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Learnings from
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JUNE 2020, VOLUME 31, ISSUE 5
Working safely with children online // The power of imagery to help healing Finding meaning after loss // How to be a better telephone counsellor
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JUNE 2020 | VOLUME 31 | ISSUE 5
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Our professionalliability policyprotectsyou againstthe expenseand worryassociatedwithpotential legalactiontakenagainstyou,suchas contractor copyrightdisputes,professionalnegligenceand breachof confidentiality. Ourtailoredpolicyincludescoverfor:
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Contents, 1 VERSION
Contents June 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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Jeanine Connor (Entering their world, pages 34-37)
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Regulars Turning point It changed my life The bookshelf Dilemmas Analyse me
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Learnings from lockdown The pandemic has shown up the cracks in our profession, says Nicola Banning (pages 18-21)
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Opportunities
Learnings
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‘Some people made an assumption that remote working isn’t suitable for children’
The big issue Nicola Banning’s post-pandemic impact report In practice What makes effective telephone counselling? By Sally Brown The big interview Catherine Jackson interviews Emmy van Deurzen, existential psychotherapist The art of healing Catherine Ann Lombard explores how art and imagery can help clients cope with cancer Entering their world Jeanine Connor discusses working online with children and young people The trouble with hope Should we encourage clients to believe things can get better? By Nicholas Willatt Finding meaning after loss Grief specialist David Kessler describes his struggle to cope with the death of his own son
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Contact us by emailing: therapytoday@thinkpublishing.co.uk
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Welcome
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e are a profession of helpers, so it’s no surprise we have rushed to offer our services pro bono to support NHS staff. But when we volunteer our services for free, are we sabotaging our own profession? And, as Nicola Banning, author of our ‘Learnings from Lockdown’ feature explores, the issue of whether free counselling is either needed or appropriate is a complex one. Don’t miss her hard-hitting report on page 18. Another highlight of this issue for me is Catherine Jackson’s interview with Emmy van Deurzen on the existential crisis that we are sharing on a national and international level. She also offers her insights into how clients will be impacted by the current uncertainty, both in the here and now and the long term. Don’t miss that on page 26. I am also delighted to bring you a heartfelt account of finding meaning after loss, written by David Kessler, the US grief specialist who worked with Elisabeth KĂźbler-Ross on her famous books about grief (page 42). He describes how no amount of knowledge prepared him for the impact of the sudden death of his 21-year-old son. But through his experience of surviving more pain than he ever thought imaginable, he offers valuable insights both for practitioners and for anyone personally dealing with loss. It has been a great privilege to work on this issue for you and, as ever, I welcome your feedback. Do get in touch at sally.brown@thinkpublishing.co.uk
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I’ve been deeply moved by the fact that so many of our members have taken the time to write to us and call us to commend our response to this crisis.
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Many of you have expressed your gratitude for the support made available at this challenging time, and you have also responded to the recent membership survey in volumes to tell us what we can do to help you with your practice and to continue working. As a direct result of your feedback, we have launched D VXFFHVVIXO FDPSDLJQ WKDW DLPV WR UHDIƓUP WKH FULWLFDO role counselling and psychotherapy play in supporting the nation through the coronavirus crisis. We’ve also been able to provide free CPD and resources on the topics that you told us matter most, such as how to move your practice online, supervision in times of crisis and the importance of your own self-care. This feedback is all the more encouraging as it aligns with our recently launched strategy that focuses on membership engagement. It’s one thing to update members on our many exciting initiatives, but it is of vital importance to allow the space for discussions so you can tell us what you need, and that we can ensure that we are supporting you in the right way.
Sally Brown Editor
Natalie Bailey BACP Chair
THERAPY TODAY 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 IMAGE: COVER JON BERKELEY/IKON IMAGES
Chief Sub-editor Marion Thompson Sub-editor Catherine Jackson 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
THINK
Therapy Today is published on behalf of the British Association for Counselling and Psychotherapy by Think, Capital House, 25 Chapel Street, London NW1 5DH t: 020 3771 7200 w: www.thinkpublishing.co.uk Printed by: Wyndeham Southernprint, Units 15-21, Factory Road, Upton Industrial Estate, Poole BH16 5SN ISSN: 1748-7846 Subscriptions Annual UK subscription £76; overseas subscription £95 (for 10 issues). Single issues £8.50 (UK) or £13.50 (overseas). All BACP members receive a hard copy free of charge as part of their membership. t: 01455 883300 e: 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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As always, I hope you, your families, friends and colleagues are managing to stay safe and well. Our trustees, teams and volunteers at BACP are still working as hard as we can to ensure you have the resources and guidance you need to help you to continue to work during these challenging times. In this month’s update you’ll hear about an exciting new CPD module that we have developed in partnership with The Open University. The module was developed by Open University academics Naomi Moller and Andreas Vossler in conjunction with the Professional Standards team at BACP. It is in response to the pandemic’s impact on your ability to continue to work with your existing client group. It is designed to help you transition your existing clients
Sharing your experiences Thank you to the members who have already shared their experiences of this challenging time in our new blog section of the website. Although we face the same crisis and many of the same challenges, it is clear that we have been affected in different ways, as private practitioners who have transitioned to online working, key workers on the front line and employees who’ve been furloughed. We hope these blogs will help you feel more connected to your fellow members and provide a way to share knowledge so we can best support our clients and ourselves. Clients and the general public are also facing new challenges, and we would love to hear your tips and advice on what can help get them through lockdown and the anxiety of the coronavirus crisis. Email us at communications@bacp.co.uk to share your blog. You can read the blogs we’ve had so far at www.bacp.co.uk/ news/news-from-bacp/coronavirus/ member-blogs
to working online where appropriate. We hope this will be a valuable resource for you as you navigate new ways of working. We have also recently launched a new LinkedIn member community, which we hope will be a space where you can come together and share best practice. There are details of how you can join on page 8. I’m also thrilled to let you all know that, at the time of writing, our campaign to maximise the role of counselling and psychotherapy in supporting the nation through the coronavirus has reached 10,000 signatures. I’d like to send my thanks to everyone who signed, and to organisations and professional bodies who added their names to the campaign. Hadyn Williams BACP CEO
Join us on the Board You will soon 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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JUNE 2020
News, 1
How can we help carers?
MEMBER BENEFITS ¢ Launch of new Private Practice Toolkit In an exciting joint project between our Membership Engagement team and BACP Private Practice, our new Private Practice Toolkit has been launched to assist private practitioners during these FKHĆ‚EWNV VKOGU 6JG VQQNMKV KU C QPG UVQR UJQR HQT RTKXCVG RTCEVKEG resources, including articles, good practice guides and online %2& 6JG RTQLGEV YKNN DG GZRCPFKPI QXGT VJG EQOKPI OQPVJU VQ RTQXKFG VJG OQUV WR VQ FCVG KPPQXCVKXG CPF GPICIKPI EQPVGPV Adam Pollard, BACP Product Manager, says: ‘We know that more than 30,000 of our members are working in private practice in UQOG ECRCEKV[ 1WT PGY VQQNMKV DTKPIU VQIGVJGT C JWIG CTTC[ QH existing resources into one dedicated platform, offering support CPF IWKFCPEG VQ OGODGTU CV GXGT[ UVCIG QH VJGKT LQWTPG[ o 6JG dedicated space will support members in setting up, developing CPF ĆƒQWTKUJKPI KP RTKXCVG RTCEVKEG 7UKPI GZRGTVKUG KP VJG CTGC YGoNN CNUQ YQTM YKVJ [QW VQ GPUWTG YG CTG FGNKXGTKPI YJCV KU OQUV PGGFGF %C\ $KPUVGCF $#%2 2TKXCVG 2TCEVKEG FKXKUKQPCN NGCF QP VJG RTQLGEV UC[U n1WT CKO KU VQ YTKVG CPF RTQFWEG PGY OCVGTKCN VJCV GPCDNGU RTCEVKVKQPGTU VQ EQPUKFGT CPF TGĆƒGEV QP VJG FKHHGTGPV HCEGVU QH TWPPKPI DQVJ CP GVJKECN CPF UWUVCKPCDNG DWUKPGUU o You can access the toolkit on our website at www.bacp.co.uk/ pptoolkit (QT OQTG KPHQTOCVKQP QP $#%2 2TKXCVG 2TCEVKEG XKUKV www.bacp.co.uk/bacp-divisions/bacp-private-practice
¢ New course in partnership with The Open University 9GoXG YQTMGF KP RCTVPGTUJKR YKVJ 6JG 1RGP 7PKXGTUKV[ VQ RTQFWEG CP GZEKVKPI HTGG RTKOGT EQWTUG CXCKNCDNG VQ CNN OGODGTU 6JG CKO QH VJG EQWTUG KU VQ JGNR [QW HGGN OQTG EQPĆ‚FGPV CDQWV YQTMKPI QPNKPG CV C VKOG YJGP KP RGTUQP VJGTCR[ KU PGKVJGT RQUUKDNG PQT UCHG 9TKVVGP KP TGURQPUG VQ VJG %QXKF RCPFGOKE D[ 1RGP 7PKXGTUKV[ academics Naomi Moller and Andreas Vossler, the course will help [QW QHHGT TGOQVG EQWPUGNNKPI GVJKECNN[ CPF GHHGEVKXGN[ # OGODGT who has completed the course says: ‘The content is great and it feels really interactive with the different exercises that are included VJTQWIJQWV o +VoU CXCKNCDNG HTGG QP VJG 1RGP.GCTP %TGCVG RNCVHQTO 6Q Ć‚PF QWV OQTG IQ VQ www.bacp.co.uk/news/news-frombacp/2020/21-april-new-course-for-online-counselling-helpshundreds-of-members
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The Covid-19 crisis has thrust care staff into the front line of the battle against the coronavirus. Pre-pandemic, a BACP-funded research project got underway to evaluate counselling provision in three care homes in the Midlands in England. Qualitative research so far with care home managers, care teams, counsellors and residents has demonstrated a lack of knowledge and awareness of the role and value of counselling and how it can be accessed. Two further themes have also HPHUJHG ĹŠ Ć“UVW WKDW FRXQVHOORUVĹ? FRQQHFWLRQV and relationships with the care team are paramount and, second, that support is needed for care home staff as well as UHVLGHQWV ĹŒ8QGHUWDNLQJ WKLV SURMHFW KDVQĹ?W been straightforward and has presented FKDOOHQJHV WR WKH GHVLJQ RI WKH VWXG\ Ĺ? VD\V -HUHP\ %DFRQ %$&3Ĺ?V 2OGHU 3HRSOH /HDG ‘With many care home residents living with dementia, we have had to be mindful of how the Mental Capacity Act relates to our work. We have also obtained approval from the Social Care Research Ethics Committee to ZRUN ZLWK FDUH KRPH UHVLGHQWV Ĺ? The project trainer and supervisor is Danuta /LSLQVND DXWKRU RI Making Sense of Self: counselling people with dementia. Three therapists have been recruited to work in WKH KRPHV LQFOXGLQJ /\QVH\ -XGJH 3RUWHU D school counsellor who also works part-time in a care home in Warwick. We intend this initial research project to inform a larger study to evaluate more fully the effectiveness of counselling in care homes, which all reports are suggesting will be more needed than ever post-pandemic. You can also read more about perceptions of counselling people with GHPHQWLD LQ D EORJ E\ /\QVH\ RQ RXU UHFHQWO\ launched Research Digest: www.bacp. co.uk/about-us/advancing-the-profession/ research/research-digest-issue-1
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How to cope with the impact of coronavirus and lockdown, trauma and addictions were some of the topics BACP members spoke about in the media this month.
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Trauma therapist Claire Pooley featured in The Guardian talking about the psychological impact the coronavirus crisis is having on NHS staff. Kathryn Kinmond was interviewed on BBC 5 Live’s Breakfast Show about what can help people struggling with their mental health because of lockdown. BACP Private Practice Executive chair Lesley Ludlow spoke to BBC Online about how people may cope during lockdown, and Huff Post UK about the impact that nature can have on our ZHOOEHLQJ LQ WKHVH GLIƓFXOW WLPHV Indira Chima’s comments about how to cope with the anxiety of a supermarket shop were used in articles on 27 local newspaper websites across the country, including Leicestershire Live, Wales Online and Devon Live. An article on how to beat the Easter blues during lockdown on The Independent’s website featured comments from Therapy Today editor Sally Brown. Andrew Harvey was interviewed for Huff Post UK and Stefan Walters for Eastern Eye about the challenges faced by addicts during lockdown. Jackie Rogers explained in The Mirror why people were feeling tired during the lockdown period. Members who were quoted in a BACP article on how to cope with anxiety during lockdown were also featured several times on The Mirror’s website, and in articles on more than 20 regional newspaper websites, including Bristol Post, Belfast Live and Nottingham Post. The members featured were: Vasia Toxavidi, Elizabeth Turp, Melani Halacre, Emma Brand, Hansa Pankhania, Natasha Page, Catherine Gallacher, Cate Campbell, Rakhi Chand, Eve Menezes Cunningham, Sarah Wheatley and Indira Chima. If you are interested in becoming a media spokesperson, email media@bacp.co.uk
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Network from home Staying in contact has never been more important in these times when we are working from home and can feel isolated from our peers and colleagues. So we are pleased to have our new LinkedIn professional community for BACP members up and running. It’s another place where members can network and connect with each other to share ideas and best practice. It will also include news updates and articles, and contributors so far have included BACP Chair Natalie Bailey, BACP Workplace editor Nicola Banning and former BACP Chair Dr Andrew Reeves. We’ve been overwhelmed with the conversation and networking that’s already happened. Thank you to everyone who has joined and made it a positive space! You will need a LinkedIn account (free to sign up) to join the community. Find it at www.linkedin.com/groups/8919808
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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 ¢ Our campaign urging the Government to maximise the role of counselling and psychotherapy in supporting the nation through the coronavirus crisis has been backed by more than 10,000 people. We’ve received support from 19 professional bodies, providers and campaign groups, demonstrating a strong coalition behind our campaign. Steve Mulligan, BACP Four Nations Lead, says: ‘We’re grateful to all our members, supporters and campaign partners who have signed up to endorse the campaign. Our collective voice puts real power behind our call for all the Governments of the UK to better support our therapists to continue their vital role on the front line of this pandemic.’ Read more at www.bacp.co.uk/news/ news-from-bacp/coronavirus/ covid-19-campaign/28-aprilcoronavirus-10-000-peoplecall-on-government-for-actionon-therapy
¢ We’re supporting calls for more research to be carried out into the mental health impact of the coronavirus pandemic, as well as campaigning to ensure counselling and psychotherapy play a key role in the mental health response. The calls were made by a group of leading academics, writing in The Lancet Psychiatry, who warned the pandemic could have a ‘profound impact’ on the population’s mental health ‘now and in the future’. BACP Head of Research Dr Clare Symons says: ‘It’s vital we fully understand the impact coronavirus has on mental health now and in the future so that appropriate support is offered to people affected. We know our members are already playing an important role in responding to this crisis and supporting vulnerable people. Conducting research to evaluate the effectiveness of counselling and psychotherapy is always something that we promote.’ Read the full story at www.bacp.co.uk/news/ news-from-bacp/2020/16-aprilbacking-calls-for-more-researchas-coronavirus-risks-profoundimpact-on-mental-health
¢ The Welsh Government has announced an extra £1.25 million in funding to strengthen the delivery of school counselling services to support children and young people’s mental health during the coronavirus crisis. Jo Holmes, BACP Children, Young People and Families Lead, says: ‘This outstanding commitment demonstrates the value of school and community-based counselling to people in Wales and the important role it plays in children and young people’s lives. The funding, which includes paying for additional counselling over the next year, will help reach those children and young people who we know will be struggling with a range of issues linked to change, loss, isolation, family worries and other issues. The Welsh Government has always been a step ahead when it comes to funding school counselling. We’d love to see this investment replicated across the other UK nations to support young people in need.’ Read more at www.bacp.co.uk/ news/news-from-bacp/2020/17april-125-million-boost-for-schoolcounselling-to-prepare-for-rise-indemand-due-to-coronavirus
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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The Therapy Today monthly podcast gives you the chance to listen to a selection of articles read by their authors, as well as interviews with several special guests. Our latest editions include ‘Taking your practice online during Covid-19’ with Sarah WorleyJames, a specialist in online counselling; ‘In the Spotlight’ with Charlene Douglas, resident counsellor on E4’s The Sex Clinic; and ‘Telephone counselling’ with Jo Birch, a trainer in telephone counselling. The podcasts are free and available exclusively to members. Listening will also count towards your CPD requirements. www.bacp.co.uk/bacp-journals/therapytoday/therapy-today-podcast
our clients, as well as others in our lives. Peoples’ mental health and sense of being in the world have been seriously impacted by the pandemic. Our counselling and psychotherapy support is needed now more than ever.’ We’re also continuing to add CPD resources to our website, which are available to access for free during the Covid-19 pandemic. These informative resources are aimed at supporting you in your practice. Themes include working with bereavement, trauma and incident support, self-care and working remotely. Visit www.bacp.co.uk/news/ news-from-bacp/coronavirus for the full selection of free resources.
Don’t miss the research conference Our annual research conference in May went ahead as an online event this year. According to the feedback from participants, it worked well. There’s still a chance to watch free via the on-demand service available until the end of August. This year’s theme is ‘Keeping clients at the centre of research and policy’. You’ll be able to watch presentations and listen to discussions between the hosts and presenters. For more information, visit www.bacp.co.uk/events
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Short-term work on the CPD Hub EAP,agency and IAPT work is often time limited, but what can you do in six sessions with a client? Nicola Banning from BACP’s Workplace Executive explores the kind of work that can be done with a client in a limited number of sessions. The shifts achieved in just six hours can be profound, as Banning explains in this resource, which also covers how to make the most of the limited time you may have with a client. This is just one of more than 200 hours of content on our CPD Hub. There are presentations and workshops on a variety of topics, including working online, trauma, bereavement, selfcare, resilience, addiction, relationships, LGBT and identity and many more. An annual subscription to the hub costs just £25. You can subscribe today or renew your subscription as part of your annual membership. For more information and to subscribe, visit www.bacp. co.uk/cpd/cpd-hub
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‘I have been messaged by many therapists who feel isolated and alone in their practice’
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hen Peter Blundell sent out a tweet with the hashtag #TherapistsConnect in January this year, inviting practitioners on Twitter to introduce themselves and connect with each other, he had no idea that, within a few months, connecting virtually would take on a whole new significance. ‘I was interested in a way of connecting therapists with each other and creating a closer-knit community online,’ he says. ‘I sent out a tweet asking other therapists to comment with who they were, where they were from and their specialist interests. The idea was to encourage therapists to follow each other on Twitter. I was expecting a handful of responses but the response was overwhelming, with 60,000 people reached by the original tweet. The hashtag has evolved to be an all-encompassing way of highlighting debates and interests related to counselling and psychotherapy.’ Many therapists who responded talked about feeling isolated, either geographically or isolated from others of the same modality or those interested in similar specialisms. They saw the potential in social media for making connections but were also wary of abuse, as many had felt ill-treated by other therapists while debating and discussing therapy online. What seems to differentiate the #TherapistsConnect conversations so far has been an ethos of respect and mutual support. ‘I thoroughly encourage the active engagement of therapists in all debates around therapy and the profession,’ says Peter. ‘But I hope we can always be respectful of others with different views.’ This year has been an eventful one for Peter, having recently collected the CPCAB Research Award for his PhD research, ‘Responding to boundary issues: a qualitative study’, carried out at Manchester Metropolitan University. He originally trained as a counsellor to improve his interpersonal skills as an undergraduate psychology student. ‘I signed up to an introductory course in personcentred counselling,’ he says. ‘I loved it so much and saw the benefits of this philosophy reaching far beyond the therapeutic relationship. I decided to continue my training and become a qualified person-centred therapist.’ Peter’s varied career path since then has included qualifying as a social worker in 2013 and working for a
‘I thoroughly encourage... all debates around therapy and the profession, but I hope we can always be respectful of others with different views’
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local authority team focusing on children with disabilities. He still sits as an independent social worker on a local authority fostering panel and has also held a number of roles in the third sector. ‘Due to the path of my own career, I am very interested in talking to other people who work in multiple professions simultaneously and may consider themselves to have several professional identities,’ he says. He now combines a private practice in Liverpool with teaching part-time on the MA in Counselling and Psychotherapy Practice at Liverpool John Moores University. ‘Fundamentally, I consider myself a personcentred practitioner because I have found the core principles and ideas of Carl Rogers have underpinned every role I have ever undertaken,’ he says. ‘My teaching role combines both of my passions – person-centred therapy and research. I thoroughly enjoy seeing students develop their counselling skills and their identity as therapists over the three-year course.’ Trainee therapists are a group that seems to have particularly benefited from the #TherapistsConnect initiative. Recently, with Caz Binstead, a member of the BACP Private Practice executive, Peter started a new weekly Twitter discussion, called #TraineeTalk, aimed at students of counselling and psychotherapy. ‘This has already become very popular,’ he says. ‘We are encouraging other therapists with speciality interest areas to be guest facilitators over the coming weeks.’ During the coronavirus lockdown, #TherapistsConnect has also been used to share training and resources, to help therapists adapt to the challenges that Covid-19 has brought, says Peter. ‘For example, free online training and resources have been offered to help therapists move their therapy practice online. At a time when we are all feeling disconnected from others due to the need for social distancing and isolation, any opportunity for us to feel more connected is welcome. Despite the long-term impact of Covid-19 on society being uncertain, my sense is that there will be an even greater need for therapists and the work that we do. In my view, collaboration and connectivity between therapists are going to be a key aspect of our work going forward.’ ■ www.therapists-connect.com; @drpeterblundell
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It is with immense gratitude that I write in reference to the article ‘Conversations about suicide’ by Andrew Reeves and Maria-Gabriele Doublesin (Therapy Today, April 2020). Subsequent to the death by suicide of my dad in 1988, I dedicated my counselling and psychotherapy MA dissertation to the ‘Stigma Associated with Bereavement to Suicide and Suicidal Ideation’. My approach was heuristic and I soon began to appreciate that, even after 15 years or so, my search for answers and the processing of my grief was not complete. Fast-forward to January 2020 when, on exactly the same day as my dad, a client RI PLQH WRRN KLV RZQ OLIH \HDUV DIWHU P\ Ć“UVW H[SHULHQFH $IWHU PDQ\ \HDUV LQ private practice and working alongside countless clients who have been affected in some way or another by suicide, this ‘worst thing that could ever happen to me as a therapist’ happened. And I was not prepared. Who could be? Furthermore, the timing could not have been more poignant. The article gave me permission to grieve for my client. Thank you, Andrew and Maria-Gabriele. I should like to add a word of caution for therapists who are working with EAP companies. I truly believe that the reaction to me from some members of the clinical management team following the death of this client has been almost as damaging as the suicide itself. Certainly, in the moment, it was as shocking and painful. Should this situation ever arise for you – and I sincerely hope it doesn’t – be prepared to consult BACP and the legal team associated with your indemnity insurance. Lean on your supervisor. Lean hard. Because, from my experience, the ($3 FRPSDQ\ ZLOO RIIHU \RX QRWKLQJ EXW Ć“QJHU SRLQWLQJ DV WKH\ FORVH UDQNV WR protect their business. , UHIHU VSHFLĆ“FDOO\ WR RQH ($3 FRPSDQ\ RI course, and who knows how any of the others would handle such a situation. But we must be careful out there as, in the world of therapy, the FRXQVHOORU LV RIWHQ D OLWWOH Ć“VK LQ D WDQN RI VKDUNV The death of my client pierced my heart and, while I was still falling, my employers stabbed my back. And now I grieve. Jean M Buck MBACP (Accred)
Suicide survivor Thank you, Andrew and Maria-Gabriele, for your article in April’s Therapy Today (‘Conversations about suicide’). I found it liberating to hear counsellors talking about their reflective experience of suicide in both a heart-rending and heart-warming way. To draw on your experiences both professionally and personally requires a great deal of courage and tenacity, all of which I’m grateful for. Death is never an easy conversation to have in society, let alone death
by suicide. We still have a culture where confronting our own mortality is saved for later age, but this is not my reality and nor is it the reality of those I work with or have come across in my life. As an attempted suicide survivor, I can see many parallels between those who survive a suicide attempt and those who have lost someone to suicide. Huge shame and stigma still exist in our communities, including the over-medicalisation of an individual’s pain and distress. There can be at times a dehumanisation
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of the individual through their lived experiences and labelling of them through mental health stereotypes. All of these narratives still require challenging and demystifying. Speaking as a survivor, I should never feel at risk to be seen in a community that wishes to enable others to heal and have self-agency but still there are many difficulties with such transparency. There is so much still to do but, with openness and a willingness of practitioners like Andrew and Maria-Gabriele, we can continue to forge new meanings and make good progress. Kathryn Lock-Giddy MBACP
A question of safety Viewing myself as a person-centred, nondirective therapist, and also having been a client who massively benefited from the approach before training, I made myself read Penny Bullock’s ‘Is counselling enough to treat trauma?’ (Therapy Today, April 2020) with a heavy heart. I have always felt non-directive is actually the safest approach for clients as it doesn’t push people into doing things, which is especially important where there are issues of having had boundaries crossed by others. Indeed, the example the author gives as an example of where she ‘learnt her lesson’ (presumably of using what she thought was non-directive therapy), with ‘Angela’, was actually an example of her being very directive in suggesting empty chair work with the client. The client appears, in fact, to have expressed things she wished she had said to her boss. It doesn’t sound like she said she wanted to pretend she was saying them to him using an ‘empty chair’. Yet the author seems to think she was being non-directive. It seems very confused to me. Saying ‘I wish I’d said x, y and z’ to someone is very different from imagining that person in front of you and actually saying the words to them. Even imagining that myself brings some trembling in my legs and I’m just musing on the scenario! Indeed, the example seems a very good way of demonstrating why directive therapy might result in someone being pushed too far. Person-centred and non-directive therapy yet again has been presented wrongly. I find it sad
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
that this deep, beautiful, therapeutic approach is so widely misunderstood. Well before I started my own training, this type of therapy and my therapist changed my life. I believe this was much in part to trusting that someone wasn’t going to push me but would follow where I went. Katherine Smith MBACP Student counsellor I understand that all counselling work, practised from whatever modality, is only ever safe if carried out within an ethical framework of accountability, and it makes me wonder why this fundamental feature of therapy and good practice was not mentioned in Penny Bullock’s article. In order to ensure both client and therapist safety, it is not sufficient to incorporate Carl Rogers’ six conditions into person-centred counselling. It is crucial that those conditions are facilitated within an ethical framework. Implementing a strategy of safety rests on facilitating tactical objectives and I find that the BACP Ethical Framework supports this admirably. It is a reliable way to unpack a number of considerations, reduce fear and build psychological cohesion. It helps in setting limits, addressing confidentiality, establishing functioning boundaries and realistic goals and exploring and managing expectations (such as the therapist clarifying with Angela her rationale in wanting to describe the trauma experience and reprocess trauma memories). Considering safety also entails reaching a clear understanding of a client’s support network, how they are going to look after themselves between sessions, how informed they are about counselling, the need to hold monthly review sessions (a key feature to enhancing the client’s sense of agency in the therapy), and furnishing clients with relevant information regarding the counselling process. Despite disagreeing with many points, I share Penny’s view that being flexible and creative are important qualities for all counselling, not just when working with survivors of trauma. I would also add that moving forward within a contractual agreement that instils safety serves to inspire the imagination towards therapeutic change.
Person-centred and non-directive therapy yet again has been presented wrongly. I find it sad that this deep, beautiful, therapeutic approach is so widely misunderstood... this type of therapy and my therapist changed my life
Perhaps even in the dynamic of a creative collaboration, we may also focus on constructing the new, not repairing the old, to quote Carl Rogers. Peter Ryan MBACP (Accred)
Heartbreak and guilt I was amazed and even shocked to read Jason Brooker’s response (Reactions, Therapy Today, April 2020) to Sarah Templeton’s excellent article ‘Adult ADHD: are you spotting it?’ (Therapy Today, February 2020). He claims that ‘children of overly critical parents or parents that argue frequently are more likely to have ADHD symptoms’. What about the many families where argument and criticism is frequent but who do not have children with ADHD? Might it not also be possible that having such a child could mean the parent is naturally more critical? What about families of, say, three children, only one of whom has a diagnosis of ADHD? Speaking as someone who has a child (now 35) with ADD (no hyperactivity), I feel she is very like her father, who also had ADD. They were tremendously alike in their patterns of difficulty and behaviours. I have understood that conditions such as dyslexia, dyspraxia and ADD/ ADHD are about 80% heritable. I believe it is important not to lay these problems at the door of parents who may already be suffering from feelings of guilt, despair and despondency. I worked in the field of special educational needs for about 20 years and saw first-hand the levels of frustration, heartbreak and guilt that many parents felt. I don’t think children are ‘being told there is something wrong with their brain’. More likely, they are helped to understand the concept of neurodiversity and that it applies to every single one of us, since I believe no two brains are identical. And a ‘label’ can be very helpful in the educational setting because it is the only thing that may get them the help they need in terms of support, access arrangements in public exams or medication when needed. Joanna House MBACP, BA (Hons) PGCE, RSA Dip in SpLD
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First, it is widely accepted that ADHD is a genetic, neurodevelopmental disorder, in much the same way that autism is thought to be.1 There are thought to be two causes – either inherited genes, or acquired due to brain injury, with the consensus being that the majority of cases have a genetic component. While social and environmental factors can exacerbate ADHD symptoms in people with the underlying genetic predisposition, there is no evidence that environmental factors alone can cause ADHD. While I would agree there could be some misdiagnosis of this condition, it is not the job of a counsellor to diagnose or dismiss diagnosis; this is the job of a trained specialist psychiatrist. Much of the harmful stigma that people with ADHD face when disclosing their diagnosis is a scepticism about whether the condition is ‘real’. The media and society have a way to go before taking it seriously and knowing what it entails is an executive function disorder. It is unfounded to suggest (as in Jason Brooker’s response) that ‘the ADHD person’s brain has developed differently throughout their life because of things that have happened to them’. While traumas could cause symptoms similar to ADHD, we must be careful not to dismiss extensive research that ADHD brains have a biological basis, are wired differently and have a markedly different neurochemical make-up. An attitude from the therapist that it doesn’t exist may make the client with ADHD feel invalidated and isolated, and so face the same stigma they have faced in many aspects of their life due to people’s lack of knowledge and scepticism. Jason Brooker’s response to the article, that Caroline’s symptoms may be in part due to her difficult family history, is a valid point. It is important to consider a variety of factors that play a part in a client’s story. However, we must be extremely tentative about jumping to any conclusions about causality or diagnosis. It really is not our place and could play out as unintended judgment. Personally, I would be wary of suggesting to any client they may have ADHD or that their ADHD symptoms have trauma as the root cause. As Brooker suggests, biomedical language may be a hindrance to some people with ADHD, as â–ş
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Forming opinions on behalf of the client... is taking something away from them. An open and curious conversation about what ADHD means for them can be more helpful
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they may see the label as a burden, or that ‘there is something wrong with their brain’. However, for others, it may be a great help to explain that the reason for many of their struggles is not that they are ‘lazy’, a ‘failure’ or ‘stupid’, which can often be the message people get as they go through their school and work life and come up against obstacles. A diagnosis can give relief and an improved sense of identity. It’s also crucial to understand that there are many positives associated with ADHD. People with ADHD may be proud of their neurodiversity, as it’s often associated with qualities such as creativity, problem-solving, hyper-focus, sporting talent and high intelligence. Forming opinions on behalf of the client about whether a label is helpful or not is taking something away from them. An open and curious conversation about what ADHD means for them can be more helpful. A readiness to put aside any judgment about the existence of the condition is the safest bet, otherwise it may add to yet another sceptical, dismissive, frustrating experience for the person with ADHD, and this can be conveyed in the subtlest of ways by the therapist, which does not go unnoticed. Sophie Copage MBACP (student) REFERENCE 1. www.russellbarkley.org/factsheets/ WhatCausesADHD2017.pdf
Therapist fatigue Chris Paul’s article ‘Meeting the challenge of therapist fatigue’ (Therapy Today, March 2020) left me feeling rather confused. I think we all know that taking care of ourselves, our mental and physical wellbeing and our overall energies is vital for working within the counselling profession, which is why there is a whole section about this in the BACP Ethical Framework. Chris is talking about a very specific issue, which he calls ‘therapeutic fatigue’. It is clear to me that Chris has worked hard on exploring this issue and has researched matters at some depth. But at no point does Chris raise the issue of projective identification – an unconscious communication by the client that can be a very
Changing lives
powerful experience and perceived by the therapist on many different levels. It can initially be difficult to make sense of this and it needs to be thought about seriously in supervision. When I was a trainee counsellor in the 1990s, I found myself week after week experiencing what Chris calls ‘therapeutic fatigue’ with a particular client. I felt deskilled, hopeless and disempowered in her presence and I believed it was all my fault or something to do with my own lack of ability. I took this experience to supervision, only to find to my huge relief that my supervisor spotted the problem straight away: ‘You are at the receiving end of projective identification! You are feeling what your client is feeling. She is projecting these powerful feelings into you and you are asked to digest those feelings, think about and make sense of them, so that you are able to give them back to your client in an altered form, which hopefully can be helpful and enabling for her.’ I can still, after all these years, feel the enormous sense of relief I experienced in that supervision session and how much I felt helped by my supervisor naming such an important form of countertransference, which often reaches one quite unconsciously or even via physical sensations. Once projected feelings from the client are understood, they can then be thought about and made sense of. Chris does acknowledge that ‘therapeutic fatigue may mean experiencing the echo of the client’s wounds, which we then need to work with towards transformation’. It is regrettable that he needed to use the term ‘therapeutic fatigue’ to describe such a vital and important aspect of the therapeutic relationship. I imagine I am not alone in feeling unsettled by this. Ingrid Schultz BACP (Accred)
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Having recently joined BACP as a student member, I received my first edition of Therapy Today. Reading the ‘Counselling changes lives’ article (April 2020), ‘Meeting clients where they are’, the name Andrew Hallett, a counsellor working in the therapy van, seemed familiar. When I looked at the photo, I realised that I met Andrew myself when needing support working through my own trauma several years ago. Although I had forgotten his name, I had never forgotten the work we did together and the difference he made to my life. He was the first person I delved deeper with in exploring my trauma, and it is fair to say the first appointment was a little rocky. I felt uncomfortable and nearly didn’t return for the second appointment. The recognition he gave me in that second appointment and his ability to remember everything I shared with him in that first meeting was the reason I relaxed and continued to trust him going forward. Now, as a student at Salford University, learning the skills required to counsel clients myself, I have on a couple of occasions shared this experience with other students to offer understanding on the power of the relationship. This article really reminded me of how things have come full circle and confirms that counselling really does change lives! Tina Kenyon MBACP Counselling student I was fascinated to read about the innovative therapy settings described in ‘Meeting clients where they are’ (Therapy Today, April 2020), be it the Bristol boxing gym, the Trafford therapy van or the hoarding project in Croydon. I have found it interesting that many of my clients have declined the chance to work by videoconferencing or telephone as they so much value the in-person setting (and the woodburning stove in my therapy room in the evenings!). I have just arranged with a client to have a walking session as an alternative to in-person work, as the client is not comfortable with the telephone. It’s really good to think outside the stereotypical space that we offer. Jennie Knight MBACP (Snr Accred)
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CBT FOR CHILDREN AND ADOLESCENTS
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Designed for SOSSeminars Ltd by DR ANDREW BECK, Consultant Clinical Psychologist, Senior Lecturer on the Children and Young People's !APT programme, BABCP President Elect Highly qualified tutors, all Clinical Psychologists and Accredited BABCPTherapists:
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Dr Andrew Beck. Dr Lisa Anderson, Dr Rebecca Linnell, Dr Angela Latham, Prof Paul Grantham
Thiscomprehensive course consists of:
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19 training days spread over 12 months 15 training modules (1- 3 days long) 133 training hours Final Online Exam
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The month Mental health in the arts, media and online
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Portrait of a Lady on Fire director CÊline Sciamma’s earlier work Tomboy is now available to watch on BFI Player. ZoÊ HÊran touchingly plays a 10-year-old who decides to use their family’s relocation to embody a new gender and persona. It’s a tender portrait of a child navigating identity, belonging, gender and self-expression. Sciamma said she was drawn to portray childhood because it is a time when everyone pretends to be someone else. It’s just one of hundreds of gems from international cinema available by subscribing to BFI, and you can try it for free for 14 days. KWWSV SOD\HU EƓ RUJ XN VXEVFULSWLRQ ƓOP ZDWFK WRPER\ RQOLQH Essay
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My psychosis
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Thirty years ago, Tom Hartley, a senior lecturer in psychology at the University of York, experienced a terrifying one-off psychotic episode. Having kept his experience private for many years, he describes it with brave honesty in this essay. He admits that, despite being terrifying, it was not a wholly negative experience. ‘I have never felt so alive,’ he says. In conversation with Paul Fletcher, a professor of health neuroscience at the University of Cambridge, he learns that ‘psychosis’ is a set of experiences, not a diagnosis, and that BLIPS (brief limited intermittent psychotic symptoms) are surprisingly common. http://dlvr.it/RSbDqZ
%RRN themed SLFNV • Sugar Calling Cheryl Strayed is best known as the author of Wild, her bestselling memoir of a 1,100-mile solo hike along WKH 3DFLĆ“F &UHVW 7UDLO QRZ DOVR D Ć“OP VWDUULQJ Reese Witherspoon. But she’s also a compulsively readable agony aunt for The New York Times, in a column called ‘Dear Sugar’. In Sugar Calling, her new podcast, she interviews people who have inspired her, including author Margaret Atwood on how to stay hopeful, and the Japanese travel writer and novelist
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Pico Iyer, about his travels with the Dalai Lama. On Spotify, iTunes and most podcast platforms. • In Writing Therapy and creative writing have lots of parallels, not least because both are about telling stories. If you are one of the many therapists who have an urge to write, this podcast could help you get started. Freelance journalist Hattie Crisell interviews 10 successful writers about the process of writing, what helps them concentrate and how they self-motivate.
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www.hattiecrisell.com/ LQ ZULWLQJ ZLWK KDWWLH crisell-podcast • By the Book If you have a shelf full of self-help books, you will love this podcast by US comedians Jolenta Greenberg and Kristin Meinzer. Each episode sees them live by the rules of a different selfhelp book to see if it really will change their lives as promised. As well as a healthy dose of scepticism, the duo mine the genre for what really does help. Downloadable from most podcast platforms.
The Month, 1
Know of an event that would interest Therapy Today readers? Email media@thinkpublishing.co.uk
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Has the pandemic shown up the strengths and weakness of our profession, asks Nicola Banning
L
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eading up to lockdown, therapists emptied their therapy rooms without knowing when they might return to work. Files and data were transferred as people shifted themselves and their systems to spare rooms and home RIƓFHV DFURVV WKH FRXQWU\ &OLHQWV ZHUH QRWLƓHG WKDW WKHUDS\ would now be delivered virtually and the most vulnerable prioritised as many of us stepped into the unknown. Waiting to welcome us into the world of online work were the training providers, ready to help an army of new recruits to become good enough to hold their clients through life in lockdown and the threat of Covid-19. While our physical worlds shrank, our need for connection grew. If, before the pandemic, we had a love-hate relationship with our screens, suddenly they became essential in ways that would once have been unimaginable. One therapist said: ‘A few weeks ago the idea of doing EMDR trauma therapy via Zoom was unthinkable. Now it’s routine.’ Another said: ‘I think, as a profession, we’ve been so open to learning new skills to help our clients and I’ve been overwhelmed by the generosity of practitioners sharing their skills on webinars.’ ‘Unprecedented’ is a word that’s been used repeatedly to describe the deadly virus but, according to Jelena Watkins, a psychosynthesis psychotherapist who specialises in disaster mental health, this outpouring of collaboration and community is to be expected in the early phase of a crisis. ‘There is so much that we can learn from previous collective traumas to help us both to understand our early responses to the pandemic and to prepare for what will be required of the therapy profession in the future,’ she says. So, three months on, what has our profession learned?
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people affected by the pandemic. Media reports of the loss and suffering, people losing their jobs and living in isolation, and of exhausted front-line workers, often included the prediction that a mental health epidemic was coming our way. Louise Chunn of the therapy directory site Welldoing.org recalls the response IURP WKHUDSLVWV DIWHU WKH *UHQIHOO ƓUH DQG was not surprised that therapists have rushed to offer help again. ‘We were all hearing reports on the news about the pressure on NHS front-line staff and it was so shocking. Of course, therapists who understand trauma wanted to help,’ she says. ‘A couple of therapists asked us whether we were going to support the NHS workers. So we did some research, and the majority of that group said they would be interested in volunteering.’ More than 250 therapists signed up to volunteer by ticking a box on the Welldoing.org site. Chunn stresses that it’s important that ‘each therapist decides how much or how little they can give and negotiates this with the client – it could be an hour or two’. There have also been requests from D ŴXUU\ RI RUJDQLVDWLRQV IRU WKHUDSLVWV
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The rush to help As a profession of helpers, therapists were drawn to offer support for
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to volunteer their services for free, all offering access to ‘accredited therapists’ for NHS front-line workers and signposted on the NHS Practitioner Health website.1 They include Project5, Harley Therapy, The Relational School, Duty to Care, Frontline19 and Heather Wellbeing. Some are business startups that come with a crowdfunding campaign and a request for the public to donate, along with liberal use of the NHS logo on their website. But while it is right that our profession plays a central role in providing mental health support during this crisis, is it right that we offer our services for free? ‘I understand that counsellors want to help in a crisis, but colleagues who are already working in the NHS or via EAPs are being paid, quite rightly,’ says Sharon McCormick, Clinical Director at The Listening Centre, an EAP based in the Midlands. ‘When there are counsellors volunteering their services for free, I feel it’s sabotaging our own profession. We are inadvertently eating ourselves from the inside.’ At the start of lockdown, BACP released a statement saying: ‘As a profession, we believe we would be in a much better place to support anyone who needs our services if our members and the services they offer are Ć“QDQFLDOO\ VWDEOH ,W LV YLWDO WKDW WKHUDSLVWV are paid for their work.’2 BACP is also calling on the UK Government to ensure there is a workforce to deliver the comprehensive mental health response to the Covid-19 crisis. This is where our energy is needed, says Watkins. ‘Covid-19 is going to be a long haul. There’s a danger that, in the rush to help now, the help won’t be there when it’s really needed,’ she says. ‘This is the time when the profession needs to mobilise and make the case for funding.’
Help or hindrance? It’s not surprising we feel compelled to do something when we hear that NHS and care staff are ‘breaking down’, as recently reported by Labour’s shadow health minister, Dr Rosena Allin-Khan, who has returned to her role as an A&E
doctor during the pandemic.3 ‘I see it Ć“UVW KDQG ZRUNLQJ VKLIWV ,W LV VLPSO\ heartbreaking to see the toll this virus is taking on our front-line staff,’ she says. ‘There’s the fear of spreading the virus to patients and loved ones, the lack of PPE, the increased workload owing to the number of cases and staff absences, redeployment to ICUs and witnessing more patients die – staff are experiencing greater pressure, which is inevitably taking its toll on their mental health.’ But providing counselling to these staff is more complex than simply setting up D VHUYLFH DQG VD\LQJ ĹŒ:H KDYH TXDOLĆ“HG therapists ready to work for free’, as a therapist with more than 14 years’ experience in the NHS explains. ‘My role is to co-ordinate the psychological support for staff in our NHS trust and we have been absolutely overwhelmed with voluntary offers of support. But as an employer, every NHS trust has a duty of care, due diligence and governance, not to mention recruiting procedures to ensure that anyone working with 1+6 VWDII LV DSSURSULDWHO\ TXDOLĆ“HG registered and trained to meet the needs of the staff in the current climate. We already have a team of paid counsellors employed to meet those needs and a bank of counsellors who I can call on. Arrangements are in place for enhanced provision of counsellors, EAP access, a chaplaincy team, health psychologists and trauma risk management (TRiM) practitioners to support individuals, managers and teams alongside the free to NHS staff apps.’ This is what good employee support looks like and it’s not unusual in the NHS. But if you don’t work in this area, there is no reason why you would know, so it’s understandable that the offers of
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free therapy to front-line workers have rushed in. The result for many has been frustration that their services have not been called on. Chunn says, ‘There has not been a massive uptake yet; we are still in the NHS approval queue.’ In the long term, it remains to be seen whether the newly formed free services prove to be a threat to paid counsellors. Barry McInnes, a BACP-accredited private practitioner, wonders if we are already seeing the impact. ‘It seems that most of us who take EAP referrals have noticed it’s gone awfully quiet,’ he says. ‘I wonder about the extent to which newer organisations that have sprung up offering free counselling or “wellbeing supportâ€? have a part in this.’ It’s a complex issue and some argue that offering free support may ultimately help our profession by giving people who would perhaps have never considered therapy a (hopefully) positive experience of it. And does it show us acting and responding to the pandemic in a way the public can understand? Sue Monckton-Rickett thinks so. She is Chair of the Association of Christian Counsellors, which has set up a Covid-19 crisis counselling support service to offer NHS front-line workers and those bereaved during the pandemic up to 10 free counselling sessions, provided pro bono by registered counsellors. ‘Not everyone wishes to access workplace schemes,’ she says. ‘Those in contracted ancillary or agency roles in the NHS may be outside of employee provision and many NHS staff and the bereaved will QRW KDYH WKH Ć“QDQFLDO UHVRXUFHV WR VHFXUH private help. Even in “normal timesâ€?, local services such as IAPT have long waiting lists and target only certain conditions. ‘We felt that the degree of suffering for some people impacted in these ways by Covid-19 is likely to be so intense that we wanted to offer an uncomplicated and timely way of getting professional support as a humanitarian act and as part of our identity as a Christian organisation. We also see offering our services in this way as an opportunity to raise awareness about the vital role that counselling plays in the mental health of our nation not just in crisis, but also in the long-term.’ â–ş
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Free counselling aside, there have also been reports of practitioners being offered lower rates of pay by EAPs for telephone or online work, resulting in some losing up to 75% of their projected income.4 Kris Ambler, BACP’s Workforce Lead, took up this issue on behalf of members. One company, Health Assured, announced it would pay the in-person rate for telephone and video counselling, recognising the situation as out of the therapists’ control. But not every EAP provider has followed suit and therapists are still being offered as little as ÂŁ20 a session for telephone work. As any therapist who is working remotely will attest, remote working can be harder work than in-person counselling. Many of us have also invested time and money to get trained up quickly to work this way. Practitioners who coach have also suffered, with many seeing their work cut or suspended since lockdown. Michèle Down, an executive coach who works exclusively within organisations, says that her coaching and training work was suspended at the start of lockdown. She has chosen to work pro bono with existing clients out of a duty of care, and has extended this to others too, until budgets restart. ‘Some clients have offered to pay, some said they’d like to donate to a charity and others have just expressed their thanks for the ongoing support,’ she says. In theory, there may be an increased demand for coaching after lockdown as companies help employees transition back to working in physical teams again. But, like therapy, coaching and training are often seen as a luxury that can be cut when times are lean, even though they are intrinsic to the health of any working environment.
‘Like therapy, coaching and training are often seen as a luxury that can be cut when times are lean’
The future is also uncertain for therapists in private practice, with many UHSRUWLQJ D VLJQLĆ“FDQW GRZQWXUQ LQ QHZ FOLHQW HQTXLULHV SHUKDSV UHĹ´HFWLQJ WKH economic uncertainty that the country as a whole is facing. In the long-term, counsellors without an established practice, an organisational component to their work or a varied portfolio may well struggle. One counsellor in practice IRU PRUH WKDQ \HDUV VDLG ĹŒ0\ Ć“QDQFHV have always been insecure, and each year I wonder if I will be able to continue but this year particularly so.’
Opportunities Much has been written about the predicted impact on the nation’s PHQWDO KHDOWK EHFDXVH RI WKH Ć“QDQFLDO insecurity,5 and anyone who was in practice during the 2008 crash will know from experience that it can be deep and far-reaching. If we are to be part of the solution, we must be vocal about people getting access to the therapy they need. Yet the threat we face from the economic downturn is real – organisations make cuts to non-essentials in recessions, including counselling, and services provided by charities often struggle to keep going. So it’s not just our clients who will suffer. Could a further reduction in paid employment for counsellors mean more of us working in private practice, competing for a smaller number of paying clients? Ambler urges therapists to keep an eye on what is happening at a local level. ‘I’m seeing that there are commercial opportunities for therapists now right across the UK,’ he says. ‘Constraints have been lifted on local authority commissioners and there is now money to be spent on mental health support because of Covid-19.’ Rachel Walker, a therapist in West Cumbria, says that, while her private practice has all but stopped, her work with a local domestic abuse charity has increased. Vicky Pike is her manager at West Cumbria Domestic Violence Support, which offers long-term counselling for victims, children and perpetrators of domestic abuse. ‘The calls to our helpline were up by eight per
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‘We have shown ourselves to be a flexible, agile and responsive workforce’ L ' ~. ,,_ we ✓e had had 89 0'1 on .- 'l cent during during lockdown lockdown and we had 89 on cent and , , ' ,, which which was was our counselling counselling waiting waiting list, our list, which was '¡1,, :;.,- applied "Dplied fr: really worrying,’ worrying,’ she really she says. says. Pike Pike applied for for , :¡ ✓- •.- ÂŁ20,000. , : : ). two grants grants and two and received received ÂŁ20,000. ‘It’s been been amazing, amazing, because ‘It’s because we we get get a phone phone call call from from someone a someone needing needing help and and we we can can connect connect them them with with a a help counsellor and and they they don’t don’t have have to to wait. wait. counsellor They shouldn’t shouldn’t have have to to because because it’s it’s about They about their survival,’ says Pike. The waiting list has gone down from 89 to eight and Pike has increased the counselling hours of her team. ‘I’ve also applied for other grants because we predict a spike after lockdown ends, and I’m hoping to employ another couple of counsellors to meet the demand.’
Trainee counsellors 7KH ORFNGRZQ KDV DOVR KDG D VLJQLĆ“FDQW impact on trainees, many of whom are now being taught online by tutors and course providers who have no experience of delivering training in this way. For providers, the challenge was getting online courses up and running in a short space of time. Lynne Kaye, Director of CPPD, says: ‘We had 200 students on three different counselling FRXUVHV DW FHUWLĆ“FDWH GLSORPD DQG advanced diploma level. All the courses had students coming to the end of their training. We also had to create training for our diploma-level students transitioning from in-person counselling to working online with clients in our own service. There was anxiety but I think our students have coped well with the changes,’ she says. A point that is coming through from trainees on social media message boards is that it’s easier to cope with change when it’s well managed. Many trainees have been effusive in their praise for tutors who have helped them through the process with sensitivity, including one
_r•, ill ,r subsequently tutor who tutor who was was taken taken ill and and subsequently died Many students students died from from Covid-19. Covid-19. Many ' have reported have reported a a positive positive transition. transition. One One . ' said: day was was so so said: ‘Our ‘Our online online training training day engaging, it it felt felt like like II was was almost engaging, almost back back in our in our room room with with the the group.’ group.’ But not But not everyone’s everyone’s experience experience has has been positive; been positive; some some trainees trainees have have Jr' •.feeling .--"-- ~ unsupported, ., ¡ reported feeling unsupported, with reported with ., ... 1\. or ; • , ..... , little little or no no communication communication or or clarity clarity about placements about placements or or whether whether online online client hours client hours will will count. count. Perhaps Perhaps it’s it’s not not surprising that surprising that we we have have seen seen a a broad broad spectrum of spectrum of student student experiences experiences during during the pandemic, the pandemic, given given the the increasingly increasingly eclectic way way that that counselling eclectic training is is ;;~ counselling ¡ .•"1...'•~'-:t11qtraining ,_ .... _.UK, :,.:,• with \ 't now delivered now delivered in in the the UK, with university university courses courses closing closing and and independent independent training up. training courses courses springing springing up. Rory Lees-Oakes is Co-Director at the online training site counsellingtutor.com and says that counselling courses also need to adapt to the change in the way counselling will be delivered. ‘Social distancing is here to stay and I think we’re going to see a fundamental shift towards a demand for online counselling, even after lockdown,’ he says. ‘Counselling WUDLQLQJ QHHGV WR UHĹ´HFW WKH ZRUOG ZHĹ?UH living in. Stakeholders all need to come WRJHWKHU WR UHFRQĆ“JXUH ZKDW WUDLQLQJ ZLOO look like in the future.’ ,,j
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Longer-term changes The longer-term impact on our work is unclear, but having adapted to new ways of working, many practitioners are rethinking their practice. ‘Mental health professionals are leading a working life that they said could never be done. I see a future where tele-therapy, while not being exclusively used, will be far more available. There are too many advantages in being able to offer remote therapy for us to discard it,’ says Dr Sandi Mann, a workplace consultant and lecturer at the University of Central Lancaster. It’s a view shared by service manager Vicky Pike: ‘As a domestic abuse charity, we’ve learnt that online therapy is possible, it works and the feedback from clients is so positive.’ According to Down, this time in lockdown has pressed a much-needed pause button for many of her clients.
‘The people I work with are reassessing all aspects of their lives’ ‘Slowing down means that the people I work with are reassessing all aspects of their lives,’ she says. ‘They’ve worked long hours, involving a lot of travel, and I wonder how many people are going to want to go back to their jobs, if indeed those jobs still exist. People are starting to ask what they want to do with their life?’ And we coaches and therapists are ideally placed to help them explore this.
ways, there is much we can be proud of as a profession. We have shown RXUVHOYHV WR EH D Ĺ´H[LEOH DJLOH DQG responsive workforce whose skills are needed more than ever before. Yet it remains to be seen whether those skills are recognised and paid for accordingly. Looking ahead, Watkins reminds us of the potential for post-traumatic growth as we come through this crisis. ĹŒ6RPHWKLQJ VLJQLĆ“FDQW LV KDSSHQLQJ DW a local, societal and global level as we collaborate,’ she says. ‘We’ve done well so far in our response to Covid-19 but, as a profession, our real work hasn’t even started yet.’ â–
Valuing care One emerging hope is that in this new world we may reappraise how we value care work. Providing carers with the counselling support they need may be a potential new market for counsellors. ‘I hope our society will have a better understanding of the work of carers in care homes,’ says Jeremy Bacon, BACP’s Older People Lead. ‘Staff are so skilled, and we need to insist that carers deserve better and must not be left to the vagaries of the market. We’ve equated low pay with low skill and we need to totally turn that on its head.’ This change is called for in a recent report by the Institute for Public Policy Research,6 which calls for a new social FRQWUDFW WR RIIHU ĹŒFDUH Ć“W IRU FDUHUVĹ? for both NHS workers and carers. A key priority is the mental health and wellbeing of workers, and our profession has the skills to meet that need and provide that care.
Post-traumatic growth I am sure I am not the only practitioner to believe that, if we are to learn from our early response to this crisis, we’d be wise to avoid a rush to offer care workers free therapy where services already exist. As a profession, we need to build on the foundations in place and strategically make the case for the provision of professional, paid counselling. We have navigated uncharted waters in the last three months and, in many
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About the author Nicola Banning is a supervisor, trainer and BACP-accredited counsellor specialising in working with individuals and organisations. She has a background in broadcasting with the BBC, writes on counselling and mental health at work, and is editor of BACP Workplace. workplaceeditor@bacp.co.uk
REFERENCES 1. www.practitionerhealth.nhs.uk 2. https://labour.org.uk/press/rosenaallin-khan-calls-for-assurance-frontlinestaff-will-get-mental-health-supportthey-deserve 3. www.bacp.co.uk/news/news-frombacp/2020/14-april-volunteering 4. www.bacp.co.uk/news/news-frombacp/2020/6-april-working-with-eaps-toensure-therapists-are-valued-during-thecoronavirus-crisis 5. www.bacp.co.uk/news/news-frombacp/2020/16-april-backing-calls-formore-research-as-coronavirus-risksprofound-impact-on-mental-health 6. www.ippr.org/research/publications/ FDUH Ć“W IRU FDUHUV
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elephone counselling was one of the earliest ways that therapeutic practitioners worked remotely with clients and, for many of us, it remains the first choice, despite the ubiquity of videoconferencing. It’s less prone to technological hiccups and appeals to a different client base, including those who aren’t familiar with videoconferencing software. Telephone work offers visual anonymity, which may be important for some clients and counsellors. It’s a popular choice of remote working for EAP providers and services, as clients only need a mobile phone. It also allows both counsellor and client more flexibility over where the session takes place, which has become all the more important during lockdown, when some clients have resorted to taking sessions in their parked cars. If you have had to transition to telephone work quickly or without any training, or less than you would have liked, you may be surprised at how deskilled you find yourself. This was my experience. I opted for telephone over videoconferencing to work with most of my clients during lockdown as I had reservations about intruding into clients’ homes (and them seeing into mine). ‘How different can it be?’ I mused, only to find out very quickly – it is very different. I found myself asking far more direct questions than I ever would in the therapy room, and finding it difficult to judge when and how long to leave silence. ‘Just because you are an experienced counsellor and you obviously are used to talking on the phone, don’t assume you will automatically feel competent with telephone counselling,’ says Sarah Hart, a long-established telephone counsellor and supervisor who also provides training in telephone counselling for individuals and organisations. ‘It’s important to get training if you want to be effective at it.
Working on the phone is very different to in-person work, not least because we’re not able to see our clients. We are trained to use all our senses when we work with clients but all that is channelled into one sense, our hearing, when we work on the phone. It can be very intense – the client’s voice is right in your ear.’
Disinhibition Telephone sessions can also be intense in terms of how fast they move, with clients disclosing faster than with in-person or videoconferencing work. BACP’s competency framework for working remotely (see Support Resources, right) notes that this may lead to an ‘inappropriately rapid disclosure of sensitive information that risks leaving the client feeling overwhelmed; an inappropriately rapid development of intimacy, sometimes followed by withdrawal or distancing; difficulty in pacing sessions because clients have disclosed more information than they had intended; clients coming to regret having made an uninhibited disclosure; clients disclosing issues they would not address had they been in face-toface therapy; the uninhibited expression of anger, hatred, criticism.’ But, handled appropriately, rapid disclosure can be an advantage, says Hart. ‘Early disclosure can help create a therapeutic relationship if the client feels understood by you, which means they may engage in the therapy more quickly. Research tends to show that talking about issues with associations of shame or embarrassment can be easier when there is visual anonymity, because the client does not have to bear a
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physical response, even if it’s just a slight raised eyebrow, that might suggest judgment.’ According to the BACP competences, practitioners are required to have an ability to help clients pace their communications by, for example, interjecting to summarise what the client has been saying or asking the client how they feel about what they have said. We also need to be aware that counsellors can also experience disinhibition in remote work, which may mean they make unhelpful interventions that are ‘too direct, forthright or insensitive’. ‘We need to remember that we are human too! We are more likely to disclose more than we would ordinarily – and may feel the aftermath of guilt, regret and shame,’ says Jo Birch, a counsellor, coach and supervisor who has also been offering training in telephone counselling.
Beginnings and endings Who starts a session by making the call is down to personal preference or agency policy. When the client is responsible for making the call, they retain autonomy over whether they ‘turn up’ to a session. ‘If we call the client, then we’re not giving them the chance to come to us,’ says Birch. ‘And on a practical level, the client making the call allows them to ensure they are somewhere private first. If you are working for an EAP provider, agency or protecting your personal phone number, it may be that you call the client. We need to think through the aspects, including individual client circumstances and impact on the therapeutic relationship.’ The person who makes the call also pays for it – another factor that needs consideration, although more and more mobile and landline providers now offer inclusive call packages. With endings, telephone counselling does not allow the physical transition time of leaving
Sound of silence Judging when silence is helpful or becoming uncomfortable or even persecutory for a client can be harder on a phone call without the usual visual cues that we rely on to assess what may be going on for the client. So it may be that we need to be more direct with clients, checking in to say, ‘I am aware there is silence and was wondering how that feels right now.’ If a client ever says ‘Hello?’, then you know you have let the silence go too long, says Hart. ‘They are wondering if you are still there,’ she says.
Payment matters a therapy room. So it’s good to discuss with clients what they will do after a call to ground themselves. They might simply take a few minutes to reflect and for some deep breaths or, if they can, step outside the house for a walk or some fresh air. Allowing enough time to prepare for and process a telephone session is also important for counsellors, says Birch. ‘When we meet in person, we may take time before a client arrives to set up the space, plump the cushions, get the water or whatever, then sit quietly and reflect on the session ahead. For telephone work, there may be a temptation to think it’s “just a telephone call”, and not take time to prepare in the same way or allow ourselves time to process afterwards. But attending to this is an important part of the process,’ she believes. ‘Take time to create your space, somewhere comfortable and free of office clutter. I prefer to put the phone on a stand and talk on speaker to provide a space between us where the words can unfold. But I know other people enjoy the intensity of the earphones, and they also offer privacy if there is potential for the session to be overheard.’ Hart also recommends taking as much care to prepare your telephone counselling space as you would your counselling room. ‘It’s best to be free of distractions, so perhaps choose a neutral space rather than sit at a desk that you usually do other work from,’ she says. ‘I have invested in a good pair of Bluetooth headphones, which means I can sit naturally, stand or move around – another great bonus of telephone work for me is that it frees me from sitting down all day.’ Birch agrees that this is one of telephone counselling’s selling points. ‘Moving around can help you and the client embody the experience,’ she says.
Telephone work can be done without hiring physical premises or incurring travel expenses but that doesn’t mean you should charge less than you do for in-person work, Hart argues. ‘It is intense work that requires additional skills and training, so why would we be paid less for it?’ Working on the telephone also allows you to offer a specialist service across a wider geographical area than in-person work. ‘I work with parents, but mostly mothers who are separated from their children. It is niche work but, as I work on the telephone, I can work with clients wherever they are, including in temporary accommodation,’ says Hart. Online banking makes payment for remote working much easier, but you need to clarify when you expect the payment – before or after a session – before you start working. ‘I ask clients to pay me before the session and include in my contract that, if payment is not made, then a session may not go ahead,’ says Hart. ‘You will also need to be clear on your cancellation policy and how much notice you require before a payment may be incurred.’
SUPPORT RESOURCES Competences for Telephone and E-Counselling, a BACP framework, can be accessed at: www.bacp. co.uk/media/8113/bacpcompetences-for-telephoneecounselling-apr20.pdf For information about Sarah Hart’s telephone counselling courses for counsellors and organisations, see www.sarahhart.co.uk For details of Jo Birch’s ‘Introduction to Telephone Counselling’ course for the Rowan Consultancy, visit www.eventbrite.com/ o/rowan-consultancy13933810664 A podcast interview with Jo Birch about effective telephone counselling is available at: www.bacp.co.uk/bacpjournals/therapy-today/ therapy-today-podcast
client needs some thought if a client has opted for phone counselling because they don’t have internet access or a computer. If it can’t be sent by email, you will have to send it by post.
Contracting Clarifying payment terms is just one element to be included in a contract for telephone counselling, and a good reason to recontract if you have transitioned an in-person client to telephone work. Other issues to cover include what you will do if you get cut off during a call. For instance, is it up to the client to call back? If they can’t get through, will you continue via email? Privacy is important, especially if the client is taking the call at home. ‘It’s worth specifying that calls should be taken in an appropriate space, so that means not while driving, on public transport or in a public space where they could be overheard, such as a café,’ says Hart. How to get the contract sent to and signed by the
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Training and supervision If you are thinking of making telephone work a regular part of your practice, then a training course will help you work effectively, ethically and in a way that is sustainable. It’s also worth considering getting a telephone-specific supervisor who can support you, especially when you first start out, says Hart. ‘It makes sense to be supervised in the medium you are working in, which means you aren’t restricted by locality in finding a supervisor. My advice would be to look for a supervisor who has chosen to work on the telephone, rather than offer it ad hoc when clients can’t make in-person sessions.’ ■
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‘I know what can happen when we stand together, no longer silenced by shame and isolation’ or me, #MeToo started in October 2017 with an impassioned Facebook post. It was the first time I’d said ‘#MeToo’ outside therapy, supervision and conversations with my most trusted people, in a more public place and in the written word. I say ‘more public’ because my Facebook profile settings are private. Although my words were impassioned, I was a gibbering wreck as I pressed ‘post’. I had to interrupt the silence. I feared the world would tip sideways. The world stayed upright, and I received messages of love and support. Then dread, like the slow, sludgy bubbling up I remember as a little girl, fearing what was about to happen, too scared to sleep, too tired not to. That passed with the relief of being believed, similar to the relief six years before, telling my mum for the first time about being abused at the hands of a family member. I’d told her before about being abused by family ‘friends’. This time was different; maybe I spoke more clearly; maybe she heard more. I still feel my shoulders dropping as she responded with care, rather than doubt and denial. Over the following days, posting about #MeToo on my public Facebook page this time and reading about civil rights activist Tarana Burke’s originating of the movement in 2006, I noticed a secondary shame of even being associated with the movement. The proud parts of me looked away, haughtily, urging me to keep on with the painful anaesthesia, swallowing it down. Even being associated with the calling out of sexual violence reminded me how dirty I felt. Parts of me surged with excitement – good excitement, rather than the uneasy excitation of being aroused during abuse, a feeling which haunted me during this period. I was in awe of the worldwide upsurge of energy, the ignition of a body of people standing tall, standing together, saying ‘No!’ to the devastation, making it loud and visible, rather than internalised and hidden. They were giddy times, except this time healthy giddy, safety-in-numbers sort of giddy. All the while, this young me beside me, wide-eyed and absolutely terrified of being wrong again, being wrong for the rest of time. Reading this now as a therapist makes me wince. Not because therapists aren’t ‘victims’ of sexual
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violence and abuse, but because I know that clients, supervisees and colleagues are reading this. There’s a relief in the honesty and there’s the fear of being wrong, the memory of all the things I’ve been taught as a therapist about self-disclosure whirling around. Where are the edges of what’s OK and not OK to share? It’s a work in progress. In 2018, I was invited to co-edit a #MeToo-inspired book for counsellors and psychotherapists. Feeling the fear and doing it anyway (a phrase I’ve liked since Susan Jeffers coined it in 1987), I said yes, because I believed the book would be important for the therapy profession and I felt it was necessary to do something ‘out there’ at a time when lasting changes felt slightly more possible. I was compelled by the part of me, a well-known protector, that wants to fight for those with less voice than my own and parts of me with less voice. The desire to do something useful and the longing to add depth, nuance and action – beyond celebrities – overtook the fear. For nearly 17 years I’ve worked therapeutically with those who have experienced sexual violence. Clients have yet to mention my #MeToo declaration. I have written other books, on childlessness, ecopsychology and meditation, and some clients seek me out for that reason, while others don’t know I write. What’s most pressing now is how we achieve justice for those of us who have experienced sexual abuse and violence and how we stop it happening to our children. Personally, too, I wonder what justice would look like for me. How do I find more peace? Do I push ahead with the complaint to the police I made 18 months ago, and then shelved when the night terrors returned and I feared he would turn up on my doorstep? Or is my energy more creatively put to use in raising awareness and challenging our still victim-blaming culture, in collaboration with others? Having said ‘#MeToo’, I know what can happen when we stand together, no longer silenced by shame and isolation. I look forward to how this changes my work, both in and outside the therapy room. ■
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About the author Emma Palmer is a BACP-accredited counsellor, relational body psychotherapist, supervisor and ecopsychologist, and co-editor, with Deborah A Lee, of #MeToo: counsellors and psychotherapists speak about sexual violence and abuse, published this month by PCCS Books. www.pccs-books.co.uk
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Catherine Jackson talks to Emmy van Deurzen, philosopher and existential psychotherapist, about the lessons we can learn from times of uncertainty
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Catherine Jackson: Some months before the coronavirus pandemic moved from China into mainland Europe, you embarked on a book about Brexit and how the process of leaving Europe plunged the citizens of the UK, and of Europe, into an existential crisis. You intended to write about ‘rising from’ this existential crisis. How would you conceptualise this new crisis facing arguably the whole of humanity now? Emmy van Deurzen: It has been a remarkable time in terms of changes and crisis in the UK. The four years of Brexit created a deep sense of desolation for many people, particularly for EU citizens living in the UK and Brits living in Europe. This was something close to my heart because of my own background, having been born in the Netherlands and having studied and worked in France for many years before I came to Britain in 1977. It was terrible to witness the personal suffering of so many of my friends and clients who were harmed by the situation in which they lost control of their lives and felt they no longer had any future. This is something that still endures for many of them to this day, though this is now overshadowed by the much larger crisis of the pandemic. Having created a free emotional support service for EU citizens who had become disenfranchised by the Brexit situation, I collected a lot of information about their experience and their mental health problems. There are many lessons to be learnt from this situation about how people cope in a crisis and how they are able to rise above it. This became even more relevant as most of the world population was plunged into the coronavirus pandemic. It became obvious that many people needed support in processing difficult experiences in this respect as well.
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CJ: What is an ‘existential crisis’? +RZ GR \RX GHƓQH LW" EvD: An existential crisis is a situation in which our entire existence and everything we used to take for granted is in the balance, so that we feel insecure and threatened and lose our bearings. This affects all dimensions of life, at the physical, social, personal and spiritual levels. It means that our bodies are
‘Our bodies are challenged, our relationships are changed, our sense of our self is altered, and our beliefs and values are shaken up’ challenged, our relationships are changed, our sense of our self is altered and our beliefs and values are shaken up. For most people, this is a very difficult experience to encompass as it leads to a revolution of our established patterns, routines and habits. It always involves a lot of loss and therefore leads to feelings of bereavement and sorrow, as well as confusion, fear, anger, doubt and panic. If it isn’t dealt with properly, people may end up suppressing their emotions, which can lead to further complications further down the line. In some situations, it may lead to the person suffering post-traumatic stress disorder and becoming incapacitated for a long time. However, from an existential viewpoint, it may also lead to a renewal of existential courage and strength, and it is this latter response that I am most interested in.
CJ: How do we ‘rise from’ a crisis of this nature, both in the immediacy of the national and internal lockdowns and when we begin to emerge and re-establish normal living? EvD: The reality is that most of our lives are touched by existential crisis at some point and many of us, with hindsight, recognise that these moments of crisis have become points of growth, development and transformation for us. While we are in the midst of such a defining predicament, we usually feel turmoil and fear. Our inner peace is shattered and can be hard to re-establish. Nevertheless, many people are capable of doing something positive with this shattering, as it allows
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them a certain amount of new freedom, because old identities become obsolete and expectations are lowered. This gives us permission to start doing things very differently. When the crisis is critical and leads to loss of life, it may feel calamitous and completely negative. It may take many years, sometimes decades, to absorb the shock, and the scars will last forever. Even then, people often find ways of making meaning out of this experience. Viktor Frankl’s work is a shining example of this. He went through one of the worst imaginable existential crises, when he lost all of his family in World War II and found himself interned in a concentration camp. He made it very clear in his writings and also in person, that everything he had valued was wiped out and that he was forced to find the creativity and determination to craft new meanings. Afterwards, when he was released from the camp, he was able to stand strong with his clients through the worst of times, like a rock in the sea, because he had been able to face the abyss and didn’t fear it any longer. Such an example of rising from crisis is hard earned. We cannot really learn to do this unless we are ourselves exposed to a similar situation. This year, we are living a very strange reality, where many people across the world have been in lockdown and have feared for their own lives or those of other people. These circumstances have certainly become traumatic for some of us and, as counsellors and therapists, we need to figure out how to approach the situation. It’s not enough, and almost certainly impossible, to aim for people simply to re-emerge and re-establish their old lives. New lessons have to be learnt from this period of trials and tribulations. These are existential lessons.
CJ: What is the role of therapists in this current coping and in the rising/resurgence? EvD: For such times of existential crisis, we need therapists who are able and willing to face things head on and who have the capacity to imagine how bad things are for some of their clients. When we are exposed to this much difficulty and challenge, we become highly sensitive to other people’s responses. ►
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The Big Interview, 1
The big interview
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‘We can only help people to go as far as we have gone ourselves in our own lives’
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If we sense that our therapist is not genuine in their understanding of our critical position, we cannot remain open and trusting. Thus, we need therapists who are capable of showing their mettle and who are used to confronting the depth of despair with their clients, while keeping their eyes on the possibilities ahead. We can never fake authenticity or existential courage. We can only help people to go as far as we have gone ourselves in our own lives. If we haven’t faced down failure, catastrophe, disaster, crisis and death, we cannot truly command authority in the face of such experiences in our clients’ lives either. Maturity and reflective understanding are therefore extremely important.
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CJ: What do you see happening now among your clients – emotionally, mentally, physiologically and existentially? Have their personal issues receded in the face of this greater threat (remembering that suicide rates dropped during World War II, for example)? And for couples and families, is there a coming together or a falling apart? EvD: It’s quite extraordinary to see once again how crisis and catastrophe bring out both the worst and the best in people. Those who have had previous mental health problems are far more at risk again. Not only do they find it scary to be faced with a
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situation they cannot control and oversee; they also fear other people’s bad responses in the situation. They stop feeling they can trust society, or even nature, and feel dreadfully alone in that disappointment. I have seen some people becoming more obsessed with cleanliness than is good for them and more inclined to remain in total isolation than even the Government has suggested. I have seen some people becoming more paranoid or more agoraphobic. The same happened with the Brexit situation and EU citizens too. People feel terribly alone and abandoned, and it is a good thing we have been able to provide online therapy sessions to help them remain connected and find some solace and support. Some people feel aggrieved at the way others are operating in the circumstances, especially when this involves profiteering from other people’s misery. It is however also uplifting to see how many good people there are and how genuine the response of helping others has been, not just from health and care professionals but from many ordinary people who have staunchly volunteered to support those who are more vulnerable. This teaches us much about the human condition and our capacity to rise up when faced with misfortunes. We are seeing how crisis affects people across the whole spectrum. Many people have begun to think more deeply about their lives and what is of most importance to them. People have started thinking more about death and fate as well. They realise that things can change at the drop of a hat and that we should never waste time. In both the Brexit and pandemic situations, there has been a knock-on effect on people’s livelihoods. Some have found themselves in sudden situations of hardship they weren’t at all prepared for, and this too can lead to terrible tragedies and hardship. We have also seen the impact of such struggles on families and couples, both in the positive and in the negative. Some have realised they need to pull together in their quandary; others have
become far more conflicted and just want to get away and break up as soon as possible. More people have learnt what it is to live with anxiety and depression. The confinement of the lockdown has impacted on people’s physical, emotional and mental health and wellbeing. We learn how important it is to look after ourselves and find mental and emotional strength and balance in order to stay sane. Many people remark on their desire to find new purpose and make something better of their lives, having seen how fragile everything is.
CJ: Your parents would have had personal experience of extreme deprivation of food, liberty, freedom of movement and more in the wartime Netherlands, and you would have also experienced some of this in the 50s in your childhood. Are there lessons for us from the past and from previous such crises, whether war or disease? EvD: You are very right about that! My parents used to tell me so much about their plight in World War II, when they lived in the occupied Netherlands and my father had to go into hiding in terrible circumstances, while my mother worked as a nurse with children dying of tuberculosis and diphtheria. While
‘It’s quite extraordinary to see once again how crisis and catastrophe bring out both the worst and the best in people’
the stories used to frighten me as a child, I know that living through this with them in my imagination has given me quite a lot of backbone. The horrors of their suffering, witnessing family members being deported or shot in the street for being part of the resistance, challenged me to find the inner strength to cope with my own problems. I never forget that my parents survived by the skin of their teeth, living on nothing but soup made of flower bulbs, as the occupied part of the Netherlands was entirely deprived of supplies for the final nine months of the war. My dad nearly died of double pneumonia, as there was no heating anywhere and he was hidden in the rafters of an old building. Such images are always at the back of my mind, and knowing my parents got through all this has often given me courage in the face of difficulties. I can see that people are finding courage in that same way again, today. As my parents often remarked, the war made them grateful and more aware of what was of true value in life. I very much hope that the new generation will learn similar lessons from the current situation.
CJ: How would you hope to see people changing how they live and relate to one another in a better future, when we are through this? EvD: I fervently hope that we shall have become more united and more aware of the need for kindness. So many people are discovering that wealth, popularity and fame are not so important. What matters is that we make a worthy contribution to the world and that we keep learning, loving, communicating and searching for clarity, understanding and fairness. What matters also is to find out how we can rise after suffering and take something good from our dark nights of the soul. This is what we used to call building character, dropping or polishing some of our bad habits under
‘I have found my personal confrontation with the possibility of my, or my husband’s, imminent demise very invigorating, to put it mildly’
About Emmy van Deurzen Emmy is a philosopher and existential therapist. She is also a professor of psychology and psychotherapy, with 17 books to her name, several of which have been translated into a dozen languages. She is the Founder and Principal of the New School of Psychotherapy and Counselling at the Existential Academy, which offers postgraduate training courses, in partnership with Middlesex University. Among her books are the bestsellers Existential Psychotherapy and Counselling in Practice (Sage), Psychotherapy and the Quest for Happiness (Sage), Everyday Mysteries (Routledge) and Paradox and Passion (Wiley). Her new book, Rising from Existential Crisis, will be published later this year by PCCS Books. www.emmyvandeurzen.com
pressure and acquiring strength and vitality. When we see this happening, not just in ourselves but in others around us, we retrieve a feeling of our connectedness and purpose in life.
CJ: Where now for you in terms of the planned book on rising from crisis? EvD: Though my book has been temporarily put on hold to deal with some of the practical requirements of putting all my work online, both at college and in my practice, I have also become more ardent in my desire to make this a book that can help people with these issues and problems. I am grateful that there was time to ponder about this and shift the emphasis of the book, making it much more about the experience of learning that we filter and distil from our difficulties. I have found my personal confrontation with the possibility of my, or my husband’s, imminent demise very invigorating, to put it mildly. It has brought me up closer to the plight of my clients. It has made me more determined than ever to use my abilities and talents to help this world change for the better.
About the interviewer Catherine Jackson is a freelance journalist specialising in counselling and mental health. J
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The big interview
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ave you put something in my tea?’ asked Sylvia,* a client who came for support after her cancer diagnosis. She had arrived for her therapy session full of anxiety and despair. As part of the session, she was led through a guided exercise, ‘Imagery of a Good Place’. During her imaginative journey, Sylvia had experienced being in a beautiful garden. Now she was feeling euphoric. Days later, Sylvia reported experiencing a lasting sense of peace. People who are confronted with cancer face innumerable challenges. Their fundamental feelings of security and having control over their lives are WKUHDWHQHG DQG WKHLU VHOI FRQĆ“GHQFH sense of meaning and wellbeing are often undermined. Such loss can create shock, panic, fear and anger. In addition, cancer patients face bodily impairment, chronic fatigue, scarring and other permanent physical effects of the disease and its treatment. In the case of illness and crisis, imagery and artistic expression can help enhance one’s quality of life, strengthen a sense of meaning,
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improve interpersonal communication and reduce feelings of anxiety, fatigue, stress, pain and depression. In the case of cancer, clinical evidence shows that imagery and art can help to increase resilience.1 Internal imaginary experiences and expressions in any artistic form – such as drawing, writing, singing and dance – can revive a
‘Clinical evidence shows that imagery and art can help to increase resilience’
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sense of autonomy and can activate healing resources.2 The ritual use of imagery and art has always been an integral part of human behaviour. It’s not only part of what makes us human, it plays a role in forming identity and the development of mental, social and physical skills.3 Sheikh and Assagioli, WZR RI WKH PRVW VLJQLƓFDQW ZULWHUV LQ WKH ƓHOG RI WKHUDSHXWLF LPDJHU\ ERWK name imagination as a core function of WKH SV\FKH 6KHLNK GHƓQHV LPDJLQDWLRQ as the central arena within which the personal identity is formed, and also where access to deep sources of problem-solving can be found.4 Assagioli states that every image has within itself a drive that tends to produce the physical conditions and the external acts corresponding to it. In other words, by clearly imagining a possibility, we bring it closer to actualisation.5 In this way, imagery offers us a powerful source of inspiration, healing and inner freedom. Within neuropsychology, the discovery of mirror neurons has FRQƓUPHG WKH FHQWUDO UROH SOD\HG E\
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the imagination in learning processes, as well as in recuperation after injury.6 That which we perceive, imagine, paint, model or sing is represented and activated in our brain, and this stimulates corresponding behaviour. The advertising industry uses this psychological principle extensively, and motor imagery is applied widely in the world of rehabilitation and sport. Studies show that visualising a muscle moving can produce physical changes.7 Similarly, the many studies on the placebo effect have shown that expectations, such as imagining that ‘this pill helps’, can relieve symptoms and foster resilience and healing, even when the participant in the study has been told that the pill is a placebo.8, 9
Resilience and healing Human beings possess an innate selfreinforcing capacity, a healing potential that works through the imagination. Imagery therapy makes conscious use of this imaging power. In this type of therapeutic work, clients become deeply familiar with an image, to the point that the image becomes an integrated part of their inner world. Clients then GLVFRYHU WKDW WKH\ FDQ LQŴXHQFH WKHLU images and apply them in their daily lives. The therapist’s role is to facilitate the client’s navigation of conscious and unconscious self-images, drives and potential talents, and stimulate their active application in daily life. Techniques used in imagery work include observing and merging with an image, dialoguing with it, artistic expression, insight, emotional and bodily integration and application in daily life. The technique that a therapist chooses depends on the client’s process. Questions to ask include, what may strengthen the coping capacity and resilience of the client, and what needs to be further developed?
able to own and master the images? This is particularly critical in the case of prescribed guided imagery. For instance, clients who compel themselves to imagine something positive while simultaneously repressing more negative feelings or images could be OHIW ZLWK GLIƓFXOW HPRWLRQV WR SURFHVV Only images that are fully accepted and well-integrated into a person’s personality and daily life tend to
EH EHQHƓFLDO DQG WUDQVIRUPDWLYH The therapist needs to avoid using positive healing images that might feel forced or uncomfortable to clients, especially in the case of those with a life-threatening illness. When fear of suffering and death play a major role in a client’s presentation, prescribing imagery that they cannot relate to can provoke strong feelings of tension, guilt and failure, as well as cause depression.
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‘I t’s my tree, it can grow’ Symbol cards with a wide variety of photo images can offer clients a visual means to verbally explore what is going on for them and provide an entry into the person’s own imagination. For H[DPSOH ZKLOH UHĹ´HFWLQJ RQ ĹŒZKDW VKH needed’, Maria,* a breast cancer patient, FKRVH WKH V\PERO FDUG RI D Ĺ´RZHU VHH photo, page 30). While concentrating on the image and then closing her eyes, Maria saw the image develop into a tree, which acquired tremendous VLJQLĆ“FDQFH IRU KHU ĹŒ,WĹ?V P\ WUHH LW FDQ JURZ Ĺ? VKH VDLG ĹŒ, P\VHOI DP DW WKH ERWWRP RI WKH WUHH DQG , DOVR ZDQW WR JR XS ,W LV WKH VPDOO FLUFOHV WKDW FRPH XS ,I
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Potential pitfalls Essential to the successful use of imagery is the degree to which the person feels comfortable with the images created and can integrate them. In other words, is the client
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Art and Cancer, 1
Counselling changes lives
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The spontaneous images of the person should always be the starting point. From there, the therapist can work on what the person needs and on the images and symbols that go with those needs. A major pitfall, however, is over-focusing on visualising physical healing. However much physical healing is, understandably, desired by the client and also by the therapist (countertransference), this focus makes the therapy limited. It is often the existential, spiritual essence of life that needs to be given heartfelt attention.
Imagery toolbox Jan Taal is a psychologist and psychosynthesis psychotherapist with more than 40 years of experience of working with people with cancer and chronic illness. He and his colleagues at the Amsterdam School for Imagery developed the Imagery Toolbox, a FROODERUDWLYH QRQ SURĆ“W SURMHFW ZLWK the Cancer in Images Foundation.10 Taal and colleagues launched the Dutch-language edition 10 years ago, and it became available in English last year. It provides user-friendly tools, techniques, guided meditations and inspiration to support counsellors working with cancer patients to access wellness and inner healing. A pilot study from the University of Humanistic Studies in Utrecht on the effects of working with the Imagery Toolbox found that it powerfully stimulates the imagination and mobilises the mental healing potential of the participants.11 A large research project on the effectiveness of the toolbox, a collaboration between the University of Groningen and the University of Twente in the Netherlands, is currently in its early stages. The Imagery Toolbox includes a course book, symbol cards, an audio CD and MP3s with eight imagery exercises (including ‘Imagery of a Good Place’), a set of watercolour pencils, paintbrush and sketch book, modelling clay, a notebook and a '9' ZLWK WZR VKRUW Ć“OPV $OO RI WKHVH seemingly simple tools synthesise into a powerful collection of possibilities
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About the author
&DWKHULQH $QQ /RPEDUG is a psychosynthesis psychologist, practitioner and researcher. She received her MA in psychosynthesis psychology from the Institute of Psychosynthesis, /RQGRQ ZKLFK LV DIĆ“OLDWHG WR Middlesex University, London. 6KH KDV KDG QXPHURXV VFLHQWLĆ“F and popular articles published on psychosynthesis psychology. Over the years, Catherine has successfully used many of the Imagery Toolbox visualisations with her clients. You can follow her blog at www.LoveAndWill.com
REFERENCES
for the therapist to offer clients who might be suffering from illness or be in crisis. The course book also has a chapter explaining how family members can use art and imagery to help in the healing process and, if necessary, prepare for the death of their loved one and provide aftercare. Much of the material is available for free from ZZZ LPDJHU\WRROER[ FRP. In an era where the costs of healthcare are constantly increasing, self-reinforcing methods such as imagery and artistic
expression are important additions to the care of cancer patients. When illness or crisis hits, we are often forced into an intimate meeting with ourselves, and both imagery and artistic expression can FRQWULEXWH VLJQLĆ“FDQWO\ WR SURPRWLQJ RXU inner and outer coping and resilience. Imagery and art provide a humanistic, individualised, empathetic and patientcentred response to this challenge. â– $OO WKH SHRSOH LQ WKH FDVH VWXGLHV DUH SVHXGRQ\PV DQG WDNHQ ZLWK SHUPLVVLRQ IURP WKH ZRUN RI -DQ 7DDO 12
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1. Linz D. The effects of art therapy interventions in cancer care. Nijmegen: HAN University of Applied Sciences; 2014. 2. Fancourt D, Williamon A, Carvalho L, Steptoe A, Dow R, Lewis I. Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. Ecancer 2016; (10): 631. 3. Morriss-Kay GM. The evolution of human artistic creativity. Journal of Anatomy 2010; 216(2): 158–176. 4. Sheikh AA (ed). Healing images: the role of imagination in health. New York, NY: Baywood; 2003. 5. Assagioli, R. Psychosynthesis: a manual of principles and techniques. New York, NY: Hobbs, Dorman & Company; 1965 (p144). 6. Keysers C, Fadiga L. The mirror neuron system. Hove: Psychology Press; 2009. 7. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. Journal of Neural Transmission 2007; 114: 1265–1278. 8. Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS ONE 2010; 5(12): e15591. doi:10.1371/journal. pone.0015591. 9. Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron 2008; 59: 159–206. 10. www.imagerytoolbox.com 11. Alma H, Taal J. Verbeeldings Toolkit. Psychosociale Oncologie 2015; 23(1). 12. Taal, J. Course book Imagery Toolbox. Amsterdam: School for Imagery; 2017.
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Counselling changes lives
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Entering their world Working online with children and young people brings both joy and challenges, says Jeanine Connor THERAPY TODAY
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Contemplating the threat I started thinking in mid-March with supervisees, young people and families about potential contingency planning, as measures were put in place to try to contain the spread of the coronavirus. No one opted out, and the decisions we made to continue in-person sessions were based on honest communication and trust, established over weeks, months or years of working together. I realise now that we were literally trusting each other with our lives. In most sessions, young people said that they were sick of hearing about coronavirus. Some likened it to ‘the new Brexit’, and I could see what they meant. Several focused on the positives: the skies of Wuhan were blue again following bans on travel and the closure of factories; in Venice, fish, swans and dolphins had been spotted in the canals. I spoke to young people, using age- and developmentally appropriate language, about how we might need to change the way we worked. None of them were keen to do things differently, and it is to their credit that they valued the therapeutic boundaries highly enough to regard shifting them as alien and unwelcome. But we had no choice.
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his is f**king weird,’ exclaimed one adolescent lounging on his bed. ‘I’m not keen,’ grumbled another from the Wi-Fi hotspot halfway up the stairs. As the coronavirus pandemic took hold, I, like lots of other psychotherapists and counsellors, was given a bird’s-eye view into the private homes of young people as I shifted my practice online. I’ve worked this way before; it’s a service that suits some people for a variety of reasons: young people who have moved away to university, people I’ve never met in person who live overseas, those who are unable or unwilling to leave home for reasons such as illness, anxiety or agoraphobia. These individuals have benefited enormously from choosing to work online. And therein lies the rub; what’s happening now is not a choice.
Adjusting to social distancing On Friday 20 March, schools and colleges closed their gates to all but a few students, in line with Government instructions. Children and young people expressed
their excitement at no more lessons or early mornings. For Years 11 and 13, it meant no more revision, no GCSEs or A-levels. They were delighted. Or at least that’s how they said they felt. My sense was that they were bewildered. A large part of my caseload is made up of 15- to 16-year-olds whose entire existence had revolved around working towards their exams. The relief that they expressed at not having to sit them was palpable; they fully acknowledged for the first time the extent of the weight that had been lifted. I’m working with 17- to 18-year-olds too, for whom A-levels have symbolised a gateway to the future. Now those doors are closed. One young person told me his friends celebrated with an ‘end of the f**king world’ party, quoting the popular Netflix series with that title. I wondered what alternative routes young people would be forced to navigate towards their futures and what new obstacles they would have to overcome. I was also overwhelmed by a sense of what was lost – end of school performances, shared memories of shared experiences at leavers’ assemblies, scribbled messages on shirts and dressing up for proms. August results days will pass unobserved and thousands of young people may be underprepared for the most important transitions of their lives. The classes of 2020 are missing out. ‘Sh*t got real,’ as one young person said to me on 23 March, when the Government announced stricter social distancing measures and we were told to stay at home. Sh*t got real for counsellors and psychotherapists too, because we had to make tough decisions about if and how to continue working. Some people made an assumption that remote working isn’t suitable for children, underestimating both the capacity of young people to adapt, and the competence of
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children and young people (CYP) therapists to work this way. But the decision to work remotely with children and young people – or not – is complex, and should be made jointly between child, therapist and parent or carer, just as any decision to start or stop therapy should be made collaboratively. BACP’s Ethical Framework states that ‘anyone making significant differences in their practice should give careful consideration to what will be involved and have taken adequate steps to be competent in the new ways of working before offering services to clients’.1 I encouraged supervisees to consider how to take ‘adequate steps to be competent’, thinking together about their knowledge and previous experience, technological ability and the potential differences between in-person and remote working. None of us have received formal training in telephone or online counselling because, to my knowledge, it’s not included in any BACP or UKCP-accredited CYP training. Hopefully that will change.
Managing loss Some of my caseload, and that of my supervisees, includes children in care. Because they have a social worker and/ or an Education and Health Care Plan (EHCP), their carers have the option to send them to school. But everything else has changed – their social workers don’t visit and planned contact with their families has been cancelled indefinitely. For some, therapy has stopped indefinitely, too. One supervisee was informed by the agency he works for that it didn’t support remote counselling, either online or by telephone. He wasn’t given any prior notice and was therefore denied the opportunity to think about it with the young people he counsels. He felt distraught and told me in our online supervision, ‘It goes against so much of what’s important in counselling – the relationship, the consistency, planning for breaks and endings...’ We were able to process his sense of loss and the memories it evoked of historic losses, premature endings and lack of control. We could only hypothesise about the impact on young people. Children in care, in particular, endure multiple losses which often have a cumulative effect because they have been left unprocessed prior to therapy. ►
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The sudden breach in the therapeutic relationship is potentially devastating. I heard a comparable story from a counsellor who works in a school, where all counselling has ceased. Similarly, some parents who pay for private therapy have taken a decision to stop. It is difficult, in these circumstances, to contain the rage we might understandably feel towards whomever we hold responsible for discontinuing therapy, based on financial or practical considerations rather than therapeutic ones. A study by mental health charity YoungMinds of more than 2,000 young people found that 26% of those previously accessing mental health support were unable to do so due to the closure of schools and cancellation of peer support groups and in-person services that weren’t being offered online or over the phone.2 We might (internally) accuse the headteacher of devaluing counselling. We might (internally) hate the manager of the residential children’s home for severing the therapeutic relationship. We might (internally) feel furious towards the parent who doesn’t value therapy highly enough to be flexible. We might (internally) blame the Government for the reduction in our income if we are self-employed. All of these feelings are valid and will ideally be worked through in supervision and personal therapy. BACP’s ethical decision-making tool urges us: ‘Reflect upon the relational processes that have played out in the situation.’3 It’s been useful for me to consider any parallel processes between my feeling response to decisions that are beyond my control and what might be going on for the young person – a sense of not being valued, heard or respected enough, perhaps. Another important aspect to consider is the risk of relational breakdown, not just with the child but with their parent or carer, school or organisation. How we respond now will have implications for professional and therapeutic relationships when this is over, although it’s hard to think of the future just now.
Psychotherapy in lockdown Despite initial reluctance, most of my young clients who were able to do so continued their sessions remotely, illustrating the value they and their families place on therapy. It’s different to meeting in person and, in some cases, it’s been challenging, but we’re
‘The sudden breach in the therapeutic relationship is potentially devastating’ working it out, in the same way we’re used to working out new and challenging stuff together. I’ve opted to work online because it gives my clients the most flexibility. They have choices whether to use audio and/or video, text and images. As much as possible, I’ve kept online sessions at the same time as their in-person sessions, for continuity. I’ve included parents and carers in setting up the therapeutic frame in order to ensure a safe, confidential space where sessions won’t be seen, overheard or interrupted. Even in the most chaotic households, families have been willing to consider the importance of maintaining boundaries of time and space.
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While absolute security cannot be guaranteed in the digital world, I’ve taken every possible precaution to ensure safety and integrity and avoid unauthorised intrusion and technological botches. As psychotherapists, we are responsible for protecting online communication by using adequate password protection and data encryption to prevent intrusion and by installing adequate firewalls and virus protection.4 I’ve also advised families about how to protect security at their end, by shutting down the application after use, deleting the history and only using private Wi-Fi. As with in-person psychotherapy, I’m confident that I’ve done all that I can to create and maintain a safe online clinical space, bound by the terms and conditions of a sound therapeutic contract. In in-person work, my formulations are significantly informed by visual cues: how and where the young person moves and sits in the room and how they relate to the physical space. There’s nowhere to hide; there they are in front of me, and I in front of them. Online, there’s more control over what’s shown/seen or hidden/unseen, which I’ve found to be symbolic. I had one session with an adolescent who was up close to the camera, head lowered, wearing a hoodie. He spoke about how hard it was for him to feel validated at
home as a black, gay man, socially isolated with homophobic parents. ‘We’re really close together but worlds apart. It’s like they don’t even see me,’ he said. I hadn’t seen much more than the top of his hood for 50 minutes and I commented that I could sense how hard he was finding it to be seen. Another young person opted to have the video function on but pointed the camera at the floor, so that for 50 minutes all I saw were grey floor tiles. She spoke about the ‘vast emptiness of being grounded’ and how lonely she felt being away from her friends and boyfriend. We too have a choice about how much we show to our clients online and where we focus our gaze. Do we sit close to the camera so that only our head and shoulders are in the frame, or sit back, showing more of our physical self? Do we look into the camera, so that it seems to the young person as if we are looking at them, or do we look at the actual image of them on the screen? I think it’s important not only to consider our choices and notice theirs but also to name what we see – and don’t see – and explore it, as we would with anything else that gets brought into therapy. As well as noticing the seen/unseen parts, it’s important to consider what’s said and unsaid too. Some clients present as disinhibited when they connect remotely. A supervisee told me one young client had shared more in their first telephone session than they had in months of in-person work. We hypothesised about why this might be. Perhaps it’s easier to disclose without the scrutiny of the counsellor’s gaze. Perhaps that’s why many young people choose car journeys to share important stuff with their parents, as they sit behind or beside them, out of view, and perhaps it explains the traditional use of the couch in psychoanalysis. For some, it feels freeing to remove the intensity of the other’s gaze while at the same time continuing to feel contained and witnessed. For others, though, working remotely can have the opposite effect of inhibition. One adolescent I’m working with has always spoken openly and honestly in person, while online they presented as quiet and reserved. When I shared this observation, they told me they were worried about who might hear and what they might do with the
‘Self-isolation, social distancing, restrictions and lockdown are startling terms’ information. Responses to the YoungMinds survey similarly suggest that some young people have declined remote support due to concerns about privacy.
Different and the same As well as attending to the themes and patterns of psychotherapy, it’s also been important to address the new vernacular. Self-isolation, social distancing, restrictions and lockdown are startling terms. For children and young people, the terminology can be confusing. They get put in isolation if they misbehave. People worry about them if they become socially distanced. And lockdown sounds like an advanced version of being grounded. Even the meaning of familiar language has changed. I’ve heard people comment that the coronavirus crisis has brought out the best and worst in people. It’s a bit of a truism. What I’ve seen is that people have become an exaggerated version of themselves and are living an exaggerated version of their lives. The challenges faced by the gay adolescent who struggled with his sense of self in a family of homophobes precoronavirus haven’t changed, but they’ve become amplified. People who previously experienced symptoms of depression or anxiety feel even more overwhelmed. Parents, agencies and headteachers who were ambivalent about funding counselling might feel they’ve been given a legitimate reason to stop paying. Counsellors and therapists who were always flexible and client-centred, in the broadest sense, are discovering creative ways to work remotely. As for me, a talking therapist and author, I’m always fascinated by language. When you shrink the therapeutic frame to a computer screen, communication seems to matter more, whether it’s spoken or written. With so many enforced restrictions, our words are one of the few things that remain in abundance and within our control. They have never felt so precious. ■
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REFERENCES 1. BACP. Ethical framework for the counselling professions. Lutterworth: BACP; 2018. 2. Coronavirus: impact on young people with mental health needs. London: YoungMinds; March 2020. 3. BACP. Decision making for ethical practice. www.bacp.co.uk/media/6875/ bacp-ethical-decision-making-model.pdf 4. BACP. Working online in the counselling professions: Good Practice in Action fact sheet (GPiA 047). Lutterworth: BACP; 2019.
About the author Jeanine Connor is a child and adolescent psychotherapist, supervisor and trainer in private practice and editor of BACP Children Young People and Families. Her new book, 5HŴHFWLYH 3UDFWLFH LQ &KLOG DQG $GROHVFHQW 3V\FKRWKHUDS\ OLVWHQLQJ WR \RXQJ people (Routledge), is out now.
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ope can seem in short supply these days. My clients are more likely to mention it in terms of there being no hope, ‘for my job, my relationship, my children and the planet’. How we relate to clients around their hope, or their lack of it, is pivotal. This article explores three aspects of hope relevant to the therapeutic relationship. Should counsellors encourage clients to have hope? Are there problems with counsellor assumptions and beliefs about hope? How can we best facilitate clients to feel free to approach hope in their own way? It may surprise ‘positive thinkers’ to find that, in the ancient Greek myth, hope was in Pandora’s box among all the evils. It was put there by the god Zeus, as an act of revenge. In 700BC, the poet Hesiod said all ‘those who
‘A problem with hope is that it is both personal and instinctive’
hope are gullible’. Then, in the Christian era, St Paul maintained that we could hope because life was no longer bound by death. So hope came down to the modern world as a Christian virtue, along with faith and charity. This philosophical evil-versus-virtue debate is evident today, and it presents some dilemmas for talking therapists. Hope is good when it motivates clients to overcome their troubles, feel better and take empowering actions. It is not so good when people overuse it and avoid examining disturbances seated in the realities of their past and present.
Embedded in culture A problem with hope is that it is both personal and instinctive. We don’t tend to question ‘Why do I respond with a “glass half full” attitude to this situation?’ Rather, we tend to assume that our hopeful position is correct; it is defended as a healthier attitude, or, conversely, more realistic when our response is ‘half empty’. Socrates said, ‘An unexamined life is not worth living,’ and because hope is so instinctive in this way, it is easy to have unexamined beliefs about how other people should be in relation to hope. Such unexamined beliefs or assumptions are a questionable basis for doing therapy.
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Many of these beliefs about hope seem to be embedded in our present culture. We are told that being hopeful is an antidote to low mood, that adopting an optimistic outlook overcomes adversity, and that being hopeful is better for long-term relationships – but then also that anyone who is hopeful is deluded. Furthermore, as therapists we are surrounded by many powerful injunctions about hope, and it can be challenging not to pass them on to our clients. For example, therapists may be influenced by the digital commercial world we all inhabit. Marketing and advertising campaigns show everything as upbeat, with the promise of a better life. Add to this the apparently joyous lives being led by our social media ‘friends’, and we are left with an insidious message of hope to which we must always aspire and be upbeat or we will be left behind. Therapists may say that they do not let these things influence them when they are with clients. However, while we may lead more self-examined lives, we are far from immune from this culture of commercial aspirations. ‘I am a positive person’, ‘upbeat’, ‘hopeful’, ‘buoyant’ we say on our directory profiles.1 Even therapists and coaches are using hope to
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sell their wares and imply promises that they may not be able to keep. Additionally, injunctions that we should be positive and hopeful exist at a deeper level: hope is embedded into our spiritual lives. A belief in an afterlife or spiritual world in any form is, for many, the seat of hopefulness, as it was for St Paul. Those in the helping professions with these convictions often cite evidence showing that people who have spiritual or religious beliefs are more hopeful and psychologically resilient.2 It is difficult not to unconsciously carry such deeply held beliefs into the work and this may be unsuitable for the therapeutic relationship with many clients. A further influence on talking therapists at present is that positive thinking has become extremely fashionable in both counselling and coaching. Behavioural and mindful methods of dealing with ‘negative’ thoughts and moving towards more ‘positive’ ones have certainly helped many people. However, there now seems to be an assumption in many talking therapy circles that these methods are a cureall. I question this.
Seed potatoes At the humanistic end of the range of therapies, some injunctions about hope are also being challenged. Carl Rogers, on whose shoulders many of us stand, had what now seems a rather hopeful 1960s attitude. In a much-quoted metaphor, he said that, given the right conditions, all seed potatoes will eventually grow, reaching for the light, and have the potential to ‘self-actualise’.3 Today, snowballing inequality means that many seed potatoes seem doomed to life conditions of complete darkness. This phenomenon is increasingly evidenced in our consultation rooms, and for therapists to advocate ‘positive thinking’ could mark a denial of reality of Orwellian proportions. This leads to another unexamined assumption that therapists may now be carrying when they meet clients: hopelessness. Many commentators foresee doom in our politics, our society and our planet. Therapists inclined to this view may find themselves running a counter sub-script in sessions with people with a hopeful outlook. In addition to all these cultural influences, the notion of hope is enticing for therapists as it makes them feel good. Like many others, ►
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I have experienced how life-affirming it is to hear clients move to more positive feelings about themselves and their future; it implies I have done a good job. So the drive to be proactive in moving clients towards a more hopeful attitude is pushed by a personal need. And it is pulled by the fact that sitting with clients who feel relentlessly hopeless can be acutely uncomfortable. If we carry unexamined assumptions about hope, they can interfere with the three basic core conditions.4 Empathy, for example, can become a challenge: the nature of a client’s no-hope world is unimaginable if we are carrying a sedimented belief that there must always be some hope. Nor can we be fully genuine or congruent with the person who is exploring the darkness of hopelessness if we have pressing and repeated thoughts that some ‘positivity’ is the route back to health. Equally, it is hard to be fully accepting if we find ourselves asking why on earth this person is denying reality by continually ‘looking on the bright side’.
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So how should we manage the tricky subject of hope with our clients? Every therapist will find their own way of course. However, it is useful to discriminate between two different ways of talking about a desired future. The difference between them can be subtle yet significant. The first approach is when we say something like, ‘There is also the potential of a good outcome for you.’ Although this may be appropriate on occasions, it imposes a condition; it guides the client to focus on the positive– what the therapist wants. The second approach is illustrated by a therapist asking, ‘How would you really like things to be eventually?’ This asks the client to imagine or envision the future that he or she desires. When people imagine what they really want in the future, they are gaining understanding about who they are. Counselling is a place where people have the possibility to look within themselves and accept what they see – their deepest, heartfelt likes and dislikes. Only then can they gain the power to make their own choices about the future. Imagining a desired future with a client is different from imposing a message that they must cling onto hope and ‘think positively’ – an attitude that prioritises the action of
hoping over the content. Hope may be a wonderful symptom of improvement, but this does not mean it leads us directly onto the path forward. This article was inspired by two past counselling experiences. In the first, a couple began by saying they had been together for so long, it would ‘be such a waste to throw it all away’. It transpired that, underneath their apparent hopefulness, bitterness had simmered for years. Yet I sensed an injunction to make things work; I was asked for help and now I embodied their hope. Our sense of failure inexorably progressed, with each session exposing further ugly realities. Supervision revealed how obstructive my hope was. I realised how important it was for their children’s future, and theirs, for me to stop trying; then we could all manage better the sad reality of inevitable separation. I learned that my role was to accept reality, not to embody hope. Later I worked long-term with an abuse survivor who was chronically job-stressed and depressed. One day he began, ‘I have at last realised something that comforts me.’ My hopes leapt after years of bleakness. He said, ‘My future is to continue in this job and caring for my parents until they die. I will then retire and wait to die myself.’ I felt shocked and said, ‘That makes me sad. I had hoped for better for you.’ He replied, ‘F**k your hope! I had just worked out how to not feel disappointed all the time.’ This initiated a journey towards a more enabling relationship; I was released
‘When it comes to hope, it is not our job to try to direct our clients’
About the author Nicholas Willatt MBACP (Snr Accred) is a counsellor, supervisor and trainer who has been working in the profession since 1980. He has specialised in couples work DQG LV D TXDOLĆ“HG DQG H[SHULHQFHG imago therapist. He also has H[WHQVLYH H[SHULHQFH RI ZRUNLQJ ZLWK VXEVWDQFH XVHUV GLIĆ“FXOWLHV between teenagers and their families, and loss and grief. He is the creator of the relationship website www.relationshipegg.com
REFERENCES 1. BACP Therapist Directory. www. bacp.co.uk/search/Therapists (accessed January 2020). 2. Mental Health Foundation. Keeping the faith: spirituality and recovery from mental health problems. London: Mental Health Foundation; 2007. 3. Rogers CR. The Carl Rogers reader. London: Constable & Robinson; 1997. 4. Rogers CR. The necessary and VXIĆ“FLHQW FRQGLWLRQV RI WKHUDSHXWLF SHUVRQDOLW\ FKDQJH b-RXUQDO RI &RQVXOWLQJ 3V\FKRORJ\ ĹŠ b
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to hold his hand on useful visits to the dark realities of his no-hope world. Hope is not always the ‘brave saviour’. It is my strong personal opinion that, when it comes to hope, it is not our job to try to direct our clients; we are not responsible for them in that way. It is our job to bracket our own preconceived ideas and to remain empathic and accepting, however hopeful or hopeless our clients may feel. I believe that this is particularly challenging in today’s world; it is only possible after significant personal reflection and examination of our own beliefs and assumptions about where we stand in relation to hope. Clients are seldom wrong. The consulting room is a place where they should feel absolutely and completely free to find their own hope for themselves, in their own way – or not, as the case may be. â–
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herapy more than changed my life; it’s been a vital component of my existence. I’ve had the privilege of being able to seek help both in times of crisis and in calmer periods when I’ve simply wanted to work something out with the guidance of an objective, trained professional. I seem to be almost entirely unembarrassed about this, often merrily informing strangers, ‘I’m off to see my shrink.’ I do believe that, if you possibly can, being open about therapy is helpful to others. As far as I knew, therapists didn’t exist when I was growing up in rural Devon in the 1970s. Well, it turns out that the odd one did, but along with Indian and Chinese takeaways, tutors, good orthodontics or any of the standards of modern urban life, they simply weren’t visible in a time and place more marked by wild pony traffic jams and schools that tolerated illiteracy. Escaping to London at the age of 18, I fell in with a – to me – glamorous crowd in which serial divorce, celebrity friendships and psychoanalysis were perfectly normal. By the age of 23, influenced by these new friends, I was fixed up with my first therapist, who saw me through serial weeping fits about my mother and, it turned out, kept half an eye on the newspapers because she actually believed my claim that I was going to be a writer. When it happened some years later, she wrote to me, and my memories of her good work came back. She was my ‘starter’ therapist – just right for the time; not too deep, a bit maternal and very kind. My father died when I was in my 20s and she helped me through that, as did a bereavement counsellor, who gave her services for free when I was wracked with guilt and grief.
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I went for almost a decade without help and then, for the first and last time, I did the proper couch analysis stuff. She was Kleinian, strict and boundaried. Out poured my childhood in more detail. If that hadn’t been unpacked, aired and analysed, I don’t think I’d have become the halfway functioning adult I am. She helped me see the pattern of my somewhat extreme love life, to the point that I was genuinely no longer interested in repeating that pattern. To me, it really does take someone else to spot, unearth and make you start to see those patterns themselves. Friends can certainly help, but friends are subjective and not paid to open up unpalatable truths. My friends have helped enormously over the years, but a well-trained, experienced professional can, over time, work magic – often subtle, and sometimes in the form of epiphanies. I’ve also had an experience of therapy that was not so good and that sent me to yet another therapist to work on the damage it caused. I also have a friend who had an affair with their therapist, which did untold harm and inspired me to write about boundarybreaking in my new novel. Mercifully, such therapists are the exception. I’m currently seeing – or Zoom conferencing in Covid-19 lockdown – a therapist who has kept me going through a difficult time, has calmly and safely helped and is my weekly prop, however much I don’t feel like it. We live in an age in which therapy is not a dirty secret. If they can afford it or can manage the NHS waiting lists, I thoroughly recommend that everyone sees a therapist. It’s not navel gazing. It’s just a pretty wonderful feature of modern life. ■
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About the author Joanna Briscoe is a journalist, broadcaster and novelist. She grew up in the West Country, and now lives in London. Her sixth novel, The Seduction, is published by Bloomsbury on 11June. www.joannabriscoe. com The
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Finding meaning after loss Nothing in his professional life as a grief specialist prepared David Kessler for the loss he experienced with the death of his son
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n 1969, Elisabeth Kübler-Ross identified the five stages of dying in her groundbreaking book On Death and Dying. As a psychiatrist, she saw that patients who were dying appeared to go through common experiences, or stages. Her work captured the world’s attention and would forever change the way we talk and think about death and dying. She ushered the truth of this universal experience out of shadowy euphemism and into the light. Decades later, I was privileged to be her protégé, friend and co-author of two books. In the second book we wrote together, On Grief and Grieving, which was her last, Elisabeth asked me to help adapt the stages she’d observed in the dying to account for the similar stages we’d observed in those who are grieving. The five stages of grief are denial (shock and disbelief that the loss has occurred), anger (that someone we love is no longer here), bargaining (all the what-ifs and regrets), depression (sadness from the loss), and acceptance (acknowledging the reality of the loss). These stages were never intended to be prescriptive, and this holds true for both dying and grieving. They are not a method for tucking messy emotions into neat packages. They don’t prescribe, they describe. And they describe only a general process; each person grieves in his or her own unique way. Nonetheless, the grieving process does tend to unfold in stages similar to those we described, and most people who have gone through it will recognise them. In the years since that book’s publication, I’ve experienced a great loss
myself, and I can confirm that the five stages really do capture the feelings we experience as we grapple with the death of loved ones. The fifth of Kübler-Ross’s five stages is acceptance. At this stage, we acknowledge the reality of the loss. We take some time to stop and breathe into the undeniable fact that our loved ones are gone. There’s nothing easy about this stage. It can be extremely painful, and acceptance doesn’t mean that we’re OK with the loss, or that the grieving process is now officially over. However, there’s been an assumed finality about this fifth stage that Elisabeth and I never intended. Over the years, I came to realise that there’s a crucial sixth stage to the healing process: meaning. This isn’t some arbitrary or mandatory step, but one that many people intuitively know to take and others will find helpful. In this sixth stage, we acknowledge that, although for most of us grief will lessen in intensity over time, it will never end. But if we allow ourselves to move fully into this crucial and profound sixth stage – meaning – it will allow us to transform grief into something else, something rich and fulfilling.
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Empowering Through meaning, we can find more than pain. When a loved one dies, or when we experience any kind of serious loss – the end of a marriage, the closing of the company where we work, the destruction of our home in a natural disaster – we want more than the hard fact of that loss. We want to find meaning. Loss can wound and paralyse. It can hang over us for years. But finding meaning in loss empowers us to find a path forward. Meaning helps us make sense of grief. When working with people whose loved ones have died, I often see how hard they search to find meaning in it. It doesn’t matter whether the death occurred after a long, debilitating illness, or if it came as a total shock after an accident or something else sudden and unexpected. There’s often a desire to see meaning in it. What does meaning look like? It can take many shapes, such as finding gratitude for the time we had with the loved one, or finding ways to commemorate and honour them, or realising the brevity and value of life and making that the springboard into some kind of major shift or change. Those who are able to find meaning tend to have a much easier time grieving than those who don’t. They’re less likely to remain stuck in one of the five stages. For those who do get stuck, it can manifest in many different ways, including sudden weight gain (or loss), drug or alcohol addiction, unresolved anger, or an inability to form or commit to a new relationship out of fear of experiencing yet ►
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another loss. If they remain stuck in loss, then they may become consumed by it, making it the focus of their life to the point where they lose all other sense of purpose and direction. Although you can’t pin all your troubles or vices on getting stuck after a loss, there’s almost always a connection.
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Grief is extremely powerful. It’s easy to get stuck in your pain and remain bitter, angry or depressed. Grief grabs your heart and doesn’t seem to let go. But if you can manage to find meaning in even the most senseless loss, you can do more than get unstuck. When circumstances are at their worst, you can find your best. You can keep growing and finding ways to live a good and, some day, even a joyous life, one enriched by the lessons and love of the person who died. Nothing in either my personal or my professional life as a grief specialist had prepared me for the loss I experienced with the death of my 21-year-old son. This was a loss so shattering that, despite all the years I’d spent helping others through their grief, I didn’t know if there was anything that could assist me through my own. And, despite my awareness that the search for meaning is one of the keys to healing from grief, I didn’t know if there was any way I could find meaning in this loss. Like so many others who grieve, something in me felt that my grief was too great to be healed. In 2000, I’d adopted two wonderful boys from the Los Angeles County foster care system. David was four years old and his brother, Richard, was five. By that time, the two of them had been in five different foster homes and had one failed adoption. Addiction in their family background had hindered their permanent placement, as had the fact that David had been
CLIENT
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Grief, 2
Experience
born with drugs in his system. When I heard that, I feared it might mean something was wrong with him that wouldn’t be fixable. But it only took looking at the faces of those two little boys to tell me that love conquers all. The adoption went through, and in the years that followed, my belief in the power of love appeared to be confirmed. David and Richard both made an amazing turnaround and were wonderful kids. Unfortunately, the trauma of David’s younger years came back to haunt him when he became a teenager. At around 17, David began experimenting with drugs. Luckily, he came to me not long afterwards and told me he needed help. In the next few years, our lives were filled with rehab and 12-step programmes. By the time he was 20, however, he was sober, in love with a wonderful woman who was a recent social work graduate, and entering his first year in college. David had shown a real interest in following a career in medicine, and I felt hopeful. But then, a few days after his 21st birthday, he made some typical relationship mistakes, and he and his girlfriend broke up. He met up with a friend from rehab who was also having a tough time, and they used drugs again. The friend lived. David died. I was across the country on a lecture tour when I received a call from Richard, sobbing that his brother was dead. In the months that followed, I was in an agony of grief. Fortunately, I was surrounded by friends and family who saw me not as a grief expert but as a father who had to bury his son.
SHUTTERSTOCK
Hitting bottom My friend Diane Gray, who headed the Elisabeth KĂźbler-Ross Foundation at the time and is a bereaved parent herself, told me, ‘I know you’re drowning. You’ll keep sinking for a while, but there will come a point when you’ll hit bottom. Then you’ll have a decision to make. Do you stay there or push off and start to rise again?’ What she said felt true. I knew in that moment that I was still in the deep end of the ocean, and I also knew that I was going to have to stay there for a while. I wasn’t ready to surface. But even then, I felt I would continue to live, not only for the sake of my surviving son but for my own sake as well. I refused to allow David’s death to be meaningless or to make my life meaningless. I had no idea what
FINDING MEANING  Meaning is relative and personal.  Meaning takes time. You may not ƓQG LW XQWLO PRQWKV RU HYHQ \HDUV after loss.  Meaning doesn’t require understanding. It’s not necessary to understand why someone died in RUGHU WR ƓQG PHDQLQJ  2QO\ \RX FDQ ƓQG \RXU RZQ PHDQLQJ  Meaningful connections will heal painful memories.
I would do to wrest meaning from this terrible time. For the moment, all I could do was to go through KĂźbler-Ross’s stages and allow them to unfold as slowly as I needed. Still, I knew I couldn’t and wouldn’t stop at acceptance. There had to be something more. At first, I wasn’t able to find any consolation in memories of my love for my son. I had a lot of anger at that time – at the world, at God and at David himself. But in order to go on, I knew I’d have to find meaning in the grief I was feeling. In my deep sorrow, I thought about a quote I share at my lectures: grief is optional in this lifetime. Yes, it’s true; you don’t have to experience grief, but you can only avoid it by avoiding love. Love and grief are inextricably intertwined. As Erich Fromm is widely quoted to have said: ‘To spare oneself from grief at all costs can be achieved only at the price of total detachment, which excludes the ability to experience happiness.’ Love and grief come as a package deal. If you love, you will one day know sorrow.
’Love and grief come as a package deal. If you love, you will one day know sorrow’ THERAPY TODAY
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 Your loss is not a test, a lesson, something to handle, a gift, or a blessing. Loss is simply what happens to you in life. Meaning is what you make happen.  (YHQ ZKHQ \RX GR ƓQG PHDQLQJ you won’t feel it was worth the cost of what you lost. From Finding Meaning: the sixth stage of grief by David Kessler (Rider Books £14.99)
I realised I could have skipped the pain of losing David if I’d never known and loved him. What a loss that would have been. In the moment when I really began to understand that, I found gratitude for my son having come into my life and for all the years I got to spend with him. They weren’t nearly long enough, but they’d changed and enriched my life immeasurably. That was the beginning of my being able to see something meaningful in my grief. As time goes by, I’ve been able to keep finding deeper meaning in David’s life as well as in his death. Meaning is the love I feel for my son. Meaning is the way I’ve chosen to bear witness to the gifts he gave me. Meaning is what I’ve tried to do to keep others from dying of the same thing that killed David. For all of us, meaning is a reflection of the love we have for those we’ve lost. Meaning is the sixth stage of grief, where the healing often resides. Copyright Š 2019 by David Kessler
About the author David Kessler MA, RN is an expert on healing after loss. He is the author of six books, and a co-author with Elisabeth KĂźbler-Ross and Louise Hay.
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Online lessons
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What has working remotely taught you?
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‘We have to adapt to survive’
PRODUCTION CLIENT
Private practice is a business and I’ve always been surprised by the number of counsellors who were resistant to providing online services and insist on traditional methods of payment. We’re supposed to be facilitating clients to be less limited in the world, yet so many therapists work in a limited way themselves. While we could never have envisaged this situation arising, I think my willingness to embrace modern methods has helped me weather the Covid-19 storm. While I understand online counselling might not be for everyone, I think it’s important that we, as contemporary practitioners, are stretched. This period brings home the need to embrace modern methods, move with the times and stay relevant, because clients deserve choice and convenience. And we need to futureproof our businesses by adapting now and for the future. If we don’t, we won’t survive, let alone thrive.
‘We can read each other’s faces more closely on screen’ 7KH PDLQ WKLQJ ,Ĺ?YH OHDUQHG LV WKDW P\ FROOHDJXHV ZKR KDYH EHHQ SUDFWLVLQJ RQOLQH IRU \HDUV DOUHDG\ ZHUH DEVROXWHO\ ULJKW UHPRWH ZRUNLQJ LV QRW ĹŒVHFRQG EHVWĹ? ,W KHOSHG WKDW , OLNHG WKH GHVLJQ RI =RRP 3UR LPPHGLDWHO\ , Ć“QG WKH ĹŒLQYLWDWLRQ WR D PHHWLQJĹ? IRUPDW VKDUSHQV WKH GHĆ“QLWLRQ RI WKH WKHUDSHXWLF IUDPH , VRRQ DOVR OHDUQHG ZLWK UHOLHI WKDW WKH ZDUP IHHOLQJV RI FRQQHFWLRQ DQG UHDO XQGHUVWDQGLQJ WKDW DUH VR YLWDO WR HIIHFWLYH WKHUDS\ DUH QRW ORVW LQ WKH ĹŒ]RRPRVSKHUHĹ? ĹŠ DW OHDVW QRW ZLWK FOLHQWV , ZDV VHHLQJ EHIRUH ORFNGRZQ :LWK QHZ FOLHQWV WKH PHGLXP VHHPV WR HYRNH D GLIIHUHQW NLQG RI LPPHGLDF\ DQG LQWLPDF\ WKDWĹ?V EHHQ XQH[SHFWHGO\ EHQHĆ“FLDO 6RPH RI WKH VXEWOH UHFLSURFLW\ RI SK\VLFDO HQFRXQWHUV LV ORVW EXW ZLWK JRRG TXDOLW\ ZHEFDPV QRW DOZD\V WKH FDVH ZH FDQ UHDG HDFK RWKHUĹ?V IDFHV PRUH FORVHO\ RQ VFUHHQ HQKDQFLQJ WKH WKHUDSHXWLF GLDORJXH 0RUH SUDFWLFDOO\ ,Ĺ?YH OHDUQHG WR PDNH VXUH SHRSOH WDNH WLPH EHIRUH DQG DIWHU HDFK VHVVLRQ DV WKH\ ZRXOG ZKHQ WUDYHOOLQJ WR VHH PH LQ SHUVRQ WR SURYLGH D SHUVRQDO ERXQGDU\ DURXQG WKH WKHUDS\ VSDFH )RU P\VHOI DQ RQ VFUHHQ GHWDLO ,Ĺ?YH QRWLFHG LV KRZ , KXQFK P\ OHIW VKRXOGHU ZKHQ ,Ĺ?P FRQFHQWUDWLQJ LQWHQVHO\ ,WĹ?V JRRG WR EH DEOH WR UHOD[ WKDW FRQVFLRXVO\ QRZ IRU P\ RZQ EHQHĆ“W DQG VWLOO JLYH P\ EHVW DWWHQWLRQ Jim Holloway, counsellor and supervisor
â&#x20AC;&#x2DC;I canâ&#x20AC;&#x2122;t wait until I sit opposite someone in person againâ&#x20AC;&#x2122; 7KH ORFNGRZQ KDV IXUWKHU VROLGLĆ&#x201C;HG P\ YLHZ WKDW WKH DELOLW\ WR VLW GRZQ DQG UHDOO\ WDON DQG OLVWHQ WR VRPHRQH LV D OX[XU\ 2XU EXV\ OLYHV KDYH PHDQW WKDW WLPH KDV EHFRPH D SUHFLRXV FRPPRGLW\ DQG RIWHQ FRQYHUVDWLRQV DUH VQDWFKHG UXVKHG RU XQĆ&#x201C;QLVKHG <HDU RQ \HDU PRUH FRPPXQLFDWLRQ WDNHV SODFH GLJLWDOO\ ZLWK HPRMLV XVHG WR FRPPXQLFDWH KRZ ZH IHHO P\ PRVW XVHG HPRML LV Ĺ&#x152;ODXJK WLO \RX FU\Ĺ? IDFH ,Ĺ?YH DOZD\V UHJDUGHG LQ SHUVRQ WKHUDS\ DV VRPHWKLQJ SUHWW\ VSHFLDO %HLQJ DEOH WR VSHQG DQ KRXU HDFK ZHHN IRU D FRQVHFXWLYH QXPEHU RI ZHHNV WDONLQJ WR VRPHRQH RSHQO\ LV TXLWH D UDULW\ $V LV EHLQJ OLVWHQHG WR ZLWKRXW WKH ULVN RI GLVWUDFWLRQV VQDWFKLQJ DZD\ WKH IRFXV :RUNLQJ RQOLQH RU E\ SKRQH SURYLGHV D JRRG DOWHUQDWLYH LQ WLPHV RI FULVLV EXW , FDQĹ?W ZDLW XQWLO , VLW RSSRVLWH VRPHRQH LQ SHUVRQ DJDLQ , DP ORRNLQJ IRUZDUG WR ZKHQ , FDQ VHH D SHUVRQĹ?V ZKROH ERG\ QRW MXVW D KHDG WR EHLQJ DEOH WR VHQVH WKH WLQ\ ERG\ PRYHPHQWV WKDW WKH FDPHUD GRHVQĹ?W FDSWXUH DQG IHHO WKH HQHUJ\ LQ SHUVRQ DJDLQ 7KHUDS\ LQ ORFNGRZQ KDV PDGH PH UHDOLVH MXVW KRZ PXFK RI LQ SHUVRQ FRXQVHOOLQJ FDQĹ?W EH UHSOLFDWHG Nicola Strudley, psychotherapist and coach
Indira Chima, therapeutic counsellor
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JUNE 2020
Talking Point, 1
Talking point
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SHUTTERSTOCK
â&#x20AC;&#x2DC;Virtual work may not be perfect, but it is good enoughâ&#x20AC;&#x2122; I am a counsellor who also manages an acute oncology support service based at the Royal Surrey Hospital in Guildford. Before Covid, I was a fervent opponent to online counselling, believing that in-person counselling would always be best. But I have discovered that, while virtual work may not be perfect, it is good enough. From seeing families (dad in hospital, mum and kids at home), to running online family bereavement groups and supervision, my perspective has shifted. I have been moved by my online sessions and comforted that, even though we are not in the room together, we are still connected. I have had to adjust to working at home, my â&#x20AC;&#x2DC;sacred spaceâ&#x20AC;&#x2122;, and also to abrupt beginnings - once we press that keyboard button, we are on! And pushing the â&#x20AC;&#x2DC;offâ&#x20AC;&#x2122; button at the end feels equally sudden and even harsh. Most of our clients are grateful we are reaching out virtually and, although some have refused to move online, a few have said they prefer working this way. Post-lockdown, now that we have lifted the lid on virtual counselling, my feeling is that it will be here to stay. It makes sense to offer this service to clients who, for example, may not be well enough to attend an in-person session. As a profession, I am sure our learning and insights from this incredible and strange time will not be lost. Julie Cole, head of counselling for the Fountain Centre
THERAPY TODAY
THIS MONTHâ&#x20AC;&#x2122;S TALKING POINT IS COMPILED BY SALLY BROWN
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The bookshelf
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Peer Counselling in Schools: a time to listen Helen Cowie and Sonia Sharp (eds) 5RXWOHGJH e
ART PRODUCTION COMPILED REVIEWS BY JEANINE CONNOR
CLIENT
:KHQ WKLV VKRUW ERRN ZDV Ć&#x201C;UVW published in 1996, I can imagine that it was read with great interest by educational professionals looking for a systemic or whole-school response to the issue of bullying. Certainly, the six case examples in part two make for inspirational reading. However, in the interim 24 years, much has changed in societal and school-based counselling landscapes. I am not sure why the book has been republished with no update in either case examples or new research. There is only one amendment that gives a passing mention to the Data Protection Act. No mention is made of the impact of online or social media on children and young people, or how bullying manifests itself in these virtual environments. There is no mention of some of the most concerning current issues, such as online grooming or county lines, and no mention either of any of the huge statutory changes in the UK, such as the Welsh Governmentâ&#x20AC;&#x2122;s funding of statutory school counselling provision from 2008. No credence is given to the development of schoolbased counselling, or any mention of accrediting bodies such as BACP, UKCP and COSCA using Professional Standards Authority registration. What is helpful, however, is the acknowledgement that a school-based counselling service will only work if it is truly a whole-school approach. But, overall, it reads like the reissue of a title from the back catalogue without the original writersâ&#x20AC;&#x2122; input. Julie Blackman-Nandi is a transitional space therapist
Mental Health and Wellbeing: intercultural perspectives (foundations of mental health practice) Charles Watters (Macmillan, ÂŁ25.99) This slim volume provides a cutting-edge overview of intercultural perspectives in mental health. It takes a broad, socialmodel approach to mental distress and concludes that, although, worldwide, we live in times of increasing hostility towards migrants, there is also huge potential for drawing together diverse healing traditions. Central to the authorâ&#x20AC;&#x2122;s argument is the importance of explanatory models: that the way in which an illness is represented has consequences for wellbeing. Too true, as the media representation of the current Covid-19 pandemic illustrates. Although written well before the pandemic, the book contains much of relevance to our current predicament. Does coronavirus cause a PLOG FRXJK RU D OXQJ Ć&#x201C;OOLQJ OLIH WKUHDWHQLQJ pneumonia? Of course, it does both. But LW LV GLIĆ&#x201C;FXOW WR KROG RQWR ERWK DVSHFWV DW once. What you believe, and therefore how you behave, will depend on your age, health and capacity to tolerate self-isolation. Drawing on the work of the anthropologist Tanya Luhrmann and his own research in healing churches in Brazil, Watters examines the role of religion, nature and place in the healing process. Parallels are drawn between healing through prayer and psychotherapy practice, centred on Winnicottâ&#x20AC;&#x2122;s work on transitional objects. This section really spoke to me and could be of particular relevance to WKRVH FRQĆ&#x201C;QHG WR WKHLU KRPHV LQ IHDU and isolation. I would have liked more case studies and some mention of the psychodynamics of forced migration. That aside, this is a timely summary of theory, policy and practice on the impact of migration on mental health. Jane Cooper is a former senior counsellor at the University of Cambridge
THERAPY TODAY
BLACK YELLOW MAGENTA CYAN
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JUNE 2020
Conquer the Clutter: strategies to identify, manage, and overcome hoarding Elaine Birchall and Suzanne Cronkwright -RKQV +RSNLQV 8QLYHUVLW\ 3UHVV e
Informed by her practice as a social worker and specialist hoarding coach, Birchall is an integrative practitioner Conquer with a multidisciplinary approach to working with the people overwhelmed by Clutter hoarding. She struck me as the type of practitioner who is not afraid to roll up her sleeves and get stuck into the physical, psychological and emotional environment of her clients. The complexity of hoarding and KRDUGLQJ GLVRUGHU LV GHĆ&#x201C;QHG XVLQJ D YLVXDO guide that takes the reader into the home environment. Written in plain language, the book is presented in three sections. Section RQH GHĆ&#x201C;QHV KRDUGLQJ DQG FOHDUV WKH SDWK to understanding the clutter and associated thinking patterns. Birchall offers a variety of assessment tools to help practitioners address issues such as risk and onward referrals. Section two outlines preliminary methods used to organise thinking and the environment and moves on to maintenance and inspiration, integrating some deeply moving case studies. The book concludes with a resource section. Many books about hoarding describe the issue rather than attempt to offer ways to address or understand it. Birchall goes further, by tackling some of the deeper FRPSOH[LWLHV 7KH EHQHĆ&#x201C;W RI WKLV ZDV DOVR the challenge. I felt, ironically, that it was strewn with ideas, such as identity and epigenetics, that were not fully explored. Unconscious processes like shame and disgust were alluded to but left unnamed and unaddressed. For me, this felt like a missing piece and a parallel process perhaps to the issue in hand. That said, there is much to learn from this comprehensive manual; a fascinating guide to the overwhelming and impenetrable. Georgie Bainbridge is a psychologist and psychotherapist
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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 Steps to Recovery: a clinicianâ&#x20AC;&#x2122;s guide Graeme Flaherty-Jones and Sarah Dexter-Smith 6DJH e
This practical and straightforward guide from two practising clinicians places individual experience at the heart of mental health recovery and can be readily applied in the real world. The eight chapters are structured as session plans, with accompanying worksheets, all of which are available online. Areas covered include setting goals for living a meaningful life, exploring individual resources, identifying support networks and making a relapse plan. The material is suitable for group or individual sessions with clients who want to start or revisit their recovery journeys. A composite worksheet is included, which can be used by clients to make note of key points in each session, so they have an aide-memoire to take away at the end of the work. There is an emphasis on tailoring the sessions, with the authors recommending clinicians run them in an order that makes sense for each person they work with and skip parts that do not resonate. They provide examples of how they share their own experience of recovery where it can be of value to clients and encourage clinicians to do the same. Narrative therapy techniques are used to support individuals to tell their own recovery story. One such step involves LQYLWLQJ D VLJQLĆ&#x201C;FDQW SHUVRQ LQ WKH FOLHQWĹ?V MRXUQH\ WR D MRLQW UHĹ´HFWLRQ VHVVLRQ 8VHG wisely, the inclusion of this step may help clients begin to feel seen and heard beyond the therapist-client relationship. What stands out is the use of narrative therapy techniques in the context of recovery and the congruent, cogent guidance on supporting individual recovery within therapy sessions. Both novice and seasoned practitioners will Ć&#x201C;QG VRPHWKLQJ RI XVH DQG WKH ERRN ZLOO particularly appeal to clinicians who want to hit the ground running. Zorana Halpin is a counsellor
A Clinicianâ&#x20AC;&#x2122;s Guide to Gender Identity and Body Image: practical support for working with transgender and gender-expansive clients Heidi Dalzell and Kayti Protos -HVVLFD .LQJVOH\ 3XEOLVKHUV e
This guide will help therapists understand eating disorders in transgender or genderexpansive clients and how these can differ, both in origin and in manifestation, from those experienced by cisgender clients. The authors stress our UHVSRQVLELOLW\ WR Ć&#x201C;UVW HGXFDWH RXUVHOYHV about gender identity and diversity and then to keep this in mind when working with clients who present with disordered HDWLQJ RU GLIĆ&#x201C;FXOWLHV DURXQG ERG\ LPDJH At the end of each chapter, the authors offer prompts for further exploration, LQYLWLQJ XV WR UHĹ´HFW RQ WKH WRSLFV ERWK personally and in relation to our clients. The book is rich in clinical vignettes. In one, Rickie, a 16-year-old transgender client assigned female at birth, began eating more restrictively to make â&#x20AC;&#x2DC;my body right and to get rid of curvesâ&#x20AC;&#x2122;. In response, his mother said he looked â&#x20AC;&#x2DC;like an ugly girl, not a boyâ&#x20AC;&#x2122;. Here, as with several of the examples, the outset of disordered eating is intrinsically linked to a disconnect between assigned sex and gender identity â&#x20AC;&#x201C; a subtlety that might not immediately be picked up by an uninformed practitioner. Other clinical examples demonstrate the harm that can be done to clients who have been pathologised by professionals because of their gender identity and expression. Regrettably, it seems these experiences are not uncommon. Indeed, as well as offering practical guidance, this book is also an important call to action for therapists to understand the marginalisation and trauma faced by our transgender clients and to translate this into being explicitly and actively inclusive in our practice. Emmanuelle Smith is a psychodynamic psychotherapist in training
THERAPY TODAY
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The book that shaped my practice
The Gift of Therapy Irvin D Yalom (Piatkus, 2002)
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VERSION
Clinical wills
REPRO OP
OUR ETHICS TEAM CONSIDERS THIS MONTHâ&#x20AC;&#x2122;S DILEMMAS:
BREAKS AND ENDINGS SUBS ART
Unwanted emails
Loose ends
â&#x20AC;&#x2DC;My client has agreed on a break while the lockdown period is in force. However, they have taken to sending me emails letting me know how they are getting on. Is this OK?â&#x20AC;&#x2122;
â&#x20AC;&#x2DC;I gave all my clients the option of pausing or ending their therapy during WKH ORFNGRZQ IRU Ć&#x201C;QDQFLDO UHDVRQV 0DQ\ more opted to end than I expected, and I am now concerned that I didnâ&#x20AC;&#x2122;t do any ending sessions to tie up loose ends. 6KRXOG , KDYH LQVLVWHG RQ KDYLQJ Ć&#x201C;QDO sessions with these clients?â&#x20AC;&#x2122;
PRODUCTION CLIENT
THE RESPONSE TO YOUR DILEMMA may vary depending on the terms of the break. For example, did you or the client initiate the break? Did you identify alternative crisis support services? Did you discuss with your client who would make the first contact afterwards? And what, if anything, was agreed about any interim contact? Ideally, you would have made it clear to your client whether any contact would be limited to arranging appointments, or whether they would be welcome to let you know how they were getting on, and whether you were willing to provide any kind of support service during the lockdown period. In other words, you would have established where the boundary lies regarding your availability. The question is, how acceptable to you are your clientâ&#x20AC;&#x2122;s emails? It sounds as if you are unsure, so perhaps itâ&#x20AC;&#x2122;s not too late to explain to them that contact is to be limited to practical matters. On the other hand, it could be therapeutic for your client to express their thoughts and feelings in writing, so you might be prepared to accept the emails but not to respond to them. Or you could let your client know that you will save them for the time when they return for further sessions, in case they wish to refer to them then. No doubt you wish to be caring towards your client, but you also need to consider your own needs, and if you encourage unlimited contact from all your clients, your self-care could suffer and you could end up feeling resentful. Clarity is called for around exactly what you are prepared to offer and what can be expected from you both.
BEARING IN MIND the ethical principle of â&#x20AC;&#x2DC;autonomyâ&#x20AC;&#x2122; and respecting the clientâ&#x20AC;&#x2122;s right to be self-governing, you cannot insist on having an ending session. However, you can suggest it, and explain to your clients why you would prefer to have an ending session to review the work, consider what might be outstanding and may still need to be worked on, identify what resources and alternative support are available to them and clarify whether this is, in fact, an â&#x20AC;&#x2DC;endingâ&#x20AC;&#x2122; or just a pause. In normal circumstances, we would â&#x20AC;&#x2DC;endeavour to inform clients well in advance of approaching endings and be sensitive to our clientâ&#x20AC;&#x2122;s expectations and concerns when we are approaching the end of our work togetherâ&#x20AC;&#x2122; (Ethical Framework, Good Practice, point 39), â&#x20AC;&#x2DC;give as much notice as possibleâ&#x20AC;&#x2122; of any planned breaks (point 40) and manage any unplanned breaks â&#x20AC;&#x2DC;in ways to minimise inconveniencing clientsâ&#x20AC;&#x2122; (point 41). In the current climate, various kinds of endings and breaks have been forced on us and our clients. To end the therapy abruptly could leave our clients feeling bereft, abandoned and unsupported at the very time when they need some stability and consistency. If they choose to end or pause the therapy for financial reasons, we need to respect that, but we can do our best to ensure that there is clear understanding on both sides about how things are being left. Even one further session, perhaps by telephone, might provide sufficient opportunity to do just that, and to â&#x20AC;&#x2DC;tie up loose endsâ&#x20AC;&#x2122; as you put it.
THERAPY TODAY
BLACK YELLOW MAGENTA CYAN
50
JUNE 2020
â&#x20AC;&#x2DC;My supervisor has asked me to write a clinical will stating what will happen to P\ FOLHQWV LI , JHW LOO EXW , DP Ć&#x201C;QGLQJ LW hard to get to grips with it. Do I really need one? Iâ&#x20AC;&#x2122;m young(ish) and in good health.â&#x20AC;&#x2122; JUST IMAGINE THE LIKELY EFFECT on a client if they were to try and make contact at the appointed time for their session, only to find that there was no response. It is important for every practitioner to think through how their clients (including supervisees) would be notified if they were suddenly incapacitated themselves. The term â&#x20AC;&#x2DC;clinical willâ&#x20AC;&#x2122; might sound dramatic, implying that it would only come into effect on the death of the practitioner, but what is more likely, especially in the present circumstances, is the possibility of being taken ill at short notice and prevented from contacting clients to let them know. It is incumbent on BACP members to give this some serious thought. As stated in the Ethical Framework, Good Practice, point 42: â&#x20AC;&#x2DC;In the event of death or illness of sufficient severity to prevent the practitioner communicating directly with clients, we will have appointed someone to communicate with clients and support them in making alternative arrangements where this is desired. The person undertaking this work will be bound by the confidentiality agreed between the practitioner and client, and will usually be a trusted colleague, a specially appointed trustee or a supervisor.â&#x20AC;&#x2122; A Good Practice in Action resource has been written on this subject (GPiA 104: Clinical wills and digital legacies), and this should address all your questions about it. Iâ&#x20AC;&#x2122;m curious, though, to know why you are finding it â&#x20AC;&#x2DC;hard to get to gripsâ&#x20AC;&#x2122; with this. Is it just a practical concern about what a clinical will should include, or who you should appoint as your trustee? Or is it something deeper â&#x20AC;&#x201C; perhaps your fear of letting your clients down, or the thought that you wonâ&#x20AC;&#x2122;t always be there for them and they might have to manage without you? If so, perhaps this needs taking to supervision or personal therapy. If we are to help our clients face their vulnerability and mortality, we need first to acknowledge our own.
Not for me? â&#x20AC;&#x2DC;I did not want to work remotely as it doesnâ&#x20AC;&#x2122;t sit well with my modality and I am not very computer literate, so I have
BOB VENABLES/IKON IMAGES
told clients that work is paused for the foreseeable future. Most have understood, but one has reacted with anger and told me he feels abandoned. Am I letting clients down by not attempting to work remotely with them?’ IT’S IMPORTANT to be working within your competence (‘Our commitment to clients’ 2a; and Good Practice, point 13), so it is better to refrain from working remotely if you are not confident to do so than to succumb to pressure and feel uncomfortable. The therapy is hardly likely to be effective if you are working under duress! Is there any alternative, though, that you can offer your clients, to support them while your direct work with them is paused? For example, would you be willing to provide telephone counselling? That way, you would not need to be ‘computer literate’, as you would be using a medium with which you and your client are familiar. There would still be some significant differences from in-person working, which you would need to discuss with your client, such as attending to privacy and agreeing who will make the call, but you might find that effective work can still be done. Telephone counselling is explored in depth in this month’s In Practice feature, on
page 22. Another possibility might be to offer email exchanges. If you were to consider telephone or email counselling, you could use the published competences (see ‘Support and Resources’ on page 52 for the link) to assess your own abilities and identify any gaps that might need to be filled, by seeking some training, CPD or input from your supervisor. You say that work is paused with your clients, but you have not explained how things were left with them. Maybe some are happy to wait until normal service with you is resumed, but you could offer some temporary form of support, such as occasional check-ins by phone or email, to help contain their feelings of abandonment. It is also possible that some of your clients might consider transferring to another therapist who
‘You could offer some temporary form of support, such as occasional check-ins by phone or email, to help contain their feelings of abandonment’ THERAPY TODAY
51
is qualified to offer online counselling. If so, you could signpost them to relevant directories. You are not alone in feeling reluctant to move to a remote form of therapy. Many therapists have found the initial intense push to move clients online, and having to navigate a steep technological learning curve, a particularly anxiety-provoking process. However, feedback has been positive – through a combination of accessing available CPD and practising with technology, members have been able to feel a degree of confidence and competence in working online with some of their existing clients. Many resources are available, including the Covid-19 resources on the BACP website and introductory courses in online working alerting us to the main considerations we need to take into account (see ‘Support and Resources’ for links). Remote working is not for everyone, though, and practitioners of some modalities might feel that they can only engage in direct work with the whole person in front of them. Finally, a thought about abandonment. It seems to be a prevailing existential condition of the current crisis. Many sectors of our society are feeling abandoned; the front-line workers, carers, the elderly, the sick and dying. One of our tasks as therapists is metaphorically to hold our clients with their anxiety, which might well include holding their sense of abandonment (and perhaps our own!). It can’t be solved, but it can be contained. Your client’s anger may be a manifestation of fear, and containment might be what’s needed, above all else.
Take me back ‘I have a long-term client who often takes a break from therapy for a few weeks then comes back. I feel under obligation to ƓQG D VSDFH IRU KHU ZKHQ VKH GRHV FRPH back, even if it means my caseload then becomes heavier than is optimal for me. Do I have an ethical duty to take her back after each break?’ MUCH WILL DEPEND ON what was discussed and agreed before the break. You say that your client is long-term and that she often takes a break, so it seems to have become the norm for you to take her back each time. Is the ‘taking back’ something you discuss openly with your client? Does she assume that you will always have availability for her, or that you are keeping an appointment time free for her? Or do you start again, and recontract each time? It appears that this may not have been clarified, so that ►
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Dilemmas, 1
Dilemmas
Dilemmas, 2
Dilemmas VERSION REPRO OP SUBS ART
arrangements remain rather vague and your client’s expectations do not match your own. If you had promised to take her back, then there is some ethical responsibility to do so (the principle of ‘Being trustworthy’). If you ended with your client with no expectation that she would return, you are not ‘under obligation to find a space for her’, especially if your caseload is already full. To ignore this would mean disregarding your self-care and self-respect. The learning from this is to be clear with your clients about what you are prepared to offer, and to check on their expectations and assumptions, to avoid misunderstandings and resentment and a breakdown in the trust that is such a vital pillar supporting the therapeutic relationship. Even if the ‘taking back’ has become a habit, maybe it’s time to address this issue openly and to revisit the contract with your client. If you did continue to work with her, what else might need bringing out into the open, such as attachment issues (on either side)?
SUPPORT AND RESOURCES BACP’s competences for telephone and e-counselling can be found at: www.bacp.co.uk/events-andresources/ethics-and-standards/ competences-and-curricula/ telephone-and-e-counselling Guidance and resources for members working during the Covid-19 pandemic can be found at: www.bacp.co.uk/news/news-frombacp/coronavirus A new online counselling primer course produced by The Open University in partnership with BACP is available free for members on the OpenLearn platform: www.open.edu/openlearncreate/ course/view.php?id=5039
<RX FDQ ƓQG PRUH LQIRUPDWLRQ and guidance in these BACP resources, available online at www.bacp.co.uk/gpia: Working online (GPiA 047) Unplanned endings (GPiA 072) Self-care for the counselling professions (GPiA 088) Planned breaks in practice (GPiA 102) Clinical wills and digital legacies (GPiA 104) Fitness to practise in the counselling professions (GPiA 078 and 094) Boundaries (GPiA 110 and 111)
PRODUCTION
Fit to practise?
CLIENT
‘A close friend of mine has recently passed away having contracted Covid-19. An existing client has just had an online therapy session in which they disclosed that they have just lost a relative to the virus. I’m not sure I’m in the right headspace to support them. What should I do?’ NO DOUBT YOU ARE EXPERIENCING
a whole range of emotions as you try to come to terms with your friend’s death, and it is important that you give yourself time. However much self-awareness work we have done as therapists, we are still prone to the natural feelings of loss and grief when someone close to us dies. So, first of all, you should consider your need for self-care. One of our ethical responsibilities is ‘monitoring and maintaining our own psychological and physical health, particularly that we are sufficiently resilient and resourceful to undertake our work in ways that satisfy professional standards’ (Good Practice, point 91b). With your supervisor, you need to assess whether you should take a break, and if so, what you should say to this client and to your other clients as well. You could come up with wording that explains your need to cancel or postpone your sessions, and what you will do to resume contact, without disclosing more than they need to know. You might also
consider with your clients what support they could access in the meantime. Although it is difficult to predict how you will react in a session with your client, you might find it useful to reflect on Good Practice, point 7: ‘We will make each client the primary focus of our attention and our work during our sessions together.’ This can be a helpful gauge of our ability to practise after a personal bereavement. Are you likely to make your client the primary focus of your attention, or is it more likely that you will be distracted by your own grief? What is not likely to help is the assumption that, ‘Now I know exactly how you feel’. Commonality of experience may help us to empathise, but over-identification does not.
‘However much self-awareness work we have done as therapists, we are still prone to the natural feelings of loss and grief when someone close to us dies’ THERAPY TODAY
BLACK YELLOW MAGENTA CYAN
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Your uncertainty about being ‘in the right headspace’ would seem to indicate that it could do more harm than good if you were to see this client just now. Hopefully, they will have opportunity to work with you through some of their grief at a later stage, but for now your need might be to sit with what is yours. ■ ABOUT THE AUTHOR Stephen Hitchcock 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.
The dilemmas and responses reported here are typical of those worked with by BACP’s Ethics Services. BACP members are entitled to access this consultation service free of charge. Appointments can be booked via the Ethics hub on the BACP website.
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ReferraIs Accepted contact@emotionallyfocusedtherapyclinic.co.uk Clinical affiliate of EFT International School Introductory EFTworkshops, Monthly EFTSupervision groups, EFT Movie Club, EFT Forum 5th Annual EFT Summer School 2020 www.eftinternationalschoollondon.com
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COUNSELLING & TRAINING
CPD in DORSET
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REPRO OP
*NEW* - CPD Remote Workshop - Counselling Remotely *NEW* - CPD Remote Workshop Assessing Clients (including remotely) *NEW* - CPD Remote Workshop Counselling during the Pandemic
A 9
Certificate in Foundations of Working with Companies
Diploma in Integrative Supervision of Individuals and Groups
SUBS
CPCAB Level 5 Diploma in Psychotherapeutic Counselling - September 2020
Certificate in Therapy for Couples & Other Relationships
CPCAB Level 5 Certificate in Counselling Young People - September 2020 CPCAB Level 5 Diploma in CBT - September 2020
ALL COURSESNOW ONLINE
ART
CPCAB Level 4 Diploma in Life Coaching September 2020
Intakes in Spring & Autumn Therapy room rental near Bond Street
info@thegrovepractice.com
PRODUCTION
Redlands Counselling Training For more information contact us on 01202 859354 or email info@redlandscounselling.co.uk
020 7637 7763 thegrovetraining.co.uk
CLIENT
NA c)S
LondonDiploma {{( )t in Psychosexual and ~ RelationshipTherapy
FROM INNER TO OUTER CHANGE
Thegoldstandard ofpsychosexual andrelationship therapytraining
Diploma in Energy Therapy Sepember 2020
-
June 2021
9 weekendsin Londonplus 3-day retreat in Kent Awakenthe inner healer. Over the last decade,psychotherapy hascome to align itself more strongly with the notion of energy healing (Mollon, 2008). This coursesupports students' developmentthrough embodied exploration of subtle energies, discoveringhow to perceiveand activate energyfor therapeutic use,and learningto direct energyfor self- healing and for relational work with others. Core tutor: MarcusSorensen.
2-Year Diploma in Neurosomatic Psychotherapy Year t: Jan-Nov 2021
Year 2: Jan-Nov 2022 Eachyear: 9 weekendsin London+ 5½ day retreat From Cell to Soul. We welcomeapplicationsfor a pioneering two-year neurosomaticpsychotherapytraining basedon a solid foundation in neuroscienceand physiologyintegrating with psychotherapeuticinterventions. Core tutors: MarcusSorensen& Bernd leygraf. Our courses are accredited by NCP Enquiries: info@naos-institute.com Or Call: 0794 1254035 National Council Forfull coursedetails: off'sythotherapists www.naos-institute.com/training/ NAOS Institute: 3 Montpelier Avenue,London w5 2xP -
Applications areinvitedforthiswellestablished part-time modular training, 2021,Central London . Weareopentopractitioners within scheduled forJanuary thecaring professions (counsellors, clergy, psychotherap ists,healthadvisors, medical practitioners, nurses andothers) . Entryrequirements : aminimum of120 . In hrscounselling trainingorequivalent andaminimum of50hrsclienthours I",. NATIONAL exceptional circumstances thesemaybewaived . Thecourse philosophy isHumanistic-Integrative ~ ~g ~ ~~ LLING supporting thedevelopment ofacomprehensive model professiona l • • ofrelationship therapy andanin-depthunderstanding "-.....,.~ standards 'Y authority ofbothorganic andnon-organic causes ofsexual accred ited register dysfunctions . Weaddresstheunderlying issues brought intotherapy byindividuals andcouples . Course fees ofVAT anduniversity for2021are£7300(inclusive registration) intotalforthetwoyears, whichmaybe instalments. Interviews are payable over21monthly scheduled forApriltoJune2021andearlyapplications arestrongly advised since wetendto beoversubscribed . Thecourse maintains collaborations withmayplacement European , including theNHS. providers throughout theUK Association for Counselling Further detailsandapplication forms:
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www.psychosexualtraining.org .ukoremail JudiKeshet -Orr judi@psychosexualtraining.org .uk l?I Middlesex Alternatively call02084554511 ~ University
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EMDR Training in the UK REPRO OP
EMDRis successfulin treatingPost-Traumatic StressDisorderand manyother clinicalconditions in whichadverselife eventsare a significant component.Add this effective,NHS& WHO recommendedevidence-basedtherapyto your existingclinicalskills
CPD Workshops
Using Metaphor in CBT with adults, children, young people and families Dr Steve Killick 25th Sept 2020 - BPS London
SUBS
An Introduction to Compassion Focused Therapy for Depression
Duringthe presentCOVID-19emergency, manyof our EMDRcourseshavebeen postponed.
Dr Chris Irons 6th Nov 2020 - Radnor Hall London
The Supervisory Relationship: Difficulties and Delights
Pleasecheckour websitefor up-to-dateinformation. ART
All coursesare fully accreditedby EMDRUK and EMDREurope
Robin Shohet 30th Jan 2021 - Radnor Hall London
PRODUCTION
www.emdrworks.org Tel: 01727 851251 Email: admin@emdrworks.org
For details and for our full range of workshops :stantonltd.co.uk or grayrock.co.uk
CLIENT
Holistic Insurance Services Insurance for Counsellors and Psychotherapists
SECONDARY & PRIMARY SCHOOLCOUNSELLING PLACEMENTS-LONDON We are currently seeking applicants for our clinical placements in schools across London . This is an exciting opportunity to gain clinical hours and specialised professional experience counselling children and young people. Trainee counsellors should be able to commit for one day per week for the whole academic year and be able to see 5 students (ages 11-18 or 5-11) on their working day. There are also counselling placements working with the teaching staff in our secondary schools. Orientation will be provided .
Contact Tehmeena on:07775920430 admin@entrust-schoolcounselling.com orStaceyon:02084442670 contact@entrust-schoolcounselling.com www.entrust -schoolcounselling.com Allsuccessful applicants willbeasked to undertake anEnhanced Disclosure fromtheDBS
THERAPYTODAY
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INSURANCE
Are you paying too much for your insurance? We can provide malpractice, professional indemnity, public and products liability cover on a losses occurring basis, with full retroactive cover from ÂŁ61.00 for a limit of indemnity of ÂŁ5,000,000 . To apply for cover and find out more about Holistic Insurance Services, please visit our website at:
www.holisticinsurance.co.uk or telephone 0345 222 2236 and quote reference 'Therapy Today'. Holistic InsuranceServicesis a trad,ng nameof Gins Ltd authonsedand regulated by the RnancialConductAuthonty.
JUNE 2020
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Internal Family Systems Therapy Step-by-Step Procedures for Healing Traumatic Wounds and Alleviating Anxiety, Depression, Trauma, Addiction and More
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Presented by certified IFSTherapist and Consultant
ALEXIA ROTHMAN, PhD
CLIENT
EARN 12 CPD HOURS
SAVE£100 USE CODE LRTT100
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Trainingin ChildandAdolescent P~chotherapyand Counselling
REPRO OP
MAin Childand Adolescent Psychotherapyand Counselling Can lead to UKCP Registration and BACP Individual Accreditation Duration:five years part-time
MAConversion Course SUBS
Leading to UKCP registration and Middlesex University MA in Child and Adolescent Psychotherapy and Counselling Duration:two years part-time
Diplomain Child,Adolescent and Adult Psychotherapyand CounsellingSupervision Duration:one year part-time
For more information about trainingwith Terapia
ART
Call: 020 8201 6101 ~mail: training@terapia.co.uk
MAin Forensic Practice with Childrenand YoungPeople Duration:two years part-time Introductionto Therapeutic workwith Children Duration:five days
PRODUCTION CLIENT
Counsellingand PsychotherapyTraining Online and in London
TR A INING
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TAVISTOCK RELATIONSHIPS
Online Summer School - Developing SkillsinCouple Work Practitioner Clinical Trainings
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This online summer school, which will be held using the Zoom teleconferencing app/web platform, is for psychotherapists working with individuals, children, families or groups who would like to learn more about the couple relationship, and the principles of psychoanalytic work with couples. Dates: Monday 13 July to Friday 17 July 2020. Cost: £475. For more information or to book a place, go to tavistockrelationships.ac.uk
MAin Couple Psychoanalytic Psychotherapy Course length:4 years (advanced standing min. 2 years).
PGDip/MA inCouple andIndividual Psychodynamic Counselling and Forthcoming Online CPDCourses (viaZoom webcam platform)Psychotherapy
Between Partnering andParenting : Psychoanalytic Approaches Presentation and discussion group exploring the link between parenting difficulties and the couple relationship in the context of psychotherapeutic work with couples. Date and time: 5 June 2020, 5pm-6.3Opm . Trainer:Andrew Balfour, TavistockRelationshipsChief Executive.Fee: £30 .
TheImpact ofAddiction ontheCouple This full-day course will explore the impact of alcohol and substance misuse on the couple relationship. Date and time: 4 July 2020, 1Oam-4pm. Trainer:Liz Hamlin, Couple PsychoanalyticPsychotherapist.Fee: £98 .
Course length:3-4 years (advanced standing min. 2 years). Please visit website for further details and current fees, plus othe, qualification courses including the Diploma in Psychosexual Therapyand certificate courses.
Online SeH-Directed Study Courses
(Allcourses provide atleast three months' access) Titles include: Working withNarcissistic States : Healthy Narc issism, Unhealthy to Make theTransition • Online Therapy - How • Tavistock Relationships Authors Lecture Series Narcissism andEchoism Processes inDivorce Drawing on theories about narcissism and echoism, the day will feature a theoretical • Psychological • Psychosexual Studies : Sexual Dysfunctions presentation, as well as confidential discussion of clinical material. Female Disorders Date and time: 18 July 2020, 1Oam-4pm. Corporate rates available forlarger orders. Trainer:Dr Jan McGregor Hepburn, BPC Registrar. Fee: £98.
BOOK NOWTel:02073808288I Email: training@TavistockRelationships.ac.uk Iwww.TavistockRelationships.ac.uk THERAPYTODAY
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FOR QUALIFIED COUNSELLORS AND PSYCHOTHERAPISTS Highly flexible:
Modules can also be taken as standalone CPD courses:
Full and part time routes, choose the modules that are best for you delivered by subject expert practitioners
Bereavement and Loss Compassion Focused Therapy Counselling Children and Young People
Fast track routes for accredited counsellors and MSc top-up for PG Diplomas
Expressive Therapies Research Methods
Entry possible with level 4 and 5 Counselling Diplomas
Supervision
Clinical Supervision training pathway as optional embedded pathway
Trauma-Sensitive Mindfulness We also offer a CPD Certificate in Couples Counselling.
Postgraduate loan available for September 2020 entry
(subject to eligibility)
For more information contact Tim Duerden: t.duerden@salford.ac.uk www.salford.ac.uk
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Where you look affects how you feel REPRO OP SUBS ART
Brainspotting trainings teach the latest scientific theory in relational neuroscience and the neurobiology of trauma informed therapy . Brainspotting is an embodied approach that removes obstacles and enhances the ultimate resource of transcendent attunement to realise the immense power of eye positions to access and process trauma .
Trainings Online and Beyond
In these current times, we have the chance to adapt and evolve in terms of delivering the most effect ive therapy to those who need it most. Brainspotting has been used successfully both face to face and online for some years, as the principles of the model are immediately transferable. Brainspotting tra inings are now provided online and will deliver the richness of theory, practice , demonstrations and paired work to empower you in your practice .
17th - 19th October
with Dr Mark Grixti
Phase 1 12th - 14th June
0
2020
Online
2020
Londono
Phase 2 Masterclass with Dr David Grand 6th - 8th November 2020
London
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25% off June Phase 1 for all! 50% off Phase 2 if returning to online upskill. Save a further £45 where booking Phase 1 and 2 together Free post training online group supervision.
0 =Online
"Profoundand authentic."
Special prices apply to 2020 trainings only
Brainspotting : The Revolutionary New Therapy for Rapid and Effective Change - David Grand, PhD (2013) For more information enter 'Brainspotting Sketch Animation' into YouTube PRODUCTION
For further information please contact : www .bspuk .co.uk Email: info@bspuk .co.uk I Phone: 07886 659976
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The Association for Child and Adolescent Mental Health
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IICP
Progress your Career in Counselling and Psychotherapy
COLLEGE LEARN • GROW • SUCCEED
SUBS
BA (HONS) IN INTEGRATIVE COUNSELLING AND PSYCHOTHERAPY FINAL YEAR ENTRY: This Degree is ideal for BACP therapists who want to advance their
Diploma to Degree Level. MA IN PLURALISTIC COUNSELLING AND PSYCHOTHERAPY:
ART
Developed with Professor John Mcleod, this MA equips therapists with a cutting edge training to meet the needs of contemporary society. MA IN INTEGRATIVE CHILD AND ADOLESCENT PSYCHOTHERAPY:
This MA will equip learners with the necessary knowledge, skills and competencies to meet the therapeutic needs of children and adolescents. PRODUCTION
For more details or to apply visit www.iicp.ie
CLIENT
Online CPD Programme Summer Series 2020
IICP COLLEGE LEARN • GROW • SUCCEED
IICP have just released an exciting range of 15 Online CPD workshops for Summer 2020, meaning you can still attend our high-quality trainings and receive your CPD credits from the comfort and safety of your own home. Amongst others, our workshops include: ❖ ❖
❖ ❖
❖
CBT for the Anxious Mind Working with Attachment In the Wake of Suicide Dreams Workshop Online Therapy with Adolescents
For more details or to apply visit www.iicp.ie
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Post-Qualification Doctoral Programmes Joint Programmes with Middlesex University
•
1\I MET ANO IA INSTITUTE
REPRO OP SUBS
Doctoratein Psychotherapy by Professional Studies
Doctoratein Psychotherapy by PublicWorks
The DPsych(Prof)is renownedfor its innovationand quality in practice-based research.A scholarlycommunityof more than 120graduateshavemadesignificationcontributionsto the developmentof the psychologicaltherapies.
This awardappealsto senior,accomplished,practitioners, who havealreadymadea substantialcontributionto the fieldof psychologicaltherapythrougha rangeof publicationsand/orpublicworkssuchas: the development of innovativetherapyservices; majororganisationalchange; establishmentof successfultrainingprogrammes .
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The Programmeis aimedat re-vitalisingand nourishing seniorqualifiedpractitioners . It offersan alternativeto traditionalresearchbasedPhDor academic,taught doctoralprogrammesandcan be completedwithinthree and a halfyears. Duringthe first yearof the Programme taughtmodulestake placeapproximatelyoncea month. Candidatesare then supportedto developa research submissionwhichis project- ratherthan thesis- based.
Candidatesare supportedto undertakean intensive, reflexive, 12-18monthauditof their existingachievements .
PRODUCTION
For full details please contact: .ac.uk Sonia Walter,SeniorAcademicCo-ordinator,on 0208 832 3073 or email her at sonia.walter@metanoia MetanoiaInstitute,13 North Common Road, Ealing, London,W5 2QB www.metanoia.ac.uk
Registered Charity 10050175
Certificate in Supervision
Rlllll onlinetraining CLIENT
Uiil ..for counsellors
tools and training for tomorrow's counsellor
For counsellors and psychotherapists looking to demonstrate competence at any stage in their career
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The course is over 3 weekends and will cover:
• The role and tasks of supervision • Effective supervision skills • Different theoretical approaches • Ethical framework • Administrative tasks
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Course Dates: 19 & 20 Sept, 17 & 18 Oct, 21 & 22 Nov 2020
OR 30 & 31 Jan,27 & 28 Feb,27 & 28 March 2021
Diploma in Online Counselling Start date 1 October 2020 delivered online over 6 months
Venue: Bourne End,Buckinghamshire May be delivered by ZOOM if self-distancing regs stil apply
Booking information for all courses jasmine@onlinetrainingforcounseLlors.co .uk Telephone 01324 831642 9 am - 6 pm www.onlinetrainingforcounseLlors.com
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This Level 5 OCN accredited course is for counsellors with a minimum of 2 years post-qualifying experience, who are seeking a compact, rigorous and affordable training.
66
Course Fee: £995.00
For more details please visit: www.lisamasscounselling.co.uk Email: contact@lisamasscounselling .co.uk
Tel: 0777 300 78 94
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Integrating the reflective mind and reactive brain/body system into online and face to face practice Rated by participants as one of the most useful one day CPDs they have ever attended
SUBS
1/3 of CPD fees go to the charity Shelter Therapy Today Article P32-35 Dec 19
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Feedback from online & face to face CPD participants: PRODUCTION
"It has been received verY positively by my clients, being easy to grasp and giving scope for reflection fuel/mg much scope for rich work."
CLIENT
Working through the RM hail the effect of bringing detyJ issues to the surface." "Very useful tool as it ties in nicely with fTJJ'_attachment based/EFT practice. " ''Adaptable for integrative practice with individuals, couples and young people." "Useful for emotionally dysregulated clients and working with trauma. " "Ipractice Gestalt psychotherapy and like the overlap of phenomenological enquiry." "Useful and enlightening_to see the trigger cyde duration." "The map_can be used where I may be feeling stuck in helping the client to open up." "It fits wellinto Po/yvagalTheory and EMDR."
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This unique new programme has been designed to enhance the skills, knowledge, experience and scholarship of those involved in teaching and supporting the learning of counselling, psychotherapy and related disciplines . Successful completion of the programme will lead to a formal postgraduate qualification and prepare participants for HEA Fellowship. It will provide a vital developmental qualification both for those new to supporting academic and professional training in the psychological therapies as well as for those with considerable experience but without a formal training in learning and teaching in this highly specialised subject.
ART
Metanoia Institute has a long-established reputation as a Centre of Excellence in this field and so this award is a natural development within this setting. The programme, validated by Middlesex University, will be facilitated by experts in the field and has been designed as a blended learning, delivered both online and in person, so that assignments are built into the everyday working practice for those teaching the psychological therapies in an HE setting .
MSc in Creative Writing for Therapeutic Purposes PRODUCTION
Creative Writing for Therapeutic Purposes offers an innovative intervention to engage with a wide range of health and community needs, as well as a broad spectrum of the problems of living presented by those seeking coaching, mentoring, counselling or personal guidance . Tutored by four published writers with extensive experience of using therapeutic writing in health and community settings . These courses offer excellent support in personal and professional growth .
MSc in Creative Writing for Therapeutic Purposes - commencing Bristol September 2020 CLIENT
This unique programme prepares participants to work at this growing edge . Students will develop and enhance their ability to work in this field via personal creative and reflective writing, group-work and research and inquiry projects . • 10weekendsper taughtyear (2 years) plusdissertation • Now recruitingfor our Bristolcampus- commencingSeptember2020 http://www.metanoia .ac.uk/programmes/special-interesUmsc-in-creative-writing-for-therapeutic-purposes/
FREE ONLINE Introductory Workshop Morning - 6th June 2020 http://www.metanoia.ac.uk/introductory-workshops/msc-in-creative-writing-for-therapeutic-purposes/
Practitioner Certificate in Creative Writing for Therapeutic Purposes - London 2021 A course for qualified counsellors and psychotherapists and those advanced in their training that will build on participants' abilities to incorporate creative writing techniques into their professional practice and personal self-care . Recruiting for our London campus - 10 days as Friday and Saturday modules http ://www .metanoia.ac .u k/progra mmes/specia 1-interest/practitioner-certificate-creative-writing-for-therapeutic-purposes-cwtp-for-thera
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Post Qualification Diploma in Adolescent and School Counselling Commencing October 2020 This is a practice-based Diploma modelled on the BACP competence framework for counselling children and young people and designed to support each participant's 'aware practice' with young people . It will be of value both to existing school counsellors and those wanting to add working with young people to their practice . The course will include in-depth explorations of the complexities of the school setting, mediating the culture of counselling and school, issues of safeguarding and ethics, models of child development, the self-awareness of the counsellor, adolescent process, research on counselling young people, using outcome measures relationally and best practice service development.
Entry Requirements Diplomatrainingor abovein counsellingor psychotherapy Evidenceof workingtowardsBACPCounsellor/Psychotherapy accreditationor equivalent http://www.metanoia.ac.uk/programmes/special-interest/dip-in-adolescent-and-schools-counselling/
For more information on any of these courses, please contact the Senior Academic and Research Coordinator, Cristina Soares: Tel: 020 8579 2505 / 0208 832 3096 (direct) Email: cristina .soares@metanoia.ac.uk
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Coverincludes£ 10 million public liability as standard. Choice of limitsfor any other civil liability:
Totalannualcost of the insurance
SUBS
£1,500,000 (onepoint five millionGBP)any one claim
£65.17(£43.80fortrainees)
£2,000,000 (two millionGBP) any one claim
£70.49
£3,000,000 (threemillionGBP) any one claim
£75.85
£5,000,000 (fivemillionGBP) any one claim
£107.88
ART
MARSH COMMERCIAL
PRODUCTION
This is a marketingcommunicaijon. Pricesquoted includeinsurancepremiumtax at 12% and are subjectto status. Oxygenand OxygenProfessionalRisksaretrading namesof Jelf InsuranceBrokersLtd, which is authorisedand regulatedby the Financial ConductAuthority(FCA). Not all productsand servicesofferedare regulatedby the FCA.Registeredin Englandand Walesnumber0837227. RegisteredOffice: 1 TowerPlaceWest, London EC3R5BU. Je~ InsuranceBrokersLtd is a whollyowned subsidiaryof MarshLtd.
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Do You Want to Train as a Registered Child Counsellor,Child Psychotherapist, WellbeingPractitioneror MentalHealth Practitioner?(AccreditedPITTrainings)
CENTRE FOR CHILD MENTAL HEALTH ONLINE LEARNING & LIVESTREAM EVENTS LIVE STREAM TRAINING with Ellie Baker Sat 30/5/20, 10am-4.30pm (cost: £99)
Calm,Creativity andCompetence : LearnRelaxation andCalming Techniques forChildren
I MAin Integrative ChildPsychotherapy (UKCP reg.) I Diploma in TraumaandMentalHealth-Informed Schools andCommunities (Practitioner Status)
LIVE STREAM EVENT with Dr Dan Hughes Sat 6/6/20, 12pm-5pm (cost: £125)
I Diploma in Community Wellbeing Practice forChildren, YoungPeople,Families andOrganisations (University validated)
DrDanHughes Presents: Building theBondsof Attachment -Awakening LoveinTraumatised Children
I Diploma in ChildPsychotherapeutic Counselling (UKCPreg.) I Diploma in Parent-Child Therapy
LIVE STREAM EVENT Sat 13/6/20, 10am-4 .30pm (cost: £125)
I Certificate inTherapeutic Play(University approved) I Conversion Course : Post-Qualifying Diploma in Integrative ChildPsychotherapy (leading to UKCPreg.)
WEBINAR with Dr Dan Hughes Cost: £65 for 30 day subscription (52 min webinar)
info@childmentalhealthcentre.org
www.artspsychotherapy.org tel:02077042534 email:info@artspsychotherapy .org 2-18Britannia Row,Islington, LondonN1BPA THERAPYTODAY
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Howto HelpPeople TellTheirStoriesinOrderto Heal Emotionally (DrMargot Sunderland, DrLucyJohnstone)
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THE FOUNDATION CERTIFICATE IN COUNSELLING
CPD WORKSHOPS
REPRO OP
This course provides a robust theoretical and practical introduction to counselling, with an emphasis on putting your knowledge and skills into practice .
Work ing With Mood & Madness - An Introduct ion to Bipolar Disorders
The Foundation Certificate is a one-year, part-time course run over a number of weekends from TAC Clapham.
Anna Minogue , 20th June 2020
SUBS
The course is suitable if you are considering a career in counselling, or if you wish to develop your interpersonal and communication skills . This training offers 120 contact hours .
Anna Minogue , 6th June 2020
Taking Care of Ourselves as Practit ioners Dynamic Interpersonal Therapy Anna Bravesmith, 27th June 2020
Solution Focused Brief Therapy Martyn Lloyd, 25th July 2020
Setting up in Private Practice Kevin Hamilton, Bonny Allyson & Capsar Kennerdale , 12th December 2020
CPD Workshops are held on Saturdays, from 10am - 4pm. The fee per workshop is £100 . A CPD certificate will be issued .
Dates: September 2020 • July 2021 Application Deadline : 26th June 2020 Select ion Day: 30th June 2020
ALL TRAININGS ARE RUNNING ONLINE UNTIL WE ARE ABLE TO RETURN TO FACE-TO-FACE ART
For full details please visit
www .theawarenesscentre .com/tac-training -school For more information call Dan Smith on 020 8673 4545 or email training@theawarenesscentre.com
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TAC Clapham - 41 Abbeville Road, London SW4 9JX · www.theawarenesscentre.com
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We offer training & CPD workshops to therapists and mental health professionals at both introductory and advanced levels. Allp rioes fistedare VATnot appficable
During COVID-19 all courses are being delivered online . Please check our website for details of when on-site training resumes . Introduction to CBT 2 days (12 hrs): 24/25 Oct, 27/28 Feb 2021 £180 This 2 day course is the introduction to the basics of CBT and how to use it in client sessions. It can also be used as a starting point for further CBT training.
TransactionalAnalysis Courses Introduction to Transactional Analysis (TA101) 2 days (12 hrs), 26/27 Sept, 30/31 Jan £170 The course introduces the key concepts of TA theory and practice and will encourage you to look at clients' interactions in new ways, expanding your existing methods and skills. Foundation Certificate in Transactional Analysis 1 year pit 2020/2021
Establishedfor 50 years, WPFTherapy offers this reputable and respected, four year, part-time training
ruwpf ~therapy make a change
Clinical Qualification in Psychodynamic Psychotherapy ---
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• Placementsin our ClinicalServiceprovidinga wide range of client experience • Supervision of clinical work included • Leadsto a qualificationwhich enablespractice in once weekly psychodynamicpsychotherapy • A BACPaccredited coursethat leadsto eligibility to register with BPCand UKCP
1 weekend per month Sept- Jul (120 hrs)
TA psychotherapy can be used to explain communication and relationships and is a system for personal growth and change. Covering the foundational elements of TA, this course is a stand-a/one course and also a springboard to further training and qualifications in TA. Looking to broaden your skill base, a new direction or just self-development , this course is for you. We train in small groups of up to 16. Contact us for a prospectus . To see our full training programme or to find out more, visit us at www .thehorsforthcentre .co.uk, call 0113 2583399 or email contact@tatraining .org The Horsforth Cenlre, 138 Low Lane, Horsforth , Leeds, LS18 5PX
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• 2nd or 3rd year entry for APELapplicants WPFTherapyusesmulti-channeldeliveryand it may be that somesessionswill be deliveredremotely. Visit www.wpf.org.uk/want-to-train/ to find out more about this course and apply online. Email training@wpf .org.uk for information. WPF Therapy, 23 Magdalen Street, London, $El 2EN Company no. 1214251. Registered charity no. 273434
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UNIVERSITY OF REPRO OP
DERBY ONLINE LEARNING
SUBS ART PRODUCTION CLIENT
IN YOUR CAREER Deliver impact with your chosencounsellingor psychotherapycareer. We offer a range of university courses, short courses and 20 credit modules designed for Continuing Professional Development (CPD) to complement you self-development. • Counselling Studies and Skills University Diploma • Cognitive Behavioural Therapeutic Approaches BSc (Hons) Top-Up • Cognitive Behavioural Studies and Skills University Advanced Diploma • Clinical Supervision Postgraduate Certificate
• Health Psychology MSc* • Exercise Psychology Certificate of Credit • Child and Adolescent Mental Health
Courses start
September. January and May
+ A range of psychology programmes online * Accreditedby the BritishPsychologicalSociety
Find out more derby.ac.uk/therapytoday
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MA in EXISTENTIAL COACHING MA in EXISTENTIALAND HUMANIST PASTORAL CARE
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MSc in AUTISMAND RELATED NEURODEVELOPMENTAL CONDITIONS
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PSYCHOTHERAPY STUDIES DProf in EXISTENTIAL PSYCHOTHERAPY AND COUNSELLING DCPsych in COUNSELLING PSYCHOLOGY AND PSYCHOTHERAPY (!Ni)(9a
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NEW SCHOOLOF PSYCHOTHERAPY AND COUNSELLING 61-63 Fort une Green Road London NW61DR 'l! 0207 435 8067 II 0203 515 0223 @ admissions@nspc.org. uk S nspc.org.uk
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Alf programmes are quality assured by MiddlesexUniversityand you will receivea Middlesexaward on successfulcompletion.
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National Centre tor Eating Disorders
thebritish psycho logical society
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Courses for safe & effective practice with anorexia, bulimia, compulsive eating & obesity with mentorship & support Enhance your practice with up-to-date, evidence -based skills for eating disorders & obesity . AND transform your own relationship with food. Fit your CPD with a range of courses, from our 2 day Introduction, to the full Master Practitioner Diploma Programme. Each course is stand-alone, BPS Approved & suitable for all health professionals .
Master Practitioner Eating Disorders & Obesity .µ •...-l Cl) •...-l
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& Obesity: 2 days ~[]W ~@[n ~®~®
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with Deanne Jade & Professor Julia Buckroyd Each course is stand-alone; The modules are
Eating disorders and weight problems are common, harmful & often comorbid with many other emotional problems you encounter in your work. This new masterclass is an academic & experiential introduction to their treatment , led by psychotherapists Bernie Wright & Deanne Jade, Founder, NCFED Learn how to identify an eat ing disorder, how to support recovery and add to your existing skill-set.
This world-renowned Diploma Course which teaches integrative skills from a wide range of up to the minute therapies for the treatment of binge eating, bulimia and anorex ia. You will also work on your own relationship with food. Autumn 2020 8-11 October & 22-25 October, Hammersmith, London Essential Obesity: Psychological Approaches 3 Days Help people with weight problems, compassionately & effectively with state-of-the-art skills from counselling , clinical & health psychology . Summer 2020: 4-6 June, now on line with Zoom Nutritional
Date : Date: 25 & 26 September 2020 Fee: £265 Venue : The Polish Centre, Hammersmith, London
View a prospectus for each course & book on line at www.eating-disorders.org.uk/training Or call 0845-838 2040
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Interventions
for Eating Disorders 2 days
A superlative , one of a kind course to teach nutrition-related aspects of eating disorders & obesity for psychotherapists . Autumn 2020: 26 & 27 November, Hammersmith, London
Receive a big discount if all 3 course are booked together, please call for details The Master Practitioner Programme is available in Ireland - see www.llfe-therapies.com
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Presented by international expert and author PRODUCTION
PETERLEVINE,PhD
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Join the live, interactive video webcast and learn how to: • Articulate the four major developmental stages that increase vulnerability to trauma and how to · r~cognise them in your clients. ,.
• Demonstrate the importance of "Bottom-Up" processing versus ''Top-Down" processing to improve treatment outcomes.
• Determine the naturalistic mechanics of trauma and survival responses of flight, fight, freeze and collapse as it relates to clinical treatment.
• Analyse the effects of stress on somatic and emotional syndromes in clients.
• Discover the evolutionary underpinnings of trauma and Polyvagal theory and their clinical implications .
• Incorporate Dr. Levine's simple containment tools in order to more effectively engage your client in trauma therapy.
EARN 6 CPD HOURS
Information & bookings W: https://bit.ly/3aRCZIQ T: 01235 847393 I E: info@pesi.co.uk Limited availability, reserve today!
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Hopefully living in Spain, looking at this issue of the magazine, eating paella and watching the sea.
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What motivated you to become a therapist? It was my own
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experience of anxiety in my 20s that led me to having CBT therapy initially, and then a self-fuelled quest to find out all I could about anxiety. The anxiety itself stemmed from vestibular migraines, but I didn’t know that at the time, so I was misdiagnosed. After lots of study, I eventually became a counsellor by default, but it was a serendipitous mistake! 'R \RX KDYH D VSHFLDOLVW ƓHOG of practice? I am an addiction
therapist in drugs and alcohol. Anxiety was my first speciality, and I’m also involved in critical incident work and EMDR. All these are linked in a way – trauma is usually involved somewhere along the line. What advice would you give to someone interested in entering the profession? Don’t go down the
wrong path! Follow the accredited brick road. You can spend a fortune on training courses that may not get you where you want to go. CBT is not the only fruit. And if you want to earn a lot of money, counselling is probably not for you.
Counsellors talk a lot about death, so the reaper’s bony finger is forever in our peripheral vision. This reminds us to squeeze enjoyment out of life’s orange and, in the words of Greek writer Nikos Kazantzakis, ‘leave death nothing but a burnt-out castle’. Therapy has also helped me mix my metaphors. :KDW GR \RX ƓQG FKDOOHQJLQJ about being a therapist? And what is the most rewarding?
The hardest parts are trying to help someone find a reason to live when they’re suicidal. Sometimes their reasons to ‘leave’ make perfect sense, and that’s difficult even for a seasoned pro like me. The rewarding part is when the client sees that all is not lost because you believe in their value. What is the most recent CPD activity you’ve undertaken? Was it worthwhile? Acceptance is
the key to many of life’s issues, and I have recently been on a Buddhist retreat. In my darkest days, Buddhism and breathing meditations have given me the quickest and most effective relief. I can teach some skills to others in my clinic.
more reflective and aware of time.
Walking is my recuperative hobby. And music. I’ve been a semiprofessional musician all my life
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What’s the longest you’ve seen a client? I have some clients
who come and go over a span of years, so probably 10 years, but this was not regular sessions, more like top-ups. What’s the most recent book on therapy you’ve read and can recommend? I’ve just re-read
Essential Help for Your Nerves by the late Dr Claire Weekes – a seminal evergreen. I think every therapist should read it.
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About Anthony Now: BACP-accredited addiction therapist for a private detox/rehab facility in the north of England, a 12-step recovery unit that treats drug and alcohol patients. Once was: In my 20s and 30s, I was a piano and keyboard player in orchestras and bands throughout the UK and sometimes on cruise ships. First paid job: Assistant organist at a church in Manchester, and a chorister at Manchester Cathedral.
What is your favourite piece of music and why? Rachmaninov’s
Piano Concerto No 2, for the drama and brilliance. I’ve loved it all my life. It has everything and is full of life. And then anything by Stevie Wonder. What gives your life meaning?
What do you do for self-care? How has being a therapist changed you? It has made me
and could read music before I could read words. I grew up steeped in the Church of England’s choral tradition and initially trained as a musician at Leeds College of Music. I found from an early age that music changed my mood. It speaks to a different part of the brain, as explained in Musicophilia, Oliver Sacks’ wonderful book on the subject.
Music, again, my daughter, Stratfordupon-Avon, my wife and her vegan cooking, Shakespeare and my old Mercedes.
Who would you like to answer the questionnaire? Email your suggestions to the Editor at therapytoday@ thinkpublishing.co.uk
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ON THESEMOST POPULAROF SDS COURSES
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over "600 , completed PRODUCTION
Essential Supervision Skills (BPS Approved Certificate in Cl inical Supervision)
CLIENT
08 - 09 October 2020 04 - 05 November 2020
LOCKDOWN OR NOT -
WORK
C BT: Introductory Course (BPS Approved Certificate) 09 - 11 June 2020 09 - 11 September 2020 08 - 10 December 2020
LIVE WITH
YOUR
TUTOR
If lockdown is lifted - the courses will run, as always, at BPSOffice in London. If it continues - they will still run by Live Interactive Webcast (LIW}.
HOW IT WORKS: •
You sign up to the webcast as normal
•
You watch the webcast LIVEon the day
I have always been an avid face to face course goer before, I am nowconverted!C.P.,LIR Participant
• The tutor works with you through the day LIVEvia the chat box or on Zoom • They see and answer all your questions and engage in all discussions •
After the course, you receive FREEaccess to the full recording of the course for 60 days. It means, if you can't attend the course live, you can catch up with it later .
the british psychological society approved
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JOIN THOUSANDS OF YOUR COLLEAGUES
VERSION
CPPD
"CPPD goes beyond teaching you the theories and practice of counselling. A rewarding and life changing experience." Introduction to Counselling (part-time)
REPRO OP
Certificate in Humanistic Integrative Counselling Autumn2020
SUBS
BACP Accredited Training Programme in Humanistic Integrative Counselling (two years, part time) Diploma - Year 1 Autumn2020 Advanced Diploma - Year 2 Autumn 2020
In these uncertain times, we will be making adjustments to the delivery of our courses for the safety & wellbeing of our students. These may include some online sessions and ensuring that face to face work is undertaken following recommended social distancing guidelines.
Short Courses - Professional Development Introduction to Therapeutic Groupwork Sat 30 & Sun 31 January 2021, 10.00-17.00. £269 inc. VAT Develop your skills facilitating groups and using the resources of the group to support therapeutic change. Suitable for all levels.
ART PRODUCTION CLIENT
CPPD is one of the UK's leading humanistic integrative counselling schools, offering tuition responsive to the needs of each individual student. We value each student's existing life experiences and skills within our friendly and creative environment.
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Please visit www.cppd.eo.uk/our-courses for more information and application forms
CPPD
Unit 1-2 Palace Gates, The Campsboume, Homsey, London N8 7PN www.cppd.co.uk • mail@cppd.co.uk • 020 8341 4843
COUNSELLING
SCHOOL
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