WR YLGHR FDOO D FOLHQW ZKR GLG QRW DWWHQG WKHLU Ć“UVW RQOLQH VHVVLRQ DV , KDG FRQFHUQV DERXW WKHLU ZHOIDUH (YHQWXDOO\ ZH PDGH FRQWDFW EXW WKH\ GLGQĹ?W UHYHDO WKHPVHOI E\ WXUQLQJ RQ WKH YLGHR ZKLFK , IHOW ZDV VLJQLĆ“FDQW LQ VRPH ZD\ , ZDV XQVXUH ZKHWKHU P\ QRW ZDLWLQJ IRU WKHP WR LQLWLDWH WKH RQOLQH VHVVLRQ had failed to maintain a necessary boundary or whether, in WU\LQJ WR PDLQWDLQ D FRQQHFWLRQ ZLWK WKHP , KDG FRQYH\HG a sense of sustained relatedness at a time of social isolation, IHDU DQG XQFHUWDLQW\ 2Q ODWHU RFFDVLRQV , IRXQG D GLIIHUHQW solution, a middle way, where I would contact the client online to let them know that I was ready to take their call, and WKHQ ZDLW IRU WKHP WR PDNH WKH RQOLQH FRQQHFWLRQ 7KH\ VRRQ turned their video back on, a development that symbolically VHHPHG WR UHĹ´HFW D UHVXPSWLRQ RI D GHHSHU UHODWHGQHVV LQ WKH WKHUDSHXWLF UHODWLRQVKLS

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‘The therapist gives away more of themselves online’

Jonathan Smith, psychodynamic psychotherapist

The LGBTQ+ community we support as a team of therapists is vulnerable to isolation. As the lockdown started, it quickly became clear that we needed to adapt and be flexible in our approach in order to continue to provide therapy. Appointment times, for those clients that chose to move online, remain the same in most cases. But in online work, the therapist ends up giving away more of themselves when delivering therapy from home. The decoration and personal possessions that are visible give clients more of an idea or a concept of the therapist as a human being beyond the therapy room. But therapy is, after all, about the relationship between the therapist and the client, and, as a team, we are experiencing that this relationship can form online. Perhaps we will see changes in therapy practice in future, where clients no longer have to choose a therapist close by but can select the right therapist for them, wherever they are. Hugo Minchin, director and co-founder of Talk to the Rainbow

THIS MONTH’S TALKING POINT IS COMPILED BY NADINE MOORE

‘I called a client I had concerns about’

‘Being flexible is an approach I am committed to’ 7KH QDWXUH RI ZRUN ZLWKLQ D FROOHJH RU XQLYHUVLW\ VHWWLQJ DOZD\V UHTXLUHV Ĺ´H[LELOLW\ +RZHYHU WKH QHZ circumstances have compelled us to be even more Ĺ´H[LEOH DQG DJLOH LQ RUGHU WR IDFLOLWDWH RXU FOLHQW ZRUN Some adjustments have had to be made with all our work RQOLQH ĹŠ FRXQVHOOLQJ WKH FHQWUH UHFHSWLRQ UDSLG UHVSRQVH ZRUNVKRSV DQG DOO WKH VXSSRUWV WR ZKLFK ZH XVXDOO\ VLJQSRVW VWXGHQWV IRU VWXG\ UHODWHG RU SUDFWLFDO VXSSRUW 6HVVLRQV IRU WKH SDUHQW RI D \RXQJ WRGGOHU ZHUH VFKHGXOHG GXULQJ WKH toddler’s nap-time; an appointment was rescheduled at VKRUW QRWLFH IRU D Ć“QDO \HDU QXUVLQJ VWXGHQW ZRUNLQJ RQ WKH IURQW OLQH LQ WKH ORFDO KRVSLWDO &OLHQWV KDYHQĹ?W \HW DVNHG IRU DGGLWLRQDO HPDLOV RU SKRQH FDOOV 3HUVRQDOO\ , KDYHQĹ?W UHYHDOHG information about my situation and would only do so if I were FRQYLQFHG WKLV ZRXOG EH WR WKH FOLHQWĹ?V EHQHĆ“W E\ YDOLGDWLQJ RU QRUPDOLVLQJ WKHLU H[SHULHQFH IRU H[DPSOH %XW , DP FRPPLWWHG WR EHLQJ Ĺ´H[LEOH DQG WKLV ZRXOG VHHP WR EH D FRPSDVVLRQDWH DSSURDFK GXULQJ D SDQGHPLF %HLQJ XQZLOOLQJ WR FKDQJH DQG DGDSW PLJKW ZHOO EH UHFHLYHG DV ODFNLQJ LQ LPDJLQDWLRQ DQG HPSDWK\ Sue Wheeler, integrative counsellor at the University of Surrey

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The bookshelf

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CLIENT

5HĹ´HFWLYH 3UDFWLFH LQ &KLOG DQG Adolescent Psychotherapy: listening to young people Jeanine Connor (Routledge, ÂŁ19.99)

Inside Out, Outside In: transforming mental health practices Harry Gijbels, Lydia Sapouna and Gary Sidley (eds) (PCCS Books, ÂŁ23.99)

This honest, bold and frank book consists of seven chapters, each focused on a theme related to working therapeutically with young people. 7KH Ć“UVW FKDSWHU outlines the nuts and bolts of child psychotherapy, shining a light on the clienttherapist relationship, emphasising process over content and addressing issues such as unconscious and non-verbal communication, transference, boundaries and loving our clients. The next seven GLVFXVV WKH VLJQLĆ“FDQFH RI FKLOGUHQĹ?V fantasies and lies; diagnosis and issues around labelling; the sexual lives of children and young people; identity development; the importance of play, and to end, a beautiful chapter on endings. Classical and contemporary psychotherapeutic literature underpins FOLQLFDO UHĹ´HFWLRQV DQG FDVH VWXGLHV EULQJ themes to life. The author generously invites us into her therapy room, where we get to witness a piece of the process and join her in making sense of what’s going on for the child or young person. Every SDJH LOOXVWUDWHV WKH VHQVLWLYLW\ SURĆ“FLHQF\ DQG UHĹ´H[LYLW\ QHHGHG WR ZRUN ZLWK WKLV client group. At the same time, the author demonstrates an honesty that reassures us all that it is OK to be unsure, uncertain and simply ‘good enough’ as a therapist. For me, all that is missing is a chapter RQ KRZ WKH DXWKRU DSSURDFKHV UHĹ´HFWLYH work with professional ‘others’, such as school staff, carers and social workers. This book is a valuable resource for professionals, parents and anyone seeking to make sense of young people’s behaviours, moods and ways of communicating. Michelle Higgins is a counsellor in further education and a child and adolescent psychotherapist in SULYDWH SUDFWLFH

This collection of papers offers a critical perspective on mental health practices and showcases innovative alternative approaches from both within and without traditional frameworks. Chapters focusing on pedagogy are written from the ‘inside out’ perspective of social work, clinical psychology, occupational therapy and mental health nursing. The authors highlight the socio-political context and the injustice and trauma experienced by service users, as well as the need for radical new approaches to training. The essays that follow detail projects ‘inside’ service provision. One example is Drayton Park, an NHS-run women’s crisis house, which is run on trauma-informed, feminist and systemic principles. This chapter is particularly compelling as the story is told largely through the words of a former resident. She writes of its inclusive, non-judgmental ethos: ‘I never felt punished like I had in hospital, where staff set off alarms once they’d discovered you’d self-harmed... That always made me feel worse.’ The ‘outside in’ chapters focus on projects that were created in response to what were perceived as mainstream services’ failures, and to address the marginalisation and oppression that is often seen to be at the root of mental distress. These include SlǕ Eile, a residential community in Ireland, the Leeds SurvivorLed Crisis Centre, Canerows peer support services in south London, and Mary Seacole House in Liverpool. Despite the wide range of subjects covered by so many different authors, this book reads like a cohesive whole. This is testament to the editors’ skill in weaving together these stories of pioneering, usercentred practice in mental health. Emmanuelle Smith is a psychodynamic psychotherapist in training

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JULY 2020

Counseling Addicted Families: a sequential assessment and treatment model (2nd edition) Gerald A Juhnke and W Bryce Hagedorn (Routledge, £32.79) This book presents a powerful argument for always working with the family in PLQG DQG IRU D ŴH[LEOH intentional approach to using different therapy models, whatever the issue. It provides a useful organising framework, not just for work with addictions but for integrative work in general. Taking as its basis the trans-theoretical model of change, it maps seven models of therapy onto the six stages of change, from pre-contemplation through to relapse prevention. It is accessibly written, with vignettes to illustrate the theory and end-of-chapter questions and summaries. There are useful chapters on etiology, assessment and the neuroscience of addiction. But the meat of the book is its detailed description of the sequential movement of treatment through the seven models, delivered by the same therapist. For example, motivational interviewing is used to help clients move from pre-contemplation to contemplation. Solution-focused therapy helps clients enter the preparation stage. Structural family counselling and CBT shift preparation into action, and three insight-oriented psychodynamic therapies are used to help clients maintain and terminate their treatment. Perhaps because it is American, where issues of cost are crucial, the authors have ƓQH WXQHG WKH UDWLRQDOH RI VHTXHQFLQJ WKH theories – starting with the briefer, more costeffective ones and moving towards the timeintensive ones only if necessary. However, this movement is not perceived as a failure – more a matching of needs to treatment PRGHOV , WKLQN 8. SUDFWLWLRQHUV FDQ EHQHƓW from what is described here: a tighter focus on what works best with which clients and which issues. I highly recommend this book. Jane Cooper is a former senior counsellor DW WKH 8QLYHUVLW\ RI &DPEULGJH

Bookshelf, 1

Reviews If you would like to join our list of reviewers, please email reviews@thinkpublishing.co.uk with brief details of your professional background and interests 3HUVRQDO 'HYHORSPHQW *URXSV for Trainee Counsellors: an essential companion Jayne Godward, Heather Dale and Carole Smith (Routledge, ÂŁ24.99) This book is an all-female collaboration of three authors and two contributing writers, who draw on their extensive experience as trainers, academics and practitioners to explore and explain the nature of personal development in counselling training. The main focus of the book is on personal development group work. Divided into four parts, the book encompasses a historical overview of these groups, student and facilitator experiences of them, how and why selfawareness enhances practice, and wider aspects of personal development, such as supervision, self-care, personal therapy DQG UHĹ´H[LYLW\ The authors combine theory, activities, vignettes and case studies in a way that LQYLWHV UHĹ´HFWLRQ DQG HQJDJHV WKH UHDGHU in a participatory way, thereby bringing to life the process of personal development in counselling training. As a personal development group IDFLOLWDWRU , IRXQG WKH FKDSWHU DERXW FRQĹ´LFW in group process particularly reassuring and encouraging. Other chapters dealing with ethics, relational patterns and identity provide a thorough context to the value of practitioner self-awareness. The book is written in an accessible style and is a comprehensive resource for counselling trainees and facilitators alike. It will help trainees gain a thorough understanding about the purpose and process of personal development group work in their training. For personal development group facilitators, the book offers a wealth of ideas to develop and use with trainees. It would also be an informative resource for anyone with an interest in the wider context of group work and personal development. Michelle Higgins

,Q /RYH ZLWK 6XSHUYLVLRQ FUHDWLQJ WUDQVIRUPDWLYH FRQYHUVDWLRQV Robin Shohet and Joan Shohet (PCCS Books, ÂŁ22.99) This book describes the four-part supervision training course that Robin and Joan Shohet facilitate, based on the seven-eyed model of supervision created with Peter Hawkins. The reader is taken through the course and offered practical H[HUFLVHV UHĹ´HFWLRQV on both the process and their process, and demonstrations and roleplays in action, which give a good feel for the participant H[SHULHQFH 7KH 6KRKHWVĹ? LQĹ´XHQFHV DUH eclectic and wide-ranging (the work of Byron Katie, Appreciative Inquiry and Bion, to name but a few). The style of the book mirrors their process model, which aims to educate rather than train, because ‘to be prepared against surprise is to be trained, to be prepared for surprise is to be educated’. The seven-eyed model anchors it to a solid theoretical base, but readers will not Ć“QG VLPSOH DQVZHUV RU IRUPXODH IRU WKH role of supervisor. Both Robin and Joan write with characteristic candour and openness, including a chapter in which they and some of their students share UHĹ´HFWLRQV DERXW D WUDLQLQJ FRXUVH WKDW was severely disrupted by both a real-life storm and the rumblings of an angry and GLVVDWLVĆ“HG JURXS RI SDUWLFLSDQWV ,Q KLV UHĹ´HFWLRQV 5RELQ DSSOLHV WKH FRUH EHOLHIV he preaches: ‘Everything is data’, and ‘Be willing to look at the shadow side of everything (including yourself)’. This book is useful for those offering individual supervision and organisational supervision contexts. Working through the prompts for self-inquiry will help both prospective and experienced supervisors to examine their core beliefs about supervision. Supervision as described here is spiritual practice, a way of life and, yes, love. Sam Clark LV DQ LQWHJUDWLYH psychotherapist in Margate, Kent

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The book that shaped my practice

Windows to Our Children Violet Oaklander (Gestalt Journals Press US, 1989)

Way back in the early 1990s, I was a volunteer counsellor in a child and family unit and in a children’s centre, under the supervision of Betty Rathbone, a clinical psychologist with many years’ experience and wisdom. Betty LQWURGXFHG PH WR WKLV ERRN ƓUVW published in 1969, but worth hunting for. It’s full of fun, humour and a treasury of ideas and insights. Oaklander believed in accepting her child clients with good will, respect and regard, refraining from interpretations and judgments and paying gentle attention to their needs. Even though the book is a little dated – for example, in some perceptions of family and school roles – Oaklander was ahead of her time. Reading it again now, this book still generates ideas for creative activities, visualisations, writing and artwork with children. Has a book contributed Barbara Mitchels is a to shaping your practice? psychotherapist, author and Email a few sentences to professional consultant reviews@thinkpublishing.co.uk

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I have been really struggling with my own anxiety during the lockdown period EXW Ć“QG , FDQ XVXDOO\ SXW LW WR RQH VLGH during client sessions. Is it OK to still see clients even if I am not in my usual robust state of mind?

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LIKE THE CORONAVIRUS ITSELF, anxiety has spread far and wide and affected us all in different ways, so you’re in company with countless others in struggling with your anxiety. Whether or not it is OK still to see clients depends on the extent to which you can ‘put it to one side’. Are you able to make your clients your primary concern (Ethical Framework, Our Commitment to Clients, point 1a) and the primary focus of your attention (Good Practice, point 7)? And even if you’re not in your ‘usual robust state of mind’, are you feeling robust enough to see your clients? Few, if any, of us are immune to feelings of anxiety at this time, so it may be unrealistic to stop seeing clients until our own anxiety has disappeared entirely. The coronavirus is presenting us with a challenge to our empathic attunement, as we will all be sharing in that universal anxiety to some degree. But it is important that this commonality of experience does not lead us to assume too much about our clients’ anxiety. We are all in this together, but the causes, triggers and manifestations of anxiety will vary widely, ranging from fear of contracting the disease and concerns for employment and income through to a dread of bereavement and a fear of dying. Is your own form of anxiety too much of a distraction, or is its conscious acknowledgement sufficient for you to be able to set it aside and enter your client’s unique frame of reference? These are questions for your own reflection and for discussion with your supervisor.

In the self-assessment process, you might be helped by reviewing the personal moral qualities that the Ethical Framework suggests counsellors attain, including care (benevolent, responsible and competent attentiveness to someone’s needs, wellbeing and personal agency); courage (the capacity to act in spite of known fears, risks and uncertainty); empathy (the ability to communicate understanding of another person’s experience from that person’s perspective); humility (the ability to assess accurately and acknowledge one’s own strengths and weaknesses); resilience (the capacity to work with the client’s concerns without being personally diminished); and wisdom (possession of sound judgment that informs practice).

Tired and resentful Increasingly I have found I prefer to ZRUN LQ WKH PRUQLQJ DV , Ć“QG P\ DELOLW\ to focus and really be with a client is depleted as the day goes on. But I have agreed to work by telephone late in the day with two of my existing clients, as they have young children at home during lockdown, and can only get privacy after their bedtime. I thought it would be for a couple of weeks but, as the lockdown FRQWLQXHV , DP Ć“QGLQJ P\VHOI JHWWLQJ more tired and resentful about the late sessions. Now I have agreed to work this way, I feel stuck. YOUR SELF-AWARENESS and honesty are commendable in admitting that you are becoming tired and resentful. However, these are not ideal feelings to be taking into a counselling session. Tiredness and resentment will affect the therapeutic relationship and may well be detected by your clients. The question is, what are you going to do about it? A useful question to ask yourself in the ethical decision-making process is, ‘What

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will do the most good and the least harm?’ Did you discuss with your clients at the time of the transition to telephone sessions whether this was just a short-term or an indefinite arrangement? In other words, did you recontract with them and, if so, what was agreed? If not, maybe now is the time to address the issue, be clear about what you are prepared to offer and clarify your clients’ expectations and wishes. You might decide to admit openly that you are finding the telephone work more tiring than you had expected and work towards an ending, while considering with your clients what ongoing support they might need and signposting them to alternative therapists or services. On the other hand, if you were to continue working with these clients, is there anything you could do differently so that you feel less tired in the evening? Do you pay enough attention to your self-care? Good Practice, point 91a reminds us that ‘We will take responsibility for our own wellbeing as essential to sustaining good practice with our clients by‌ monitoring and maintaining our own psychological and physical health, particularly that we are sufficiently resilient and resourceful’ and ‘keeping a healthy balance between our work and other aspects of life’. Maybe, if you were to allow yourself enough breaks earlier in the day, you might feel less tired and resentful. Or perhaps you could negotiate a reduced frequency with these clients, or a fixed number of remaining sessions, rather than leaving the arrangement open-ended. This would give you an end in sight. One final thought, are you sure that the tiredness is entirely yours – purely the result of working in the evening? Could it be a sign that something is being avoided, either by you or by your clients, that needs naming? Candour and openness would seem to be called for here, first with your supervisor and then with your clients.

Shared grief One of my long-term clients has been EHUHDYHG E\ &RYLG DQG , DP ƓQGLQJ working with them is bringing up unresolved emotions about my own father’s sudden death last year. I would like to pause the work as I am beginning to dread the aftermath of the sessions, but I am torn and question whether it would be unprofessional of me to leave

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IT’S INTERESTING THAT you are questioning whether it would be unprofessional to leave your client, as it could also be unprofessional for you to continue working with them while your own emotions are ‘unresolved’. At such times, we need to take responsibility for our own wellbeing and to have the capacity to work with clients without being personally diminished (Good Practice, point 91). In the interests of self-care, it is important to give yourself time to come to terms with your own loss and to have processed your own grief to at least the point where you can focus on your client and make them your primary concern. If you do decide to take a break, you would no doubt want to clarify with your client how long you might be unavailable. How much of an explanation you give your client is something to consider carefully and discuss with your supervisor. What would be in your client’s best interest? For example, would disclosing your own loss help to convey empathy? Having named it, might you be able to give fuller attention to your client? Or might your client then be wondering if they are adding to your burden or feel the need to take care of you? Maybe there’s also an issue of trust here. Do you have enough confidence that your client would manage without you? Would you be prepared to let them go if (with your support if necessary) they were to seek another therapist? And then there’s the question of your own integrity and self-respect – would you be modelling self-care (to your client and others) if you were to go on ignoring your own needs, while working with them on taking seriously their own? Some might consider us all to be wounded healers, but we need to allow our own wounds to heal too.

SUPPORT AND RESOURCES  <RX FDQ Ć“QG VSHFLĆ“F JXLGDQFH DERXW LVVXHV UHODWHG WR WKH FRURQDYLUXV LQ WKH ĹŒ)$4VĹ? VHFWLRQ RQ WKH ZHEVLWH DW www.bacp.co. uk/news/news-from-bacp/ coronavirus  %$&3Ĺ?V Decision Making for Ethical Practice WRRO FDQ EH IRXQG DW www.bacp.co.uk/events-andresources/ethics-and-standards/ ethics-hub/decision-making-forethical-practice <RX FDQ DOVR Ć“QG IXUWKHU LQIRUPDWLRQ DQG VXSSRUW LQ WKHVH %$&3 UHVRXUFHV ZKLFK DUH DOO DYDLODEOH RQOLQH DW www.bacp.co.uk/gpia

NATURALLY YOU ARE MISSING the support of your own therapy, but a stop-gap therapist might not be the answer. It’s not ideal to stop and start with different therapists in quick succession, especially if you plan to resume working with your usual therapist as soon as possible. It really depends on what you need the therapy for. If it is primarily to have somewhere to offload, a temporary therapist might serve the purpose. If, however, you were part-way through processing deeper, long-standing issues, it might be quite disruptive to try to pick up with another therapist. But your experience of finding the client work harder suggests that your supervisor, rather than a therapist, might be able to meet the need. Clearly, supervision is not a substitute for personal therapy and supervisors have a responsibility for holding that boundary. However, there is a valid

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‘Supervision is not a substitute for personal therapy... However, there is a valid place in it for the “restorative�’ THERAPY TODAY

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 Ethical decision making (GPiA 044)  Monitoring the supervisory relationship from the perspective of the supervisee (GPiA 011)  Working online (GPiA 047)  Unplanned endings (GPiA 072)  Fitness to practise in the counselling professions (GPiA 078 & 094)  Self-care for the counselling professions (GPiA 088)  Planned breaks in practice (GPiA 102)  Workload (GPiA 99 and 109)

place in supervision for the ‘restorative’, especially if your client work is being affected, and a solid supervisory relationship may be particularly important during these challenging times. According to Good Practice, point 60: ‘Supervision provides practitioners with regular and ongoing opportunities to reflect in depth about all aspects of their practice in order to work as effectively, safely and ethically as possible. Supervision also sustains the personal resourcefulness required to undertake the work.’ Supervisees have a responsibility ‘to draw attention to any significant difficulties or challenges that they may be facing in their work with clients’ (point 72). In the Good Practice in Action resource Monitoring the Supervisory Relationship, the question is asked: ‘Do you feel free [in supervision] to explore your emotions, including those you find more difficult?... A good supervisor will help you to put your feelings into words.’ Your therapist’s absence might give you the opportunity to take a step back and reflect on the nature of your relationship with them. Have you become overly dependent, perhaps, and is this a chance to see how you can manage without them and discover more of your own, internal resources? Your therapist has revealed his or her vulnerability and your clients will be bringing theirs. Is it time to embrace your own?

Need for a break

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, XVXDOO\ WDNH D ZHHN RII DW (DVWHU EXW WKLV \HDU , FRQWLQXHG WR RIIHU FOLHQW VHVVLRQV DV RXU IDPLO\ KROLGD\ ZDV REYLRXVO\ FDQFHOOHG , DP UHDOO\ IHHOLQJ OLNH , QHHG D EUHDN EXW DP Ć“QGLQJ LW KDUG WR MXVWLI\ WDNLQJ WLPH RII ZKHQ FOLHQWV NQRZ , ZRQĹ?W EH JRLQJ DZD\ DQG PDQ\ DUH UHDOO\ VWUXJJOLQJ BREAKS FROM WORK could be more important than ever at this time. Many therapists are reporting how tired they are feeling, whether from having to learn new ways of working, coping with their own pressures and demands of home life or spending many hours talking on the phone or interacting with a computer screen. We might have thought that life would be so much simpler right now, with limited freedom to travel and socialise, but it doesn’t feel that way. Outside, it may be unusually quiet and peaceful, yet inside we find ourselves feeling stressed, distracted and overloaded. We can easily forget that we have some choices about

how many clients we take on, how we pace ourselves throughout the day and when we take our breaks. It sounds as if you might be getting caught up in the frenzy of ‘doing’ – trying to solve the unsolvable, make it all better for the many who are really struggling, and save the world, rather than acknowledging your own limitations and accepting your role as a container. We are committed to ‘keeping a healthy balance between our work and other aspects of life’ (Good Practice, point 91d), and you have acknowledged that you need a break. If you disregard this need, you are hardly likely to be providing your clients with the best service.

‘If you were to allow yourself a holiday, you would hopefully return feeling refreshed, energised and more readily available’ THERAPY TODAY

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Your work could become arduous, and you could feel resentful. On the other hand, if you were to allow yourself a holiday, you would hopefully return feeling refreshed, energised and more readily available to your clients and their needs, having attended to your own. You say that it is hard to justify taking time off, but it might be harder to justify not taking time off when you obviously need it. Your clients might assume that you won’t be going away, but does that make a difference, even if they are, as you say, really struggling? If we waited until our clients stopped struggling, would we ever take a break? A searching question in BACP’s Decision Making for Ethical Practice 12-step decisionmaking tool is: ‘Whose ethical issue or challenge is it?’ This one would definitely appear to be yours, and supervision would seem to be the ideal place to take it. It might actually benefit your clients, and you, to discover that they can survive without you for a week or two. You could also be considered to be modelling self-care by giving clients the message that it’s important and OK to take a holiday during this time. The fallout from the coronavirus pandemic is likely to be enormous in terms of the likely increased demand for therapy, and so far we may be seeing only the tip of the iceberg. It’s more important than ever that we look after ourselves and ensure that we are fit to practise, adequately resourced and sufficiently resilient to face what may lie ahead. ABOUT THE AUTHOR 6WHSKHQ +LWFKFRFN is BACP’s ethics consultant. He is a senior accredited counsellor and supervisor with 20 years’ experience and he has a private practice in the Lake District. Stephen previously worked with BACP’s Professional Standards department as an accreditation assessor and moderator. This column is reviewed by an ethics panel of experienced practitioners.

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Analyse me, 1

The questionnaire VERSION

:KDW GR \RX GR IRU VHOI FDUH to relax? Potter in the garden,

me Analyse

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pretending to know what I’m doing. Cook. Run. Writing is also up there. The other day I was struggling to relax and creating a piece for my blog sorted me right out.

Rakhi Chand speaks for herself

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What motivated you to become a therapist? Nothing altruistic like

hard. What’s rewarding is getting to talk to people I love for a living.

‘wanting to help’. It seemed natural. Even at school, I found other people fascinating and was at home with chatting about feelings.

:KHUH GR \RX VHH \RXUVHOI LQ ƓYH years’ time? I’m working on a new

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couples and groups. Over the past decade, an increasing number of black, Asian and multiracial women have found me. I’m more attuned to gender and racial and intersectional inequalities than ever before and motivated to do something about it. I believe this is why I’m attracting affected client groups. Incidentally, this is how I landed on this page – I contacted the editor to discuss the representation of black, Asian and multiracial people in Therapy Today. How has being a therapist changed you? I’ve become less

annoying. More able to see things from others’ point of view. Less judgmental. And better able to deal with my anger. :KDW GR \RX ƓQG FKDOOHQJLQJ rewarding about being a therapist? What’s challenging is that

there’s little of me that is categorically unavailable to my clients, little of my experience, awareness or feeling that I am outright unwilling to draw on during a session. This also means there’s no hiding and that can be

venture that I hope will still be live – and more – in five years. I’m setting up We Be Women (www.webewomen. co.uk), a low-cost service offering therapeutic groups for women. I’ve just contacted my local church in east London about hiring space. My hope is that eventually there will be many such groups in different locations. I’d love to hear from women who may be interested in being involved. I’m also considering a PhD, researching barriers facing black, Asian and multiracial women attaining influential positions. I’m in the early stages of this, floundering about on ‘FindaPhD.com’. For several years, I’ve reviewed research submitted to a cultural psychiatric journal; now it may be time for my own research. :KDW ERRN EORJ SRGFDVW GR \RX UHFRPPHQG PRVW RIWHQ" The book

White Fragility by Dr Robin DiAngelo. Over the years I’ve had more black, Asian and multiracial clients tell me they’ve come to me – as opposed to a white therapist – in the hope of being better heard. So, I gave White Fragility a whirl and settled down in a quiet corner of my local. What happened next I didn’t expect – I had a wee cry. I didn’t know that I was carrying such sadness and frustration

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over injustices I have grown used to. The premise of DiAngelo’s work is that white people ‘cannot’ hear about structural racism and its symptoms, including those who would describe themselves as ‘progressive’. DiAngelo explains that it’s more than defence, and that everyone is socialised into being racist, albeit to differing degrees. It’s inevitable, it doesn’t make us bad, and it is only mitigated by effort. I’d go so far as to say this is an essential read for any therapist committed to ‘not doing harm’. As a bonus, DiAngelo is entertaining too, particularly in her lectures on YouTube. I also recommend A Podcast of One’s Own, by the Global Institute for Women’s Leadership. Listening this morning, I learnt that female ‘Viagra’ was predominantly tested on men. I’m learning some facts about the nature of gender inequalities, while being tickled. What would people be surprised WR ƓQG RXW DERXW \RX" Perhaps that

I’m impulsive – I decided to move to Amsterdam in 2014, on a whim. I moved there a month or so after making the decision, with no home or job, not knowing the language and no friends. Because I’m also impatient, within six months I had set up in private practice, found a home and made some beautiful friends. The language bit didn’t work out quite as well (ahem). That was a positive manifestation of my impatience, a character trait I’m not proud of.

About Rakhi About Rakhi Now: Supervisor, trainer and therapist in private practice in east London. Writer for a few platforms, including my blog: https:// chandcounselling. co.uk/blog. Editorial Board Member of the World Cultural Psychiatry Research Review. Founder of We Be Women low-cost group counselling service. On Twitter @rakhichand. Once was: A banker. I made some lovely friends but, unsurprisingly, it was not the ticket for me. First paid job: A hardto-define summer holiday role at The Tavistock Institute in London, working for the editor of the Evaluations journal.

Who would you like to answer the questionnaire? Email your suggestions to the Editor at therapytoday@ thinkpublishing.co.uk

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