BACP Therapy Today

My dyslexia allows me to work more creatively with clients

Access all areas

The reasonable adjustments that we can all make to open up our practices

Uncovering the real causes of burnout // Supervision and assessing fitness to practise When a client has a life-limiting diagnosis // Is it OK to work under your first name only?

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Main features

‘Years of not being able to physically fit into spaces can leave you apologising

taking up space’

Johnson (‘Opinion’, pages 26–27)

the british psychologi

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From the Editor

One of the most rewarding aspects of this role is making connections with members. Often it starts with an email, like the one from Abigail Denny, which contained a simple challenge –‘Why don’t you have any disabled therapists in articles?’ She pointed out that our coverage of disability issues was client focused and there was little representation of disabled people working within the profession. ‘Are we not part of the community?’ she asked. Our subsequent email exchange led to Abigail’s ‘Experience’ article in this issue in which she describes training as a therapist after surviving a brain haemorrhage that affected her speech and mobility. Abigail had to overcome being stared at and talked over in her therapy training, then asked by her first therapist why she chose to train in a talking therapy. It seems our acceptance and non-judgment as a profession has limits.

Callum Jones describes his neurodivergence being treated with ‘apprehension and confusion’ during his training: ‘There seemed to be an unspoken message that this was not a place for a neurodivergent, as those with autism are unable to recognise emotional and social cues (a myth).’

As a wheelchair user, Craig Johnson says that without the post-pandemic opening up of online work, he couldn’t have accessed the therapy or supervision required to complete his training. As he puts it: ‘It strikes me as odd that so many of those in private practice seem to work from inaccessible spaces, almost as if they personally don’t expect to have to consider client access, even when they are apologetic, empathic and understanding of the issue.’

Under the 2010 Equality Act, anyone offering a service has a legal duty to make reasonable adjustments for

THERAPY TODAY

Editor Sally Brown

neurodivergent people and clients with disabilities so that the service is accessible to them. This includes those in private practice – it’s not just something that can be left to ‘specialist services’. Our first ‘Accessibility issue’ was inspired by the publication of a new BACP

Good Practice in Action resource that addresses this issue and advises private practitioners on what ‘reasonable adjustments’ look like in terms of advertising, contracting and delivery of services. Our 12-page special section starts on page 18.

We have more compelling stories elsewhere in this issue. Don’t miss Sharon Watt’s account of the course of action she followed when her very first placement client alerted her to a possible terrorism risk. Jenny England meanwhile shares insights from working with clients with life-limiting diagnoses, and Francis Norton describes how training as a therapist helped him piece together the factors that triggered his previous career burnout, which then inspired his specialism. As ever, I am grateful to all the practitioners who have taken the time to share the benefit of their experiences with their fellow members.

If you have a story to tell, do drop us a line at therapytoday@thinkpublishing.co.uk

Sally Brown Editor

Contributing to Therapy Today We welcome submissions. Please send your article or an email describing what you would like to write about to therapytoday@ thinkpublishing.co.uk. Please note, we currently do not publish poetry. For further guidelines, see www.bacp.co.uk/bacp-journals/author-guidelines

Art Director George Walker

Managing Editor Marion Thompson

Contributing Editor Catherine Jackson

Consultant Editor Rachel Shattock Dawson

Reviews Editor Jeanine Connor

Production Director Justin Masters

Client Engagement Director Rachel Walder

Executive Director John Innes

Commercial Partnerships Director Sonal Mistry

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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 the contributor’s employer, unless specifically stated. Publication in this journal does not imply endorsement of the writer’s views by Think or BACP. Similarly, publication of advertisements and advertising material does not constitute endorsement by Think or BACP. Reasonable care has been taken to avoid errors, but no liability will be accepted for any errors that may occur. If you visit a website from a link in the journal, the BACP privacy policy does not apply. We recommend that you examine privacy statements of any third-party websites to understand their privacy procedures.

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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.

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lives

Anyone offering a service has a legal duty to make reasonable adjustments for neurodivergent people and clients with disabilities so that the service is accessible to them

From the CEO

Anna Daroy, Chief Executive Officer of BACP

In this, my second opportunity to connect with everyone through this column, I’d like to focus on a passion of mine: policy – an important aspect of the work BACP does to influence the UK’s governments and ensure that counselling and psychotherapy are at the forefront of policy making.

Advocating for our profession and for access to counselling services for all is one of the most important aspects of my role as CEO. With mental health high on the policy agenda right across politics, society and business, BACP has a strong voice to contribute at an important time on behalf of members.

As CEO, I represent BACP on the influential Health Devolution Commission, chaired by Andy Burnham and Sir Norman Lamb. Recently the Commission looked at the new integrated care systems (ICSs) as a response to the current cost of living crisis. We know that financial pressures are having an increasing impact on people’s mental health, and we made a strong case for increased investment in counselling and psychotherapy through the ICSs. We will continue this work as there is a lot more to do here.

In March the Chancellor revealed the new spring budget and there were three announcements I was pleased to see. First, the inclusion of additional investment for suicide prevention. Second, the recognition that charities are dealing with increased demand from vulnerable groups and a new £100 million fund to support their work. And finally, increased mental health support for helping people remain in, or return to, employment. This is welcome news, but unfortunately it is likely to fall short

of the increased demand for mental health support. It’s vital this is addressed by the forthcoming Major Conditions Strategy, launched to tackle major conditions and diseases including mental illness, and we’ll be calling on the Government to invest in and utilise the skills of our members so more people can access life-changing therapy.

There are also, unfortunately, challenges around funding for two key initiatives we originally helped to secure. In Scotland, universities and colleges are awaiting important assurances from the Government regarding ongoing investment into counselling. We’re working with the National Union of Students UK, Colleges Scotland and Universities Scotland to call on the First Minister for an urgent commitment to long-term funding.

We also received very disappointing news that the Healthy Happy Minds programme, which provides counselling and other therapy interventions to primary school children in Northern Ireland, won’t be continued. We’ve collaborated with the British Association

of Art Therapists and key counselling providers to continually highlight the risks of ending the programme, which will leave children without vital support at a critical time and create uncertainty for our members providing these services. We will continue to work with Ministers and Commissioners in Northern Ireland to ensure that young people have access to school counselling.

Partnership working has been key to the success in originally securing these investments for counselling, and I’m keen to build on our existing relationships to develop even more opportunities for our members and the clients and communities we support.

BACP was again represented at this year’s Health and Wellbeing at Work Conference, which attracts thousands of delegates and employers to discuss and shape issues around workplace wellbeing. During the two-day event we promoted the benefits of investing in workplace counselling and the role of our members working in organisational settings to employers. This is an important avenue to pursue since we know mental ill-health is the most common condition among working-age people not in work due to poor health, as evidenced by the Institute for Public Policy Research think tank last year.

These are just some of the great opportunities we engage in relentlessly on behalf of members. We’re committed to continuously striving to expand the reach of the profession and the amazing outcomes that counselling and psychotherapy can have on people’s lives. •

‘BACP has a strong voice to contribute at an important time on behalf of members’

News round-up

Our monthly digest of news, updates and events

Working for you

Briefing for Westminster debate

Earlier this year we briefed Kevan Jones, Labour Member of Parliament for North Durham, ahead of a debate on the 10-Year Mental Health and Wellbeing Plan. Mr Jones used the information supplied in our briefing to speak about the importance of counselling and psychotherapy, and of early intervention and prevention, saying: ‘We know for a fact that around 50% of mental health conditions are established by the time that a child reaches the age of 14 and 75% of them are established by the time someone is 24. However, it is estimated that 60% of children and young people who have diagnosable mental health conditions currently do not receive NHS care. I share the very valid concerns raised by mental health charities and others that scrapping the 10-year plan and merging mental health into the major conditions strategy means that the people who will be at most risk will be children and young people, who are less likely to have chronic physical health conditions, but are most likely to benefit from early intervention, for example counselling or psychotherapy.’ He also echoed our calls for children to have access to a funded school counsellor, a change we have long campaigned for. Karan Chhabra, our Policy and Public Affairs Officer, said, ‘We’re extremely pleased to see the benefits of early interventions such as counselling and psychotherapy discussed in this debate. The skyrocketing rates of mental ill health, particularly in children and young people, that have been exacerbated by the cost of living, mean that investment in counselling and psychotherapy is more important than ever.’

Roundtable on rural mental health

As part of our sponsorship, exhibition and attendance at the 2023 Health and Wellbeing at Work Conference, Kris Ambler, BACP Workforce Lead, and Karan Chhabra, BACP Policy and Public Affairs Officer, hosted a roundtable event on the topic of mental health in rural communities, attracting delegates from across the conference to share their thoughts and experiences. We used this opportunity to talk about recent research evidence suggesting that people in rural communities have higher rates of mental ill health and suicide, and the barriers in place that are stopping people in those communities from accessing vital support such as counselling and psychotherapy. We also highlighted BACP’s parliamentary engagement on the issue, including our recent collaboration with Richard Foord MP on a question asked in Parliament. Karan said: ‘It was fantastic to see so many delegates at our roundtable, showcasing the level of interest in rural mental health and commitment to ensuring that people in rural communities are able to access life-changing support when they need it.’

Support for school counselling

We welcome a new Barnardo’s report, ‘It’s Hard to Talk’: expanding mental health support teams in education, which argues for the inclusion of registered and accredited counsellors in schools and colleges via an expansion of mental health support teams (MHSTs) into an MHST+ Model, highlighting how this could provide significant cost savings for taxpayers. Jo Holmes, our Children, Young People and Families Lead, urged the Government to act on the report’s findings: ‘This is an important report by Barnardo’s that highlights the value of school counselling, not only to the children and young people it benefits but also to the public purse. The availability of counselling offers an accessible step care approach for existing teams to refer on to for those children who often fall into the missing middle, caught between what MHSTs currently offer and higher tiered CAMHS. The report gives a true picture of what’s needed in schools and will take the pressure off CAMHS and school staff and provide wider access to counselling in the many schools that can’t afford to pay for additional counselling provision. The recommendations need to be acted on. They can’t go under the radar or simply be ignored.’ The costbenefit analysis by Barnardo’s found that for every £1 invested in MHSTs, there’s a predicted return of £1.90 to the state. This is through savings in further healthcare costs and the indirect benefits of improved school attendance and educational attainment.

• For more details and to keep up to date with BACP’s policy news, see www.bacp. co.uk/news/news-from-bacp

News round-up

Spreading the word

Jo Holmes,• BACP’s Children, Young People and Families Lead, spoke to the BBC and the Belfast Telegraph about the impact the end of funding for the Healthy Happy Minds programme will have on primary school children and therapists in Northern Ireland. • Kris Ambler, BACP’s Workforce Lead, contributed to an article in the Financial Times about banks and law firms offering counselling as a staff perk.

BACP Vice President Julia Samuel discussed the death of an adult child in Saga magazine

An article in Metro exploring the mental health impact of the pandemic three years on featured statistics from our annual Public Perceptions Survey and expert comment from Nicola Vanlint Statistics from the BACP survey on the impact of climate change were used in The Sunday Times.

Lina Mookerjee contributed to a feature in the Daily Express and Daily Record on highly sensitive people. Lina also spoke to iNews for a feature on how to be kind to yourself. Simon Coombs and Stefan Walters spoke to the Vice news website with advice to men on how to start dating after a toxic relationship.

Cate Campbell and Lindsay George featured in a piece in iNews on sex and intimacy in marriage.

Cate also spoke to a number of publications, as well as the HuffPost website, about the emotional and psychological barriers preventing women exercising as part of Sport England’s ‘This Girl Can’ campaign.

• Hansa Pankhania spoke about the positive impact of kindness for a piece on ITV’s Woo website, while Natasha Rae Adams • spoke to the same website about seasonal depression. A Refinery 29 article on the dynamics of growing up as an eldest daughter featured comments from Louise Tyler

Royal visit for organisational member

The Prince and Princess of Wales visited Brynawel Rehab near Pontyclun in south Wales to hear about the important work it does in supporting those struggling with the effects of drug and alcohol addiction. During the visit, they announced that their Royal Foundation will work with Life at No.27, a horticultural therapy and counselling provider, and Brynawel to create a set of therapy allotments and gardens. BACP member Paul Doster, Head of Therapy at Brynawel, said: ‘Prince William spoke to some of the people who have been through the programme and now come back as volunteers and are training as peer mentors. He was interested in their journeys through the process, how they’d found the therapy, how life had been before coming in. He spent some time speaking to family members about the changes they’d noticed and how life was now they’d been through the programme. There was a genuine interest from both of them, which was fantastic.’

Present at Making Connections

Our Making Connections events are free for members and as well as providing CPD they give attendees the chance to meet with other members, divisional executive members and BACP staff. They also offer an opportunity for practitioners local to the area of the events – which take place throughout the four nations – to present and share their ideas and experience. Previously, speakers have covered topics such as neurodiversity, male sexual trauma, online counselling and domestic abuse. Anthony Davis shared his presentation, ‘Psychological distress among black gay, bisexual

and men who have sex with men (MSM): implications for therapeutic practice’, at our Making Connections London event last November and said: ‘The attendees were welcoming and demonstrated reflection and interest in my presentation.’ Making Connections will be in Belfast in June 2023, Edinburgh in October 2023, London in November 2023 and Lincoln in January 2024. If you’d like to share your professional or personal expertise, we’d love to hear from you. For more information, see www.bacp.co.uk/eventsand-resources/bacp-events/ share-your-expertise

Promoting our members and our profession through the media

Don’t miss out on the CPD hub

Our CPD hub currently contains more than 300 hours of online resources, helping you to continue to develop your competence and knowledge throughout your career. Content covers a variety of topics, with new content added every month, and includes numerous presentations from experts in their field. All of our resources count towards your annual CPD requirement and come with a certificate for you to download. Our

members find the hub to be of great value – one feedback comment was:

‘The CPD hub is a gift! There is a wide range of easily accessible topics and continuous learning. It’s both interesting and inspiring no matter if you are newly qualified or have been practising for years. Really enjoyable learning.’ A CPD hub subscription costs members £25 per year. To find out more, see www.bacp.co.uk/ cpd/cpd-hub

Updated membership fees

As a professional association, our commitment to providing you with a consistently high level of service is dependent on our financial stability. Recent rises in inflation have had a significant impact on our operating costs, and while we’ve made efficiencies within the organisation and absorbed rising costs wherever possible, this isn’t sustainable in the long term. Before the pandemic, membership fees would increase

annually in line with the consumer price index but we’ve not done this since 2019. We made the difficult decision therefore to increase fees for our individual and organisational members. This came into effect on Saturday 1 April and represents an average increase of 4.4% across membership categories. For more, see www.bacp.co.uk/news/ news-from-bacp/2023/marchupdate-on-our-membership-fees

AGM: An update on this year’s processes

This year’s AGM takes place on Thursday 2 November, and we encourage all members to get involved with our AGM processes – this is your chance to help shape the future of BACP. There are several ways to be involved, and the timelines for our motions and resolutions, and Governor elections processes, have now been confirmed. You can view them on our website at www.bacp.co.uk/AGM2023

At each stage of these processes, all members will receive emails from Natalie Bailey, BACP Chair, via our independent partner MiVoice, which manages the AGM processes on our behalf. You’ll receive emails and reminders with details on how to take part at each stage. Please check your junk mail folder for these emails if you don’t receive them once the processes open. If you have any questions, contact us at governance@bacp.co.uk

Individual accreditation to temporarily close

As part of the preparation period for the Scope of Practice and Education (SCoPEd) framework implementation, BACP’s current individual accreditation scheme will close for around three months at 12 noon on Tuesday 31 October 2023. Eligible members who wish to can still apply for individual accreditation using the current online application process until it closes in October. After this time, we won’t be accepting new accreditation applications for around three months, as time is needed to complete the assessment of accreditation applications submitted under the current scheme, make changes to the online application form and prepare staff for the transition period.

In early 2024 we’ll move into the transition stage, where you will be able to apply for accreditation via temporary mechanisms and move between BACP membership categories mapped to the standards of the SCoPEd columns. Details of the temporary mechanisms will be shared with members by September 2023.

It’s important that you feel ready to apply for accreditation when you prepare and submit your application. Whether that is before the current scheme closes or during the transition period will depend on your readiness to go through this process. You won’t be disadvantaged either way. A key aim of the accreditation schemes and the transition period is to enable members to move to the membership category that best aligns with their training, experience, knowledge and skills. Members will be able to apply for accreditation at any time during the transition or thereafter by evidencing they have met the accreditation standards.

In addition, we’re currently exploring a range of financial support options to help members with particular needs to apply for accreditation. We hope to be able to provide more information on these soon.

If you want to discuss your options for accreditation, you can email the accreditation team on accreditation@bacp.co.uk or see www. bacp.co.uk/membership/accreditation for more details. To find out more about SCoPEd next steps, see www.bacp.co.uk/scopednextsteps

News round-up

Our monthly digest of news, updates and events

Healthy Happy Minds campaign

Hundreds of people backed BACP’s campaign to extend a vital primary school counselling programme that makes a positive difference in children’s lives across Northern Ireland. Healthy Happy Minds provided access to counselling and other therapy interventions, including art, music, drama and play therapy, in 566 primary schools. However, it was announced funding for the programme would end on 31 March because of budget pressures, leaving children without crucial counselling support and the therapists who provide the services facing financial uncertainty. BACP called on people in Northern Ireland to support the campaign by emailing their members of the legislative assembly and Parliament to highlight the scheme’s positive impacts and encourage elected representatives to contact the Northern Ireland Department of Education and ask for funding to continue. The campaign was supported by the British Association of Art Therapists.

Jo Holmes, BACP’s Children, Young People and Families Lead, said: ‘Speaking to a school counsellor can be a transformative experience for a child or young person. It can help them cope with the difficult circumstances they face in their lives – and to go on and flourish in the future. We’re grateful to the hundreds of BACP members in Northern Ireland who have taken action to write to their elected representatives.’

Although the Department of Education has now provided final confirmation that funding for the service will end, we remain committed to fighting for improved access to school counselling across all four nations of the UK.

PROFESSIONAL CONDUCT

¢ BACP’s Public Protection Committee holds delegated responsibility for the public protection processes of the Register. You can find out more about the Committee and its work at

Join a BACP divisional executive

Our divisions are networks of occupation groups or special areas of interest, each led by a voluntary executive committee of up to 10 members who run their own meetings, formulate strategies in line with our objectives and actively support us to promote their sector. We’re currently looking for new executive members to join each of our seven divisions, including Coaching, Healthcare, Private Practice, Spirituality, Universities and Colleges, Workplace, and Children, Young People and Families. Divisional executives are appointed for up to three years, with the potential to be extended for a further three. You’ll attend meetings in person or online and have a background or interest in that specific divisional occupation. Paul Carslake, acting Chair of our Private Practice division, shared his experience of being a divisional executive member: ‘You get a chance to be part of a team that is trying to shape the best possible services for fellow practitioners. If, through your therapy work, you’ve missed the chance to sit around a table and discuss ideas and make plans, this could be for you.’ To find out more about each of our divisions, including details of how to apply for available vacancies, see www.bacp.co.uk/news/news-from-bacp/2022/4august-join-a-bacp-divisional-executive

www.bacp.co.uk/about-us/protecting-the-public/ bacp-register/governance-of-the-bacp-register

¢ BACP’s Professional Conduct Notices can be found at www.bacp.co.uk/professional-conduct-notices

SHAROMKA/SHUTTERSTOCK

BACP events and CPD

The on-demand service from our children, young people and families (CYPF) conference, ‘Breaking the cycle of trauma and promoting healing and hope’, which took place in March, is available to purchase and view until Saturday 24 June. It includes presentations on ‘Linking principles of polyvagal theory to clinical work’, ‘The fragile interplay between learning and healing’, ‘Trauma and eating disorders’, ‘Working with refugees as a school counsellor’, ‘Grief and loss’

CYPF conference on demand Supervisors event

and ‘The context for trauma in parents of children with special educational needs and disabilities (SEND)’. There are also keynote presentations from Claire Harrison-Breed and Dr Renée Marks. Access to the on-demand service costs between £40 and £50 for members, depending on divisional membership status, and £100 for non-members. To find out more, see www. bacp.co.uk/events-andresources/bacp-events/ondemand-services

Don’t miss the Research Conference

There is still time to book on to the 29th annual Research Conference, ‘Global issues in counselling and psychotherapy, policy and practice’. This hybrid event will take place in Leeds in person on Friday 19 May and Saturday 20 May, and online on Saturday 20 May. You can choose any combination of booking you prefer, deciding whether to attend online, in person or a mixture of both. The conference will address research related to matters of worldwide public concern, with topics including climate change and refugee wellbeing.

The second BACP Supervisors event will take place in Manchester on Saturday 8 July. After the success of the pilot event held in 2022, this Supervisors event will take place in person. It’ll explore some of the issues manifesting in the supervision encounter, including the challenges supervisors might face. It’ll also look at the contextual, contemporary and practice-based issues that

present in supervision. There’ll be a mix of workshop topics on offer, along with facilitated discussion groups and opportunities for supervisors to network and share their passion for supervision. There’ll also be one keynote speaker, and the day will close with a panel discussion. Attendance costs £120 for BACP members and £170 for nonmembers. To find out more, see www.bacp.co.uk/events

Day one (in person): Day one will take place at the Hilton Leeds City hotel on Friday 19 May and costs £95 to attend. The event will start at 12pm with a panel discussion session, followed by a range of presentations and workshops. It’ll also include a ticket to the networking dinner. Day two (in person): Day two will take place at the Hilton Leeds City hotel between 8.30am and 4.30pm on Saturday 20 May and will cost members £120 to attend. It’ll feature two keynote sessions along with a variety of presentations and workshops. Lunch and refreshments will also be included. Day two (online): Our online event takes place on Saturday 20 May between 8.30am and 4.30pm and will cost members £50 to attend. Online attendees will have access to two strands of presentation content, including research and discussion papers, symposia and more.

For more information and to book, see www.bacp.co.uk/events-andresources/research/conference

ASTAROT/SHUTTERSTOCK

‘My previous career in politics has shown me the importance of getting the message across to those in power’

Recently, the charity DadsWork asked me to speak at their annual general meeting about my counselling work with them. DadsWork is a community project in East Lothian working with fathers and male caregivers, offering counselling, support groups, positive parenting classes and workshops, and trips and outings for fathers and their children.

Despite the growth in such community-led initiatives, along with high-profile campaigns such as Movember – men’s mental health awareness month – there remains a lot of work to do to bring an end to the stigma that stops many men asking for help.

I grew up gay in the 1980s, when the mainstream cultural attitude towards homosexuality was highly discriminatory and often abusive, largely fuelled by fear of the newly emerging HIV virus and AIDS. It was difficult and sometimes impossible to ‘come out of the closet’, a term that perfectly sums up the hidden nature of my own experience. There were limited avenues for men to talk about issues around sexuality or identity in general, and the introjected values of many meant that feelings or problems were simply not acknowledged or understood. It took me a while to accept the need for counselling but it was an experience that greatly helped me understand and accept myself. Later, my journey moved on to exploring the spiritual aspects of life, including meditation. Now, some 30 years on, we have started to see a shift in men’s willingness to explore their own lives, including that ‘no-go area’ of talking about feelings.

Over the years I have had the privilege of knowing many men and women who are dealing with ‘hidden’ difficulties, including the many unpaid carers in our society. I didn’t appreciate the stress and

challenges they are under until I looked after a relative who had dementia for five years, and experienced first-hand the lack of available support. Accessing counselling support was difficult and delays in receiving it were agonising. I know this is an issue experienced by many.

After a traumatic year I realised that I had to make changes in my life, and began thinking about where I could make a difference, particularly in supporting men’s mental health. Until then, I had had a successful career as a civil servant, including working as a caseworker to two members of parliament for 15 years. It felt like a big leap to start counselling training, with the first hurdle being my own fear of studying at a more mature age. One of a few men on the course, I was also the oldest in my class and very conscious of the age gap. But I found that I enjoyed the course and even the ever-present assignments. Three years later

I was able to take this journey another step and begin to practise, after qualifying and completing my placement.

My motivation to join the BACP Board was fuelled by a drive to make a difference to the mental health of all, not just men. In these turbulent, post-pandemic times, we know that mental ill health is an issue that is becoming critical.

My previous career in politics has shown me the importance of getting the message across to those in power, and that now is always the best time to act. As an Association, we at BACP are continuing to set the standards for counselling in the UK. We need to be relentless in pushing for advances and changes in the four nations’ Governments’ approach to mental health. One of the most important developments is our recently launched equality, diversity and inclusion strategy, with its focus on making counselling and psychotherapy accessible and appropriate for people who may have previously felt excluded from getting the right support.

Destigmatising men’s mental health remains important to me, as I know that many men still feel that counselling is not for them – social pressures and societal gender roles continue to make it difficult to ask for help. There is a persistent, underlying philosophy around masculinity – and I speak as someone who once held it – that we should be tough enough to fix our own problems, and that showing any vulnerability or seeking help is wrong. Only by continuing to promote the message that it is ‘OK to be not OK’ can we fundamentally shift those perceptions. I am excited to be part of a professional membership body with the ability to make this happen, and to change the lives of so many people. ■

Ewan Irvine, Trustee, BACP Board of Governors

MIKE SEWELL

Reactions

False memory

Lynda Thompson’s article, ‘Surviving the false memory wars’ (Therapy Today, February 2023) makes several flawed claims about the British False Memory Society (BFMS). The position of the BFMS is that trauma is more likely to be remembered than forgotten and the psychoanalytic notion of repressed memory is not supported by the science of memory. Ms Thompson asserts that false memory is a convenient ‘invention’ to undermine therapists and victims of sexual abuse. The BFMS was founded in 1993 to support fractured families torn apart after their adult children had typically entered therapy for, for example, depression, anxiety or eating disorders and, following counselling sessions, claimed to have recovered unconscious memories of abuse. Prior to starting therapy the accusers had no indication or conscious memories of ever being abused. This is a crucial difference from those victims of sexual abuse who have always retained memories of sexual abuse but do not want to talk about the abuse. In essence, we are looking at two distinct data sets. The BFMS abhors child abuse, which is morally reprehensible.

Ms Thompson cites the ‘groundbreaking’ work of Bessel van der Kolk, asserting that ‘we now understand that the frontal cortex of the brain shuts down during trauma when the imperative is to stay safe and survive, not stop and think’. In our opinion, this hypothesis is based on a convoluted perspective. The notion of body memories is not supported by scientific research – not the least being the knowledge of how body cells and neurons work in biology, and cognitive and clinical research in psychology.

Ms Thompson also appears to be unaware of several recent studies regarding beliefs about memory and the reliability of repressed memories. See, for example, Patihis et al (2014), Are the ‘memory wars’ over? A scientist-practitioner gap in beliefs about repressed memory; French and Ost

(2016), Beliefs about memory, childhood abuse, and hypnosis among clinicians, legal professionals and the general public; Pendergrast (2017), Memory warp: how the myth of repressed memory arose and refuses to die; Patihis et al (2018), Memory experts’ beliefs about repressed memory; Otgaar et al (2019), The return of the repressed: the persistent and problematic claims of long-forgotten trauma.

In What science tells us about false and repressed memories, Otgaar et al (2022) postulate: ‘Concerning the controversial topic of repressed memories, we show that plausible alternative explanations exist for people who claim to have forgotten traumatic experiences; explanations that do not require memory mechanisms such as the unconscious blockage of traumatic memories. Finally, we demonstrate that people continue to believe that unconscious repression of traumatic incidents can exist. Disseminating articulated knowledge on the functioning of memory to contexts such as the courtroom is necessary as to prevent the occurrence of false accusations and miscarriages of justice.’

As Prof Larry Weiskrantz noted, in Fractured Families: the untold anguish of the falsely accused (BFMS, 2007), repression is a theory, not a fact. Dr Kevin Felstead, Prof Chris French, Prof Henry Otgaar, Dr Lawrence Patihis

Dr Lynda Thompson responds: I agree that ‘disseminating articulated knowledge on the functioning of memory to contexts such as the courtroom is necessary’, and for this reason, I welcomed the revised guidelines on pre-trial therapy issued by the Crown Prosecution Service in 2022 (www.cps.gov.uk/legal-guidance/ pre-trial-therapy), which include the following references to memory: ‘Repeated attempts to remember commonly lead to more material being recalled. In therapy for PTSD, when processing traumatic memories, it is common to recall additional facts, sometimes quite significant ones. This is believed by many trauma experts to occur because traumatic events result in more fragmented and disorganised memories, at least for the most distressing moments of the trauma. Hence accounts often lack contextual and peripheral details which are not integrated at the time of the traumatic event.’

Addressing false memory specifically, the guidance says: ‘There is no substantive evidence that therapy will generate false memories. It is well recognised, conversely, that victims of trauma avoid engaging in trauma-focused therapies where they are required specifically to focus on the memories due to the associated distress. Further, some victims do in fact remember details of the abuse many years later; these are not false memories but rather real memories that had until that point been repressed.’

This understanding of how trauma can affect memory is the result of extensive research by trauma experts, and its inclusion in the latest Government guidelines is to be welcomed.

Dealing with doubt

Much of what I read in ‘Dealing with the demon doubt’ resonated with me (Therapy Today, March 2023). As a counsellor/ psychotherapist, I trained for five years in transactional analysis. I work part-time in this role as I have a full-time academic role; I created and co-ordinate an undergraduate psychology with counselling degree scheme (BPS accredited) and teach the undergraduate counselling modules. I have

worked in private practice since 2018 and most of my clients are long-term, including three who have been with me for more than three years. Yet I still have ‘imposter syndrome’ and experience feelings of not being good enough, and not ‘doing it right’. I shift between conscious incompetence and conscious competence, but would really like to get to a place of unconscious competence!

Thinking about circumstances and triggers, when I am neglecting my own needs and wants, my wellbeing suffers, and this leads to self-doubt. Having personal therapy is invaluable – I have a great therapist and am becoming more accepting of my own vulnerability. Finding a supervisor with whom you can really feel comfortable, someone you can trust and be authentic with, is also important.

Dr Alison Mackiewicz MBACP, senior lecturer, counsellor and psychotherapist

I just wanted to take this opportunity and say thank you for ‘Dealing with the demon doubt’ (Therapy Today, March 2023). It helps me enormously to understand that I am not alone in this way of thinking.

Taking my self-doubt to supervision and peer groups does help, but being able to see that this phenomenon is so widespread within the profession has really encouraged me to accept this part of myself, and consider that it also may well be useful to the client and the therapeutic relationship.

It occurs to me that self-doubt may be a close cousin to ‘not knowing’, and I find that, when sitting with a client, my most useful work with them and for them is usually following a period of both of us not knowing!

Thank you for highlighting an aspect of this job which can feel quite shaming if not given the normalisation that it requires. As I write this, I’m aware that I feel tense at the thought of my name being printed in Therapy Today, and would ask for my name to be withheld.

Name and address supplied

‘Dealing with the demon doubt’ left me puzzled. I was surprised to hear that more than half of therapists experience feelings of incompetence after five years of practice. If we are talking about real self-doubt and not about questioning the process or the client’s material, then this number is very concerning. Should those with an alarming amount of self-doubt see clients at all? The internal questions of self-doubting therapists noted in the article seem to me like a paranoia of unhealthy questions and stuckness with excessive bias. Curious questioning, on the other hand, is healthy. There is a problem using the word self-doubt. Do I question my effectiveness as a therapist? Yes, I do. Do I feel self-doubt? No, I do not. The difference between occasional questioning and self-doubt is enormous.

The debate about self-doubt would benefit from the addition of important demographics indicating which theoretical approach has the most self-doubters. Do they have regular supervision? Do they have personal therapy? The debate could be informed by the client’s feedback and how it is to be a client of a self-doubting therapist as well as to identify which groups of clients evoke the most doubt in the therapist. More importantly, the topic of self-doubt needs to be linked to the therapist’s attachment style and how the therapeutic process can ‘cause’ self-doubt. I refer to transference, countertransference and projective identification, which are the most common expressions of unconscious material. Slavitsa Mirovic MBACP (Accred)

Impulse control, not addiction

I specialise in compulsive sexual behaviours and would like to point out a few concerning things in Dr Hall’s article, ‘Stick, twist or fold’ (Therapy Today, March 2023). I agree with Dr Hall that the debate on compulsive sexual behaviour disorder (CSBD) versus sex addiction continues despite the acceptance of CSBD in the ICD-11, but the debate exists because some therapists refuse to accept that CSBD is not classified as an addiction. Although the World Health Organisation (WHO) clearly states that sex addiction and CSBD should not be used interchangeably, some therapists continue to do so, despite WHO’s guidelines. DSM-5 also refutes ‘sex addiction’ altogether because there isn’t enough evidence for it. Using sex addiction and CSBD interchangeably is confusing and makes it much harder for the public to understand what kind of treatment they’ll be getting.

I agree with Dr Hall that clients care more about getting help than the debate on nomenclature, but they also care about getting the help that is right for them, and they care about their therapist having a good grasp of what they’re treating. It is our job to be clear with clients about what we are treating (addiction or not) and what treatment we are offering, so that they can make an informed choice. Although this may appear to be semantic, it is actually important and, in my opinion, an ethical issue, because an impulse control treatment is different from a ‘sex addiction’ one. Nevertheless, even though I firmly disagree with much of Dr Hall’s approach, it is with disagreement that our field can grow and become a safer space for clients. I applaud Dr Hall for her ongoing commitment to her work.

Silva Neves MBACP, COSRT accredited psychosexual and relationship psychotherapist, author of Compulsive Sexual Behaviours: a psycho-sexual treatment guide for clinicians (Routledge)

Thinking about circumstances and triggers, when I am neglecting my own needs and wants, my wellbeing suffers, and this leads to self-doubt. Having personal therapy is invaluable

We very much welcome your views, but please try to keep your letters shorter than 500 words – and we may sometimes need to cut them, to fit in as many as we can

The month

Mental health and the human experience in the arts, media and online

Big Women

Curated by the former Young British Artist Sarah Lucas, this massive art show lies improbably, like a crock of gold, in Colchester, at the end of the A120. Big Women is a big exhibition of big work by older women – sculpture, painting, film and fashion –celebrating women of that age. The title is lifted from the popular 1990s TV drama of the same name. It features 25 leading female artists, including Lucas herself. Its emphasis is definitely on big, on fun and, necessarily, on change – those many significant shifts in women’s bodies, identities, and the social roles and expectations placed on them that also change as they grow older. Says Sally Shaw, Director of Firstsite contemporary art centre: ‘It requires a great deal of strength and resolve to ride all those changes – and all kinds of inventiveness and imagination –especially as women are often just expected to “get on with it”. Anyone who is worried about getting older or being “past it” needs to come to this exhibition – it will prove to you how much fun it can be!’ At Firstsite, Colchester, Essex, until 18 June. www.firstsite.uk

The third series of BBC Three’s blacker than black comedy, Jerk, about a man with cerebral palsy, features big name guest stars including James Norton who plays himself, cast as a disabled French jazz drummer in a film and on the receiving end of backlash as a result. Co-written by and starring US stand-up comedian Tim Renkow who has cerebral palsy, Jerk’s comedy comes from exploiting the general public’s uncomfortableness with disability – in the first series, he tests just how ‘unsackable’ he is as a disabled man, and he spills a glass of water on his crotch to shame someone using a disabled loo. He has more than met his match in his foul-mouthed carer, Ruth (Two Doors Down’s brilliant Sharon Rooney) and his straighttalking mother played by The Sopranos’ therapist Lorraine Bracco. Nothing is off limits and at times it’s more wince-making than groundbreaking, but there’s nothing else like it currently on TV. All three series are available to download now on BBC iPlayer

Theatre

Animal places a severely disabled young man as the complex central character in a laugh-out-loud story about sex, love and hook-up culture, and how those work for someone who is reliant on people almost 24/7. Written by Jon Bradfield, the story was originated by writer, activist and Therapy Today contributor Josh Hepple, after his frank article in The Guardian about how the Grindr app transformed his sex life as a gay, disabled man went viral. It stars Christopher John-Slater as David who has cerebral palsy and is trying to assert his independence while not losing people around him. By using humour to confront dark and difficult emotions, Animal challenges the taboos and stigma that still surround disability. After a successful premiere in Manchester that received five-star reviews, the production moved to Bristol and will be at the Park Theatre in London from 19 April to 20 May. www.parktheatre.co.uk/whats-on/animal/about

Animal

Exhibition

BBC/ROUGHCUT

TV/ADAM LAWRENCE

PIERS FOLEY

Know of an event that would interest Therapy Today readers? Email therapytoday@thinkpublishing.co.uk

DEEPER MINDFULNESS

Deeper Mindfulness: the new way to rediscover calm in a chaotic world is the long-awaited followup to Mindfulness: a practical guide for finding peace in a frantic world, the bestselling book and eight-week mindfulness course by Professor Mark Williams, co-developer of mindfulnessbased cognitive therapy (MBCT), and mindfulness teacher Dr Danny Penman. This book shows us how we can deepen our mindfulness practice by focusing on a subtle aspect of mindfulness known as ‘feeling tone’ or vedana –the moment ahead of the formation of a feeling or emotion –which defines emotional response.

Research into the programme at Oxford University shows it is effective in treating anxiety, stress, depression and exhaustion. Links to free, downloadable guided meditations are included. Combined with the previous book, it’s an excellent at-home introduction to mind-calming or clients – or yourself.

Deeper Mindfulness: the new way to rediscover calm in a chaotic world is published by Piatkus on 25 May.

Galatea

May is the month when all of Brighton (and Hove, actually) is flooded with cultural, political and deeply queer events in its annual festival. It’s hard to pick the highlights but for theatre, try Galatea, a modern take on a play written in the 1580s by John Lyly, a contemporary of Shakespeare and inspiration for the bard’s own comedies. This is a tale of love, joy and the importance of welcoming outsiders. Two young trans people find love while escaping oppression, a shipwrecked migrant searches for his family, goddesses clash, parents fret, an alchemist brews magic and a teenage Cupid sets hearts on fire, causing chaos and near disaster. Adapted by queer theatre-maker Emma Frankland with Subira Joy, performed against an outdoor setting crafted by the Cornish landscape theatre company Wildworks, co-produced with LGBTQIA+ culture catalysts Marlborough Productions and performed in English and British Sign Language, the play promises to ring every festival bell. Various times, 5–21 May. www.brightonfestival.org/whats-on

Podcast picks

Change and challenge

• The new series of the excellent The Spark, in which innovative thinkers discuss new ways to challenge social problems, includes Dr Rochelle Burgess, Associate Professor in Global Health at University College London, on the impact of the Windrush scandal, tackling mental health at community level and when social prescribing falls short. Available to download on BBC Sounds.

• Hillary Clinton and Cherie Blair discuss how to make change happen in the second series of journalist Anna Stoecklein’s podcast, The Story of Woman: a new perspective, which looks at society, culture, the economy and healthcare through the female gaze. The theme for this series is ‘changemakers’, and interviewees include Black Lives Matter co-founder Alicia Garza. www.thestoryofwoman podcast.com

• The Trust Race is a new six-part series, part-funded by the EU, to investigate public trust in science. Scientist and broadcaster Dr Shane Bergin talks to scientists, philosophers and activists to explore our changing relationships with trust. The first episode features philosopher Professor Heather Douglas on how and why maskwearing became politicised during the pandemic. On most podcast platforms.

HOLLY REVELL

Festival

Access all areas

Katy Evans has finally found a therapist.

Back in December 2021, Evans, who has cerebral palsy and uses a wheelchair, posted a blog about her attempts to find a therapist in the Birmingham area where she lives. She needed wheelchair access and wanted in-person therapy, because of her communication difficulties. She also has a psychiatric diagnosis. Of 505 possible therapists listed on the national directories, 141 said they offered wheelchair access. When I spoke to her,

120 had turned her down, for a range of reasons, not just access.

I emailed her again in March this year. She’d finally found a local therapist who could offer wheelchair access and would see her in person, and was not put off by her mental health diagnosis. It had taken 18 months and she’d logged more than 160 rejected contacts. When we spoke, she was still in the early stages of working with her new therapist, but she knows the continual rejections have scarred her, and she and her new therapist are having to work through that: ‘I’m aware that I am trying to

be the “good client” and not be too demanding. I am frightened constantly that she might reject me, like everyone else has, and that has been affecting the therapy a bit.’

Some 14.6 million people in the UK have a disability, an estimated 22% of the population –that is, to use the official Government definition, ‘they have a physical or mental health condition or illness that has lasted or is expected to last 12 months or more, which reduces their ability to carry out day-to-day activities’.

Disability is associated with poorer mental health and wellbeing, as measured by markedly

All practitioners have a legal and ethical responsibility to make reasonable adjustments to their premises and practices so that disabled people can benefit, says Catherine Jackson

JOHN HOLCROFT

different scores for life satisfaction (6.5/10 compared with 7.6 for non-disabled people); for feeling that life is worthwhile (7/10 compared with 7.9 for non-disabled people); for happiness (6.4/10 for disabled people compared with 7.6 for non-disabled); and for anxiety (4.6/10 for disabled people compared with 3/10 for non-disabled). They are also much more likely to report feelings of loneliness (15.1%) than non-disabled people (3.6%).

The disparities can be seen at every level and in every aspect of life and opportunity –particularly education, employment, housing and social participation. The most common impairment is mobility (46%), followed by stamina, breathing and fatigue (33%) and mental health (29%).

If ever a population group was justified in seeking help from a profession and healthcare intervention that claims to ‘change lives’, surely disability is it?

And yet there is a massive dearth of knowledge about how many disabled people access counselling, how easily they access it and, very importantly, how helpful – or unhelpful –they find it and why.

Ensuring disabled people can access the benefits of therapy is a major part of BACP’s equality, diversity and inclusion (EDI) strategy. This was launched in March this year, with the statement that ‘as the UK’s leading professional body for counselling professionals, we aim to lead on best practice in EDI, creating a profession where our members, colleagues, staff, partner organisations and clients can thrive and fully be themselves’. This month sees the publication of a new Good Practice in Action (GPiA) resource which, alongside updated existing resources, will set out very clearly, individual and organisational members’ legal duties under the Equalities Act and their ethical responsibilities to make ‘reasonable adjustments’ to their premises and practices so that disabled people can benefit. There is also a lot of work going on behind the scenes to make BACP’s own registration, accreditation and professional conduct procedures and processes more accessible to people with learning disabilities and different accessibility needs.

In addition, BACP will be conducting a review of the research to gather data on the questions asked at the start of this article. BACP Good Practice Lead Tina Williams, who heads up this part of the EDI work, says: ‘When we were reviewing the existing resources, the issue was

constantly raised about members’ apparent reluctance to make reasonable adjustments, particularly when first approached. So we decided to commission a new resource to look at this, and to focus it on the needs of private practitioners in particular, as organisations tend to have more resources to deal with the issue. Part three of the Equality Act makes it unlawful for any service provider – and this includes counselling services and private practitioners –to discriminate in how they afford access to someone with a protected characteristic, such as a disability, or in the quality of the service provided or how they advertise their service. You are not allowed simply to say, “No, there’s nothing I can do”.

‘The new resource includes a checklist of what you need to consider right from the start when setting up in private practice, including what you put on your website and in your directory listings; what you tell your clients when they first contact you, whether you know they have a disability or not; what to ask in the initial assessment when you first meet; what are the best digital platforms to use for your online work, as not all are suitable and some are more suitable than others, and when in-person sessions may be more suitable. The mindset we are promoting is in the spirit of the Ethical Framework, which states very clearly that our members should seek to “overcome barriers to accessibility, so far as is reasonably possible, for clients of any ability wishing to engage with a service”.

‘We are not telling members to make adjustments that may conflict with their modality, but we do ask that they have looked at what adjustments they can make right from the start so that they are in a position to respond to the needs of the individual clients when they seek their help, not after the event.’

Anticipatory duty

Steve Rattray, a senior accredited BACP member who specialises in palliative care counselling, reviewed and wrote the new resource. He is sight impaired, and has worked with BACP as a consultant on its EDI materials for many years. ‘One of the things I experienced as my fading sight started to really impact me was this presumption that a person without any personal experience of disability knew what I needed better than I did and expected me to be grateful for what they felt was appropriate. So many disabled people I speak to have experienced the same thing. They decide what we need and they decide what we get. And that’s it. But the Equality Act changed the focus – yes, the final decision about what reasonable adjustments are made rests with the provider of the service, but the law gives us the right to stand up and ask for them. Providers cannot actively ignore our access needs.

‘But much more important than that, the Act empowers disabled people to experience an inclusive society. If you want to engage with someone and make real progress to change, they have to feel safe and they have to feel heard. When the doors open, suddenly you feel you can be part of the world,’ Rattray says. ‘What I find so frustrating is that making reasonable adjustments is not always complicated or expensive. It’s not about rebuilding your clinical space to provide wheelchair access. Very often it just requires a bit of preplanning. So in the new resource I’ve looked at the different things we can do. How can I make sure my practice is accessible? Do I need to put any physical aids in place? Are there any barriers that people might face? Are there people I need to engage with? If a new client is coming with a condition you’ve no knowledge of, do you have somewhere to go for advice? And ask the client how you can change things. Would it help to move the chairs away from the window because of the light or external noise? Would it help to install some kind of hearing support? If someone has an impairment, ask how they would prefer the space to be arranged right at the start.’

Clare Goodridge originally trained as an architect specialising in inclusive design. For many years she worked in the disability sector and as an access consultant and local authority access officer to ensure design standards, regulations and their implementation (whether in new build or refurbishment) met the needs of the whole community, including disabled

‘If ever a population group was justified in seeking help from a profession that claims to “change lives”, surely disability is it?’

people. Nine years ago she decided to train as a counsellor, and she is now in private practice.

‘It’s not easy for therapists,’ she agrees. ‘When I’ve needed to hire therapy rooms myself, I’ve looked at so many in London, and the majority seem to be up or down steep stairs. And very often what are advertised as accessible counselling rooms just aren’t when you get there. I’ve had to rent rooms in non-therapeutic premises just because they were accessible, but often they aren’t suitable as therapy settings because of what is going on in the rest of the building, which impacts client confidentiality.’

For small counselling businesses, accessibility is often seen as an additional expense because it’s not in the budget, she says: ‘The tendency is for people to try to make special arrangements when the situation presents itself. But that is not an inclusive service.

‘The legal duty is anticipatory. The service provider should be proactive, and should have been since the Disability Discrimination Act came into effect in 1995, and then the Equality Act in 2010. We should all be thinking, “What should I do to ready myself or my organisation? Do we have a plan as to how we are going to be ready for clients – and therapists – with impairments of all sorts, within a reasonable timescale?”

‘It’s not up to the service provider to decide what is “reasonable”,’ she says. ‘There are standards and guidance out there. That said, even where those standards are met, you still have to respond if someone comes along and says, “That doesn’t work for me”. And that should feed into the next phase of your organisational development. Having a plan and implementing it should not be a one-off event – it needs to be a dynamic and evolutionary process. When we train as therapists, we talk ad infinitum about the importance of providing a safe space for clients. What is a safe space? Somewhere I feel welcome. I’m not going to feel welcome if I’m asked to go in a back door and the disabled loo is full of cleaning equipment or I have to make very complicated arrangements about when and where my appointments take place. Philosophically we should be seeking to create an inclusive society. We should have moved on, as we should have done with race. It just doesn’t seem to occur to many people that they might find themselves working with someone who is disabled. If we rent rooms with other therapists, we should all acknowledge that we have a shared interest in making the premises fit for purpose and negotiate with landlords accordingly.

BACP’s commitment to challenge

Suky Kaur, BACP Head of Stakeholder Relations, who led on the recently launched equality, diversity and inclusion (EDI) strategy, says:

‘We acknowledge that individual experiences of impairment, disability and ill-health can inform and benefit the BACP community and the communities those in the counselling professions serve. For BACP, accessibility is about making sure our services can be used by as many people as possible and ensuring that nobody is excluded. A central objective is also to ensure that roles within the community, including BACP staff and BACP members, are available to all and to actively encourage diversity.

‘Some of BACP’s organisational practices, processes and materials may have unintentionally created disabling barriers to meaningful inclusion. We aim to remove these barriers to ensure that the counselling profession supports the creativity and individuality of everyone within the community. In line with our Ethical Framework, we are striving for a higher standard than is set by the legal minimum. Our new EDI strategy includes a key commitment to create a consistent approach to accessibility across our membership offer, promote it and continually improve it for our members.’

 For more information on BACP’s EDI strategy, see www.bacp.co.uk/about-us/edi/edi-strategy

Inclusivity should be seen as a key principle of good business.’

Goodridge says all members can start by considering their publicity, websites and directory listings. ‘People use all sorts of unhelpful woolly phrases about being “disabledfriendly” and “wheelchair-friendly” – what does that mean? Access needs to be spelled out in terms of what it guarantees. There should be a baseline and that baseline needs to be black and white. Either your premises are accessible according to British standards, or they are not. And it would help if BACP spelled out what members should be doing as a minimum, so clients don’t face rejection and aren’t pushed from pillar to post.’

BACP member Becky Hedley has a progressive degenerative condition, a form of muscular dystrophy. She recently began using a wheelchair at work to enable her to continue in her role as pastoral lead for safeguarding and mental health in a primary school. She feels that therapists are not providing enough information for disabled clients seeking therapy: ‘I started looking round locally to see what other therapists were putting on their websites. There were a few people who

said their premises were accessible but not in any detail – they used words like accessible or disability-friendly, but that still puts the onus on the disabled person to find out what that actually means. If the information isn’t there, then it’s down to the person with the disability to find out if they can go or not. If the information is there in the first place, you can at least make an informed choice, which is what everyone wants to do, really, isn’t it.’

Attitudes and assumptions

‘As well as improving access to therapy for disabled clients, we also need to make it easier for them to see a disabled practitioner, if that is their choice,’ says Helen Rutherford, who runs Emotional Respite disability counselling service, a therapy service staffed by disabled therapists that is specifically aimed at disabled people seeking therapy. Rutherford is an accredited member of BACP and an electric wheelchair user who has spinal muscular atrophy. She set up the organisation as an act of principle, to highlight the absence of a visible disabled presence in the therapy profession. To her, it’s a social justice issue: ‘Disabled people should have the choice

to access a level of empathic understanding, knowledge and validation of their identity and experiences as disabled people. They should not be exposed to that feeling of being “other” when they seek therapy.’

She and her four associates work online, partly because video, audio and email therapy are the most accessible forms for many disabled people, and partly due to COVID precautions. She trained back in 2007, the only disabled student in her cohort, and struggled then with some attitudes she encountered among her peers and tutors: ‘Some students implied that they couldn’t believe that I could be OK with being disabled. I’d come to that place through many years of therapy, self-development and reflection, coming to terms with it, working through my trauma and grief, but there was this sense of disbelief – they couldn’t put themselves in my position and think they could be OK with it, so I wasn’t allowed to be OK with it,’ she says.

‘There are all these internal biases likely to be at play. And there’s the assumption that the disability has to be the problem, for the therapist and for the client. Personally, my disability is just a small part of who I am. When someone comes for therapy, I check in with them and we work with what they bring. I do not assume that they are coming to talk about their disability.’

She wants to see her non-disabled peers doing more training and personal work on the issue: ‘CPD on working with this complex group is really important. It’s really not acceptable for someone to say they don’t want to work with this group of people because they don’t feel comfortable with it. That says to me they have a lot of work to do on themselves around their own prejudice around disability and their own fears. Maybe it brings up anxieties about their own mortality or it feels too uncomfortably close to them. That was something I had to go through myself. I had to question if maybe I was too close to this subject to be able to facilitate the work effectively before I concluded that I was competent to work with disabled clients.’

In 2015, Rutherford co-founded the Disability Counsellors Facebook group with another therapist, Emma Thompson, for those specialising in working with disability. It has since grown to more than 600 members. ‘There is this network of disabled therapists that is untapped. It’s a place where we can network, share CPD resources and also talk about how we navigate working as disabled therapists. Disabled therapists need a much greater

presence so we aren’t marginalised within our own profession,’ she says.

Abigail Denny decided to train as a therapist after she suffered a massive cerebral bleed in her early 20s. It came out of nowhere and meant she had to relearn how to walk and talk, essentially challenging her brain to find different ways to control her movements and speech. She still struggles with balance and speaking, and with fine motor skills.

She was in hospital for a very long time, sharing a room with another young woman, who later died – she just lost hope and gave up the struggle, Denny says. That was what propelled her into training as a therapist. ‘Our whole world has been turned upside down and we are having to come to terms with the fact that we may not walk again and struggling with communication – people not listening to us and not hearing us, which is incredibly detrimental –and we were left to deal with it ourselves.’

Denny is trained in person-centred counselling but has since added to that through CPD and further training to offer a more integrative practice that allows her to be more flexible in meeting clients’ individual needs and preferences. ‘I had a long-term counsellor who worked from a purely person-centred foundation, and for me that worked. However, I felt if I went to her with a practical problem she couldn’t develop an intervention that suited my needs. She could just work on that personcentred level of non-judgmental, unconditional positive regard but couldn’t help me in day-today life. I needed more directive help sometimes.’

Hidden disabilities

Mental health issues are very commonly associated with disability – in part due to the challenges thrown up by society’s failure to take on board disabled people’s needs, and partly

because disabled people, through childhood and beyond, are more vulnerable to the adverse experiences such as abuse, victimisation, bullying and exclusion, as well as unemployment, poverty and poor housing, that are known to affect mental wellbeing.

Katy Evans has been given a diagnosis of dissociation disorder, which she says stems largely from her childhood experience of being seen and treated as a dysfunctioning body with no thought for her as a person. She also experienced sexual abuse. She doesn’t agree with the diagnostic system, and feels it’s the diagnosis that has often barred her from accessing the mental health support and services she has needed, including counselling. It’s been used as a reason not to offer her therapy when she’s contacted potential counsellors.

‘How I am is I think an understandable reaction to the things that have happened to me and how I’ve had to adapt to survive. Labelling it as a disorder makes a natural adaption “other”, which creates unnecessary alarm and fear, leading to exclusion. I’ve found that when I mention the diagnosis to therapists, straight away they go, “No, I can’t deal with that.” I try saying the biggest thing I need is another human being, I don’t need techniques. But it’s like the diagnosis became a massive red light flashing above my head. And it’s really tricky getting a balance between being open and honest so they can make a decision based on their capabilities and not scaring them. I find that really challenging. Because I don’t want to be with a therapist who I feel I have to be reassuring all the time that I’m not going to kill myself or something.’

Even if they aren’t a specialist, they should be willing to admit it and discuss it with her, she says. ‘The therapist I am seeing now has been quite open that she isn’t particularly trained in it but has had clients who have had dissociation. She says if I’d come 20 years ago she would have said no, but that experience has enabled her to feel confident to sit with it a bit more. When I trained in counselling up to level three, we were told, “Anyone with a diagnosis, you refer on. No questions asked.” They never said who you should refer on to. And now I’ve become that person, and with a disability as well, I feel I can’t fit in any box.’

Neurodivergence

Neurodivergent people can also struggle to access therapy, because of their widely different

‘I’ve found that when I mention the diagnosis to therapists, straight away they go, “No, I can’t deal with that”’

and very specialised needs. There is also a common perception that neurodivergent people cannot train and work as counsellors. This is very far from the case. Callum Jones successfully completed master’s level training and is now doing a doctorate while working in private practice. But when training, he frequently felt as though his neurodivergence was like some kind of ‘dirty secret’: ‘There’s almost this suspicion around us – “Why are you here? You can’t be a therapist”. I remember one person saying that I didn’t look very autistic and I thought, am I supposed to present in a certain way, to tick every box that fits?’ he says.

When he ‘came out’ as neurodivergent at university, in the spirit of congruence and authenticity, he says he felt rejected. ‘I was referred off to the disability advisory department, who were brilliant, don’t get me wrong, but they were a different department –I wanted the person who was training me to sit down and tell me where I could be helped.’

His plea to the profession is to open its eyes to what neurodivergent people can bring to it: ‘BACP says, “Counselling changes lives” – I agree with that. Therapy is a place for change. So let it change the lives of neurodivergent people, as clients and as practitioners as well.’

Tracey Cleary is utterly convinced that counselling changed her life. As a young mother escaping domestic violence, with two children aged under four, when her GP referred her to the counsellor working from his practice, ‘it was the first time I felt truly heard. It was a pivotal moment in my recovery,’ she says. Today, some 20 years later, she is a qualified counsellor supporting students at the University of the

Highlands and Islands Inverness, where she herself trained, inspired by her own experience of counselling. It’s a common enough story, except that Cleary is neurodivergent, as are her children, although she only thought to get a diagnosis 10 years after they’d been diagnosed. ‘It really helped me understand myself and the struggles I had. And that’s why this job isn’t really a job and why it’s so important to me. I am able to support other people to make the best achievement that they can and see how education can support them in their mental health recovery, and that getting out into the community can help your mental health even if you are struggling with your anxiety and your fears. There is a way of being what you can be and a productive member of society.’

She was, she says, lucky in her choice of university to study at. ‘My tutor was a very experienced social worker as well and was very good at making the accommodations I needed, academically and practically, in terms of physical adjustments.’

SUPPORT AND RESOURCES

The newly published resource, Reasonable adjustment in private practice (GPiA 129), will shortly be available at www.bacp.co.uk/gpia

Recently updated resources include:

 Equality, diversity and inclusion in the counselling professions (GPiA 056) Research Overview

 Equality, diversity and inclusion within the counselling professions (GPiA 062) Commonly Asked Questions

 Equality, diversity and inclusion within the counselling professions

(GPiA 063) Clinical Reflections for Practice

 Reasonable adjustment in the counselling professions (GPiA 080) Fact Sheet

 Equality, diversity and inclusion (EDI) in the counselling professions (GPiA 108) Legal Resource

The university’s wellbeing service goes above and beyond to reach out to its neurodivergent students, Cleary says: ‘For in-person work, we try to create a quiet, calm space wherever possible. We’ll switch to a different room if a student finds outdoor noises, or sudden or loud noises, difficult. We try to avoid other little things that maybe colleagues have not considered to be important, such as heavy perfumes, distracting jewellery, hard lighting. We use a white noise machine that can play all sorts of other noises at different volumes.

‘During COVID when we were forced online, we found that appointments dramatically increased because it made counselling accessible to people who were so anxious outside their comfort zones that they couldn’t seek counselling. We could have a video conversation and they’d still be in their comfort zone, which supported them to explore what was happening for them. We don’t insist they have their cameras on. We go at their pace. We ask what they prefer. And when they are ready to try it, we can support them to try out in-person counselling. We desensitise it, to make it easier for them to get used to it.’

But above all, it’s the basic fundamentals of counselling that worked for her and that work now for her student clients: ‘The biggest thing is people need to be genuinely, genuinely non-judgmental and unconditionally accepting; they need genuinely, genuinely not to flinch when you say something that some people might find out of the ordinary and just take it in their stride. We might say, “That’s fine,” but our body language says something different; our faces and eyes say something different, and that can be picked up very quickly.’

• For further support in exploring these issues, the online ‘Working with...’ event, ‘Increasing inclusivity in your practice’, takes place in July. To book, see www.bacp.co.uk/events-andresources/bacp-events

About the author

Catherine Jackson is a freelance journalist specialising in counselling and mental health.

‘Therapy is a place for change. So let it change the lives of neurodivergent people, as clients and as practitioners’

Anew client, a black woman in her 40s, was emotional at the end of our initial session. ‘It’s been so challenging to find a therapist, and one who is culturally sensitive,’ she said. ‘It feels like a load has been lifted off my shoulders.’

As I smiled at her, I didn’t tell her what I was thinking – that I never thought as a black, working-class woman diagnosed at age 49 with dyslexia, I would be working as a qualified counsellor in private practice at age 50.

When I was 20, I was sectioned for attempting to take my own life. Back then, if someone had told me I would graduate from a respected training centre with a diploma in counselling, be selected to be the student to speak at the graduation ceremony, and accepted on a master’s course, I would not have believed them. Not me! I had wanted to be a counsellor all my adult life, since a wonderful counsellor saved my life by sitting with me in my pain and helping me talk through it. I will forever be grateful to that counsellor. But I believed I didn’t have the intelligence or abilities to train as a therapist – you had to be clever, right?

I didn’t have a good experience of school, and when I expressed my desire to be a PE or English teacher, a white male teacher responded with these words, which I internalised my whole life: ‘That’s not for people like you; stick to what you are good at – sports. Stay in your lane.’

This same teacher, for some reason, seemed to enjoy humiliating me in class when he would ask me to stand up and recite my times tables or read a passage from a book. Unbeknown to him or me, I was dyslexic. It would reduce me to tears, and when it caused me to wet myself in front of the whole class I stopped trying at school. My academic life was over at nine years old. I stayed in my lane.

That all changed on 14 June 2017, when I lost friends, and my friends lost family members, in

the Grenfell Tower fire. My community, friends, neighbours and my son, who lost a friend aged five at the time, were hurting. Friends who had lost their loved ones told me: ‘Time is precious and short; get the tools to help heal our community, Sarah.’

Those words catapulted me through the doors of The Minster Centre, to start my therapy training.

I recall my interview with a tutor. We had to write a 500-word bio, which at the time seemed like 5,000 words to someone like me who had never written an essay before. I thought another white man sat between me and my learning. Then he said, ‘Your bio was well written; you understood the brief, so many don’t.’ These words stayed with me throughout the training.

As a black, working-class woman in a white, middle-class profession, with undiagnosed dyslexia and no formal qualifications, I wrote my first essay in 2018. The experience of having to build my academic ladder, attempting to climb it to qualify, and battling my own internal demons around my dyslexia and not being good enough now informs my work with my clients. In the counselling room it shines bright for me, allowing me to work more creatively in verbally expressing myself and interacting with clients by using art materials, music and play.

My approach is integrative and my interest is in working with somatic, body-based techniques within the basic framework of counselling. A sensorimotor approach can aid a client struggling with words to work through the body and senses and connect their feelings, thoughts and words. I use Rogers’ core conditions to create an intersubjective space for me and the client to enter into – a meeting of two people’s minds.

My hope for the future is to specialise in working with more marginalised groups in society who may have not been exposed to therapy or believe it is not for them.

About the author Sarah Jane Colbourne MBACP is a recently qualified counsellor working in private practice and currently undertaking a master’s accredited by Middlesex University.

‘My dyslexia allows me to work more creatively with clients’

Istarted training as a therapist straight after I left mainstream education, inspired by my experiences of therapy over the years – good and bad. I was diagnosed with autism in early adolescence on the recommendation of a psychologist who had noticed my high IQ but inability to

recognise certain social cues, and my lack of resilience in social situations. The diagnosis shook my foundations – it was 2007, and although autism was becoming known, there was still an inherent stigma surrounding it.

I was provided with therapy to help me comprehend my diagnosis as well as process

my difficulties in adapting to mainstream school. My allocated therapist unfortunately had no training in neurodiversity and was ill-equipped to work with my recent diagnosis, instead focusing on other issues, such as my experience of bullying and lack of attendance at school. Not being able to discuss my

‘There seemed to be an unspoken message that this was not a place for a neurodivergent’

We will continue to fail neurodivergent clients until therapy training is more inclusive of neurodivergence, says Callum Jones

diagnosis with my therapist compounded a sense of shame and dismissal about it. Sadly, not getting appropriate help remains an all too familiar story for clients with neurodivergence, and one I have observed in my professional and personal life ever since. Part of my motivation for training was to provide the kind of help that I didn’t get. I was also inspired by others who had experiences of appropriate therapy, which showed me that therapy can change lives.

According to a recent study only 53% of psychotherapists interviewed had experience of working with autistic clients.1 Only 13% of participants said that they had undertaken specialist CPD in working with autism, while 80% of practitioners said their understanding of autism came from the media or professional/ personal experiences and associations. A shocking 53% had no comprehension of what ‘neurodiversity’ is. Other research has shown that a proportion of practitioners still see an autistic client’s differences as something to be ‘cured’ to enable a ‘better quality of life’.2

This lack of knowledge and training impacts neurodivergent clients in many ways.3 We know that neurodivergent people are at higher risk of suicidal ideation and depression, yet they can find it difficult to be taken on by a therapist, as some practitioners avoid working with neurodivergent clients. Those that are open to working with neurodivergent clients may have counselling spaces that invoke sensory overload through lighting or noise.

My postgraduate training in counselling included no formal training in working with neurodivergent clients and, at times, I felt that my presence as a neurodivergent student was treated with apprehension and confusion. There seemed to be an unspoken message that this was not a place for a neurodivergent, as those with autism are unable to recognise emotional and social cues (a myth).

My neurodiversity includes dyslexia, which has frequently caused issues when submitting

work both during my initial training and as I have continued in academia. Even when I have made potential assessors aware of my dyslexia, the feedback I have received on some counselling assignments, and on potential published works of counselling and psychotherapy, suggests a lack of understanding of the impact of that diagnosis. I now have my work checked prior to submission by a learning mentor, as I have learned that in the academic world written work is still assessed against standards set for, and by, neurotypical people. But many people with neurodiversity are unsupported in academia, either through a lack of diagnosis or choosing not to disclose it due to historic stigma and the belief they would not get further support.4

Now qualified and BACP accredited, I work with a variety of clients from different backgrounds. My neurodiversity helps me empathise with the process of neurodivergent clients, and offer compassion for their individual processes. It also allows me to see situations outside of the frame of reference for someone who is neurotypical. Therefore, I am able to offer a neurotypical client a perspective which they may not gain from a neurotypical therapist, along with more advanced core conditions, including a true lack of judgment.

For a profession that prides itself on providing an inclusive environment there is still a lack of awareness of the neurological and psychological conditions that make counselling training spaces more accessible and friendly to prospective neurodivergent practitioners. To me, the acknowledgment of the constructive influence of neurodivergence on culture and society is an issue of civil rights and social justice.5 Until more neurodivergent people train as therapists – and working with neurodivergent clients is included in counselling training – the counselling and psychotherapy professions will never be inclusive or safe for people like me.3 ■

REFERENCES

1. Garrett C. ‘There is beauty in diversity in all areas of life including neurological diversity’ (Bella): a mixed method study into how new thoughts on neurodiversity are influencing psychotherapists’ practice. Zeitschrift für Psychodrama und Soziometrie 2022; 21: 147-161. 2. Leadbitter K, Buckle KL, Ellis C and Dekker M. Autistic self-advocacy and the neurodiversity movement: implications for autism early intervention research and practice. Frontiers in Psychology 2021; 12(1): 635-690. 3. Hallett S and Kerr C. ‘You need support, validation, good coping skills. You need and deserve acceptance’: autistic adult experiences of counselling. Autistic Mental Health and Autistic Mutual Aid Society Edinburgh (AMASE); 28 1(1): 1-25.

4. Griful-Freixenet J, Struyven K, Vantieghem W and Gheyssens E. Exploring the interrelationship between universal design for learning (UDL) and differentiated instruction (DI): a systematic review. Educational Research Review 2020; 29.

5. Chapman R. Neurodiversity and the social ecology of mental functions. Perspectives on Psychological Science 2021; 16(6):1360-1372.

About the author

Callum Jones MBACP (Accred) has a master’s in clinical counselling and is currently studying for a doctorate at the University of Chester, researching counselling and psychological trauma. He has had two articles published in BACP’s Counselling & Psychotherapy Research journal: ‘Is person-centred counselling effective when assisting young people who have experienced bullying in schools?’, based on his master’s research and published in the March 2020 issue, and in February 2023, ‘That is just your stuff: the potential use and abuse of congruence in counselling and psychotherapy practice and training’. He currently works as a counsellor in private practice, and at Beacon Counselling in Stockport.

‘There is a lack of awareness of the neurological and psychological conditions that make counselling training spaces more accessible to prospective neurodivergent practitioners’

‘Years of not being able to physically fit into spaces can leave you apologising for taking up space’

It’s time for private practitioners and organisations to step up and really consider accessibility, says Craig Johnson

When I started my counselling training in September 2022

I was unaware that I would need to consider the impact of space and how I would fit into it as a client, a supervisee and a counsellor as much as I am having to. The construction of physical space in the counselling industry feels like the number one barrier people with disabilities face when seeking support. As an active manual wheelchair user I have faced physical barriers on numerous occasions, including the time I was told that access to the university counselling service was usually via the flight of stairs on the outside of the building, as it allowed people to ‘go up unnoticed’.

I see space as the product between the two people inhabiting it – as French philosopher Gaston Bachelard put it, space is not something we merely observe, ‘it is something that we participate in, that we live in, and that we create through our actions and our thoughts’.1 I also like Henri Lefebvre’s observation that space is a ‘social product, a particular geometry of power relations’.2

In a world where barriers are plentiful, the person with a disability also contends with the psycho-emotional effect that this has on them, and the impact of being excluded from spaces their able-bodied counterparts can access.3 To me, it conveys that a hierarchy of bodies, selves and personhoods exists. In my experience, years of not being able to physically fit into spaces can leave you apologising for taking up space.

It’s not enough to point to the broader availability of online therapy. It works for me, but I still find myself frustrated that I do not have a choice over the mode of delivery of the personal therapy I am required to have as a trainee. It’s also been strongly suggested that, as trainees, we experience both counselling and supervision in person as well as online,

the former of which is currently not an option for me. Although my institution accepts my personal circumstances, I worry that later down the line my experience won’t be considered valid as not every organisation treats online work as equivalent to in-person.

In therapy, I’ve recently uncovered that deep down I am angry at the world and its rigid thinking. People with disabilities want to be able to do everything their able-bodied counterparts do. Despite this, we are constantly exposed to introject values perpetuating the hierarchy of ablebodiedness as the social world’s preferred mode of operation.

As someone new to the counselling profession I’m surprised this isn’t a larger issue. I read in Therapy Today that people who identify as disabled only make up 11% of BACP’s members,4 despite 21% of the working population considering themselves disabled.5 Nine per cent of the UK’s children are also considered disabled5 – if their bodies, minds and emotions are not physically able to be accepted into a counselling space, we risk alienation of a significant proportion of the population.

This is why I am reminded that anger, although unpleasant, is worth holding on to. It can mould into energy to change the world around us, solidifying into passion and becoming a catalyst for change.

How spaces are laid out and constructed socially and politically truly matter, especially if we are genuinely committed as a profession to improving the diversity of people who access our services. It strikes me as odd that so many of those in private practice seem to work from inaccessible spaces, almost as if they personally don’t expect to have to consider client access, even when they are apologetic, empathic and understanding of the issue.

I am not saying this to criticise but to encourage practitioners to reflect on their practices through a lens of diversity. Could you

take time to consider whether you are going to be one of the many practitioners who responds with ‘I’m really sorry but the space isn’t accessible’ to trainees like me seeking therapy or supervision? Could you instead consider your space and ways around any obstacles to access? Could you offer to meet in a mutually agreed space that is free to use, such as a community centre?

It’s disheartening when door after door closes, and I have wondered where I fit as a client but also as a supervisee and trainee counsellor. I guess time will tell. ■

REFERENCES

1. Bachelard G. The poetics of space. Paris: Presses Universitaires de France; 1958.

2. Lefebvre H. The production of space. London: Wiley-Blackwell; 1991.

3. Reeve D. Psycho-emotional disablism and internalised oppression. In: Swain J et al (eds). Disabling barriers – enabling environments (3rd ed). London: Sage; 2014; pp92-98.

4. Jackson C. You can knock, but you can’t come in. Therapy Today 2022; 33(2).

5. Disability facts and figures. Scope. [Online.] bit.ly/3yE2wmf [accessed 15 March 2023].

About the author

Craig Johnson is a student member of BACP currently training at the Centre of Integrative Counselling Studies at Stockport College. Prior to entering the counselling profession, Craig completed a BA (Hons) in English and Sociology and an MA in Gender, Women’s Studies and English. He also co-hosts The Therapy Files podcast with Callum Jones.

‘I am reminded that anger, although unpleasant, is worth holding on to. It can mould into energy to change the world around us, solidifying into passion and becoming a catalyst for change’

DANIEL PUDLES/IKON IMAGES

HAD TO RELEARN HOW TO WALK AND

– BUT IT MADE ME DETERMINED TO TRAIN AS A COUNSELLOR’

On 31 July 2010, I was enjoying a friend’s barbecue when the day suddenly took a devastating turn. Two weeks later, I woke up in the high-dependency unit of Hull Royal Infirmary. I can picture it so clearly –the sharp beeping of machines piercing through my ears, paired with the distinct smell of antiseptic and bleach.

I opened my eyes to see my parents talking. ‘Where am I?’ I asked, confused, but no sound came out. When I tried to sit up so they would notice me, I found I could not move. Petrified, I just lay there, feeling the stiff cotton sheets against my body and my aching muscles. The beeping intensified and medical staff appeared – so many people. I understand now who they all were and why they were there, but in that moment all I remember was a group of people moving so fast they seemed like blurred silhouettes. Absolutely nothing made sense. I felt a sudden, dull pain in one foot and I looked down to see a man squeezing a pen, hard between my toes. Looking up at me, he explained that I’d had a cerebral haemorrhage. Smiling, he said, ‘You’re very lucky, due to your age [20] you can fight this and make a full recovery.’ The only words I heard at that moment were ‘full recovery’. Focusing on these words I felt something light up inside me – I was ready to fight.

Once stable, I was discharged and transferred to my local hospital to wait for a bed to become available at the neuro rehab centre, which had been described to me as the place I would learn

to ‘walk and talk’ again. I was so excited, so desperate to go and get my life back, that the waiting felt like my life had been put on hold and taken out of my control. All I could produce were faint vowel sounds and gurgling. I could lift my head but was still unable to sit up on my own. For five weeks I lay staring at a clock on the wall in front of me, which at first seemed like random numbers in a circle. It was a while before I relearned about time and what the numbers and moving arms represented. Finally there was space for me to start rehab. It was less intense than the boot camp I had imagined, but I gave it my all and slowly relearned the basic skills of walking, talking and eating. Eventually, seven months later, my time had finally come – I was discharged to live independently again. I still had limited movement but could walk some steps with crutches, and I could speak, although it was distorted, slurred and slow.

Making noise

The external world shook me to my very core –I did not remember society being so unkind. I thought my biggest battle was personal recovery, but I quickly realised a new battle had begun, dealing with prejudice and discrimination. I would tell myself that the staring of strangers was just human curiosity, perhaps uneducated and a little ignorant. It was much harder to deal with the responses from people who I had to directly interact with. So many assumed my visible impairments meant I was mentally slow – I was constantly spoken over, or the person I was with addressed on my

behalf. I just wanted to lead a normal life again, but I felt lonely, isolated, invisible and yet simultaneously vulnerable and bare; my whole entity was on display for society to judge. I felt that no matter how much noise I made no one heard me, yet everyone saw my differences.

It was around this time I was told that a young girl I had shared a room with in the rehab centre had died. Why? She had given up fighting, I was told.

There was no therapeutic support as part of the rehab process other than some sessions with a cognitive psychologist to reframe our thought processes. I was told I was ‘lucky’ to possess that internal drive, the focus to keep me going (there was that ‘lucky’ word again). But I couldn’t help thinking about the others who may not have that drive – who was empowering them to not give up? Where was the safe space to help us process our emotions and come to terms with the massive disruption to our identity and sense of self? I felt something inside me erupt and it was in this very moment I knew I wanted to be a counsellor and provide that space for other people.

Driven by that passion, I began my counselling journey, eventually enrolling on a BA Hons Counselling Studies degree. During my time at university, I struggled immensely with daily barriers. Just physically entering the building was difficult. Factors that I previously never gave a second thought to became huge to me – would the path be slippy if it had been raining or was frosty? Was it windy? I remember mapping out my route to the door – if the blue badge spaces were all full, which they often

Abigail Denny describes how enduring a life-changing injury ignited her passion for creating a truly non-judgmental space for clients

‘I

TALK

were, there were extra barriers to overcome. Once in the building, my first hurdle was a canteen full of people and enduring often blatant staring as I made my way to the lifts –the course was taught on the third floor (I used to pray the lift was working). Even the classroom didn’t always feel like a safe space – my slower speech often meant I was spoken over or there wasn’t space for my opinions. But the end goal – a qualified counsellor, practising with my own innovative and unique approach with individuals – remained clear in my mind.

True communication

I started the personal therapy required by my course and in one of the early sessions my counsellor said, ‘I wonder why you have chosen a talking therapy?’ My heart sank – I knew my speech ability wasn’t what is expected of a counsellor but felt angry that she chose to address it in such a shaming way. Our therapeutic relationship ended at that single moment.

Now I can look back and see it came from the therapist’s limited frame of reference in relation to difference. What must have seemed like a valid question to her hurt me deeply at a time when I was still adjusting to the perception of the ‘new me’ by the world around me. I ended therapy and found another specialising in the humanistic approach.

I didn’t allow this comment to deter me – if anything, it only encouraged me to try harder. I know communication is a vital part of the counselling relationship, but I also know it’s not just about words. I started independently researching, observing and reflecting to understand as much as I could about what communication really involves. I learned that only seven per cent of what a person is communicating is spoken. We communicate through our entire bodies, and our bodies often reveal the hidden truth behind what is being said and what a client really wants to share. To me, moving the focus beyond verbal communication creates a truly holistic approach to therapy that deepens the therapeutic relationship, allowing us to fully immerse ourselves in the person’s frame of reference.

Equality

Now my practice is built on welcoming uniqueness. I believe in accepting everyone’s unique phenomenology beyond labelling and deterministic notions of fixed ability. I know from experience that being placed

in a box based on your personal differences is undermining for self-esteem. How can anyone feel good about themselves if they feel they have to create a mask in order to fit in?

Training to be a therapist helped consolidate my personal and professional values. I discovered who I was again, firmly securing my place in the world. My personal experience and adaption to my own new normal has only strengthened my professionalism. Navigating my way around the barriers along my own journey has encouraged me to think more innovatively and creatively in my approach. Rather than working with a rigid approach, I see outside the box, creating integrative, unique frameworks that centre around the individual. To me, the client is always the expert and I am grateful to be on their journey of discovery with them, respecting unique autonomy.

Many counsellors will no doubt say they also strive to give that respect. But what shocks me is that this respect does not seem to extend to counsellors with impairments or differences. The emphasis in my training was very much on how to manage clients presenting with any kind of difference, and also how we as counsellors can deliver anti-oppressive practice. But there was nothing about practising as a disabled therapist – the assumption seemed to be that all practitioners are ‘unimpaired’.

Overcoming barriers

I am a fully qualified registered counsellor, I have numerous years’ experience in mental health, bereavement, trauma and, more recently, with special educational needs (SEN) children and adolescents, within an educational setting. I have a postgraduate qualification and experience of teaching on the degree course I undertook in university. Yet my disability has remained a huge barrier for me in securing paid employment. After being turned down at numerous job

interviews I was finally given the opportunity to do what I am trained to do, as a school counsellor. I feel incredibly privileged to be working with the students at Demeter House School in Lincolnshire, where I live, providing a therapeutic environment where individuals feel safe to be their authentic selves. I feel my presence means the children see that ‘professionals’ can come in all physical guises. We are not bound by any restraints society tries to put on us – no one should be placed in a box based on other people’s views.

As ethically trained professionals we pride ourselves in the removal of any apparent barriers to therapy for our clients, creating anti-oppressive practice and promoting equality. So why on earth is this barrier still in place for qualified therapists? I do not feel the disabled therapist is represented or empowered and it seems absolutely ludicrous to me that we are still in this place in 2023.

We can change this. I personally do not believe there are any permanent barriers. I strongly believe the word ‘disabled’ is not viable, everyone is abled, we can all reach our goals, but some of us may need specific support to get there. What happens when that support is not there?

When we talk about a collaborative community coming together, the disabled professional is often forgotten. Society would still prefer to turn a blind eye to the constant struggle disabled people face to overcome barriers and fight social prejudice. My hope is that sharing my experience will shine a light on all professionals enduring any difference. ■

About the author

Abigail Denny MBACP is a school counsellor and mental health and wellbeing teacher at Demeter House School. She is also a fully qualified teacher, teaching up to degree level in universities, and currently undertaking independent research into anti-oppressive practice in the therapeutic relationship, alongside how non-verbal communication positively impacts practice.

‘I do not feel the disabled therapist is empowered and it seems ludicrous to me that we are still in this place in 2023’

In the mirror, I apply a sweep of bright-red lipstick. I don’t know much about the woman I’m meeting. I found her profile on a website where you search for this sort of thing. But she has a kind smile in her photo and wrote that she understands this is a strange way to meet someone. I absolutely concur. I think we’ll get along.

I’ve chosen my outfit carefully. I want to look together, smart, maybe a little bit stylish, but like I’ve made no effort too. As I nervously prepare to leave the house I’m already formulating the small talk I’ll offer up to ease the awkwardness of those first few minutes before we get down to business.

I’m not about to cheat on my husband. I’m off to my first counselling session.

Like one in six people in Scotland, I’ve long suffered from mental health problems. In my case, I got an unlucky double whammy – a long line of generational mental illness featuring big-ticket items like schizophrenia and bipolar disorder, and then a childhood deprived and chaotic enough to ingrain the belief that the world was a harsh, frightening place.

I recently told a friend that I white-knuckled my way through my 20s, on a rollercoaster propelled by my messed-up brain chemistry. I grew up in working-class communities where mental illness was simply called being ‘highly strung’ and everyone had problems with which to contend.

The idea of talking therapy never even occurred to me – that was for rich women who wore pearl earrings and called olives ‘amuse bouche’ without any irony. My dad had been addicted to Valium and so I had a deep fear of mental health medication. Instead, I used crying on buses, extreme diets and enough booze to satiate a tanker full of sailors as my main coping mechanisms. Not so much crutches as sticks to beat myself with.

But when I was 32 an amazing, astounding thing happened – Random House decided they would publish my first novel. Me, a girl who grew up in what other people thought were the worst parts of

Coatbridge, who had left school at 15 to work as a waitress – I was going to have a book published. Because that felt like a fairy tale, I began to believe that maybe magic was possible. Maybe a different future was possible, and so I went to the doctor and I told him I was scared all the time and I couldn’t stop crying. That, though it looked to everyone else as if I was smiling and waving, I was drowning.

The doctor was gentle and entirely unfazed by my decade-long secret. First, he prescribed little pink pills to ease my sudden bouts of anxiety that would lead to me twitching and gasping for breath. Later, we supplemented these with lemon and lime Prozac capsules, which settled over me, subduing my ever–present feeling of dread like a warm, soft blanket.

I do wish I hadn’t left it so late. I wish I had gone to the doctor sooner, sought out sliding-scale or free counselling. I wish I had known that simply seeking help, admitting I wasn’t OK, would feel like a pressure valve being released. That the one step forward, one of the hardest I’ve ever taken, would be enough to motivate myself to take another step forward and then another until I reached ‘here’.

‘Here’ for me has been no picnic in the last three years, but it is manageable in a way it wasn’t in the past. Ironically, now I have access to counselling regularly, I probably need it less than ever. Over a decade of mental health medication that works, dipping in and out of low-cost therapy, meditation, sleep hypnosis, exercise – plus, honestly, luck and cathartically writing about my own experiences –means I’m doing OK.

Today I hurry through the Glasgow drizzle. For once this counselling is not an Elastoplast on a broken arm. Instead, this is maintenance on the life I have built. I walk down into the office; two small, green, velvet chairs, a box of tissues on the table between us. My counsellor smiles, warm, professional. Her accent reminds me of the strong women I grew up with. She asks, ‘How are you feeling?’

I smile and I tell her, genuinely, ‘Actually, I feel really good.’

About the author

Kerry Hudson is an awardwinning Scottish author. This is an edited version of a column that appeared in Scotland’s Herald newspaper. Kerry’s novel, Tony Hogan Bought Me an Ice Cream Float Before He Stole My Ma, was published by Chatto and Windus.

‘I wish I had known that simply admitting I wasn’t OK would feel like a pressure valve being released’

I

When breaking confidentiality is your only choice

Anita* presented with anxiety and was struggling to cope with some of the side effects of her teenager’s neurodivergence. She was my first-ever client at my placement at a local centre offering low-cost counselling. Most of our first session was spent going through our working agreement, which included, of course, setting out the limits of confidentiality and when it might be necessary to alert other professionals. The session was going well. The client was open and trusting from the start, and seemed happy to continue and book a second session. Feeling proud of myself, I documented the session and looked forward to our next session the following week.

As the second session began, I noticed the client seemed noticeably anxious and upset. As she started to explore her thoughts and emotions she revealed that she had concerns that her teenager was at risk of becoming radicalised through various channels. They already showed a keen interest in building bombs and explosives, and there were further concerns about online relationships being formed with strangers and money being stolen. My mind was racing but I did everything I could to remain calm, keep my attention on Anita and give her time to fully explore this situation and what she felt it meant.

I knew I would need to report what I had been told as a safeguarding issue, but I was unsure about how to ethically go about it. My instinct was to be open, letting the client know I would be obliged to report her concerns, but I was also aware that there was a risk that by doing so I could commit an offence known as ‘tipping off’ under the Terrorism Act.1 I was also aware it was important not to miss any vital information, so I endeavoured to park my panicked thoughts and focus on listening

intently to what the client was telling me. As the session came to an end, Anita said she felt better after talking about her concerns, and that she would see me next week.

As the session finished and she left the room, my anxiety was soaring. Given the nature and the seriousness of the disclosure, I knew I needed to seek guidance as soon as I could. However, neither my placement mentor or my college tutor were available. Thankfully I did manage to get through to my supervisor and arrange a 20-minute video call for when I got home, which helped to put me at enough ease to leave the centre.

When I spoke to my supervisor and explained the situation they reassured me that I had done the correct thing in not ‘tipping off’ the client. We worked through BACP’s 12-step ethical decision-making model together2 and discussed the laws around terrorism. Together we made a decision to report the disclosure to the police and break the client’s confidentiality, having come to the conclusion that I had a duty of care not only to my client but to the wider public.

By this time I had alerted my college tutor, and they did some further research on my behalf, looking for a way to report without breaking my client’s confidentiality as this was a third-party disclosure. We then proceeded to call the Counter Terrorism Policing confidential reporting line (act.campaign.gov.uk) and

was able to give them all the information disclosed without naming my client directly. As the call ended, I felt a rush of relief and exhaustion. I could not believe that I was being faced with this level of ethical challenge so early on in my career. The feeling of relief did not last long before the worry for my client started to creep in. I could feel my anxiety building again and I was concerned about what to do next as my client was still booked in for her session the following week. I was drowning in my thoughts and fears – will she turn up for the session? What will I say to her? Do I keep quiet and wait till she brings it into the room? Should I be completely honest about what I have done and explain the reasons why and refer to our working agreement, risking the breakdown of our relationship so early on?

I started to approach this scenario objectively and asked myself questions such as, if the client arrives for the session and I say nothing, how present will I be in the session? I concluded I would be distracted and not able to truly listen, which would not be beneficial to them. After referring to the Ethical Framework and taking into account our ‘commitment to clients’ to demonstrate accountability and candour, along with the principles of being trustworthy, and the personal moral qualities of sincerity and respect, I decided that transparency and explaining the reasons for breaking confidentiality was the only course of action.

Sharon Watt describes how she managed her first placement client alerting her to a potential terrorism risk

‘You just don’t know what you will be faced with in any session and it is wise to keep yourself up to date with the law and what is expected of you when dealing with any kind of risk’

Once I had made my decision, I was nervous about what the client’s reaction would be, and I struggled throughout the week in the lead-up to the session. Exploring my feelings with a personal development group helped reduce my anxiety and gave me an opportunity to seek support from my peers.

On the morning of the session, part of me hoped that the client would cancel or just not show. But she arrived and I was shocked by her response once I explained what I had done. She thanked me and said that she had been crying out for someone to listen to the seriousness of the situation – she had disclosed her concerns to other professionals with no action taken. She was relieved that the police had visited – it felt like now she was being truly listened to. Rather than fracturing our relationship, it seemed to grow the client’s trust in me, and she attended all the remaining sessions with me she had allocated.

Now when I think about this situation, I feel reassured that I managed with professionalism

and ensured I was well informed. We talk about the limitations of confidentiality in our training and may even include in our contracts a reference to the risk of terrorism being one reason for breaking confidentiality while probably never really expecting to have to deal with it –I certainly didn’t. It has made me realise that you just don’t know what you will be faced with in any session and that it is wise to keep yourself up to date with the law and what is expected of you when dealing with any kind of risk.

This was a massive learning experience for me that involved both navigating through the ethical decision-making model and navigating my own thoughts and fears. I am aware that most practitioners go through their whole careers without coming across a situation like this, but I feel thankful that this happened while I had the full support of my mentor, lecturers, and supervisor.

*Although written consent to tell this story has been given by the client, her name and identifiable details have been changed.

REFERENCES

1. Legislation.gov.uk (2003). Terrorism Act 2000, Part III, Subsection 21D, Tipping Off: regulated sector. www.legislation. gov.uk/ukpga/2000/11/contents

2. www.bacp.co.uk/events-andresources/ethics-and-standards/ ethics-hub/decision-making-forethical-practice

About the author

Sharon Watt MBACP is a newly qualified counsellor who completed her diploma with Glasgow Clyde College, Anniesland. www.counselling-withsharon.co.uk

CONVERSATIONS WITH THE DYING

Helping clients with a lifelimiting diagnosis consider death and ways to approach dying is a privilege, says Jenny England

Cancer Research statistics show that every two minutes someone in the UK is diagnosed with cancer.1 Receiving a life-limiting prognosis is shocking, especially if there have been no symptoms or recent illness to warn that something might be serious. It can feel overwhelming, and it can be hard to know what to do. Family and friends may feel helpless, not sure what to do or say. Understandably, they may focus on hope as a way of offering comfort and avoid any mention of dying.

For the past seven years I have worked in a small team in an NHS trust providing counselling for cancer patients at any stage of their journey, from diagnosis, during treatment and beyond. When I started working in this area, I wrongly assumed that as death is one of life’s certainties most people would have given it some consideration. But I noticed that for many clients the initial shock of their prognosis was followed by the additional shock of their mortality.

Wanting to understand this led me to the work of anthropologist Ernest Becker, who suggested that humans are probably the only mammals to have knowledge of their own mortality.2 He saw this knowledge creating a dilemma – on the one hand we know we are going to die, but on the other there is our instinct to survive.

Becker suggested that to live in constant awareness of the fact that we will die could be overwhelming, so instead we suppress the thought in order to function and survive. We suspend what we know as it is hard to comprehend that we will not exist, that we will one day die.

The 30-something columnist Kris Hallenga who writes about living with cancer describes her own experience of this when she says ‘is there a word for knowing something to be real but not believing it?’3 This ‘knowing and not knowing’ seems to be present in conversations I have with clients.

In many Western populations, developments in medicine and social changes have increased our life expectancy and also influenced where we are likely to die. When dying happened at home, it allowed generations to witness dying, and to grow up with an idea of what dying involves, and what others might need of us when they are dying. Rather than spending our final days at home, we die in institutions such as hospitals and hospices, and dying has become removed and remote. Being told we are dying by someone we trust to have knowledge, such as a doctor, breaks through this suspension of reality and can be disorientating and confusing.

More dying time

Advances in medical technologies can now detect the presence of cancer earlier than previously and monitor its progression. Developing treatments are increasingly able to delay cancers progressing, buying us ‘more time’. What we won’t always know is how long that extra time will be. This situation is, I think, relatively new – rather than just extending life, a different period of living is created, one of living knowing we are dying. Stephen Jenkinson describes this as ‘more dying time’.4 Knowing how to manage the thoughts and feelings that can come with this can be challenging for everyone.

A client recently described her experience of this: ‘I feel like I’m living a double life. I look normal on the outside but there’s a battle inside me. On the one hand I’m hoping that they might find a cure, or I’ll be one of the ones that defies everything and lives longer than anyone thought possible. Then there’s the other side of me that is so scared, not knowing when it’s going to come, it’s like having this presence looming over me.’ In among this can be what someone described as ‘scan roulette’ – each time you go for a scan, you’re wondering if this will be the time it all changes, when they say the cancer has spread.

Living in an in-between state can be disorientating – you’re still here but living knowing that you are leaving. Making plans can be difficult. When others talk about the future it can be hard to know where you fit in. You may be feeling hopeful that you’ll be there yet reticent to engage with plans, maybe even feeling superstitious that if you do so you might be tempting fate.

When I asked one client how he was managing, he described finding the waiting and uncertainty ‘unbearable’. He felt he would have been better not knowing about it: ‘Then I could just deal with it when it arrived.’ His comments reminded me of the film The Farewell, the true story of the director’s grandmother in China who was diagnosed with terminal cancer.5 Unlike my client, the grandmother didn’t know her prognosis as her family decide not to tell her. Instead, they held the feelings and anxieties around her future, and the grandmother continued to outlive the medical expectations. Although few of us would feel it is ethical to withhold such information from the person it affects most, when we opt for honesty without helping the patient manage their responses to it, we are giving them the worst of all worlds.

Disbelief

Living with the awareness that time is limited is a relatively new experience, so we can’t assume people who are in this situation know what to do or how to manage this. I also wonder if there can ever be a ‘right’ or ‘normal’ response to a life-limiting diagnosis when everyone’s past and present circumstances are different. For one female client in her early 50s, cancer seemed like the physical manifestation of negative mental energy accumulated by traumatic experiences that had occurred throughout her life. She felt if she could counteract this negative energy with positive energy, the cancer would go. She exhausted herself rushing frantically between various alternative therapies, medical treatments, and counselling.

When we met she talked rapidly, barely drawing breath, and frequently repeating ‘it is not my time’. She worried about leaving her teenage son without a mother. While she gained some comfort from the various therapies, our conversations helped her realise that the time they took up left less time to spend with her son. She slowed down and

‘Living in an in-between state can be disorientating – you’re still here but living knowing that you are leaving. Making plans can be difficult’

began to find some acceptance of what was happening just as she went into hospice care. A couple of weeks before she died, we spoke on the phone. Although calmer, she was now dealing with the regret of not slowing down earlier and wishing she had spent more time with her family. She realised that her sense of disbelief at her terminal diagnosis had been compounded by the fact that although she was in her 50s, she hadn’t known or seen anyone die, or ever given it proper thought.

When death is talked about in popular Western culture, it’s often described as an enemy to fight, with a response to a life-limiting diagnosis seen as a call to battle. The media often use a heroic narrative around cancer, describing celebrities as ‘bravely battling’ it. When someone dies, they have ‘lost their fight’. The focus on battling or fighting may help some people, but it can be felt as an additional pressure. If cancer returns or progresses, people can feel as if they have let their family down or failed to fight hard enough.

Focusing on fighting cancer can also imply that any acceptance of dying is giving in, making it harder for those affected to start important conversations about preparing to die. Palliative care doctor BJ Miller has highlighted how this can be felt as an additional burden in the patient, and leave them feeling isolated.6

Anticipatory grief

Given the current cultural approach to dying, it is not surprising that receiving a life-limiting diagnosis often creates anticipatory grief. It can bring waves of sadness thinking about future events we might miss, often creating an unconscious withdrawing from family and friends. One client described her experience as feeling like ‘being at a really good party, knowing my taxi is going to turn up any time, so I’m not joining in as much. I am there but with my coat on, and half looking out of the window.’

Sometimes life continues for longer than anticipated. While there may be a sense of gratitude for this, it can bring different challenges. Friends and relatives who may have suspended parts of their lives to spend time with their loved one may feel pressure to resume their normal routines and responsibilities and need to reduce some levels of support. This can evoke a sense of abandonment and loss.

Reviewing life and recalling special memories can be comforting for those dealing with anticipatory grief. Sometimes it can feel important to share hopes and dreams even when knowing they may never come to pass. This was the case for one client, a 30-year-old man. What I remember from our conversations are the courage, dignity and compassion he showed during his last few months. He had travelled to many countries and enjoyed sharing funny stories and some of his happy memories from his travels. He also wanted to spend time talking about the things he would miss out on. His greatest sadness was not having had the chance to fall in love. He had focused on building a career, thinking there would be plenty of time ahead for romance. Our conversations allowed him to spend some time dreaming about how his future life might have been, something he felt would be too much for his family to talk about. He was already concerned about the impact his illness was having on them, particularly his parents. Sometimes traumatic memories that have been stored away need to be heard and witnessed. This was the case for a client in her late 70s. She had never spoken about

the abuse she’d experienced when she was taken into care as a child. For years she had held this secret and with it a sense of shame. Telling her story enabled her to understand her experience from an adult perspective, reframing her view of events so she could feel more compassion towards her younger self. Knowing that she was nearing the end of her life, it was important for her that at least one person knew what had happened to her.

Being present

Psychiatrist Andre Christophe describes how ‘living in awareness, touched by ordinary things’ can help keep a sense of self and being alive amid the demands of illness.7 This seemed true for one client who had lived an active life and had only just retired from a successful career in the health service when she was diagnosed with cancer. Her illness progressed more rapidly than expected. Though she had frustrations with the side effects that came with her treatments, she adapted quickly to the changes she faced.

After reconnecting with her faith and enrolling on a mindfulness course, she shifted from keeping busy to slowing down and paying

attention, being aware of even the smallest of things. Focusing on the present moment gave her an anchor when she started to feel anxious and panicky. She found an appreciation of all around her, noticing things she had been too busy to see before. Even though she was dying, living in the moment brought her closer to life. Surgeon Rahul Jandial noticed this with some of his patients, how they experienced a sense of freedom when facing death by letting go of worries that felt less important and finding ‘a new appreciation of life, and openness to possibilities, a reordering of priorities’.8

Legacy

Having a sense of leaving something meaningful behind can bring a sense of purpose when facing the end of life. It can be helpful to recognise legacies not only as objects, estates or finances but also as ideas, values and characteristics that we might pass on. Irvin Yalom uses the word ‘rippling’ to describe this way of ‘leaving behind something from your life experience; some trait; some piece of wisdom, guidance, virtue, comfort that passes on to others. Known or unknown.’9

A male client in his early 60s struggled with living in a state of limbo, unable to continue with many of the physical pursuits he loved. For him, talking about death moved him closer to it. He wanted to carry on living and leave death to arrive in its own time. But thinking about his legacy gave him a sense of purpose and idea of what to do with the time he had left. He could leave memories. Our sessions helped him clarify simple ways he could do this, such as introducing a ritual when his granddaughter stayed over where they would open the curtains in the morning and welcome the new day together. With his adult sons, instead of doing their repairs for them, he decided to give them his tools and started passing on his skills. Thinking about his legacy gave him a way to make his time meaningful again.

Legacy can be a way of affirming life and the connections we have to each other that can

continue beyond death. In her book Dear Life, palliative care doctor Rachel Clarke describes a moment when her dying father reminded her that he would live on in her heart, and in his grandchildren too, describing a way they would continue to be connected beyond the physical separation of death.10

Life-changing

Dying is an inevitable part of life but it is one we seem to find harder and harder to accept. I wonder about the long-term impact of our increasing disconnection and medicalisation of the process of dying. How easy will it ever be for those living with the knowledge they are facing death to talk about their feelings when they are surrounded by messages that death is something to deny or fight at all times?

There is no magic that occurs when we face a time before we die – we don’t intuitively know what to do. Finding a way to help people talk about death and prepare to die is not only a kindness to the person dying but also a kindness to us all. One of the things I have learned from conversations with clients over the years is that just as finding a way to live well matters, so does finding a way to die well.

The author Stephen Jenkinson writes that ‘dying changes what life means if you are willing for it to be so’.3 There are moments when I have seen clients allow themselves to be changed, to let go of how things have been and become open to living without excluding knowing that they are dying. Together we can consider what they may miss if they turn away from dying. There is a special humility for all of us in recognising the transience and uncertainty of life. Accepting that death will come at some point can bring a deeper appreciation not just of our own individual life but of life beyond us. ■

*To protect confidentiality, descriptions of clients are composites in which I have changed personal and clinical details to ensure individuals are not identifiable.

REFERENCES

1. Cancer Research UK. Cancer statistics for the UK. [Online.] bit.ly/408TBoG [accessed 16 March 2023]. 2. Becker E. The denial of death. New York City: Free Press; 1973. 3. Hallenga K. Glittering a turd: how surviving the unsurvivable taught me to live. London: Unbound; 2021. 4. Jenkinson S. Die wise: a manifesto for sanity and soul. United States: North Atlantic Books; 2015. 5. Wang L (dir). The Farewell. Ray Productions; 2019. 6. Miller BJ and Berger S. A beginner’s guide to the end. New York: Simon & Schuster; 2019. 7. Andre C. Mindfulness: 25 ways to live in the moment through art. London: Rider; 2014. 8. Jandial R. Life on a knife’s edge: a brain surgeon’s reflections on life, loss and survival. London: Penguin Life; 2021. 9. Yalom I. Staring at the sun. San Francisco: Jossey-Bass; 2008. 10. Clarke R. Dear life: a doctor’s story of love, loss and consolation. London: Abacus; 2020.

About the author

Jenny England MBACP

(Accred) is a counsellor and supervisor who has worked as a drama therapist, mental health nurse and mental health adviser in higher education. She currently works as a counsellor in the NHS and has a small private practice as a supervisor.

jennycengland@gmail.com

‘Finding a way to help people talk about death and prepare to die is not only a kindness to the person dying but also a kindness to us all’

The path out of burnout

Identifying clients’ individual risk factors is key in helping them process burnout, says

Francis Norton

Icannot look back on the later stages of my former career in software without feeling physical sensations of guilt and shame. I now know I was experiencing severe burnout, but at the time I felt like an overpaid, underachieving and unemployable fraud. I was totally exhausted, increasingly cynical about the company I had worked for and believed in for 30 years, and utterly incapable of working at the level I was employed at. I ticked all three boxes on the widely used Maslach burnout inventory – emotional exhaustion, negativity and loss of efficacy.1 But I didn’t know about burnout back then, so this felt personal – this was me, my identity. I remember writing in an intermittently updated journal: ‘Every day I come into work, I feel like I’m clinging to a cliff face by my fingertips, just waiting to fall.’

Eventually recognising that these feelings and sensations were simply part of my burnout was a turning point, and I have seen similar recognition and relief in the counselling room. Now that I’m sitting in the therapist’s chair, I think it’s important to include psychoeducation to explain burnout to clients who may be experiencing it. As well as the Maslach burnout inventory, I may talk about Farber’s three subtypes of burnout: frenetic, the classic escalating stress spiral; worn out, when your best efforts are relentlessly punished; and underchallenged – the least obvious – when life seems lacking in opportunities for growth, validation or achievement.2

I also find it helpful to be aware of the somatic aspects of burnout. Stress is a biological process, as physical as it is mental, and it’s important to recognise that if you have a client who is so burnt out that they have had to take medical absence from work, this is not simply because they’re ‘not coping’ but are, according to recent research, quite likely to be experiencing the physical effects of excessive noradrenaline, cortisol and serotonin depleting their bodily resources.3 Again, psychoeducation is key here to challenge any beliefs the client may hold that their physical weakness is merely a manifestation of what they may perceive as their mental weakness.

Social identity

With hindsight I can see how some of the stress dynamics leading to my burnout

were rooted in my social identity. As a man I expected to take on financial responsibility for my family, and naturally assumed any difficulties I encountered were entirely my own problem. I had no explanation for the darkening of the sky and the closing in of the walls that I was experiencing, and no model in my personal life for discussing these inner fears and vulnerabilities with friends, colleagues or family.

Each individual’s path into and through burnout is unique, but there are patterns, and social identity can feed into these patterns. Women, for example, although more likely than men to seek support, also face an expectation that they will take on disproportionate levels of emotional labour, looking after the welfare of colleagues as well as their own families. Other identity factors that I have seen influence the burnout path include socio-economic class, sexuality, neurodiversity and minoritised ethnicities. Recent research on intersectionality in public sector burnout shows how the burnout experience varies when the employee subdimensions of gender, ethnicity and age are mapped against the burnout subdimensions of exhaustion, negativity and inefficacy – frustrating for scientists trying to create statistical models but validating for therapists who focus on the diversity of the individual experience.4

As a runner, I know that the ‘stress + rest = growth’ equation is the key to improvements in performance. When stress becomes chronic, and the rest factor is removed, the effect is the opposite of growth. But we know that what creates stress in people is not universal, and there are also differences between individual capacities to tolerate stress.

Alex’s story

There are some common factors that determine people’s ability to manage everyday or unusual stressful events – one

of the most common being the role of relationships. I saw this play out in the case of one client, Alex,* a trader in the City of London, who was married with a daughter. Alex was driven not so much by wealth as by achievement and status, explaining that ‘it’s just that money is the most honest form of recognition’. Recently she had described being at a crossroads where if she didn’t get promoted she would get left behind. Alex found it necessary to take part in after-work drink events, partly as a coping mechanism and partly to reinforce her network. She often came home late and found her wife Bea unsupportive. Alex came to me because Bea had found me online, and asked her to call me.

In our first session Alex told me about the stresses she was dealing with. She had some awareness with regard to her work situation and the growing inadequacy of her coping methods. When talking about her home life, she cast Bea and her daughter Charlie in the role of additional stressors – Bea was grumpy, and Charlie needed to straighten herself out and ‘stop manipulating the system’. I explained how I work and discussed burnout symptoms and patterns with her.

Her sexuality hadn’t met with any outright hostility at work, but she felt that some of her managers had taken a somewhat patronising interest in her and that she’d been invited into their social lives in a rather superficial way, in order to display her to their straight friends. She identified with the first two dimensions of the Maslach burnout inventory – emotional exhaustion and negativity, though less so with loss of efficacy. When I described Farber’s subtypes, she strongly identified with the first, frenetic burnout – ‘That’s me!’ – and I sensed her level of engagement rising. My final intervention was to ask what she would like to focus on for now. She worried about losing her temper with both Bea and Charlie. It became

‘As a runner, I know that the “stress + rest = growth” equation is the key to improvements in performance. When stress becomes chronic, and the rest factor is removed, the effect is the opposite of growth’

clear to both of us that her primary goal in counselling was to hold her family together. In our next two sessions she told me more about her situation and her drives. I asked about what drew her to Bea in the first place. I heard of her partner’s beauty and intelligence but also how Alex liked the fact that Bea was dependable and not too demanding. I explained how often I’d heard people tell me about relishing their demanding jobs as long as they’d had stable relationships to go home to, until something went wrong there – sometimes them bringing stress home from work –and then finding they had one too few legs left to stand on. I asked if that felt familiar. There was a long silence – ‘possibly’, she conceded. I asked if they ever had date nights. Alex sighed and said she felt those days had gone.

In a later session she told me that they left Charlie with her mother and spent a weekend together in Bath. In the next session, she told me about taking Charlie to see a film and how much they both enjoyed the experience. It felt like she was leaning into and enriching both these relationships.

In parallel, we talked about triggers for excessive work drinking – the moment she decides to ‘just go with it’ or, as I suggested, relieve her stress by use of alcoholic disinhibition and inebriated feelings of connection. She began to develop a new career strategy, acting as a mentor for the younger colleagues rather than using them as drinking buddies for stress relief. I got the feeling that her life was getting back on track, and I was a little sad but not surprised when she decided to end counselling after a couple of months.

Culture

Both culture and childhood experience can also shape the process by which stress turns into burnout. When Mia* came to me she was

on the path to becoming an NHS consultant, while caring for a widowed mother in poor health, and suffering from anxiety attacks, poor sleep and inability to study for her next set of exams. In the psychoeducation aspect of our work, I introduced another model, Freudenberger’s 12 stages of burnout, which includes compulsion to prove oneself, seeking refuge in overwork, neglect of needs, leading to inner emptiness, depression and full burnout syndrome.5 This trajectory resonated with her, so part of the work was looking at where this compulsion to prove herself may have come from.

I learned that Mia’s immigrant parents valued education and had high expectations of her studying for a profession – an ambition further fuelled by their experience of arriving in poverty to a land of both opportunity and racism. The love in her childhood had all too often been conditional on the achievement of certain goals – when Mia returned from school with a B grade

in maths, her mother cancelled her birthday party. From an attachment theory perspective, emotion regulation as an adult can be seen as an internalised reflection of the emotional availability and support of the primary attachment figure in childhood.6 In Mia’s case, I wondered whether this could have contributed to her difficulties with self-regulation as well as her over-identification with external goals in adult life. She identified with this – part of the reason she worked so hard was to avoid conflict, she said, and she found it difficult to manage criticism or failure.

I was able to help her with the anxiety attacks by the usual means of reframing the symptoms as unpleasant but harmless, and by teaching her breathwork techniques to reduce her physical stress response. Explaining Dan Siegel’s window of tolerance – and identifying the kinds of situations that push her out of that window – was very useful here.7 I also introduced a brief mindfulness meditation to the sessions so she could become more comfortable with ‘sitting with’ her inner experience. As the sessions progressed, and she began to make more sense of her parents’ behaviour, she also became more robust about drawing boundaries at work. She also started making more space in her life for a previously unmentioned boyfriend, and re-engaging with her professional and exam stresses on her own terms, driven less by reactive responses to external pressures and more by intentional responses to her own rebalanced goals.

Coping mechanisms

It seems that the impact of uncertainty or conflict in relationships becomes more likely to lead to burnout when a client’s usual coping mechanisms are removed, resulting in a persistently lowered tolerance for stress. Don* was a data analyst who enjoyed his work but was in a transition period. When I met him he had left his last job in a Mediterranean country with a high quality of life, which he had hoped would be a good place for him and his fiancée to live together, and was waiting to start his next job back here in the UK. But this wasn’t a normal between-jobs break. I soon discovered that Don was someone who had used exercise as his main stress coping mechanism. Isolated

‘It seems that the impact of uncertainty or conflict in relationships becomes more likely to lead to burnout when a client’s usual coping mechanisms are removed’

in a foreign hotel, in conflict with a boss who had been his mentor, and with distance and lockdown stretching his relationship to breaking point, he’d gone to the gym and injured his shoulder. But in the next few days, the sprain didn’t heal as it should have, and he found himself so exhausted that he couldn’t go from his room to the lobby without having to sit down and recover.

Along with the physical exhaustion came mental exhaustion he described as ‘brain fog’. He left the job and returned to the UK. By the time we spoke he had found a new job, leaving a month to recuperate before his first day at work. In my initial assessment, I didn’t realise how physical his burnout was – although I was talking to clients daily about the biology of burnout, Don was the most physically burnt out client I had yet encountered. As well as physical and emotional exhaustion, he was experiencing insomnia, gastric issues and had started to have panic attacks. Unsurprisingly, Don was relieved to discover that both his physical and emotional symptoms were very much to be expected from his burnout experience. We were able to evaluate the particular impact of the relationship difficulties in his life, both with his boss who had been his only social connection in that country but had hired him with unrealistic expectations, and with his fiancée who had changed her mind about coming out to join him. The impact of these uncertainties was then magnified by the lack of other relational contact due to physical isolation in his hotel during a strict period of lockdown.

While he felt he was getting better, he was concerned that he might not be fully recovered by the time he started his new job. Over the next two months we discussed what had happened at work and in his private life. We realised that the breakdown of his personal relationship had contributed as much as the work difficulties to his burnout. Making sense of

these factors helped him to begin to process his breakdown. He reported that the brain fog was lifting and that he had been able to engage with concluding his relationship and finding a new flat. By the time he returned to work he could focus for most of the day, and this continued to improve. We kept an eye on personal self-care factors such as sleep, wind-down time before bed and a carefully paced return to exercise, and on work self-care factors such as expectation management and time boundaries, and by the time he was a month back at work, he felt recovered and fully engaged.

Life after burnout

Nearly three years on from my burnout job to counselling, and a year into my specialising in working with burnout, I am following my own advice. On the relational front, training as a counsellor made me more aware of my personal relationships, which I think it would be fair to say had suffered from my own emotional exhaustion. I have been able to put more into and get more out of my family and friendships, and have benefited from counselling, and the support of colleagues and supervisors. I cannot help being aware of how much purpose, meaning and learning my clients have generously given me – all of which has made me grateful both to counselling and to family, friends and clients.

Leaving my last job helped me to counteract the exhaustion and procrastination that went with it, while the satisfaction and reward of helping my clients has, in turn, helped me to cope with the stresses of being in private practice.

I’m not sure I am so totally recovered that I could contemplate returning to my old line of work, but I am sufficiently recovered that I look forward each morning to the day ahead, and to the personal and professional futures now opening up.

* Client names and identifiable details have been changed.

REFERENCES

1. Maslach C. Burnout: the cost of caring. Los Altos: Malor Books; 2015.

2. Farber B. Introduction: understanding and treating burnout in a changing culture. Journal of Clinical Psychology 2000; 56(5): 589–594.

3. Wolf A. Correspondence (letter to the editor): Gaps in review article. Deutsches Ärzteblatt 2012; 109(18): 340. bit.ly/3FwQWxi

4. Barboza-Wilkes CJ et al. Deconstructing burnout at the intersections of race, gender, and generation in local government. Journal of Public Administration Research and Theory 2023; 33(1): 186–201.

5. Freudenberger HJ. Counseling and dynamics: treating the end-stage person In: Jones JW (ed). The burnout syndrome. Park Ridge III: London House Press; 1982.

6. Mikulincer M, Shaver PR. Attachment in adulthood: structure, dynamics, and change. New York: Guilford Press; 2010.

7. Siegel DJ. The developing mind. New York: Guilford Press; 1999.

About the author

Francis Norton MBACP is an integrative counsellor in private practice in south-west London and the City, specialising in client burnout. His preferred coping skills are cooking, improv and running.

‘On the relational front, training as a counsellor made me more aware of my personal relationships, which I think it would be fair to say had suffered from my own emotional exhaustion’

ASSESSING A SUPERVISEE’S FITNESS TO PRACTISE

It’s important that supervisors are aware of their supervisees’ levels of resilience, stamina and attentiveness, says Karen Stainsby

Feeling like I’d been hit by a 10-ton truck, I awoke freezing, yet rivers of sweat ran down my body. I crawled from my bed, cancelled that day’s clients, heaved myself back into bed and stayed there for a week. A dose of flu meant that my fitness to practise was not so much compromised as wrecked. In 1962 the famous paediatrician and psychoanalyst Donald Winnicott told the British Psychoanalytical Society that when practising, he resolved to ‘keep alive and well, stay awake, be myself and behave myself’.1 While not explicitly referencing fitness to practise (FTP), his brief statement wonderfully illustrates its three elements – wellbeing, competence and conduct. Winnicott spoke of keeping well and having to behave, but I think staying awake and keeping alive didn’t just mean not dozing off in front of clients or even dying before he’d finished working with them. Winnicott’s words also gave us some idea about his drive to keep up with new developments and remain alive to what was happening in the exciting and sometimes controversial therapeutic world of the 1960s.

Fast-forward 60 years, the Ethical Framework doesn’t explicitly mention FTP either However, by agreeing to abide by the commitments, values, principles, personal moral qualities and good practice, we promise to attend to it not only in regard to ourselves but also – if we are supervisors – our supervisees. FTP is fundamental to the work of counselling professionals and this article focuses on the supervisor’s role in helping supervisees monitor and maintain their FTP, be it in a one-to-one, group or peer supervision setting.

A counselling professional’s work can often reward and boost, but at other times it makes demands and depletes. Assessing FTP is one of the many ways that supervisors support supervisees in fulfilling their commitments to clients and to work to professional standards.

Supervision can be a place where supervisees recharge batteries, dis-identify from the emotional charge of client work, and attend to self-care, regarded as ‘a healthy, self-respecting, mature process founded on self-awareness,

self-compassion and sometimes, consultation with “trusted others”’, as described in the Good Practice in Action resource, Self-care for the counselling professions (GPiA 088). As Henderson comments: ‘It is important for all practitioners to be able to bring the issues to supervision and monitor how they are bearing the pain, and how their responses are affecting the professional work, and ask honestly whether and how, their work with clients is compromised or enhanced.’2

The restorative function of supervision therefore helps supervisees look after the ‘person within the practitioner’. The normative function attends to professional and ethical guidelines, standards of practice, laws and so on, while the formative function focuses on a supervisee’s skills and theoretical knowledge.3

Joint responsibilities

My dose of flu illustrates clearly when a practitioner was able to judge their own level of FTP. I imagine that if my supervisor had taken one look at me, they’d have come to the same conclusion. But in general, how do supervisors know whether their supervisee is looking after themselves well enough or if their wellbeing might be compromised such that it impacts negatively on their professional functioning and ability to satisfy professional standards? (Ethical Framework, Good Practice, points 18 and 91).

When establishing the supervisory relationship, it’s important to inform supervisees about joint responsibilities around their FTP, and also what you as their supervisor are likely to do if you have concerns. Some tell supervisees that every so often they might ask what seems

a strange question, such as ‘What part of yourself might you not be bringing to supervision today?’ This can help normalise a process that might seem quite challenging, particularly for trainees, the newly qualified and those more familiar with case management.

While maintaining the boundary between therapy and supervision, it’s important to talk with supervisees about how things are going in life for them, perhaps at the start of each session. That way we can make a mutual judgment about FTP. We may know a lot about our supervisees’ clients but what do we really know about our supervisees’ levels of resilience, stamina and attentiveness? Are they living in a good state of emotional, physical, psychological and spiritual health? Do they feel happy enough? Are they adequately nourished in various ways? Do they sleep well? Are workloads, financial pressures, relationship difficulties, family and any caring responsibilities bearing down on them? Would you recognise the symptoms and signs of stress and burnout in your supervisees –which might manifest differently in each one? If you did, would you know what to suggest that might help them? Could you both challenge and support them? How easy might you find it to suggest to individual supervisees that they access personal therapy or other type of support?

Let’s say you’ve remembered that during the previous supervision session your supervisee Arif* looked like he might fall asleep, but he dismissed your concern saying he’d watched a late-night film the night before. Today Arif is still stifling yawns and looks even more tired, so you raise this. It’s important to bear in mind that, while we’re all vulnerable to life events, illness and accident, sometimes FTP can also be affected by chronic illness – what Bond calls ‘the insidious erosion of ability’.4

Turning to issues of competence, from what you know of a supervisee’s work –that is, the parts they choose to tell you – do you get the impression they have enough up-to-date knowledge and skills to do the job effectively, and that they satisfy the fundamental professional standards of quality and safety set out in the Ethical Framework (Commitment 2)?

‘The restorative function of supervision helps supervisees look after the “person within the practitioner”’

Supervision

Imagine that Anne* excitedly tells you she’s taken on a couple for therapy but you are pretty sure she has no training in this specialism. If you feel concerned about her competence, how would you voice your unease? During the pandemic, numerous practitioners, determined to maintain support for their clients, took their work online, and many stayed there. Working online requires specific knowledge, skills and abilities, and there is now a specific competence framework that practitioners can use to check for any skills gaps.5 Have you discussed this with relevant supervisees?

Finally, and perhaps the most controversial of the FTP elements, what impression do you get about your supervisee’s behaviour or conduct – do you imagine it is ethical and professional? Do you have faith they will ‘avoid any actions that will bring our profession into disrepute’ (Good Practice, point 48)? For example, you have a niggling feeling that something’s not quite right between Miranda* and her client. Recently, how she speaks about them has made you worry that they might be teetering on the edge of having more than just a therapeutic relationship. You know you need to share your suspicions with her, but would you know how to approach that?

It’s all very well supervisors knowing about wellbeing, competence and conduct, but do our supervisees know about these three elements, and do they understand where joint responsibilities lie? Usually – and with their supervisor’s help –qualified practitioners are responsible for monitoring and maintaining their own FTP. For trainees, responsibilities are normally shared between their supervisor, training organisation, placement and themselves –an understanding best made clear to all in a four-way agreement (see GPiA 114).

Honesty

To support a supervisee’s FTP, we ask that supervisees are ‘honest, open and draw attention to significant difficulties and challenges that they may face in their work’ (Good Practice, point 72). But sometimes a heavy or complex caseload – or life – means a supervisee forgets to consider themselves.

We know and respect that all counselling professionals are entitled to a private life, so supervisees may consider certain areas ‘off limits’ to their supervisor. Our task is to provide opportunity and the conditions of safety and containment that help them trust us with what might feel like quite sensitive personal information. For example, having become heavily involved with online slot machines and casinos, Sam* is having financial difficulties and the worry is keeping her up most nights. If Sam’s gambling wasn’t causing difficulty in her life it would be none of our business, but now it seems she can’t remember important facts from sessions. Being non-judgmental, trustworthy, collaborative and egalitarian, and creating a space where warmth, humility, acceptance, empathy and genuineness are in evidence, is important at any time but understandably more so during tricky or delicate discussions. So, we agree to respond ‘without blame or unjustified criticism and when appropriate, support them in taking positive actions to resolve difficulties’ (Good Practice, point 72).

It can never be a one-way street, and getting to know our supervisee is likely to involve them getting to know us too. Deciding where we draw the line regarding self-disclosure and judging well, perhaps by asking, where they draw their line, is useful (see GPiA 117).

Sometimes a supervisor suspects their supervisee might be ‘unfit’ but at the same time wants to sensitively support them through what might be a difficult time. A balancing act requires supervisors to tap into their integrity, wisdom, resilience and courage. Henderson reminds us that the ‘push of normative tasks is to confront the issue as sensitively and skilfully as possible,

but not to duck the responsibility to do so’. She goes on to say that there can be ‘long-term benefits if the incident can be addressed openly, or it can be the start of a negative spiral if avoided’.2

But sometimes things get in the way of a supervisor speaking out. We might tell ourselves we don’t have enough information, which may or may not be true. We don’t want to embarrass them or undermine their confidence. We decide the matter is outside the remit of supervision. Anticipating conflict, we may shy away from speaking out. We might feel concerned that, if a break from practice is suggested, income will be lost (by both). We might even feel hypocritical if the area we might want to shine a light on is too ‘close to home’ to mention, such as excessive workload (see GPiA 099 and 109).

When an issue related to FTP has been raised by either the supervisor or supervisee, it’s important to fully understand both the nature of the issue and its impact on the supervisee and thus their clients. Associated timescales, when, how and why the issue arose, how likely it is to happen again and whether the risk can be mitigated in future are essential discussion points. The supervisory relationship and, of course, you as supervisor may also have been affected. Like ripples on a pond, there may be a wider impact if the issue risks bringing your supervisee, you, the profession or even the client into disrepute. Airing the issue sometimes brings a sense of relief, possibly for both of you, but it’s important to remember this mightn’t have been easy – again for both of you. Finding out how your supervisee felt during these discussions is important as is finding out what they most need from you right now and in future times. Also, has anything happened – or not happened – within supervision that could have contributed? Have the three tasks of supervision –normative, formative and restorative – been worked with in the most helpful way? Reviewing the supervisory relationship is probably useful at this time (see GPiA 010).

Hopefully, with your help, the supervisee can now begin to explore available options and make a plan of action. Ideas might include stopping seeing clients for an

‘Working openly, respectfully and in partnership often resolves things during what might even feel like a rupture’

agreed period (see GPiA 102), modifying work patterns, limiting client numbers, or increasing supervision or seeking specialist supervision. Sometimes, remedial action might also have to be considered, for example, apologising to a client (see GPiA 073 and 113). You might be able to suggest supportive CPD, and personal therapy may be appropriate. Something else altogether may be called for, and joint creative thinking may assist. Consulting the Ethical Framework, relevant Good Practice in Action resources and using an ethical decision making model (GPiA 044) can all help clarify your thinking and determine a way forward. Sometimes, during these types of discussions, supervisors find themselves questioning both themselves and elements of their own FTP. What might you need to support yourself here – maybe a discussion with your own supervisor?

Challenging

There is always a chance that, after putting much thought into the matter and finding the most appropriate words to convey our concerns, a supervisee says ‘You’re wrong’ or ‘It’s private and nothing to do with my work’. To face our ethical responsibilities, this challenging position may again require us to call on our integrity, humility, wisdom, resilience and courage. Henderson says that ‘challengingly, it is on these occasions when the supervisee disagrees with the [supervisor’s] view, that the taking of supervisory authority is most complex’. Quite reasonably, our supervisee may ask for specific details to back up our concern, so ‘the value of observation, description, and the clarity about behaviour or needs is crucial’. At the same time, there must be ‘a genuine compassion, and a willingness to spell out the supervisor’s concerns either for the wellbeing and resilience of the supervisee or to protect clients’.2

During what might feel like a demanding time, remember that apart from consulting with your own supervisor, BACP members can also speak to an ethics officer or, if relevant, the children and young people support service. Throughout deliberations with supervisees and any relevant colleagues, it’s a good idea that a record is made, including notes of any guidance received.

It’s essential for both supervisors and supervisees to understand that it’s not uncommon for tensions to arise within the supervisory relationship, and that sometimes supervisors may have contributed to this discomfort. Working openly, respectfully and in partnership often resolves things during what might even feel like a rupture. Occasionally, supervisor and supervisee just can’t see eye to eye, and the supervisor is left feeling anxious for all involved. However, it’s valuable to remember that supervisors do have options.4 You might seek the opinion of a mutually acceptable third person who, taking a ‘helicopter view’, provides an independent assessment. If this isn’t possible or the situation remains unresolved, the supervisory relationship may break down irretrievably. In this case, it is the supervisor’s ethical responsibility to know what remedial action to take. This might mean withdrawing from the supervisor role, giving clear reasons, usually in writing or other accessible method. As with clients, we don’t have to work with supervisees forever or need their permission to end, although this major decision should ideally be taken after consultation with our own supervisor and, if relevant, manager. The ending process will depend on context and be in accordance with any organisational contracts held. The supervisor might consider – within the contract – contacting other organisations, including agencies where the supervisee works. Regarding trainees, their training college should be contacted in line with the advisable four-way contract as described in GPiA 114.

Due to the grave nature of some FTP concerns, and a supervisee’s refusal to address them, a supervisor may decide – however reluctantly – to bring a complaint via an Article 12.6 Procedure.6 Again, this action is best carried out following discussion with your supervisor and, if relevant, manager.

BACP’s Supervision competence framework is an invaluable resource for supervisors and those interested in the role. While acknowledging the pivotal role supervisors play in the provision of ethical and effective therapeutic practice, it identifies the knowledge, skills, abilities and qualities required and can be used to affirm

existing competences while highlighting areas for further learning.7

For some practitioners, providing supervision that feels ‘one step removed’ from clients means it may seem less taxing than therapy. Nevertheless, like our supervisees and their clients, a supervisor’s humanity exposes us to many of the same stresses and strains of everyday life as well as those the supervisory role might add. For that reason, it’s crucial that, as supervisors, we take care of ourselves and recognise our own potential for vulnerability. ■

* Case studies are fictitious.

• This article is based on a presentation given by the author at the inaugural BACP Supervision Conference in 2022. This year’s conference takes place on 8 July, online and in person in Manchester. For more information, see www.bacp.co.uk/events

Further information

• The Good Practice in Action (GPiA) resources mentioned here are available at www.bacp.co.uk/gpia

REFERENCES

1. Winnicott DW. The aims of psycho-analytical treatment. In: The maturational processes and the facilitating environment: studies in the theory of emotional development. London: Hogarth; 1962. 2. Henderson P. A different wisdom: reflections on supervision practice. London: Karnac Books Ltd; 2009. 3. Proctor B . Supervision: a co-operative exercise in accountability. In: Marken M, Payne M (eds). Enabling and ensuring: supervision in practice. Leicester: National Youth Bureau; 1987.

4. Bond T. Standards and ethics for counselling in action (4th ed). London: Sage; 2015. 5. BACP Online and phone therapy (OPT) competence framework. Lutterworth: BACP; 2022. bit. ly/400IVJ2 6. BACP Professional Conduct Article 12.6. bit.ly/42wKaRR 7. BACP Supervision competence framework. Lutterworth: BACP; 2021.

About the author

Karen Stainsby MBACP is senior accredited as both counsellor and supervisor and practises in Surrey. She also provides various professional services to BACP and is the author of the ethics-based responses to Therapy Today’s ‘Dilemmas’.

Research digest

News and resources from the BACP research team

RESEARCH BITES

Anna Kennedy, Research Fellow

‘As the newest BACP Research Fellow, I am very happy to be involved in research to support and enhance the wellbeing of society. I first discovered a passion for research when studying for my MSc in counselling and therapeutic communication. Through studying counselling psychology and differing therapeutic approaches, my interest in why we think, feel and behave the way we do developed.

‘To date, my research has been underpinned by an interest in gender through aiming to understand aspects of how both men and women experience the social world which inevitably impacts on their internal world. For example, I investigated coaching as a potential avenue for help-seeking among men as coaching language and practice align closely with male gender norms and, in my doctoral research, I explored the identity, everyday life and wellbeing of mothers. As a mother of four, this research is particularly close to my heart.

‘I am lucky to have joined a fantastic team at BACP and I look forward to contributing to and supporting the great work of our organisation.’

This issue’s papers focus on research in counselling and psychotherapy with people experiencing anxiety, in line with the theme of this year’s Mental Health Awareness Week from 15-21 May

Non-directive play for anxiety

A survey was conducted with 20 children aged seven to nine years who had been diagnosed as anxious – 10 children participated in 10 sessions of play therapy and 10 children did not. The results showed that anxiety scores reduced significantly for the group of children taking part in non-directive play therapy compared to the group who did not participate. Specifically, play therapy had a positive effect on agoraphobia, separation anxiety, physical injury fear, social anxiety and generalised anxiety disorder scores. The study recommends combining non-directive play therapy with parenting education and training primary teachers about non-directive play therapy.

Read more: Hateli B. The effect of non-directive play therapy on reduction of anxiety disorders in young children. bit.ly/42VJNR2

Anxiety in the perinatal period

This systematic review explored the effectiveness of cognitive behavioural therapies (CBTs) and mindfulnessbased interventions (MBIs) for reducing anxiety during pregnancy and in the first year following birth (the perinatal period). Findings indicated that CBTs and MBIs were more effective than control conditions in reducing anxiety during the perinatal period – specifically, group-based interventions and individual

interventions. However, no significant effects emerged for self-guided therapies. Both in-person and online therapies showed similar benefits. The authors suggest that randomised control trials are required to compare effectiveness between psychological interventions for perinatal anxiety.

Read more: Clinkscales N et al. The effectiveness of psychological interventions for anxiety in the perinatal period: a systematic review and meta-analysis. bit.ly/3yWaDLa

Test anxiety in adolescence

This study explored the use of compassionate mind training (CMT) as a school-based intervention for test anxiety among adolescents. CMT is an aspect of compassionatefocused therapy primarily focused on the delivery of psychoeducation to develop the skills to cultivate compassion in the self. Participants in the intervention group received eight sessions of CMT, completing pre- and post-intervention measures of test anxiety, general anxiety and self-compassion. Results indicated a significant reduction in test anxiety and general anxiety, and an improvement in self-compassion in comparison with the control group.

Read more: O’Driscoll D, McAleese M. The feasibility and effectiveness of compassionate mind training as a test anxiety intervention for adolescents: a preliminary investigation. bit.ly/40Ngu1b

Meet the team

• We’ll be hearing from other members of the BACP research team in upcoming issues.

BULLETIN BOARD

■ There’s still time to book on to our annual Research Conference, which takes place online and in person in Leeds on 19 and 20 May. The theme for this year’s conference is ‘Global issues in counselling and psychotherapy research, policy and practice’ and it will be co-hosted with Leeds Beckett University. It’s a fantastic way to find out about research that’s going on in the field, contribute to your own CPD, and network with other researchers. You’ll also be able to catch up on some of the recordings through our on-demand service. For more information, see www.bacp.co.uk/ events-and-resources/research/conference

■ All members have free online access to our research journal, Counselling and Psychotherapy Research, as well as the EBSCO information database. These are excellent resources if you’re looking to scope the research literature on a particular topic. You can find out more at: www.bacp.co.uk/bacp-journals/ counselling-and-psychotherapy-research-journal and www.bacp.co.uk/events-and-resources/research/ ebsco. Why not look at them alongside our Good Practice in Action resource, How to do a literature search (GPiA 015), which you can find at: www.bacp. co.uk/events-and-resources/ethics-and-standards/ good-practice-in-action/publications/gpia015-howto-do-a-literature-search-fs

■ If you’re wondering how you can incorporate research more into your practice, take a look at our routine outcome monitoring webpages for practical information and guidance on collecting and analysing outcome data. Members also get access to a onemonth free trial of an online client management system. See www.bacp.co.uk/events-and-resources/ research/routine-outcome-measures

In the spotlight

Amanda McGarry MBACP (Accred) is a person-centred counsellor working in private practice. Alongside this Amanda is a senior lecturer at the University of Chester, teaching on both undergraduate and postgraduate counselling courses, and an associate lecturer at The Open University. She is currently completing a PhD at the University of Chester.

Tell us about your research. My research is exploring gendered power dynamics in the therapeutic relationship from the perspective of women, non-binary and gender non-conforming practitioners. While collecting data for my research I have been fortunate enough to meet some wonderfully thoughtful counsellors, who were generous with their time and reflections.

What motivated you to undertake research on gendered power dynamics? Within my first few months of qualifying as a counsellor, I became aware that gendered power dynamics might be part of therapeutic experiences I was having with male clients. I set off to find some literature to hopefully shed light on this but found very little. I decided I’d like

to research this area myself to understand my experiences more fully, and potentially the experiences of others in this area.

What are some of the implications of your research? I hope the findings provide counsellors with an opportunity for reflection and understanding in relation to gendered power dynamics in their therapeutic relationships. I also hope that my research can be used as a stepping stone for further study in this area and add to the thoughtful discussions taking place about the sociopolitical context in counselling.

• In each issue a practitioner, postgraduate student or academic will tell us about how their research may inform therapeutic practice.

‘I HOPE TO PROVIDE UNDERSTANDING OF GENDERED POWER DYNAMICS’

CLARE LOUISE JACKSON/SHUTTERSTOCK

The bookshelf

For exclusive publisher discount codes, see www.bacp.co.uk/membership/book-discounts

When Words Are Not Enough: creative responses to grief Jane

Harris

and Jimmy Edmonds (Quickthorn)

This book was quite unlike anything I’ve ever read on grief. Written entirely from the perspective of the bereaved, it is packed with hard-earned wisdom resulting from honest, compassionate, unflinching reflection on a devastating life experience.

The authors – one a therapist, one a photographer, both filmmakers – explore creative responses to grief and the ways that creativity can help to ease the pain and accommodate the loss. They find a way to articulate a pain like no other. A key theme is that these activities are not about getting over or moving on from a death but about embracing new ways of relating to the loved one who has died.

The responses to bereavement explored are wide and varied, including filmmaking, wild swimming, poetry, photography, textiles, painting and more. In each case, the bereaved individuals found meaning in their grief, which helped them to define the ongoing presence of their lost loved one and forge a new relationship with them, which acknowledges they have died but savours the impact they had, and continue to have, on the lives of those they loved.

The book comprises 24 stories, making it easy to dip in and out of but also offering a huge breadth of experiences that demonstrate an infinite number of ways to grieve. It contains the agonies and devastation of death, as well as the joys of living, and it is comfortable embracing the liminal, sometimes surreal, space full of paradox and conflict where grief lives. For the therapist, it broadens our understanding of our clients’ responses to grief and the key components of living with it. I am already thinking differently about grief because of this book.

Nick Campion is an integrative psychotherapist

Lessons in Psychoanalysis: psychopathology and clinical psychoanalysis for trainee analysts

Franco De Masi (Phoenix)

Training analyst and clinician De Masi has used actual classes he taught at the Italian Psychoanalytical Society to inspire the 19 ‘lessons’ that make up this comprehensive guide to psychoanalytic theory and practice. The order and pacing of the chapters make sense as an introductory course, first covering broad topics such as the nature of psychoanalysis itself, then introducing canonical concepts by Freud, Klein and Bion before moving on to specific areas of clinical interest, such as anxiety, phobia and panic, trauma and depression.

De Masi has a talent for making theory accessible without diluting it. I found myself understanding ideas that I struggled with during my psychotherapy training – for example, Green’s ‘dead mother’ and Bion’s ‘K’ – as they are seamlessly invoked in the context of engaging clinical vignettes.

In a section devoted to panic attacks, a phenomenon so present in our practices and conversely so absent from literature, De Masi says that ‘two therapeutic needs must be met’. The first is to ‘help the patient control and understand his anxieties’ and the second ‘concerns the construction of a stable sense of self’. He calls for panic attacks to be analysed as they happen, which differs from techniques that focus only on grounding in the moment.

Refreshingly for a psychoanalytic teaching text, other modalities such as evolutionary biology and neuroscience are interweaved and talked about respectfully without the territorial defensiveness that can often divide our profession. However, the author maintains that psychoanalysis remains a different, parallel undertaking and that its ‘integration with [other disciplines] is neither useful nor possible, given that it has its own specific epistemology’.

Emmanuelle Smith is a psychodynamic psychotherapist

Art Psychotherapy and Innovation: new territories, techniques and technologies

Helen Jury and Ali Coles (eds) (Jessica Kingsley Publishers)

I offer this review as a therapist and artist, not an art psychotherapist. The opening chapter explores the implications of clients being restricted in their physical contact with art materials by the strictures of COVID-19. This set a constructive tone for the whole book; what can we learn from and how can we innovate within our current context? The second chapter, co-authored with a client, examines the centrality of curiosity and innovation in therapy.

Subsequent chapters offer many examples from practice. These include tailored art psychotherapy support to NHS clinicians in the UK and migrant workers in Singapore, outreach using a mobile studio in south-west England, and transitory art therapy spaces in a marginal community in Taiwan. Further chapters discuss photography as a way to enable young people to express feelings, and caring for museum objects as an experiential metaphor for care of the inner self. There are two chapters exploring aspects of trauma work and another exploring the importance of spiritual expression when working with clients in United Arab Emirates. The final chapters include the use of virtual reality with trainee therapists and clients, and a curious collaborative research study between an art therapist, a designer and a roboticist.

As a therapist, I found this a stimulating read that encouraged me to think about the significance of being creative and innovative in my practice. All chapter authors demonstrate this in a manner that is respectful and thoughtful about the needs of their clients and the purpose of their work. It is well-researched and pleasingly written. I found it thoughtprovoking and satisfying.

Steve Page is a counsellor and coach

Edited by Jeanine Connor. Please note, we do not accept unsolicited book reviews.

Working on the Frontline of Mental Health: a CBT therapist’s casebook

Steve Sheward (Routledge)

I approached this book with curiosity and some trepidation deriving from a sense that cognitive behavioural therapy (CBT) has sometimes had a difficult reputation within the wider profession. Searching for articles on CBT within BACP’s publications yields plenty of ‘family rows’ over alleged over-prioritisation by commissioners and funders.

Amid such sound and fury, this is an engaging guide for anyone wishing to understand CBT better. The case studies – composites drawn from more than a decade’s clinical practice, mostly within NHS Talking Therapies services – allow the author to explain CBT treatment protocols for post-traumatic stress disorder (PTSD), depression, anxiety, social phobia and specific conditions such as the fear of vomiting or soiling. As one might expect from someone practising a modality in which psychoeducation is central, Sheward is a good explainer, outlining key aspects of theory and technique in accessible, relatable ways. He is also interestingly frank about similarities and differences between CBT and other perspectives. He acknowledges that existentialist traditions hold important insights into learning to ‘tolerate uncertainty’ when facing anxiety or angst. Conversely, he contends that Freudian concepts of the unconscious can become ‘problematic when applied to OCD intrusive thoughts about… harming a loved one’.

One criticism of this book is that it contains frequent spelling errors, despite being published by a ‘big name’, perhaps suggestive of cutbacks in editing. The head clutcher cover photo is also questionable – haven’t we moved on from this kind of reductive, potentially stereotypical imagery? Presentational quibbles aside – which reflect on the publishers rather than the author – I recommend this as an enlightening account of what CBT involves and how it benefits clients.

David Curl is a counsellor

The Humanity Test: disability, therapy and society

John Barton (PCCS Books)

Within the counselling world, we sometimes talk about attracting the clients we need to the time we need them. I’m wondering if the same can be said for the books we are allocated to review. It certainly felt that way for me. This well-researched book covers so many issues it is hard to define – part sociology/history textbook, part political manifesto, part spiritual journey.

Barton invites us to examine the world through the lens of disability, to scrutinise the definition and to ask, is it the person who is ‘disabled’ or is society ‘disabling’? There is a lot of practical guidance and wisdom for those working with clients with disabilities, and a full critique of what it means to be human. This includes the perennial issues around access to NHS Talking Therapies and the dominance of CBT within mental health services, as well as the merits of quantitative and qualitative data to prove efficacy.

I found the writing both challenging and inspiring. Throughout the book, the author presents a coherent narrative of what it might mean to be a person with a disability and the responses they might receive from others. In challenging us to take the humanity test – that is, by examining our attitudes and beliefs around disability – Barton leads us into reflection and a call to action.

One aspect I particularly liked was the emphasis on considering the political in our practice as therapists. I remember being encouraged to do this during my counselling training, and the idea not being well received. For counsellors and therapists, this book encourages us to reflect on our practice and gain a new perspective around a topic that can be difficult to navigate.

Joanna Burridge is an integrative counsellor

Transcend: the new science of self-actualization

Scott Barry Kaufman (Sheldon Press)

I found this an inspiring read. It reinvigorated my belief in the values of humanistic psychology; values of authenticity, self-determination, growth and wholeness. It also helped me to reconnect with the foundations of my practice as a therapist.

This book updates Abraham Maslow’s ideas about human motivation using modern psychological research. The traditional ‘pyramid’ presentation is replaced with a sailboat – a strong hull to protect us from the waves, which symbolise security needs of safety, connection and self-esteem, and a sail to drive us forward, symbolising growth needs of exploration, love and purpose. This model leads into a discussion of the healthy transcendence of the contradictions and conflicts of a human life.

The writing moves easily between Maslow’s ideas, often discovered by Kaufman in unpublished essays, journal entries and personal correspondence, and modern conceptualisations and research. In so doing, the whole enterprise is given renewed energy while respecting its roots in Maslow’s work.

It is difficult to fault this book, although I did find my attention wandering when reading the many scale questions or lists of characteristics of different aspects of personality. However, I found I could skip over these without losing too much of the meaning. There are other aspects of this book that I liked, such as opportunities for the reader to get involved by measuring aspects of their own personality, and growth challenges to usher you towards becoming a whole person, for those who feel inspired to do some work on themselves.

If you, like me, are drawn to the personcentred and humanistic approaches to psychotherapy but never really explored the ideas that underpin them, then this book is essential reading.

Andy Wilson is a counsellor and supervisor

IS IT ETHICAL TO WORK UNDER YOUR FIRST NAME ONLY?

I have just started working for an agency that offers telephone counselling for young people and have been told that the company policy is that we only share our first names with clients. There is also an option to work under a false name, which some counsellors do. I feel uneasy about this – I feel clients have a right to know who they are talking to. Is it OK for the service to work this way?

Karen Stainsby replies: You want to be open with your clients but, for you, this doesn’t fit with one of the organisation’s working practices. Some counselling professionals may think there’s ‘nothing to see here’ and that your ‘unease’ is unjustified but, digging deeper, it’s more complex than first meets the eye. You ask whether it is OK for the service to work this way – perhaps a more relevant question might be, is it OK for you?

I assume you received an organisational contract that probably referred to policies and procedures. Might you have overlooked a clause about use of names? It could be an idea to revisit this paperwork and see what you legally signed up to. We do agree to ‘give conscientious consideration to the law and how we fulfil any legal requirements concerning our work’ (Ethical Framework, Good Practice, point 46). Insurance providers sometimes offer a legal helpline if needed. The organisation has employer’s liability – that is, legal responsibility for the work. Ethically, we agree to be ‘watchful for any potential contractual incompatibilities between agreements with our clients and any other contractual agreements applicable to the work being undertaken, and proactively strive to avoid these wherever possible or promptly alert the people with the power or responsibility to resolve these contradictions’ (Good Practice, point 31f). Hopefully, the organisation explains to clients that counsellors who are employed by (or volunteer with) the organisation use first names only.

Telephone counselling – even when names are known – may offer an extra

element of anonymity for younger clients who, growing up in the digital world, might have meaningful online relationships with people they’ve never actually seen and who have avatar names. Perhaps these clients may not want to know your full name. However, for some cultures, referring to a professional by their first name might feel disrespectful. Giving a full name can give a sense of increased authority and professionalism. Is there anything in this for you I wonder?

Might safety underpin the ‘first name only’ rule? But whose safety is being protected – the client’s, the organisation’s, yours, or everyone’s? The organisation could worry about potentially harmful dual relationships arising from contact via a practitioner’s website, directory entry or social media accounts. Sometimes, due to online disinhibition, people (including practitioners) publish ill-judged messages and photos on social media accounts, which clients and ex-clients could read.

Your employer has a duty of care to do whatever is reasonably practicable to protect your health, safety and welfare – as you also have. It’s easy to assume that just because we work via the phone there’s no physical risk from clients. Where a practitioner lives, or other workplaces, may not be too difficult to find using the internet. A lone working survey of members carried out by BACP and Suzy

Lamplugh Trust in 2019 identified that 15% of respondents had experienced stalking, with more than half of these by a client, ex-client, colleague or ex-colleague. We are also at risk of psychological or emotional harm from clients who may decide to post about us and our work on social media. This can present reputational risk to the practitioner, their organisation and the profession (and possibly the client). Both organisation and practitioner need to carefully consider potential risks, but sometimes it can be a hard balancing act.

Workers in other professions might say that if they don’t reveal their full names, customers can’t complain so easily about the service. This might work in some occupations but not ours, as clients should be informed how to use the organisation’s complaints procedure. Even if clients only know a first name, complaints can easily be linked to their counsellor. However, making a complaint can be very stressful. If a client is unhappy with how the process has been conducted internally, they may not be able to face taking the complaint to BACP (which does require full names). It might be a lot to ask of anyone, particularly a young person. Might organisations even try to dissuade a client from either complaining internally or escalating?

You say clients have a right to know who they talk to. Hopefully they are talking to a qualified, insured, ethical counsellor who has gone through a rigorous selection process (including an enhanced DBS check). It is also hoped that the organisation has a safeguarding statement, policies, procedures and protocols and that staff and volunteers have safeguarding training.

Clients ask therapists all sorts of personal questions and even if we don’t answer these, often they are worthy of exploration. Using well-judged self-disclosure is important. We’ve agreed to respect ‘our clients’ privacy and dignity’ (Good Practice, point 21). As all counselling professionals have a right to a private life, that respect extends to you too. You may say it helps clients to know your full name, but there are lots of ways we could help a client (as we might a friend) but we don’t for very good reasons. Clients might

If you’ll be working from the organisation’s office, chatting with colleagues may reveal how they feel about and deal with the situation. Colleagues, managers and any organisational supervisor will hopefully help you understand what lies behind this policy

OUR ETHICS ADVISER AND THERAPY TODAY READERS CONSIDER THIS MONTH’S DILEMMA:

say your full name is required in case they wish to return in future, but the organisation can easily check its records. Counsellors having the same first name doesn’t confuse matters as the ‘therapeutic couple’ can easily be identified.

Are professional standards compromised by only giving your first name? You agree with a client how you’ll work together (Commitment 3c), which might include what you call each other. I imagine most clients want to be called by their first name, which makes it easier for you also. You’ll work ‘in partnership’ (Commitment 3d), but is a full name required for you to act as ‘therapeutic companion’? You’ve promised to be ‘honest about the work’ (Commitment 5a) and communicate ‘qualifications, experience and working methods accurately’ (Commitment 5b). Is your name part of ‘the work’ and its ‘methods’? If you can explain your reasons when challenged, is withholding your full name dishonest?

Turning to the ethical principle of being ‘trustworthy’ – this is about striving to ensure clients’ expectations are ones that have reasonable prospects of being met – but this does not mean all expectations. Good Practice, point 12 reminds us that ‘we will do everything we can [my italics] to develop and protect our clients’ trust’. Applying the principle of ‘justice’ means any decision made around names must apply to all clients within that organisation. Thinking of ‘nonmaleficence’ – is not knowing your full name likely to cause harm? The principle of ‘selfrespect’ is vital, emphasising ‘care for self’. It means you are entitled to apply all other principles to yourself and not just your client, including care for your safety and wellbeing.

Turning to ‘personal moral qualities’, you can show ‘empathy’ and ‘care’ to a distressed person in the street, yet they might never know your name. Being straightforward, honest and consistent (the quality of ‘integrity’) is relevant. If when asked for your

full name you truthfully and tactfully explain why you can’t give this information, then you are acting with integrity. But you wouldn’t be demonstrating ‘fairness’ or ‘justice’ if you told some of the organisation’s clients your full name but not others. ‘Candour’ means an ‘openness with clients about anything that places them at risk of harm or causes harm’ –is harm involved here?

A few Good Practice points come to mind – attention will be given to: ‘expressed needs and choices so far as possible’ (Good Practice, point 31). The intake process will hopefully have taken this into account, but the organisation may not be able to give the client everything they want. We commit to providing clients with information so that they can make informed decisions about the service (Good Practice, point 30). Do they need your full name to decide? Good Practice, point 33 highlights the importance of personal and professional boundaries that are ‘consistent with the aims of working together and beneficial to the client’. What is your aim of working with these clients? How much more beneficial is it to them, and the work, to know your full name? We strive to be ‘open and as communicative with our clients, colleagues and others as is consistent with the purpose, methods and confidentiality of the service’ (Good Practice, point 44). The relevant wording here is ‘…as is consistent with…’

Do you feel this dilemma raises issues of inequality? The thing is, there are always going to be inequalities in therapy, whether we like it or not. For example, most clients see us as having knowledge, experience and skill and want us to help them. Also, organisations allocate clients to therapists, whereas in private practice clients usually get to choose.

You might not be the first to have this dilemma. If you’ll be working from the organisation’s office, chatting with colleagues may reveal how they feel about and deal with the situation. They may also be able to help with appropriate responses to requests for your full name. I don’t know what age range your clients are but it could span quite a few years of development. Having a ‘menu’ of potential responses and explanations that are sensitive to age, developmental stage and culture may help. Colleagues, managers and any organisational supervisor will hopefully help you understand what lies behind this policy.

Dilemmas

Working in a challenging area, it might be useful to look at the Good Practice in Action resources listed on the right. The competence frameworks for working with children and young people and for online and phone therapy can help identify any gaps in skills and knowledge, along with Counselling MindEd’s free e-learning modules, funded by the Department of Health. Remember that the Children and Young People Ethics Officer can also be contacted via the Ethics hub. Moving from childhood into adulthood can be challenging. Fallout from the pandemic and the current cost of living crisis has hit many young people hard, so you work in a very worthwhile field. I really hope you find a solution that enables you to carry on with this invaluable work.

Karen Stainsby MBACP is senior accredited as both counsellor and supervisor and practises in Surrey. She also provides various professional services to BACP.

This column is reviewed by an ethics panel of experienced practitioners.

READER RESPONSES

‘Congruence can still be achieved’

I’ve worked with an online counselling organisation that, like the organisation referred to here, allowed us and the clients to use pseudonyms instead of our real names. The anonymity can make service users feel safer and more likely to talk about issues they find shameful or feel guilt over. Expecting therapists to be anonymous in turn not only protects the therapist’s privacy but also puts us on an equal footing with the service user. When I first worked this way I questioned if being anonymous would allow me to be congruent, but congruence can still be achieved by explaining to the service user why the service you work for operates that way, and using that to explore how they feel about anonymity. You can use a variation on your name as a pseudonym, or a nickname, or even adopt a name you love – one that has a connection to you personally and therefore feels less

SUPPORT AND RESOURCES

You can find more information in the following BACP Good Practice in Action resources, available online at www.bacp.co.uk/gpia

 Making the contract within the counselling professions (GPiA 039 and 055)

 Ethical decision making in the context of the counselling professions (GPiA 044)

 Working with children and young people (GPiA 046)

 Working online in the counselling professions (GPiA 047 and 125)

 Self-care for the counselling professions (GPiA 088)

 Safe working in the context of the counselling professions (GPiA 106)

 Boundaries within the counselling professions (GPiA 110 and 111)

 Practitioner self-disclosure in the counselling professions (GPiA 117)

For the BACP children and young people (CYP) competences and the Online and phone therapy (OPT) competence framework, user guide and training curriculum, see www.bacp.co.uk/events-and-resources/ethics-andstandards/competences-and-curricula

For the free Counselling MindEd e-learning modules, see www.bacp.co.uk/ events-and-resources/ethics-and-standards/competences-and-curricula/ counselling-minded

incongruent. It can be hard at first to feel like you’re truly meeting a service user at a relational level if you don’t disclose your real name, but there’s a lot more to you than the name you go by. Your nature as a person and your style as a therapist will still shine through, and they’ll make a lot more difference to a person in need.

Joe Martin MBACP is a psychotherapist

‘Imposing such a rule can create an unnecessary disconnect’ I don’t understand the need for this, and we don’t subscribe to this with our business model. Our clients know who we are, and we know who they are, representing an ethical and transparent service. A central ethos of counselling is cultivating a genuine relationship. Imposing such a rule can create an unnecessary disconnect between the

client and their counsellor and suggests that the therapeutic alliance isn’t recognised or valued by the organisation. Maybe if one of our affiliates had had a bad experience with a client in a previous role and chose to protect their own identity, then that is their prerogative. All our counsellors are respected, autonomous, self-governing practitioners and they deserve to be treated as such. Otherwise the counsellor is merely a commodity with their sense of identity getting lost within a corporate agenda. This reminds me of another rule imposed by some EAPs – clients and counsellors being denied the option of continuing to work together in a private arrangement. As if it’s not hard enough to engage with a therapist and establish trust and confidence! For me, telling a counsellor what name they should use is about power and not in keeping with

It can be hard at first to feel like you’re truly meeting a service user at a relational level if you don’t disclose your real name, but there’s a lot more to you than the name you go by. Your nature as a person and your style as a therapist will still shine through

my core values. Is this the kind of company you really want to work for?

Sharon McCormick MBACP (Accred) is Clinical Director of The Listening Centre

‘There is a security element to be considered’

A key benefit of engaging with clients remotely is the disinhibition effect. The anonymity it permits can lessen the fear of being judged; it may be the one thing that enables that client to feel safe enough to embark on counselling and disclose trauma or risk that otherwise would not be shared and supported. So long as you have done a robust risk assessment and discussed the client’s support network with them, respecting their desire to only use their first name can aid the development of the client’s trust and, thereby, the therapeutic relationship. For the counsellor, there is also a security element to be considered in this time of social media and multiple ways of easily accessing information. Some counsellors may choose to use a pseudonym or only their first name in their professional life, to help maintain clear boundaries and limit unwanted attention. I would recommend choosing a name that is easily pronounced, that you feel comfortable with and that you will remember! And stick to it so that, if you work for an organisation and a client wishes to give positive feedback, or complain, the organisation also knows which counsellor is being referred to.

Sarah Worley-James MBACP (Snr Accred) is a counsellor, supervisor, trainer and author of Online Counselling: an essential guide (PCCS Books)

‘A first name-only approach works well for everyone’

At Childline online service, we recommend that those delivering our service, staff and volunteers, use a first name – either their own or a name they use only when working with children and young people. Some staff and volunteers have quite distinctive first names that could reveal more about their cultural or ethnic background than they feel comfortable with and become a focus of the interaction for the young person; some do not wish to be identifiable while delivering the service. The Childline service is open and freely accessible to children and young people

at any time, either by phone or online. They tell us they like the easy access and control; it sets us apart from many of the more formal services some of our users are already engaged with. Users can share as much or as little about themselves as they wish. Each time a young person contacts us, they are very likely to go through to someone different, so the possibility of an ongoing supportive relationship with a volunteer or staff member is vastly reduced. Given that the setting and nature of the relationship is also different, a first name-only approach works well for everyone. Many children and young people who contact us are in crisis and are less focused on whom they are speaking with as opposed to what help or support we, as an organisation, can give. Where necessary, our approach around names can be explained to young people, and they are overwhelmingly accepting of this. Cormac Nolan is Service Head at Childline online service

HOW WOULD YOU RESPOND?

We welcome members’ responses to this upcoming dilemma. You don’t have to be an expert – if a question resonates with you, do share your experiences or reflections with your peers. We welcome brief or longer responses (up to 350 words) by the deadline below. Email responses or any questions to therapytoday@ thinkpublishing.co.uk

When I qualified as a counsellor and started looking at putting my profile into directories, I felt uneasy about using my full surname, which is long, complex and looks very Polish. British people tend to find it very difficult to know how it is pronounced. Initially, I used my full name but had very few enquiries. I discussed with my supervisor if it might be my name that was putting clients off, and what the impact of changing it might be on me and clients. Eventually I decided to drop the second ‘married’ part of my surname (Przybysz) and keep my maiden surname only, so it sounded less weird to a native English speaker. In two months, my private practice was booked to full capacity. I can’t say if that was coincidence, passage of time or the name change! But I want clients to be able to connect with me and not to see the surname as a scary obstacle because they can’t pronounce it. I am not my surname; I am a person, and this is what I am offering to my clients first – the human me.

Honorata Chorazy-Przybysz MBACP is a counsellor and therapeutic arts practitioner in private practice

July/August 2023: Is it OK to carry on working remotely with a client moving abroad? I’m in private practice and one of my long-term clients is moving to China for two months for work and wants to continue working with me while there. We already work online. I am happy to do this, and the client has said they would value my support, but I have heard there are potential problems with working with clients not based in the UK. What do I need to consider to do this ethically? Reader responses deadline: 15 May

The dilemmas reported here are fictional but 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.

‘I am not my surname; I am a person’

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Supervision: November 29th or December 6th 2023

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Admissions: Qualification in counselling, psychotherapy or equivalent or TISUK Diploma.

Fees: £749

~!(~ ,-~--~~---·-

TRAUMAUK lllm!iD! CCMH INFORMED

SCHOOLS V

To apply and for more information

www.traumainformedschools.co.uk

Email: info@traumainformedschools.co.uk

Diplomain TraumaTherapy

March2024 - January2025• 15daysin London

COSRTandNCIPaccredited,level7

A pioneeringprofessionaltraining in howto work withthe process of trauma in a relationalway.

Thistraining isfocusedon meaningmakingrooted in sufferingand exploringthe impactof trauma on psychologicaldevelopment,the body,relationships,workandspirituality.Includedisthe effectof the client'strauma on the therapistand possibilitiesfor post-traumaticgrowth. Wesupport studentsin developinga proactiveandtherapeuticstyle,integratingdifferenttechniques insteadofdependingonthem.

Enquiries:o;,827CJ23134 or info@naos-institute.com

Forfullcoursedetails:

https://www.naos-institute.com/training/

NAOSInstitute:

74CastlebarRoad,LondonW52DD

Advanced Diploma in Relationship Psychotherapy 2024

Due to popular demand forth is course, we will have two intakes for 2024, one in-room (starting February 2024) the other zoom-only (starting June 2024), both 20 days

Thiscourseaimsto support individualstudentsin building on, enhancingand honingtheir psychotherapypracticewhen working with Intimate Relationships,bethey "couples" or "multiple-partnered".

Our intention isto enableparticipantsto work with complexand multifacetedpresentationsat a deep level,incorporatinga variety of psychotherapeutic(includingsystemicand psychosexual)models within a relationshipframework.

Enquiries: "A world class training." 2020 info@naos-institute.com 07414681553

Forfull course details: www.naos-institute.com/training/ COSITTand NCIPaccredited,level7

LondonDiploma (l( )) in Psychosexualand RelationshipTherapy

''Thegoldstandardofpsychosexualand relationshiptherapytraining"

full retroactive cover from £61.00 for a limit of indemnity of £5,000,000.

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'.

Applicationsareinvitedforthis"prestigious",longestablished,parttimetraining scheduledforJanuary2024(inroom,inLondon)orJune2024(on-zoom, studentsmayresideanywhereontheglobe),opento counsellors,therapists, medicalprofessionals,clergyandsocialworkerswitha minimumof120hrscounsellingtrainingorequivalent and50clienthours.Inexceptionalcircumstancesthese maybewaived.

Forafullcoursedescriptionvisitourwebsite: www.psychosexualtraining.org.uk

Coursefeesare,intotal£8220.00incluniversity registrationandVAT,payableover21monthly instalments.

Over200clinicalplacementareavailablethroughoutthe UK,inEuropeandfurtherafield.

Forinformaldiscussionscontact JudiKeshet-0rr

~ !NATIONAL COUNSELLING SOCIETY

- professional~'-....,...JPstandards authority accredited register

European Association for Counselling cosrt

ijudi@psychosexualtraining.org.uk) tel02084554511

l;IMiddlesex W University

"Thecourseisone ofbest I haveattended."2021

Creative SoulJourneys®

Awaken.Create.Transform.

Creative Soul Therapy", Workshops and Retreats Putting soulful, feminine energy back into CPD

Would you like to invest in your CPD with a nurturing, creative and transformative experience?

Do you feel ready to rejuvenate your energy for self and work?

Are you yearning to take time out for YOU to go on a deep personal healing journey as part of your CPD?

I offer a unique approach to self awareness and transformative learning, for therapists exploring myths with expressive movement to music and artistic processes to support the process. Safe and supportive small group.

Online three hour workshopsMay 13th, July 22nd, Sept 23rd

Autumn Retreat -Creative Soul Journey: Women Who Run With The Wolves Oct 21st-22nd in West Sussex

Certificate of Attendance given. Contact Isabella (Integrative Psychotherapist UKCP) and to book at www.creativesouljourneys.co.uk bellaflorschutz@gmail.com

New 12-Day Training in Somatic Trauma Therapy

DOCTOR OF PSYCHODYNAMIC/PSYCHOANAL YTIC PSYCHOTHERAPY CLINICAL PRACTICE

The Doctorate of Psychodynamic/Psychoanalytic Psychotherapy Clinical Practice at the University of Exeter is an innovative and flexible programme that provides clinical training to practice as psychodynamic or psychoanalytic psychotherapist. This is a four-year part-time programme to learn the necessary psychodynamic and psychoanalytic skills, theories, knowledge, and gain experience leading to professional clinical qualification, membership of BPF and registration with the BPC. This programme also enables you to explore and develop your own research ideas, including both quantitative and qualitative methods as well as possibilities for psychoanalytic and conceptual research and novel approaches.

The course structure enables programme members to participate nationally and internationally. You attend the University for a five-day intensive block week three times a year and the rest of the programme can be attended remotely. There ore fortnightly learning sets of three hours duration, including a theory seminar to learn and discuss psychoanalytic theories, ideas, and therapeutic skills, and a clinical seminar to present and discussclinical coses. You ore assigned a tutor with whom you hove regular one to one meeting, and a research supervisor, with whom you also meet regularly.

Clinical work is a requirement throughout the programme and the University will assist you to find suitable work experience. Personal therapy or analysis is also a requirement throughout the programme.

After successful completion of the first two years of the programme, you will work with two training patients and deepen the necessary skills and understanding of working psychodynomicolly or psychoonolytically within a therapeutic relationship.

The University of Exeter hos on international reputation for training clinicians in the psychological therapies. The DPPClinPrac programme is staffed by senior clinicians in the field of psychoanalysis and psychoanalytic psychotherapy, delivering high-quality training in all of its clinical, academic and research components. Whilst the programme hos clinical work at its core, it also provides a thorough grounding in theory and research relevant to psychotherapeutic clinical practice.

We offer excellence in short courses and professional development workshops for therapists, practitioners and mental health professionals

Introduction to CBT

2 days (12 hrs): 14 & 15 Oct, Leeds £190

This 2 day course is the introduction to the basics of CBT and how to use it in client sessions.

Introduction to Transactional Analysis (TA101)

2 days Sat/Sun 15 & 16 July, Leeds £180

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.

Getting Started in Couples Work £250

13 & 14 Nov 2023, 9.30am-4.30pm, Leeds

A two-day training course for counsellors and therapists who are looking to train in couples therapy. You will learn the basic theory and clinical skills of Imago Relationship Therapy. The course is also stage 1 of becoming a certified Imago therapist.

Diploma in Clinical Supervision

10 day course starting Dec 2023, Online

A dynamic supervision course for practitioners looking to become a clinical supervisor and develop, deepen and broaden their supervision practice. With places limited to a small group, our two trainers together ensure attendees get the very best theoretical and experiential training.

To see our full training programme visit www.northsidetraining.co.uk, email us on info@northsidetraining.co.uk or call 0113 2583399

BRITISH/ PSYCH<JANALYTIC /COUNCIL

National Centre tor Eating Disorders the

british psychological society approved

BPSApprovedtraining for therapistsworking with EatingDisorders& Obesitywith mentorship& support via zoom

Master PractitionerEatingDisorders& Obesity

15 days with Deanne Jade 3modules

Each course is stand-alone; with experiential content to transform your own relationship with food.

More important BPSApproved CPD for EDs

Autism, Neurodiversity & Eating Disorders 1 day

Sept. 29th with Jenny Phaure: £130 Blended/ online learning

A high number of autistic and neuro-divergent people experience disordered eating patterns, including restricted eating and ARFID. Learn how to help.

Socratic Questioning for Eds 2 days BPSApproved

Sept. 19-20 £250+VAT early bird: Online with ProfessorPaul Grantham

Eating disorder behaviour is resistant to change. Learn how to change harmful, stuck eating disorder thinking when nothing else works.

Excellence in Practitioner Skills for Eating Disorders 9 days

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 anorexia. You will also get to transform your own relationship with food.

ONLY ONE COURSEIN 2023 WITH LIMITED PLACESon Zoom

Autumn 2023: please register your interest with us 01372 439184

Essential Obesity: Psychological Approaches 4 Days

Help people who want weight change, without dieting, compassionately & effectively with state-of-the-art skills from counselling, clinical & health psychology.

Summer 2023: June 30 th -July 1 & July 7-8 Zoom

Nutritional Interventions for Eating Disorders 2 days

A superlative, unique course to teach nutrition-related aspects of eating disorders & obesity for psychotherapists.

Autumn 2023: November 23 & 30 Zoom Receive

Where you look affects how you feel

Brainspotting trainings teach the latest scientific Trainings Online and Beyond theory in relational neuroscience and the neurobiology of trauma informed therapy. Brainspotting is an with Dr Mark Grixti o. Online embodied approach that removes obstacles and Phase 1 enhances the ultimate resource of transcendent attunement to realise the immense power of 3rd - 5th March 2023 Brighton" & Online 0 2023 Brighton" & Online 0 eye positions to access and process trauma. 20th - 22nd October

In these current times, we have the chance to adapt Phase 2 and evolve in terms of delivering the most effective 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 trainings are now provided online and will deliver the richness of theory, practice, demonstrations and paired work to empower you in your practice.

"Profound and authentic."

21st -23rd April 1st -3rd December

2023 Brighton" & Online 0 2023 Brighton" & Online 0

Phase 4 with Dr David Grand

10th - 12th November

" if feasible and TBC 2023 Online 0

Check out Awe In Trauma Podcast on Apple and Spotify

Save a further £45 where booking Phase 1 and 2 together. Free post training online group Supervision.

Brainspotting : The Revolutionary New Therapy for Rapid and Effective Change -David Grand, PhD (2013)

For more information enter 'Brainspotting Sketch Animation' into YouTube

For further information please contact: www.bspuk.co.uk Email: info@bspuk.co.uk I Phone: 07776 223022

CPD WORKSHOPS with CHRYSALISCOURSES

BOOK ONLINE NOW!

https:/ /bit.ly/chrysalisCPD

ofACTARI~

SPECIALISTS IN DOMESTIC ABUSE COUNSELLING

Domestic Abuse Counselling Training

Now available across the UK

Our short online courses, developed from research and practice, build into a comprehensive training for domestic abuse work.

Working with domestic abuse experiences: What you need to know (Tues 23rd May, 2-5pm) £45

Essential domestic abuse knowledge for client work.

Upskill for therapeutic work (Thurs 25th May, 2-5pm) £45

The enhanced therapeutic skills vital for domestic abuse work.

Understand complex trauma (Wed 31st May, 2-4pm) £30

Exploring trauma theory and practice relevant to domestic abuse.

June Courses available

Compassionate Mind Training; Creative Approaches for Domestic Abuse; Working with Metaphor; Relational Dynamics in Therapy; and the Developmental Impact of Childhood Trauma.

CHRYSALIS COURSES

For full details of these courses, a schedule of our full training programme and online booking visit www.dactari.co.uk/counsellor-training

The CICS Diploma in Clinical Supervision has been designed to thoroughly prepare you for your next step in career seniority, providing solid and pragmatic knowledge on risk and safeguarding management along with a deeply nuanced consideration of the rich and unique supervisory relationship.

The course content has been developed in line with the BACP Supervision Competence Framework, the UKCP Practice Guidelines for Supervisors and the COSRT Registered and Accredited Supervisor requirements.

The course is structured in the CICS blended learning model, with detailed module pre-reads and skills demonstration videos accessible via our e-learning platform, combined with live tutor contact and skills practice time, over a seven month duration.

Course dates

• 8th September 2023: 6pm-8pm

• 22nd & 23rd September 2023

• 13th & 14th October 2023

• 17th & 18th November 2023

• 12th & 13th January 2024

• 9th & 10th February 2024

• 8th & 9th March 2024

Course tutors

Rima Hawkins

COSRT Accredited Psychosexual and Relationship Therapist, COSRT Accredited Supervisor, Pink Therapy Advanced Accredited GSRD Therapist

Silva Neves

UKCP Registered Psychotherapist, COSRT Accredited Psychosexual & Relationship Therapist, COSRT Accredited Supervisor, Author, Pink Therapy Clinical Associate

TWO-DAY

ONLINE CPD WORKSHOP

FUNDAMENTAL REUOIOUS CHILDHOODS AND ADULT HEALTH:IMPLICATIONSFOR PRACTICEIN THE ONE-TO-oNE ERAPEUTICENCOUNTE

A two-day on line workshop (Friday and Saturday) providing ten hours of research-based training for professionals on a muchneglected and often ignored topic.

For more information please email counselling@gillharvey.co.uk or make contact via www.gillharvey.co.uk

Dr Gill Harvey is a Therapeutic Counsellor/ Psychotherapist, Supervisor, Researcher and Trainer. She has written several journal articles on this topic, and links to these will be made available to delegates.

CPCAB endorsed.

Dates for 2023

Friday 30th June and Saturday 1st July

Friday 6th and Saturday 7th October

'I really enjoyed it, and I think the mark of good training is when you keep returning to it over the ensuing weeks and thinking it through a bit more.'

'I enjoyed the seminar tremendously. It was well worth the journey.'

mlBD li1DEI

ACOURSEINCLINICALSUPERVISIONTHROUGHARELATIONALANDCREATIVELENS .

The course is aimed at experienced counsellors and psychotherapistswho wish to become clinical supervisors working with individuals and groups.

Matrix College teaches a relational development integrative model of counselling and this will inform and frame our relational approach.

WHERE:Matrix College of counselling and Psychotherapy, Wymondham, Norfolk, NR18OGU

HOW MUCH?£1650

£1400 Early Bird (if booked by lstjune)

EXTRYREQUIREMENTS: 3 Years post qualification.

MORE INFO: please visit www.matrix.ac.uk or 01953 797160

starts Autumn 2023

consists of four modules of 3 days (Thursday, Friday &- Saturday)

ACT Alcohol Ltd are a Midlands-based private organisation supporling individual~ to either reduce what they drink or quit completely. We are all trained, and experienced alcohol counsellors offering therapeutic interventions to break alcohol dependency.

What training will I receive?

This informative workshop is designed to increase awareness of how problem drinking habits can affect clients, and the therapeutic process approach required to break alcohol dependency. Aimed at therapists, the workshop provides useful information & advice, when faced with a client presenting with this issue.

To book go to www.acttraining.org or email julie@actalcohol.co.uk

"There aren't words big enough to describe this feeling. It is a sense that I would rather be anyone other than myself. I/ is a belief that I am fundamentally and impossibly flawed, that I will never change, that there is no-one in the universe as unacceptable as me."

This is shame. But how con it be worked with in the therapy room?

Join our community of 35,000+ learners on this heartfelt, emotive online course and explore the overlap between the neurobiology of shame and that of trauma - and how to work with it effectively.

COURSE FEATURES:

on line & on-demand

....:ii.simple to use lifetime access

I have worked for years with clients on toxic shame, but this course taught me things I knew nothing about, and it has transformed the CPDcertificate for 6 hours

....:ii.downloadable resources ~additional reading reflection prompts usual price: £45

,,therapy I now provide. I have completed o lot of CPDover the course of my career, but this is definitely the best training I have ever accessed.

BUY NOW FOR JUST £30 WITH CODE TTSHAME

Enter code at checkout at www.carolynspring.com/wws

GROUP COACHING TRAINING/

Are you an experienced coach looking to take your practice to the next level?

Would you lik your clients a ~~ re you se

6 live online training sessions (3 hours each)

3 group supervision sessions (90 minutes each)

2 individual tutorials (&O minutes each)

12 participants max per cohort

Fees: £1600 (individuals) and £2100 (organisations)

10% off with code TT2023 - valid until 31st July 2023 Email info@quantumleap.uk.com to book your place or to find out about easy payment plans

Re-Vision is a registered charity offering a spiritual perspective with down-to-earth, quality training. A member of BACP and UKCP who accredit our counselling training and psychotherapy training respectively.

Workingwith Young People-Bringingin Soulfulness

Nine weekends from late Sept 2023 to June 2024 - £2,250

This post-qualification training brings together a professional approach to young people's therapeutic work with the depth and qualities of a transpersonal perspective that honours the soul's journey from childhood towards adulthood. Successfulcompletion of the taught course and clinical requirements would entitle you to apply for inclusion on the NCS register for work with young people, approved by the PSA.

Supervisionwith Soul

Six weekends between November 2023 and May 2024 - £7,500 The course brings together the professional standards of good supervision with the depth and ~uality of a transpersonal r,erspective that honours the life ot the soul. Option of further individual supervised hours to achieve the Diploma.

Wastraumacoveredsufficientlyin yourcoretraining? ----------

Do you supervisetherapistswho work with trauma& feel you needto knowmore?

Do dissociation,DID,flashbacksor panicattackscropup and you'renot sureyou "know enough"?

Working as a therapist, you will inevitably work with traumatised people. Their trauma may be explicit -for example sexual violence or domestic abuse. Or it can be implicit and unrecognised as traumatic -such as attachment wounds or

co-dependent relationships.

Therefore, it is vital that you understand trauma, the impact on individuals and an understanding of how to work safely & effectively with traumatised clients, as well as the potential impact on yourself. In particular, working within a three-stage trauma model is key to safe and effective trauma work.

Our workshops combine up to date theory as well an element of experiential participation. Importantly we always try to keep it real -we never underestimate how challenging this work is.

Trauma Essentials: 17th July

Creating Safety & Stabilisation : 18th September

Otherworkshopsinclude:

Working with Nesting Dolls, shells & other objects: 26th June

How to Set Up a SuccessfulCounselling Business: 3rd July

Pre Trial Therapy Guidance -new & revised : 10th July, or 25th September

Exploring the Mother Wound9th October

Delivered by Sally French, former CPSspecialist sexual violence prosecutor and Lynsey Lowe, experienced former therapist/manager from What about us? Compassion Fatigue, Burnout & Vicarious Trauma 20th November

Dissociation, CPTSD & Shame: 16th October

specialist sexual violence service.

Sally & Lynseyare both experienced trauma specialists having worked in this field for over 15years. (These are standalone workshops but we offer discounts of £25 or £40 if you book and pay for 3 or 4 courses}

Cost: £85 per workshop.

Email: inspirecpd@gmail.comI Website:www.inspirecpdfortherapists.com

Jan Hawkins & The FDP

Website: www.janhawkins.co.uk

July 1st July 2nd 2023

Residential at Debden House

Debden Green, Laughton, Essex IG10 2NZ

For full details contact jan@janhawkins.co.uk

A Person-Centred Weekend of a different sort

Day 1 Winnie the Pooh and the Inner Landscape: Most of us recognise different aspects of our beings. Some therapeutic traditions refer to 'plural selves: multiplicity, Internal Family Systems -more recent modalities refer to 'parts work' and in the Person-Centred world to 'configurations of self'. This workshop will invite participants to explore those inner dimensions in a fun way.

Day 2:Dissociation Creative Survival

Where there is chronic abuse in childhood, many learn to survive by dissociating from the experience. This may involve leaving the body, numbing out, splitting off, depersonalising and/or derealising. This day will focus on what dissociation is, how it can be a protective strategy, and how we may empower individuals who may be experiencing dissociation now. Having explored our own configurations of self with Winnie the Pooh, we will have seen dissociation as part of human experience, and this will help in understanding when trauma has taken people into deeper realms of dissociative experiencing.

Emotionally Focused Therapy Externship 2023

Sandra Taylor & Helene lgwebuike, ICEEFT Certified EFT Trainers

With Sarah McConnell, Trainer in Training

Endorsed by ICEEFT and supported by the BEFT Centre

Face to face in London November 20th to 23rd 2023

Emotionally Focused Therapy (EFT), as developed by Dr Sue Johnson, is a collaborative, structured, therapy approach to working with couples, families and individuals that fosters the creation of secure relationship bonds. EFT is a change process that facilitates movement from distress to recovery by transforming negative cycles of interaction into safe emotional connection between intimate partners and family members.

Based on the science of emotions and attachment theory as well as humanistic and systemic theories, EFT has a high success rate in achieving secure, resilient relationships in couples and within families, and in helping individuals to flexibly manage their emotional experience.

This four-day course is the foundation of the training required towards becoming a Certified EFT therapist and is endorsed by the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT). The course includes presentations of theory and clinical techniques, video clips of couple and individual EFT sessions, training exercises, group work, and a live couple session.

The course will be held at VAi, 200A Pentonville Road, London, N1 9JP

Helene and Sandra are ICEEFT Certified EFT trainers, supervisors and therapists.

They are based in Britain and run regular Externships and Core Skills trainings.

They are co-founders of the British EFT Centre (www.beflcentre.org)

Sandra Taylor,PhD

Helene lgwebuike, M.A.

For more information and to book: https:/fconserareIationshipwe11ness-com/

Or email the organiser Sarah McConnell sarahmcconn@gmail.com

Note: we have some Widening Participation reduced fee places available, especially for the Externships. Please see here for more information: https://www.acreefttraining com/wideninqparticipaUonhtml

IICP College is now acceptingapplicationsfor the following:

BSc (Hons} in Integrative Counselling & Psychotherapy

Dates:

Format:

Attendance:

September 2023 -May 2024 -Block Option

Fully Online Option

Each monthly block consists of 3 teaching days

Friday 6:00pm-10:00pm

Saturday 9:00am-5:00pm

Sunday 9:00am-5:00pm

Duration:

Cost:

Generally 1 year for therapists who hold a dipoloma and are applying under RPL

€3, 785 per year

*Online learning consists of live lectures and Moodie LMS.

MSc in Pluralistic Counselling & Psychotherapy

Dates:

Format:

Attendance:

October 2023 -May 2024 -1 weekend per month

Blended Learning Option*

Each monthly block consists of 3 teaching days

Friday 9:30am-5:00pm

Saturday 9:30am-5:00pm

Sunday 9:30am-5:00pm

Summer Series Workshops

Therapeutic use of Dreams

Date: 19th August 2023

Delivery: Online

Trauma Informed Therapy

Date: 20th August 2023

Delivery: Online

Compassion Focused Therapy

Date: 26th August 2023

Delivery: Online

Duration:

Cost:

2 Academic years

€3, 785 per year

MA in Integrative Child & Adolescent Psychotherapy

Dates:

Format:

Attendance:

September 2023 -May 2024 -1 weekend per month

Blended Learning Option*

Each monthly block consists of 3 teaching days

Friday 6:00pm-10:00pm

Saturday 9:00am-5:00pm

Sunday 9:00am-5:00pm

Duration:

Cost:

2 Academic years, plus 1 additional semester

€3,785 per year, plus €1,250 for additional semester

CBT with Depression

Date: 27th August 2023

Delivery: Online

Please visit www.iicu.ie for more information on any of our courses and to see the full list of Summer Series workshops.

Contact details:

The16th AnnualConferencefor Counsellorsworkingin schoolsor interestedin workingin schools

What'slovegotto do with it? Dowe, darewe, considerlovein ourapproacheswhenworking withyoungpeople?

Thursday28th September2023

DidcotCivicHall, Oxfordshire,OX11lJN

Jammed systems, depleted resources, being asked to love more for less... Join us in September when together we will create professional generosity and rich learning.

Openingaddress(ShanaReed-Purvis):WhatHASlovegotto dowithit?

Connectionsintherapy

Workshopsinclude:

• Fly on the Wall -A School Counsellor and Deputy Head in Conversation

• The Crocodile on the Couch: examining the power of transitional objects and usingthe reflections of grief

• The Role of the School Counsellor and its Narcissistic Perils

• 10 brawling love, 0 loving hate!' Working with strong emotions

• "Mummy's Boy" - Helping sons understand narcissistic mothers in being loved and loving

• The Ping Pong Effect: looking at the effects of divorce on the therapist and child

• Experts and Fools: are we de-skilling our young I!]~ people and stealing their opportunities for self-agency?

• Trauma and Eating Disorders in Young People: a conversationabout their association

£125 per person I info@otsa.org.uk

To book: https://tinyurl.com/5w7bx4hd

Leading sight loss charity RNIB has developed a two-day online training course, to help counsellors better understand how to support blind and partially sighted people.

For further information please contact CWTTraining@rnib.org.uk or scan the QR code below. RN I B

IHelp yourself to our free training and learn how to help people with sight loss

Analyse me

Harriet Frew speaks for herself

What motivated you to become a therapist? I was drawn to therapy as a ‘wounded healer’ – I wanted to help others in a way that I hadn’t experienced myself. I suffered from bulimia nervosa in my late teens and early 20s, and it was near impossible to get professional help back then. I was also fascinated by people, personal development and the possibility of growth and change. This all excited me tremendously.

Do you have a specialist field of practice? I have specialised in eating disorders throughout my career – my first therapy job was working for the Cambridgeshire Adult Eating Disorder Service, which I have continued on a part-time basis to this day. The role exposed me to the teaching, clients and inspiring colleagues that have cemented this road more fully for me.

How has being a therapist changed you? Doing this job brings much greater self-awareness, a toolbox of knowledge and skills, compassion for self and others and a daily recognition to live authentically and to practise what I preach.

Where do you see yourself in five years’ time? I hope to continue along this adventurous path that involves seeing clients, training counsellors, writing online courses and podcasting. Moving forward, I’d like to reach a greater audience to make eating disorder recovery skills more mainstream and accessible to everyone.

What do you find challenging about being a therapist?

With eating disorders there is a lot of understandable ambivalence around change, as the focus on food and body image is a coping strategy for underlying pain. Each individual needs to take responsibility for change and walk this path. Sitting with the ambivalence and deep acceptance of this can be difficult work.

And rewarding? I find it incredibly rewarding to walk alongside someone when they are experiencing freedom and change. I love to bring my warmth, compassion and encouragement to others. It is hugely satisfying and fulfilling work.

What is the most recent CPD you’ve undertaken? Was it worthwhile? A Myers-Briggs personal development day. It was hugely helpful. I did a similar course 20 years ago and my results hadn’t changed since then! However, it was far more meaningful and enlightening to my older, wiser self.

What book/blog/podcast do you recommend most often?

I do love Steven Bartlett’s The Diary of a CEO podcast. It’s almost become therapy as guests open up and explore their vulnerabilities, challenges and little victories.

What is your favourite piece of music and why? I am a huge 70s and 80s fan. My dad has always been a huge Dolly Parton fan so

anything by Dolly is immensely nostalgic and brings back memories of car journeys and singing along with my three sisters.

What do you do for self-care/to relax? I have always loved physical adventures, encouraged by growing up on a farm and being outdoors daily and exposed to the elements. I enjoy climbing, beginners’ parkour and going for long walks. I also read, listen to podcasts and enjoy being playful and silly with my children (although they are now teenagers, and I am extremely embarrassing to them!).

What is the meaning of life?

To grow and work towards your potential; to be your most loving and flourishing self; to spread this out into the world.

What would people be surprised to find out about you? I mainly don’t compare myself to others and am truly not a perfectionist at all. I’ve realised that many people are held back by these things to their detriment, when they have so much creativity and inspiration to offer. This has enabled me to step out of my comfort zone, and with creative projects, as I can embrace good enough.

Who is your counselling/ psychotherapy hero(ine)? I have several – the master therapists Susie Orbach, Esther Perel and Julia Samuel, and Deanne Jade, who founded the National Centre for Eating Disorders.

About Harriet

Now: Online integrative counsellor specialising in eating disorders and body image. I also run training courses for therapists and have a podcast, The Eating Disorder Therapist Podcast, available on all major platforms. Once was: Unpaid farmhand, milking cows on the family farm. First paid job: Working on a helpline for prisoners’ families.

Who would you like to answer the questionnaire?

Email your suggestions to therapytoday@ thinkpublishing.co.uk

MAPLES IMAGES/SHUTTERSTOCK

lsha McKenzie-Mavinga

Karen Minikin

Kris Black

Rachel-Rose Burrell

Ruth Smith

Sabnum Dharamsi

Stephen Abdullah Maynard Tonia Mihill

Umaa Thampu

Lucia Berdondini Pretish Raja-Helm

Sarah Henry Sonya Welch-Moring

Valerie Watson Yvon Guest

Introduction to Counselling (part-time)

Certificate in Humanistic Integrative Counselling

Autumn2023

BACP Accredited Training Programme in Humanistic Integrative Counselling (two years, part time)

Diploma - Year 1

Autumn 2023

Advanced Diploma - Year 2

Autumn 2023

Short Courses - Professional Development

Introduction to Therapeutic Groupwork 17 & 18June2023-10.00-17.00.£299inc.VAT.

Develop your skills facilitating groups and using the resources of the group to support therapeutic change. Suitable for all levels.

Clinical Supervision (part-time)

Diploma in Clinical Supervision starts November 2023

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.

"CPPD goes beyond teaching you the theories and practice of counselling. A rewarding and life changing experience."