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SEPTEMBER 2020 | VOLUME 31 | ISSUE 7 THERAPY TODAY
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Clients put a lot of trust in us, and we need to be worthy of that trust
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SEPTEMBER 2020, VOLUME 31, ISSUE 7
But what is stopping us?
Gabor Maté on healing from trauma // Essential neuroscience for counsellors The power of presence in supervision // Helping clients navigate the new normal
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Contents September 2020
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Upfront
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Welcome News round-up CPD and events Reactions In memoriam The month
Main features
CLIENT
Regulars
Rachel Dyer-Williams (The River of Life, pages 40-43)
Turning point It changed my life Talking point The bookshelf Dilemmas Analyse me
Opportunities
On the cover..
Black matters
Classified, mini ads, recruitment, CPD
We talk to black and Asian counsellors about race and the counselling profession (pages 20-24)
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Company limited by guarantee 2175320 Registered in England & Wales. Registered Charity 298361
BACP Board and officers
Chair Natalie Bailey President David Weaver Deputy Chair Caryl Sibbett Governors Una Cavanagh, Val Elliott, Andrew Kinder, Neela Masani, Julie May, Heather Roberts, Moira Sibbald, Vanessa Stirum, Mhairi Thurston Chief Executive Hadyn Williams Deputy Chief Executive and Chief Professional Standards Officer Fiona Ballantine Dykes Chief Operations and Membership Officer Chelsea Shelley
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‘All is well, but then suddenly, and without warning, we sail right over the edge of a waterfall and into change, and there’s nothing we can do about it’
The big issue We need to talk about race, so what is stopping us? Experience Chris Palmer writes to the stranger he saved from suicide The big interview Gabor Maté on treating trauma with compassion Coaching for social change Carolyn Mumby meets the coaches campaigning for social justice Using neuroscience to map the whole person Peter Afford guides us through the systems that influence emotions, behaviour and personality The River of Life Rachel Dyer-Williams on a model that may help clients navigate the new normal Being there Zoë Chouliara asks what presence has to offer the supervisory relationship
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Contact us by emailing: therapytoday@thinkpublishing.co.uk
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Editor’s letter
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So many of you have written in response to my recent blog, and I want to use this opportunity to say thank you. It has been overwhelming to read the many stories you have shared that, for the most part, have previously been unacknowledged. The past few months have been a challenge for us as counsellors and psychotherapists. Even if there are some among us who have not been directly impacted by the accumulation of events since March, it would be hard to ignore even the subtlest of effects on our colleagues and on our clients. As we prepare to meet what may be regarded as the ‘second wave’ post-lockdown, and with it a potential surge in demand for psychological support, we might want to be occasionally reminded to take utmost care in acknowledging the impact with compassion for ourselves and for others.
Natalie Bailey BACP Chair
Sally Brown Editor
Editor Sally Brown e: sally.brown@thinkpublishing.co.uk Art Director George Walker Copy Editor Catherine Jackson Consultant Editor Rachel Shattock Dawson Reviews Editor Jeanine Connor Chief Sub-editor Marion Thompson COVER IMAGE: SHUTTERSTOCK
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1. Caring and COVID-19: Loneliness and use of services. https://bit.ly/30Agful
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he responsibility for raising awareness of racism continues – unfairly – to fall largely on the shoulders of BAME people. The result, as many of our interviewees recount in ‘Black matters’, the ‘Big issue’ report this month (page 20), is emotional exhaustion. At the same time, their experiences of racism and their views on what needs to change need to be heard. I am grateful for the insights shared by several BAME practitioners on pages 20–24. In the October issue, we ask how white people can step up, and we explore the role of unconscious bias. The coronavirus pandemic has impacted some more than others. In a recent report from Carers UK,1 70% of unpaid carers said they had to provide more support for older, disabled or seriously ill relatives or friends as services and appointments were suspended. In her article, ‘Coaching for social change’, Carolyn Mumby interviews coaches who have set up services to meet crucial needs in the community, including one that supports unpaid carers. As Carolyn says in her introduction, coaching is not just for improving work performance, and an increasing number of coaches are using their skills, often pro bono, to empower disadvantaged members of the community. You can read her report on page 32. The pandemic has also brought home the fragility of life, and our usual ‘Spotlight’ column becomes ‘In memoriam’ in this issue. While this will not be a regular column, it felt fitting to pay tribute to four members who recently lost their lives and the significant contributions each has made to the profession. We are all impacted by loss, even when we are not personally bereaved. In ‘The River of Life’ on page 40, Rachel Dyer-Williams writes about her experience of using a model designed for complex grief to help clients deal with the impact of the pandemic on their working lives and relationships. Other highlights of this issue include Catherine Jackson’s ‘The big interview’ with world-renowned trauma expert Gabor Maté (page 28), and Zoë Chouliara’s exploration of presence in supervision (page 44). And don’t miss Peter Afford’s illuminating guide to neuroscience for counsellors on page 36. I have learned something from all of these articles, and I hope you find this issue just as relevant and useful. The ‘Reactions’ page is your platform for feedback, so do email your views.
Production Director Justin Masters Group Account Director Rachel Walder Executive Director Jackie Scully Sales Executive Sonal Mistry d: 020 3771 7247 e: sonal.mistry@thinkpublishing.co.uk
Therapy Today is published on behalf of the British Association for Counselling and Psychotherapy by Think, Capital House, 25 Chapel Street, London NW1 5DH t: 020 3771 7200 w: www.thinkpublishing.co.uk Printed by: Walstead Bicester, Chaucer Business Park, Launton Road, Bicester OX26 4QZ ISSN: 1748-7846 Subscriptions Annual UK subscription £76; overseas subscription £95 (for 10 issues). Single issues £8.50 (UK) or £13.50 (overseas). All BACP members receive a hard copy free of charge as part of their membership. t: 01455 883300 e: bacp@bacp.co.uk Changed your address? Email bacp@bacp.co.uk BACP BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire LE17 4HB t: 01455 883300 e: bacp@bacp.co.uk w: www.bacp.co.uk
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Disclaimer Views expressed in the journal and signed by a writer are the views of the writer, not necessarily those of Think, BACP or the contributor’s employer, unless specifically stated. Publication in this journal does not imply endorsement of the writer’s views by Think or BACP. Similarly, publication of advertisements and advertising material does not constitute endorsement by Think or BACP. Reasonable care has been taken to avoid errors, but no liability will be accepted for any errors that may occur. If you visit a website from a link in the journal, the BACP privacy policy does not apply. We recommend that you examine privacy statements of any third-party websites to understand their privacy procedures. Case studies All case studies in this journal, unless otherwise stated, are permissioned, disguised, adapted or composites, to protect confidentiality.
Copyright Apart from fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright, Designs and Patents Act 1998, no part of this publication may be reproduced, stored or transmitted in any form by any means without the prior permission in writing of the publisher, or in accordance with the terms of licences issued by the Copyright Clearance Centre (CCC), the Copyright Licensing Agency (CLA), and other organisations authorised by the publisher to administer reprographic reproduction rights. Individual and organisational members of BACP may make photocopies for teaching purposes free of charge, provided these copies are not for resale. © British Association for Counselling and Psychotherapy
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I would like to thank everyone who has submitted resolutions and motions for consideration at our AGM later this year. They’re your opportunity to have your voice heard by fellow members and by the Board of Governors and to discuss what’s important for the profession. I am always struck by the passion and commitment of our members, and that has been clearly demonstrated in the submission of resolutions and motions. And I would encourage you to have your say when voting on the resolutions and motions opens on 21 September. I want you to feel part of our Association and that your voice is heard and you’ve played a part in shaping its direction in the future. Hadyn Williams BACP CEO
The next draft iteration of the SCoPEd framework, published in July 2020, features some important changes. First, titles have been removed in this iteration, so that the focus remains on the evidence that demonstrates that all our members are qualified, respected and valued. Second, gateways have been added to the framework that recognise existing members could use their post-qualifying training and experience to meet the competences and practice standards of a column and move between them if they wish to. Third, the language throughout the framework has been updated to be more consistent, and some of the terminology has been changed to become more inclusive where appropriate. You can view the next draft iteration of the SCoPEd framework on our website. As part of our commitment to engaging with members on this project, a questionnaire has been sent via email to every member to gather your feedback. The questionnaire also gives members the opportunity to volunteer to take part in an online bulletin board, which will see a representative group take part in meaningful discussions on key themes that have arisen from the questionnaire. We want all members to have the opportunity to feed back on the project, so if you haven’t been able to complete the questionnaire and would like to give us your feedback, please email SCoPEd@bacp.co.uk. Please bear in mind that we may not be able to give an individual response to every email, but all feedback received will be incorporated into the engagement process.
THERAPY TODAY PODCAST
In the spotlight Our selection of podcasts now includes a new series, ‘In the Spotlight’. Recent episodes include BACP member Kerrie Jones talking about her clinic’s innovative approach to treating eating disorders, Dr Peter Blundell discussing his Twitter initiative #TherapistsConnect and his award-winning research, and sex and relationships counsellor Charlene Douglas on getting involved with TV work.
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Our senior event organiser, Jade Ingham-Mulliner, who works on the podcasts, says: ‘The podcasts started as an alternative way of accessing Therapy Today content and were based on authors reading their articles. After a great response from members, we are keen to expand the offering with innovative and exciting content.’ The theme of the ‘In the Spotlight’ podcasts is making a success of a career in the therapeutic professions and how different practitioners have created a rewarding and sustainable way of working. Many of the interviewees feature in the ‘Spotlight’ column of Therapy Today and the podcast is an opportunity to expand on questions with more in-depth answers.
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MEMBER BENEFITS We have organised a free film screening for BACP members of Medicating Normal, an acclaimed new documentary exploring the overprescription of psychiatric drugs through the stories of five people from diverse backgrounds (for more details, see ‘The month’ on page 18). The aim of the screening, hosted by the University of Roehampton in conjunction with BACP, is to continue the conversation about psychiatric drugs and how they intersect with therapeutic practice. There will be a panel discussion afterwards, based on questions submitted by attendees. The event counts as two hours of CPD. The event hosting team includes Professor Rosemary Rizq from the University of Roehampton and Dr James Davies, reader in social anthropology and mental health at the University of Roehampton. Both are co-editors of the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG for PDD) Guidance for Psychological Therapists: enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs. The hosts also include Nicole Lamberson, physician assistant, harmed patient and co-founder of the Withdrawal Project (withdrawal.theinnercompass.org). The discussion panel includes the hosts, plus Angela Peacock MSW, a former US army sergeant who appears in the film and is the veterans’ liaison for the Benzodiazepine Information Coalition; Professor Joanna Moncrieff, consultant psychiatrist and senior lecturer in psychiatry at University College London, and Dr Anne Guy MBACP (Accred), integrative psychotherapist, APPG for PDD secretariat co-ordinator and co-editor of the Guidance for Psychological Therapists. The screening date is 15 October, starting at 5.45pm. The film shows from 6pm, with the post-screening community discussion from 7.15pm. To register, go to
PERISCOPE MOVING PICTURES
¢ Free film screening
Research digest Have you checked out the Research digest, our regular update on the latest in counselling and psychotherapy research from the BACP research team? In the latest issue, Joanna Griffin, a counselling psychologist and parent carer, talks about her research into the unique issues faced by parent-carers of children with learning disabilities. Joanna became aware of the lack of information for parents after her son’s diagnosis with cerebral palsy. ‘My experience led me to realise that there was an information gap, so I applied to Metanoia to do a doctorate,’ she says. ‘I didn’t want to write a thesis that sat on a dusty bookshelf, I wanted something very practical and pragmatic that would be useful to parentcarers, and also for practitioners, to help them gain a better understanding of what’s going on for parents and what they need.’ Read the full interview, and the rest of our Research digest content, on the BACP website at www.bacp.co.uk/about-us/advancingthe-profession/research/research-digestissue-1
bit.ly/roehamptonmedicatingnormal
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MEMBERS MAKING A DIFFERENCE Supporting young counsellors
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BACP members Ali Xavier and Charlotte Braithwaite have launched the Network for Younger Counsellors and Psychotherapists (NYCP). It grew out of the response to Ali’s article, ‘Playing the numbers game’, about age discrimination and the challenges facing younger therapists, published in Therapy Today, July 2020. ‘To date we have had over 200 responses, with an overwhelming cry for “let’s gather”,’ says Ali. ‘I am delighted that Charlotte, one of the interviewees in my story, is working with me to put a framework together for this gathering.’ The group was launched with a closed Facebook group and a linked private Instagram account for counsellors and psychotherapists who identify as younger (broadly under 40). ‘We have pitched it as a community space, so there is a chance for it to develop from within the group. If it grows legs, I anticipate forming an advisory board with delegated responsibilities from this,’ says Ali. NYCP’s inaugural network meeting was held via Zoom in July. Person-centred counsellor Kate Dickinson said of the event: ‘I was inspired to meet a group of like-minded counsellors. The NYCP is offering a real opportunity to explore the advantages and challenges of being a younger therapist. I feel motivated by connecting with other younger counsellors in the field.’ For details of ongoing meetings, join the Facebook group @Network for Younger Counsellors and Psychotherapists or Instagram @nycp_uk
Members in the media The mental health impact of racist trauma, addictions and COVID-19 were just a few of the important topics our members have spoken about in the media recently. • Denise Freeman’s thought-provoking and helpful comments in a piece on the Refinery29 website explored racist trauma and what can help people cope with the impact of it. This was also a subject addressed by Deborah Roberts • in Harper’s Bazaar. Our Children, Young People and Families Lead • Jo Holmes and one of our members, child psychotherapist Natalie Phillips, both spoke to Newsweek about the impact that COVID-19 has had on the mental health of children and why all schools should employ counsellors. Addictions therapist Andrew Harvey • featured on Sky News – both the TV channel and website – discussing a surge in lockdown day traders. • Cate Campbell chatted to presenter Stig Abell about friendships for a podcast recorded for The Times. Natasha Page • was interviewed by Vogue about why more people are turning to plastic surgery post-lockdown. • Philip Karahassan gave some helpful advice in a Huff Post UK article about avoiding burnout while working from home. Also featuring on the Huff Post UK website was Rakhi Chand • who was quoted about how to deal with feelings of hopelessness and about the exhaustion of socialising. If you are interested in becoming a BACP media spokesperson, email media@bacp.co.uk
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Working on your behalf BACP staff are working from home and, while we can’t get out and about right now, we are still campaigning on your behalf
¢ We welcome the support of the national older people’s charity Independent Age, the latest to join our campaign for counselling and psychotherapy’s role in helping the country’s recovery from the COVID-19 pandemic. The campaign highlights the long-term mental health challenges the population will face, including bereavement, loss, anxiety, loneliness and relationship difficulties, as well as the psychological impact on key workers, BAME communities and the impact of the economic recession. The campaign has been backed by a powerful coalition of professional bodies, service providers, trainers and therapists, and has received more than 10,000 signatures. Deborah Alsina, CEO of Independent Age, says: ‘We are proud to be supporting BACP to raise awareness of the impact the COVID-19 pandemic has had on the mental health of people in later life.’ ¢ BACP Workforce Lead Kris Ambler has updated members on local lockdowns following legislation that took effect in July. New regulations include lockdown powers for local authorities to restrict access to, or close, individual premises, prohibit certain events (or types of event) from taking place and restrict access to, or close, public outdoor places (or types of outdoor public places), where necessary and proportionate to manage spread of the coronavirus in the local area. Read more at www.bacp.co.uk/ news/news-from-bacp/blogs/22-julylocal-lockdowns ¢ The effectiveness of workplace counselling has been highlighted in new research, carried out by the Institute for Employment Studies (IES) on behalf of BACP and the Employee Assistance Professionals Association (EAPA). It found
that, if implemented and used effectively, workplace counselling minimises sickness absence, reduces presenteeism, maximises job retention and helps people with health problems stay in work. Dr Zofia Bajorek from IES said: ‘The impact that the pandemic has had on mental health and wellbeing has highlighted that organisations, employers, HR managers and wellbeing should be focusing on what interventions are most effective for improving and maintaining mental health at work. This research has highlighted the important role that workplace counselling can have in supporting employee mental health.’ BACP Workplace Lead Kris Ambler said: ‘The message is clear – counselling works. Modern, progressive organisations operate in increasingly complex environments, and they need a workforce that is adaptive, resilient and well supported. We only need to look at how companies and employees have had to adapt to cope, and the uncertainty many still face due to the pandemic, to see this in action. This is a crucial time for companies to invest in workplace counselling.’ Read more at www.bacp.co.uk/news/ news-from-bacp/2020/3-august-covid19-s-impact-on-workplaces-means-thisis-a-crucial-time-for-employers-to-investin-counselling ¢ We’re calling for more detail to be released on a planned investment in the mental health workforce, following the publication of the NHS People Plan. Health Secretary Matt Hancock has announced the long-awaited plan, which looks at recruitment and retention of NHS staff and
the support available to them. It sets out a list of principles and practical actions that will be taken over the rest of 2020 to 2021. Much of the detail focuses on the response to the ongoing COVID-19 pandemic. And, while the plan mentions continued investment in the mental health workforce, we’d like to see more details about how the roles will be recruited and what skills they’re going to require. Read more at www.bacp. co.uk/news/news-from-bacp/2020/31july-more-detail-needed-after-publicationof-nhs-people-plan ¢ We’re disappointed the Government’s latest strategy document as part of plans for recovery from the COVID-19 pandemic fails to meet the nation’s mental health needs. The document, The Next Chapter in our Plan to Rebuild: the UK Government’s Covid-19 recovery strategy, doesn’t include plans to provide the urgent and comprehensive mental health support many people now require, or additional funding to support the emotional health of our children and young people. We’re urging the Government to re-examine this decision as part of our campaign to maximise counselling and psychotherapy in supporting the nation through the pandemic. With our partners, we’re urgently calling for a clear action plan to deliver a comprehensive mental health response to COVID-19 that provides funding for counselling and psychotherapy targeted at those communities and people most affected by the pandemic. Read more at www.bacp.co.uk/news/news-frombacp/2020/21-july-coronavirus-newgovernment-document-fails-to-meetmental-health-needs
BACP’s Professional Conduct Notices are no longer published in Therapy Today. They can be found at www.bacp.co.uk/professional-conduct-notices.
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Don’t miss the Private Practice conference
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There’s still time to book onto this year’s online Private Practice conference on 26 September, ‘Communication: Can you understand me?’ In the therapeutic profession, there is rarely a ‘one-size-fits-all’ approach, whether that is theoretical style or how we communicate with each other. Through a full programme of presentations and interactive workshops, the conference will explore multiple aspects of communication, including how we communicate when conventional methods aren’t appropriate, or when a sight or hearing
loss disability is present. We’ll also look at the challenges of communicating across generations, and how our own prejudices get in the way. On the day, you’ll be able to engage with keynote presentations and workshops through our online webcast platform and use the secure chatroom to network and send questions to our presenters for the live Q&As. If you miss anything on the day, you can watch the presentations again via the on-demand service. To book, visit www.bacp.co.uk/events/ onlinepp2020
New CPD hub content Working with Millennial clients Why is this age group more likely to seek therapy than previous generations? What are they looking for when they come to counselling? And how do you manage the ‘third person’ in the counselling room when sessions are paid for by a Millennial’s parent? Explore these questions and more in new resources for working with today’s 20- and 30-somethings.
Working with refugees Perhaps more than any other group in society, refugees are defined by what they have suffered, lost and been denied. Yet the refugees we meet in the UK are the ones who have survived, arrived and are ready to take on all the challenges of being in a new country. This resource explores how this happens and what we can learn from it within our own practice.
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Working with bereavement and complex grief How will experiencing bereavement during a pandemic impact on clients and show up in the therapy room? These and other questions around complex grief and bereavement are discussed by three of the UK’s top grief specialists in this free webinar. Psychotherapist Julia Samuel, author of This Too Shall Pass, is joined by Andy Langford from Cruse Bereavement Care and Dr Paquita de Zulueta, a GP and therapist specialising in mindfulness and compassionfocused therapy. They will explore key concepts relating to bereavement in the context of traumatic loss and help you consider the skills and knowledge required to work with a client who is experiencing complex grief. They will also discuss the importance of self-care when working with complex grief and steps you can take if a client’s grief presentation is beyond your competence. Watch now for free at www. bacp.co.uk/events-andresources/bacp-events/ bcg2020
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Millennial envy
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Thank you to Ali Xavier for raising the issue of intergenerational tensions among those either training or already working as counselling or therapy professionals, in her article ‘Playing the numbers game’ (Therapy Today, July 2020). Her experience as a Millennial in an aged cohort is welcome, but as a trainee psychotherapist heading towards 60, I wanted to offer some angles from the older generation that she may not have considered. I think age as difference does not get formally discussed or acknowledged in the group I am training with. I would argue that, in any multigenerational group setting, unlike with race, gender and sexuality, there is a much less developed voice beyond developmental stages to actually explore the mutual projections and fantasies that are at work. For my part, I think envy is the element that Ali avoids in her identification of what may be projected into younger colleagues by older people. I envy the Millennials in my group for having more time to develop their career and for having what I see as the wisdom to have recognised their vocation when they have the energy mental and intellectual to really go for it. It is hard not to contrast their vitality with my own decrepitude, but I also recognise that an idealisation of their youth can very easily switch to a UHFRJQLVH WKDW DQ LGHDOLVDWLRQ RI WKHLU \RXWK FDQ YHU\ HDVLO\ VZLWFK WR D denigratory sense of their ‘entitlement’. I think honest talk from both sides GHQLJUDWRU\ VHQVH RI WKHLU νHQWLWOHPHQWÎż , WKLQN KRQHVW WDON IURP ERWK VLGHV of the generational divide, with a recognition RI WKH JHQHUDWLRQDO GLYLGH ZLWK D UHFRJQLWLRQ of the losses and gains of ageing, would be a RI WKH ORVVHV DQG JDLQV RI DJHLQJ ZRXOG EH D great learning opportunity all round. I thank JUHDW OHDUQLQJ RSSRUWXQLW\ DOO URXQG , WKDQN Ali for opening up that potentially rich $OL IRU RSHQLQJ XS WKDW SRWHQWLDOO\ ULFK exchange, at least for me. Madgwick, trainee psychotherapist Allegra Madgwick, WUDLQHH SV\FKRWKHUDSLVW
Age discrimination Being 24 years old, I was highly interested in the article about overcoming age discrimination within the counselling professions (‘Playing the numbers game’, Therapy Today, July 2020). I began my first steps into counselling at age 17 and have just come to the end of the level 4 diploma. Finding a placement was challenging, for a variety of reasons. Reading the article reminded me of how frustrated I felt when I was turned down by agencies because either they were concerned about my age or because
they assumed that their clients would refuse to see a young counsellor. I truly believe that, if agencies and services were more willing to give young counsellors a chance, they would find that many clients would not react quite as negatively as they may think. I know I can only speak for myself, but a large number of my clients so far have been over the age of 60, and despite me having a lingering fear of being ‘discovered’ for the age that I actually am, not a single client has reacted negatively to it. In fact, it has actually challenged assumptions about age within the
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Email the Editor at therapytoday@thinkpublishing.co.uk @BACP, Share your views online BACP Members’ Community BACP Members’ Network
therapeutic space, both for myself and for the client. It has created a fascinating level of understanding between us, which I like to think is the shared development of wisdom. Ariana Chiarelli, counsellor Thank you, Ali Xavier, for highlighting the issues of age within counselling training, from a younger perspective. As a Millennial, I too was the youngest in my training. I started my training at age 23 and was 28 when I qualified. But when I applied for a placement, my age and gender worked in my favour. The co-ordinator said that my being young and male was just what was needed. She hoped to bring in some younger clients from an outreach project. My first client, like Ali’s, questioned my age and said directly, ‘Aren’t you a little young for this?’ He stood up for the entirety of that session, and I felt helpless. Supervision helped me to understand that he was creating a power dynamic, and that he felt helpless in his own life. Despite this early concern, he came back every week and we even extended the sessions. The co-ordinator later told me that he had never stayed for any other counsellor. Phil Puttock MBACP
Sacred cows I’m writing in response to the recent interview with Windy Dryden (‘The big interview’, Therapy Today, July 2020). It’s refreshing to see alternative ideas that challenge the mainstream views and practice. I’ve never been comfortable with any sort of ‘one size fits all’ approach. Clients and their various circumstances are far too varied and complex for that. My training was centred around, but not limited to, Rogerian principles. Towards the end and afterwards, it became increasingly apparent to me, through wider reading, that some of the sacred cows that underpinned our training were not universally held by all. I came across authors and practitioners who thought the idea of unconditional positive regard fanciful at best, and a ridiculous dishonesty at worst.
When I applied for a placement, my age and gender worked in my favour. The co-ordinator said that my being young and male was just what was needed. She hoped to bring in some younger clients from an outreach project
I have also discovered two potential risks with deep therapeutic relationships. The first is that the therapist can get sucked into an inflated notion of their own value to the client, only to be taken aback when the client fails to do the homework or cancels sessions on a whim. The second is at the other end of the spectrum, where the client ends up seeing the therapist as much more than just a temporary helper, and as a personal friend and permanent aide who is increasingly hard to say goodbye to, even when it is apparent that therapy has ended. So much for empowering clients with autonomy. Thank you, Windy, for making us think. Brian Richards MBACP I was encouraged by Windy Dryden’s views on single-session counselling (SSC). In the young people’s charity that I work for, in addition to regular counselling, we offer crisis counselling where SSC is used, and it has proved effective in meeting client needs in the ‘here and now’ and at the point that the support is needed. As a counsellor, I have also used SSC at the request of clients who want a single, focused session to work through a pressing conflict, and it has been effective in its purpose. Sometimes it has led to further work and sometimes it has been enough for the client to move forward on their own. There will, of course, be a view that SSC fails to respect the relational part of the process important to certain modalities. However, I agree with Dryden that it does not need to be an either/or scenario, but rather what best meets the needs of the client at that moment in time. SSC requires careful ethical consideration in its application and should not be driven by a managerial agenda or political directive. My only concern is that it may be used to manage waiting lists and/or reduce funding. As Dryden says of SSC in IAPT, ‘watch this space’. Jason Dudley MBACP, youth worker and BPS-certified clinical supervisor I read with great interest Windy Dryden’s article advocating SSC and in particular his comments in relation to university counselling services. We
at Cardiff University have been working in this way since 2007, when the counselling manager, Vicky Groves, along with her colleague Annie Blackburn, developed and implemented the BACP award-winning Cardiff Model. They based this single-session counselling approach on Talmon Moshe’s work, integrating it with solution-focused brief therapy, with the support and guidance of Evan George at Brief (The Centre for Solution Focused Practice). It is true that one driver was the growing waiting list – by the Easter break, any student seeking counselling was unlikely to be seen that academic year, due to the number of sessions that existing clients were receiving. This formed the second big driver for change; that it was unethical for students applying for counselling to not receive any that academic year. So Vicky sought a new approach that would also offer students what they wanted from counselling – a way to deal with their difficulties and issues well enough to be able to complete their degrees. The vast majority are not looking to work on existential concerns or deeper past issues. They want to find a way forward at a time when they are expected and expecting to be actively learning. Hence, when they enter counselling, they are looking for solutions, strategies and techniques to put into practice. We find that up to 70% of students find the 90-minute therapeutic consultation (TC) sufficient. Those who want to build on what they have learnt as a result of the TC are provided with up to four further sessions. This number was chosen to mean that, including the TC, a client could receive close to the equivalent of a traditional six- session brief therapy model. After winning the BACP Innovation Award in 2010, the Cardiff Model has been transported to many other education institutions over the intervening years. It is ever evolving, with other universities creating versions that suit their environment and culture. Indeed, at Cardiff, we have been through five evolutions and are currently creating the sixth version, a model of working with trauma, within the Cardiff Model. Sarah Worley-James MBACP (Snr Accred), counsellor and supervisor
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Connecting loss In her article ‘Finding new languages of loss’ (Therapy Today, July 2020), Sasha Bates attempts to connect the loss of her husband to the loss and grieving many may be feeling because of the coronavirus pandemic. Many people will not experience a loss from the death of a loved one due to the virus (although I appreciate some will), but she suggests that many of us will be experiencing the loss of lifestyles, certainty and freedoms due to a sudden, cataclysmic event that is out of our control. The article suggests that often, during periods of grief, words can be too hard and too painful and sometimes bodily activities like walks in the country or yoga are more effective at allowing our bodies to process the trauma. Similarly, in my experience of grief after the death of my daughter seven years ago, and in the current strange times, I find that my body responds more to yoga and my daily walk is of huge importance. I find my life now (post-lockdown but still cautious and working from home) is not dissimilar to that time of intense grief (although I took an extended break from seeing clients then). I am more in touch with nature, lead a slower pace of life, embrace yoga and enjoy more time for reflections. COVID-19 has reminded me of the importance of self-care and Sasha’s article seems very pertinent for therapists and clients alike. As Sasha points out, and I agree from my own experience, many of the emotions clients are expressing now (as we tiptoe out of lockdown) are similar to those experienced during intense grieving, such as anxiety, fear, anger and, for some, denial. There is also an enormous sense of uncertainty around as we come out of lockdown, which feels similar to the feeling of uncertainty during grieving – how will life be without this person? Grief is an intensely personal journey and, in my experience, many people are suffering a collective grief now but finding their own personal path through it. The difference in this instance is that this is a global phenomenon and we, as therapists, are having
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to negotiate our own way as well as help our clients. Remember the importance of self-care. Nicky Rawlence MBACP, integrative psychotherapist
Linear narrative
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On reading Anthony Prendergast’s article ‘The Therapy Square’ (Therapy Today, July 2020), I was immediately compelled to recreate his model on my whiteboard, for further digestion. I found myself resistant to the apparent linear narrative that I felt it could implant in the client’s mind. I was challenged by the suggestion that we are all born with ‘potential’, which can then be disrupted by familial and societal forces, leading to ‘blocked potential’. I feel concerned that the Therapy Square could lead clients to feel grief, sadness, and anger when they reflect on how their potential was ‘blocked’ by those around them and their own childhood interpretations. The field of developmental psychopathology has invested years in seeking to understand how proximal and distal factors transact to influence early psychological development. These factors may lead to successful development in some domains of functioning and a delay in others. It is hard to understand how the Therapy Square can accommodate these subtleties and avoid simplifying people’s early experiences. I can appreciate Prendergast’s attempt to distil psychological theory to support his clinical work. However, I feel that other diagrammatic models of formulation (such as the ‘5P’ used in clinical psychology) can help clients to illuminate the influence of societal factors on their early years, and can also accommodate the complexity of human development. Prendergast writes that ‘inhibiting messages are the crucial missing element’. While I agree they are crucial (though not missing from cognitive models), I think they remain just one element of the person’s development, and they can, if considered in isolation, lead to disruptive and blaming narratives. Aiden Duffy MBACP (Reg), psychotherapist and applied psychologist
Overrated feelings I would like to thank Gillian Bridge for her piece ‘Why feelings are overrated’ (Therapy Today, July 2020). It was thought-provoking and it is wise to remind ourselves that many client groups are indeed, as Gillian puts it, ‘nonpsychologically woke’, and may not have the levels of awareness and psychological understanding that is sometimes assumed of therapy clients. Working as I do with clients in probation, as well as with young people, one learns of the need to sometimes work in a flexible manner and be prepared if necessary to signpost, educate or work on skill sets. But where I diverge from Gillian is in her contention that working with feelings is over-rated and her understanding of what she describes as the person-centred, feelingsbased approach. From my perspective, this is not a question of requiring clients to articulate or to ‘revisit, rehearse or revise’ their feelings. The use of feelings in therapy is precisely to move beyond the cognitive, analytical, articulating arena. It is to move into the body, to allow and listen to the body-intelligence – Carl Rogers’ organismic process; to relearn the ability to experience one’s own feelings and trust the resulting responses, rather than remain in the stuck place a lifetime of defending against this has led to. Indeed, I have found it to be particularly the case that it is the ‘non-psychologically woke’ who are more adept at this, being less hindered by over-intellectualisation. Each therapist evolves a manner of working that is suited to their particular temperament, but whatever this is or however directive or
non-directive it may be, it is the relationship between the therapist and client that is decisive. It is in that relationship that trust and validation, self-compassion and agency can be found; it is there that the therapy takes place, as well as, indeed, if desired, the ability to take advice or learn a skill set. Peter Hudson MBACP (Accred) In her article ‘Why feelings are overrated’, Gillian Bridge observes that language and words have unique significance to each individual. Absolutely, and not just to each individual, but as an ever-changing process within each individual, as thought and circumstances adjust and change, moment by moment. When I use words and when I listen to my client’s use of words, I have to be attuned to the resonance each word sets up within me, and within my client – at least in so far as I can sense that resonance as it returns to me. And the process is a felt one. This is the essence of empathy – being in a feeling connection with my client in the moment, both as they talk to me and as I respond to them – and it involves an intense and ever-evolving feeling process. So, when Gillian Bridge insists that person-centred equates to ‘feelings-biased’ – her words – then that is probably true, though possibly not in the sense that she understands it. To imply, as I think she does, that it is the aim of the person-centred counsellor to induce catharsis suggests a serious misunderstanding of the process. I have had clients who show every desire to stay in their heads and to define themselves in terms of some sort of objective reality, and it is not my role as a person-centred counsellor to debase that process or to force something on them. On the other hand, at some point, if I ask, ‘Why are you here?’, then the response will likely be some variation on: ‘I feel awful.’ To which I might well ask in response: ‘How do you experience awful?’ William Johnston, person-centred counsellor in private practice I was really enjoying reading Gillian Bridge’s opinion piece; I found it refreshing, liberating and rebellious. Although I did not wholly agree with
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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
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The use of feelings in therapy is to precisely move beyond the cognitive, analytical, articulating arena. It is to move into the body, to allow and listen to the body-intelligence… and trust the resulting responses
what was being said, it somewhat reflected my experiences in counselling training, where I have found an almost dogmatic insistence on all things person-centred (joined with a reluctance to consider the social and political realities of our clients and, indeed, our world, although that’s another argument). However, my heart dropped when it was suggested that criminals often have ‘underdeveloped brain areas’ – an unhelpful term suggesting this is the reason for their crimes. This overlooks the fact that criminality is a social construct, defined by the laws of the country the person is in. When laws can change at the whim of the powerful, today’s hero can be tomorrow’s criminal. It was not that long ago that all homosexuals in this country were deemed criminal, so are we to believe that, at that time, all homosexuals had ‘under-developed brain areas’, but now they are somehow cured? Name withheld Reading Gillian Bridge’s article made me think about why I chose a psychodynamic approach to counselling and also the many assumptions made around ‘non-directive’ ways of working. It brought to mind a meeting of medical professionals many years ago to discuss early intervention for suicide prevention. One doctor likened counselling to a ‘cup of tea and a chat’, totally missing the value of listening, empathy, shared understanding, building a secure base and mutual respect of client/counsellor relationships in order to explore, rather than assume a didactic stance with the client. In my practice, I try to ‘be’ with the client, wherever and whoever they are. I don’t view them as normal/abnormal, educated/ uneducated, but as human beings wanting to be understood and accepted. I explore with them their inner resources, possible creative abilities, mental imaginings and, of course, their real-life situations and supports, past and present. We try to find good enough ways for making positive changes that enable the client to move forward – not my ways, their unique ways. To me, non-directive therapy is sadly misunderstood in our ‘quick-fix’ world. Linda Taylor MBAP (Accred)
Apology owed? I usually read Therapy Today by starting at the back with the classified ads and then move forwards, ending up with the editor’s letter. So, when I read the July issue, I noticed the large advert for Rosjke Hasseldine’s mother-daughter attachment training course before I got to the four-page article by Hasseldine about mothers and daughters. Seeing them in that order made me view the article as advertising for her course. But pages later, with many smiles of recognition at her insights and a developing respect for her honesty and courage in questioning the powerful status quo, I read Gillian Bridge’s opinion piece ‘Why feelings are overrated’. In this she raises all my own concerns about the way that so much counselling is reliant on the client’s articulation and examination of feelings and so is inadequate for many clients who cannot do that (for linguistic, cognitive or contextual reasons). However clever my questions might be in the therapy room, they would never enable some clients to experience that eureka moment or even very slowly and gradually to work out how to move forward. Some demand advice. Bridge points out that our therapy methods must not be limited to people ‘who feel like us’. One size does not fit all. Finally, when I got to the front of the magazine, I was very surprised to read the editor’s negative introduction to Bridge’s article: ‘I know many practitioners will disagree with Gillian Bridge’s opinion piece.’ Are we being told what to think here? This is in sharp contrast to the positive paragraph-long introduction to the Hasseldine article. A third advert, I wondered? Bridge’s opinion is based on her work with people in prison, addicts, adolescents and those with ASD, not generally the most profitable groups to work with. She is addressing the issue of diversity here in a very interesting way; a way that other safe, middle-class niche practices can never do (although their courses may be profitable for many). I think the editor owes Bridge an apology. I don’t think you will print this. Gina Crowley MBACP (Reg)
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Editor’s response: The advertising and editorial sections of Therapy Today are run separately. Sometimes, when an author has had an article accepted for publication, they choose to place an ad in the same issue, if they have a course or a book to promote. They are, of course, at liberty to do so, and this is booked through a separate department. I refer to five articles in my editor’s letter, one of which was Rosjke Hasseldine’s piece. As Gillian herself says in her article, the views she discusses ‘risk opprobium’ in the therapeutic community. My comment was aimed at acknowledging the response that may be triggered by the article, and inviting readers to put it to one side and consider her viewpoint, even if challenging.
Cultural context I found ‘The mother-daughter puzzle’ (Therapy Today, July 2020) of significant interest. However, I couldn’t help but think that the client discussed, referred to as Sandeep, could have been helped further. Not much was told about her cultural background but the name Sandeep tends to be common in Asian communities, so I assume this is the community the client belonged to. By being encouraged to become more independent and ‘reject’ her family’s ‘demands’, Sandeep was being encouraged to adopt values unfamiliar to the family’s long-existing patterns, which would be a shock for anyone. I believe that there must be more consideration of just how different BAME clients are to white British clients and how their collective values shouldn’t be suddenly rejected in order to suit more Westernised values. There are several benefits to feeling a part of a wide community, including a deep sense of unity at being among your own people. This is especially true in a society where whiteness is the norm and you rarely see yourself represented in the media or even in your own workplace. I feel deeply for Sandeep, who has most likely now not only lost connections with her own immediate family but also with her wider community. Francesca Fergus, trainee counsellor
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Eddie Carden
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Eddie Carden, former BACP Trustee, died aged 65 on 13 April. I first met Eddie in his role as CEO of Renew, a third-sector organisation. I had been asked to attend to present certificates to students and deliver a workshop. It was a joyous experience, meeting students who represented the future of our profession, but also encountering Eddie for the first time – his warm smile, which I later discovered could also be mischievous, greeting me genuinely. Eddie undertook his psychodynamic training 30 years previously while serving as a parish priest. His commitment to third-sector organisations was one of his enduring professional passions throughout his career. He became a Trustee of BACP in 2015 and sat on the Board for three years. He was additionally a member of BACP’s Finance and Policy Committee. Eddie was passionate about his family, music, gardening and walking. He took retirement in July 2019 and wrote that he would ‘take six months before embarking on anything new’. Life can be tragically cruel, and cancer denied him the opportunity to excel in his retirement as he had in his working life. We will miss you greatly Eddie, and thank you so, so very much. Andrew Reeves, former BACP Chair
Ian Paul Johnson CLIENT
Ian Johnson, supervisor and therapist, died of coronavirus after spending 10 days in intensive care in April. He was born in Islington, north London, the fourth of five children to Jamaican parents, and grew up in Essex. His father came to the UK in 1949 and his mother on the day of the Coronation. As well as working as a therapist, Ian had a long-established career as a cabin service director for BA, taking his last flight from Nashville in March. He had his own private psychotherapy practice and also worked at Time and Talents in Rotherhithe, a community centre supporting people struggling with poverty and mental ill health. One of their most successful initiatives is ‘the Shed’, a place for men to connect by making stuff together. Ian was my training therapist. I shall always remember his cheeky smile when he knew he’d given me back my own nonsense. He offered a secure base and was calm, unflustered and empathetic, but also very willing to call my resistance. He was congruent, fallible and human. He laughed at himself, and me. One memory from last year was when I was struggling with feeling like a failure and cast him as being a therapist against my not. ‘We’re colleagues, peers now,’ he said. ‘You’re not the boy who first came, he’s around far less.’ With those words, I felt seen, appreciated and understood. Ian was proud of his Essex roots and his own journey. He was my therapist, but also a hero as a colleague who did ‘good things’ in the community and was involved in the world where we lived through local charities. Since he died, I’ve found out how much he was loved and how many people he touched. He will not be forgotten. Ben Scanlan, UKCP registered therapist
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Les Garry
Les Garry, my wife, died in St Mary’s Nursing Home, Hull, aged 70, on 10 June. Les was an accredited member of BACP from 1993 and senior accredited from 2000, as well as a supervisor. She was recognised as an outstanding practitioner by her colleagues, peers and mentors. In her counselling room, overlooking her beloved garden, with its magnolia and copper beech trees, Les worked with many women who had experienced domestic violence or sexual abuse, offering a healing haven. Les showed tremendous courage and resilience over 35 years in the face of multiple severe health conditions, including rheumatoid arthritis and systemic lupus. For the duration of the sessions with her clients, she said, her own physical pain was suppressed. In the early 1980s, Les was co-ordinator of Pam Dellar’s Outreach Community Arts. Later, Les worked with Hull’s centre for young people, The Warren, where she ran workshops and training courses, and at Hull Women’s Centre, among other organisations. Les was one of Hull’s many Greenham women and involved in many aspects of local feminist politics. Les’s unbowed cheerfulness, outgoing nature and zest for living made her a magnet for others. She loved being with people, whether dancing to reggae, or entertaining friends around the kitchen table. Bruce Woodcock
Audrey Newsome
Audrey Newsome, who founded the UK’s first student counselling service at Keele University in 1964, has died, aged 91. While the name of Audrey Newsome may not be too familiar with younger members of our community, much of her early work laid the foundation for the numerous developments that we witness today. At Keele, she established an integrated service embedded within the institution. It was truly visionary in its day. The focus of the service was on the whole person – the integration of the academic, vocational, personal and social dimensions of the student’s experience. The relationship was seen as the core of all therapeutic encounters, at a time when the medical model and behavioural and psychoanalytic modalities were dominant, and counselling was still enshrined in mystery. Audrey was a pioneering figure in the development of BACP, as one of the founding members of what was then called BAC, and its second Chair. In her post-Keele days, she also established innovative counselling provision in Bloomsbury Health Authority, the Royal College of Nursing and the Marie Curie Foundation. Her numerous achievements, too many to state here, were recognised with an Honorary MA from The Open University, Fellowships of the Royal College of Medicine and BACP and, most recently, the naming of the Newsome Building at Keele. Audrey was a much loved and truly inspirational individual who touched the lives of so many and left a huge imprint on the counselling world. She will be deeply missed but will continue to live in the hearts of all of us who were fortunate to have known her. Rita S Mintz, senior lecturer in counselling, University of Chester
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Mental health in the arts, media and online
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Unboxing mental health
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Few therapists feel comfortable putting people’s lived experience of mental illness into diagnostic boxes. But is there an alternative? Melissa Black, clinical psychologist and postdoctoral researcher at the MRC Cognition and Brain Sciences Unit at the University of Cambridge, argues the case for the emerging transdiagnostic approach. Labels become obsolete if we define mental health along a continuum, based on the belief that we all share the same psychological processes, such as irrational beliefs, anxieties and low mood, that underlie so-called disorders, but we exhibit them to varying degrees. And, unlike the current system, with a transdiagnostic approach, no one is told they have a personality disorder that is ‘untreatable’. www.aeon.co/ essays/common-mentalprocesses-often-underliedifferent-diagnoses
Film
Combining cinema vérité and investigative journalism, Medicating Normal follows the stories of five diverse Americans who were prescribed psychiatric drugs for anxiety, depression, sleeplessness, focus and trauma. Director Lynn Cunningham was inspired to make the film after the normal distress of a close family member, whom she describes as a ‘high functioning, Harvard graduate and star athlete’, was diagnosed as mental illness, and treated with up to 10 different pills a day throughout her 20s. Cunningham and co-director Wendy Ractliffe collaborated with Robert Whitaker, author of Anatomy of an Epidemic, to make this exposé of the growing problem of overprescribing. For details of a free screening for BACP members on 15 October, followed by a panel discussion, see page 7.
Podcasts
Podcast picks • Michelle Obama focuses on relationships and mental health in a series of interviews with friends, colleagues and family. She starts with a heartlifting interchange with husband Barack about staying true to your values in the face of pressure. The Michelle Obama Podcast, available from Spotify.
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• Why does musical talent often go handin-hand with mental health issues? In Sound Affects: music and mental health, BACPaccredited therapist Katy Georgiou, a former music journalist, explores the question through a series of interviews about addiction, depression and psychosis. Available on Apple podcasts.
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• Michaela Coel, writer, director and actor, revealed her prodigious talent with the groundbreaking BBC/HBO drama series I May Destroy You. In this interview, part of the Economist Asks podcast series, Coel talks about why it’s still so hard to talk about sexual consent. Available from www.economist.com/ michaelacoel
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Know of an event that would interest Therapy Today readers? Email media@thinkpublishing.co.uk Television
Be inspired by these life-affirming reads. Available by mail order from the publishers’ websites or from Amazon. Why don’t friends go to therapy together to work out their issues? When Aminatou Sow and Ann Friedman’s friendship hit a rocky patch, they did just that. Big Friendship: how we keep each other close (Virago) is their personal story, and a guide to nurturing your platonic relationships.
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Life lessons
Poet and playwright Lemn Sissay talks to Alan Yentob about his mistreatment by the British care system in Imagine… Lemn Sissay: the memory of me. His Ethiopian-born mother, who became pregnant while studying in England, left Sissay with a social worker when she returned to Ethiopia. By the time she sent for him, Sissay had been renamed Norman Greenwood and placed with a white foster family – the only black person in a small town near Wigan. Described as a ‘ray of sunshine’ in a primary school report, Sissay caused problems if he ‘shined’ too much at home. When he was 12, his foster family abruptly returned him to the care system and a series of children’s homes. This shocking tale of institutional racism and rejection, including from his birth mother when he finally tracked her down (she asked him to pretend he was her cousin to his newly discovered siblings), is lifted by Sissay’s beautiful commentary and poetry. A story of humanity at both its worst and best. Available on BBC iPlayer. Art
Among the trees
Now in her 90s, holocaust survivor Dr Edith Eger still practises as a therapist in California, specialising in PTSD. In The Gift: 12 lessons to save your life (Rider), she writes about the prisons we create with our minds and the keys to freedom and living every moment as a gift.
With lifespans much longer than our own, trees challenge how we think about time. This reopened exhibition also explores our relationship with woods and forests, and how trees helped shape civilisation, through sculpture, painting, installation and photography. With contributions from 39 artists, it features trees from all over the world, including Colombian rainforests and remote Japanese islands. The show is at London’s Hayward Gallery and tickets for September onwards are available now at www. southbankcentre.co.uk
Growing up queer in his strict Muslim family in London’s East End, Mohsin Zaidi battled suicidal thoughts while winning a place at Oxford University and beating racism to become an awardwinning barrister. His honest and funny memoir, A Dutiful Boy (Penguin), is a tribute to his resilience.
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PASCALE MARTHINE TAYOU, PLASTIC TREE B, 2010 © THE ARTIST 2020. COURTESY THE ARTIST AND GALLERIA CONTINUA, SAN GIMIGNANO/BEIJING/LES MOULINS/HABANA. PHOTO: OAK TAYLOR-SMITH
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those who have walked before us, is that we will take it from here,’ she pledged. In this article, several black and Asian counsellors and psychotherapists talk about their own experiences and feelings about racism within the counselling profession and how they believe the profession could ‘take it from here’.
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We need to talk about race – but how? And what is stopping us? Here, black and Asian counsellors talk about race and the counselling profession, and what needs to change
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he issue lies between Rogers and the client like a huge dead elephant. It is there but neither want to address the issue that there is a dead elephant in the room.’ So wrote Courtland C Lee, the first black president of the American Counseling Association, in his contribution to the 2004 book Carl Rogers Counsels a Black Client.1 The book is a detailed analysis and critique of two videos of therapy sessions recorded in the 1970s by Carl Rogers with a young black man (unnamed), who is in remission from leukaemia. The first is titled ‘The Right to be Desperate’, the second, ‘On Anger and Hurt’. Yet, as Lee reports, while there is certainly a huge presence of despair, hurt and anger, neither Rogers nor the client makes any direct reference to the client’s feelings about his colour and race. There is, writes Lee, no space or invitation from Rogers for the client
‘to experience his blackness in any meaningful way’. Race remains a ‘dead elephant’ in the room. Following George Floyd’s death in the US and the worldwide protests, including here in the UK, the counselling profession has not, of course, remained unaffected by the upsurge of hurt, anger and shame. Some 50,000 counsellors and psychotherapists will have received the heartfelt personal message from BACP Chair Natalie Bailey, in which she described her own experiences of racism as a black woman and a mother of sons, and her response as a counsellor and their professional leader. Promising to take action, she urged BACP members ‘to sit with the discomfort, shock, bewilderment, or shame’. ‘I envisage we will need to talk about how we support each other through this momentous period which affects our profession, whether it be us as practitioners or our clients... My promise to [George Floyd], and to all
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Counselling as a profession has not done the work it needs to do to address its own racism, at both individual and collective levels, says child and adolescent psychotherapist Kemi Omijeh. ‘Only last week another therapist said to me, “I don’t see you as black”. My answer to that is: “If you don’t see me as black, then I don’t exist for you”,’ she says. She recalls how she spent most of her early career buttoning her lip, picking her battles and keeping her head down, because to do otherwise would have jeopardised her career in a profession she is deeply committed to. ‘It was about self-preservation. Now I address it, but five years ago, I had ambitions. I knew it would be a risk to my job and my career. I had a mental map in my head of where I wanted to go and if I encountered racism in my work, I would think, can I afford to challenge that person?’ she says. The depth of her commitment is exemplified by her persistence; she came into the profession because she saw a desperate need for more young black counsellors. ‘Like a lot of counsellors, I felt I would have benefitted from talking to someone like me when I was a teenager. All through my interviews for counselling training, people kept telling me I was a bit young, come back in a few years. But I believed I could make a difference. During my training, there was just me and one other black woman on the course. Then she left, and my blackness became all the more apparent. It felt vulnerable and lonely. This probably influenced my active seeking out of colleagues that look like me and workspaces that offer more diversity. Throughout my training, I had no point of reference – my whole
‘If I were to respond to every micro aggression, it would literally be a full-time job and would get in the way of my work’ Kemi Omijeh
education was whited out and the onus was on me to fill in the blanks. It’s only in the last three years that it feels like therapy has become more diverse and I have made contact with other BAME colleagues through joining BAATN.2 Now that I am more confident in my career and know that my experience speaks for itself, I do speak up more, but even so, if I were to respond to every micro aggression, it would literally be a full-time job and would get in the way of my work.’
Authenticity But, she says, if she does speak out, she has to confront white fragility and she is still forced to self-censor: ‘It feels like my white colleagues are playing catch-up on racism and being anti-racist, something that was apparent to those of us in the BAME community long before it became a trending topic. White people retreat into silence if I speak too passionately about the issue and I don’t want that. I want to find another way of bringing about change without people feeling guilty and retreating into silence. But we can’t keep stroking egos when there is work to be done.’ This self-censorship and denial of authenticity is a common theme and a paradox within a profession for which congruence and authenticity are ‘necessary conditions’ for effective practice. Susan Cousins, a counsellor and author of Overcoming Everyday Racism,3 says: ‘When I applied to train, I knew the course wasn’t going to speak to me in any way. I just wanted to pass it. In the personal development groups, I filtered
what I said and presented only what I felt the other students could deal with.’ Current training courses still by and large do not prepare counsellors to work with race and difference, she believes, meaning many white counsellors are unable to deal with the topic and the mêlée of powerful emotions it evokes. ‘They aren’t learning how to listen and hold their boundaries while staying curious. Their emotional responses are defensive guilt and fear.’ How then can what they offer be relevant to their black and Asian clients, she asks? Keeley Taverner, psychotherapist, writer, life coach and supervisor in private practice, had her own painful encounter with white fragility on her first counselling skills training course. ‘We were asked to do an exercise about discrimination and my white colleagues spoke about being discriminated against because they loved dogs, or they were messy – at that level,’ she says. ‘I innocently spoke about my experience as a single-parent mother, having to deal with the racist assumptions of my health visitor. My fellow trainees were angry.
I remember feeling really humiliated in the group process. So quite quickly in my career, I realised this was going to be a difficult topic to bring up.’ Child psychotherapist Deborah Clarke qualified in 2018 and recalls her strong sense of isolation during training: ‘I didn’t feel safe enough to describe some of my experiences of racism. I was the only black student in the group in my first year, although the tutor was black and another black student joined us in the second year. None of my fellow students were going to know what it feels like to be a teenager waiting to meet up with friends at the cinema and a group of white men chanting at you “There ain’t no black in the Union Jack”, or giving elderly ladies a wide berth so as not to scare them into thinking I’ll snatch their handbag. ‘I don’t want to have to sit with other people’s misconceptions and fears and embarrassment. In training, why aren’t there more recognised books from a black perspective? When videos are used, why aren’t we watching ones that relate to race and difference? Until they see it, people aren’t going to understand it. By not discussing it, it’s denying a part of my identity.’ Ruth Pimenta is a psychotherapist and trainer of Indian/English heritage. She worked for many years in child mental health and adoption, and now works in private practice. ‘I am lightskinned and I recognise my privilege in that, as I can pass for different ethnicities, yet my Indianness is an important part of my identity. When I was training, I had people say to me, “I don’t see you as Asian”, or “If you want
‘When I applied to train, I knew the course wasn’t going to speak to me in any way. I just wanted to pass it’ Susan Cousins
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to be seen as Asian, you should wear a bindi or sari”. I have also had people use the word “Paki” in conversation and then add, “I didn’t mean you, of course”. There’s the overt racism and then there are subtle things where you can’t always tell – where it’s made clear you are an outsider, where your authority is questioned. It’s about assumed superiority.’ Yet it can be so different, she says; when she worked in a local authority with a large BAME population, ‘I felt confident, valued and respected and there was real value put on different voices and different perspectives.’ That’s why Keeley Taverner now works in private practice: ‘I know all about the impenetrable glass ceiling,’ she says. ‘I experienced being held back in my previous public-sector role. Time after time, I have been more qualified than my white peers and not got promotion. So, it’s better for me to build my own business than to try to work my way up any organisation where white colleagues may not understand me or will feel uncomfortable with what I bring to the table. ‘I have created my own specialty so I don’t have to deal with being rejected, not getting jobs I am qualified for and not having my ideas brought to the table.’ In her previous career, she worked in the probation service, where most of the people doing the front-line work were black women. ‘We used to call the front-line work the cotton fields, or the plantation,’ she says. ‘In private practice, I don’t have to play the game, squash myself to make other people feel comfortable, deculture myself or go above and beyond to prove my worth.’
‘I don’t want to have to sit with other people’s misconceptions and fears and embarrassment’ Deborah Clarke
Shame and respect Billie-Claire Wright is a child psychotherapist who works for a large UK charity. For her master’s degree, she researched internalised racism. Her choice stemmed from having been gently confronted by her first therapist, a white man, who she saw when she was taking her diploma. ‘He asked why I had chosen him. I said I didn’t think a black therapist would be up to the job, and there was a palpable silence, and he said, “If that is how you feel, I wonder how you feel about yourself?” I felt a mix of shame, anger and confusion, and this stayed with me throughout my studies – “Is that how I really feel?” ‘I started looking at my whole journey – school, early years and how we were brought up. I realised I had been trying to fit into a white world and to do that I had had to lose my intrinsic self and put on a mask to make myself acceptable. This came from my parents,’ she says. ‘I am first-generation black British. I was born here, and my parents did everything they could to help us succeed in a white majority society. For
‘I realised I had been trying to fit into a white world and to do that I had had to lose my intrinsic self’ Billie-Claire Wright
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them, that meant pulling us away from our black society, speaking a certain way and behaving a certain way. I went to a convent school and didn’t mix with black people; I was told, “They’ll bring you down.” These were the messages we were given growing up, and I internalised that.’ She recalls taking this story to an experiential group during her training: ‘There was me, one other black therapist and 18 white therapists and a white facilitator. I talked about that whole tendency to denigrate everything that was black about me, and there was silence, and I felt even more ashamed. The facilitator didn’t know how to handle it and just moved the conversation on. It took a very bad experience in a job after I qualified to make me realise I had to look at it and acknowledge it and understand it, which was why I chose it for my master’s research. But doing the research was challenging because I couldn’t find participants who wanted to talk about it. It brings up lots of painful feelings – the realisation that you have such negative feelings about your race. We aren’t used to talking about how we turn that racism against ourselves. But my participants found it very liberating, as well as hard. ‘I still have moments where I feel a sense of denial and I have to fight the tendency to want to hide, to blend, not to be noticed,’ she says. ‘It’s easier, and sometimes I feel I don’t have the energy to keep fighting. It’s a daily struggle – you don’t just realise you have internalised racism and then it disappears.’
Black Lives Matter and George Floyd’s death forced Pretish Raja-Helm to confront his own internalised racism – a painful and complex process for a self-defined ‘queer, brown person’, he says. Pretish is an integrative, relational psychotherapist and co-founder of Aashna, a therapeutic space dedicated to embracing differences, which has pioneered a series of encounters called ‘Let’s Get Uncomfortable’. ‘Black Lives Matter has really made me acknowledge my own brown fragility in how I have been indoctrinated and raised as part of a dominant white structure, with my own hidden and subtle racist attitudes and prejudices. None of us are free. Even within the queer community, there is significant racism. We are encountering such complexities of racism and how we act on each other. ‘I have had sleepless nights over it,’ he says. ‘How do I respect my experiences of prejudice and racial trauma yet acknowledge that I have privilege? It’s deeply complicated and uncomfortable.’ With the help of his community and allies, including his supervisor, an Israeli Jewish woman, he is ‘digesting that and becoming comfortable with that discomfort and working towards being a more authentic ally’. But, he says, ‘The work never stops.’
The road to change Eugene Ellis is founder of BAATN – for so many black and Asian practitioners both a beacon and haven, offering professional identity and solidarity. Eugene sees the ability to initiate and sustain the ‘race conversation’ as fundamental to achieving a place where black, brown and white can be comfortable with the discomfort. But, while some individuals are doing the work, more needs to be happening at an organisational and institutional level if there is going to be meaningful change, he believes. ‘Discomfort levels are extremely high right now. I have been in spaces where people volunteer to be there for themselves and we have some really good race conversations that move people forward, but it’s not mirrored
‘In private practice, I don’t have to play the game, deculture myself or go above and beyond to prove my worth’ Keeley Taverner
in the vast majority of the profession. Generally, the people who run the institutions tend to distance themselves from all of that. They don’t get involved, and if they don’t get involved, nothing really changes. ‘In the therapy profession, in my orbit, people are just fed up with training not moving on. The dialogue is exactly the same, the questions and answers are the same but nothing is actually changing, and if nothing continues to change, people are going to find other solutions.’ He predicts BAME practitioners may abandon the larger professional bodies and seek representation and collectivity in ‘smaller, more agile’ organisations. Keeley Taverner chooses to focus her efforts on what she can change. ‘It’s a far better use of my energy than trying to fight a system that does not want to address the deeper issues of white awareness and white power,’ she says. She found her sanctum in BAATN while she was still training: ‘I realised I was naïve to hope that the counselling profession was race-aware. Once I realised that, I knew I had to strategise to best assist myself.’ Today, she supports other black people to navigate training and to function in the ‘system’. She’s a passionate advocate of selfempowerment and self-responsibility: ‘I believe in the importance of “building your own” so you can help all types of people in eclectic, culturally-sensitive, inclusive ways.’ She runs her own business, offering coaching, therapy, workshops and online programmes, and rents counselling rooms to support other practitioners in private practice. ‘I am
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using my energy in a productive way and creating content and programmes that speak directly to the people’s pain. ‘One of the problems with the Black Lives Matter movement is we’re going to the dominant power group and telling them that our lives need to matter to them. The sad reality is, time and time again, we find out how little we do matter. What matters is power, and if you don’t have power, you don’t get a seat at the table. We have to empower ourselves, individually and collectively.’ Deborah Clarke says that it is time white counsellors took responsibility for looking at their whiteness. ‘It’s a very difficult conversation for white people, to see themselves in terms of race, but it’s a very rich conversation and I think we need more of it and a more equal discussion. We need less emphasis on black people being oppressed and having all these difficulties and more focus on white people understanding their whiteness and their own identity and the history of that identity and its challenges. The point is to stop looking at us and asking us how you can understand our culture. You are responsible for your healing. Look at yourself and where you have come from and then we will talk. ‘We want our clients to be able to bring to counselling things that are raw and make them feel uncomfortable. If you, as a counsellor, can’t acknowledge what you find raw and uncomfortable in yourself and work on it, I ask if you have a place in the profession. You have to confront the parts of you that aren’t so nice.’ And it has to start in training,
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with more exposure and opportunity to discuss race and diversity, and more black tutors who are able to hold these discussions, she says. Susan Cousins agrees: ‘I would argue for a change in the curriculum, change in the power base and change on the boards to tackle the power structure of institutional racism. Our big organisations need to change because if they don’t people will do their own thing.’ Just setting up another working group isn’t good enough, she says. ‘There needs to be more BAME people throughout all the structures of the organisation. Working groups can only make recommendations. The power is still held by people who deny racism and its impact on society. That denial is still there because many of the white people at the top still don’t talk to black people. They only want to minutely tweak around the edges and BAME people know that. There is a deep-seated racism around structural power and power sharing with black people. They are scared of what they will lose and of difference.’
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Eugene Ellis directly challenges the professional bodies to decide on and implement real change: ‘Unfortunately institutions tend to put the behaviour change first and hope the attitudes change afterwards, as happened with the Race Relations Act; people fall in with it because they have to. We therapists should be able to do it differently, and someone at the top has to take the first step. I would like the professional bodies’ mission statements to say why they want more BAME people in the profession – write down why it is needed and what they are going to do about it. And then do it.’ BACP President David Weaver says it’s time for BACP and other professional bodies to make good their claims for the relevance of counselling to the mental health of the nation and put race equality on their agendas for action. In this, his last term in office, Weaver says he is determined to spearhead a drive for real change. ‘We have to put race on the agenda if we are to have any
‘We have to put race on the agenda if we are to have any relevance out there in the wider world’ David Weaver
relevance out there in the wider world when we claim that counselling changes lives. Looking at the disproportionate effect of COVID-19 on BAME communities, racial injustice is now a mainstream issue and we need to play our part in addressing that. We know the evidence around trauma and the links between stress, poverty and lifestyle issues and mental health. People need to talk, and they need therapeutic support to talk, and it is absolutely critical that we take action to address diversity in training, in the counselling workforce and within BACP. ‘This isn’t about setting up another committee,’ he says. ‘Policy frameworks are only as good as their practice. Having black people at the top of the organisation is important but it is only symbolic. Systemic change can only be brought about by having more BAME representation within and across the organisation and more black counsellors involved at decision-making, board and leadership level and in the education system. The biggest risk for us as a profession is that we don’t do it, and the biggest opportunity is that we do.’ Meantime two young women, one white and one black, have acted, tapping into the national outpouring of anger and shame to raise more than £500,000 through crowdsourcing to fund counselling for black people from black therapists. Says Annie Nash, co-founder with Agnes Mwakatuma of Black Minds Matter UK: ‘There has got to be some solutions here for black
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people to access therapy in terms of safe spaces where they can talk without having to worry about unconscious bias. We wanted to create that safe space.’ In the first four weeks of the campaign, in addition to raising the money, they had contact from more than 100 counsellors wanting to work with them and hundreds of people seeking therapy. ‘Therapy changed my life,’ Annie says, ‘I know there is some power that comes out of really looking after your mental health with someone who is qualified to help you find the tools and skills you need to cope with life and relationships that you may have grown up not having.’ The donations are still coming in, in amounts ranging from a few pounds to hundreds. It seems Black minds and lives do matter to a significant number of people. To donate to Black Minds Matter UK, go to www.blackmindsmatteruk.com
REFERENCES 1. Lee CC. Twenty-first-century reflections on ‘The Right to be Desperate’ and ‘On Anger and Hurt’. In: Moodley R, Lago C, Talahite A. Carl Rogers counsels a black client. Rosson-Wye: PCCS Books (pp228–230). 2. The Black African and Asian Therapy Network: www.baatn.org.uk 3. Cousins, S. Overcoming everyday racism. London: Jessica Kingsley; 2019.
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recent client-ending prompted a fair bit of reflection on outcome measures and challenged my love affair with numbers. Maybe I should start by confessing that I am a great fan of CORE forms, the fully blown CORE-34 forms in particular. When I worked in a counselling service, my fondness earned me the nickname ‘CORE-form queen’ in my supervision group. Most of my colleagues used the forms out of necessity, but I really embraced working with them. Rather than seeing CORE forms as a bureaucratic add-on, required by services to monitor their performance, I use them with my clients as an active and collaborative tool. I explore how they make sense of the questions and their answers to them. Which questions do they find particularly challenging to answer and why? Which answers are true snapshots of the last seven days? And which answers describe a more permanent state of affairs? Often the forms bring out much more than a purely narrative initial assessment. As therapy progresses and we work towards an end, I offer clients a side-by-side comparison of current and earlier versions of their self-assessment. Where change is noted, I enquire what, in their view, has facilitated the change. Analysing CORE forms this way appears to give many clients a deeper understanding of what happened during their counselling journey. They are often surprised when they look at the black and white records of change. The memory of how challenging things were at the beginning has often faded by the end. When I left the service to start private practice three years ago, I continued the way I work with CORE-34 forms and am slowly building my personal evidence base for change over time. I put the results into a spreadsheet to create my own data set, and I am regularly pondering the emerging picture. These figures seem to convey a level of certainty. What happens in therapy is often hard to grasp and, particularly at the beginning of my counselling career, I found that CORE outcome measures created more tangible results. I felt a sense of achievement when I could present a client ending in supervision and support it with positive CORE-form results. The greater the change from a high to a low score, the better it was, not only for the client but also for my confidence in my professional skills. However, one recent ending turned it all on its head. The client’s CORE-34 score at the end of therapy was notably higher than at the beginning. My initial response
was concern but, reflecting on it, I am very tempted to call it a success anyway. Let me explain. The client had experienced a range of very traumatic childhood events. As he grew into a generally well-functioning adult, with a steady job, friends and a long-term relationship, he was troubled by occasional anger outbursts. Ordinary, everyday mishaps would lead to eruptions of anger and destructive behaviour. He had also suffered a bereavement, after an extended period of caring for the person. When he talked about his struggle with grief, sadness and anger, these emotions were initially not present in the counselling room. He talked with a certain level of detachment. The words were there but they were not mirrored in his posture, facial expression or palpable mood state. What followed was more than a year of regular work and something I would describe as ‘emotional thawing’. The safe base of the counselling relationship allowed the client to gradually explore his emotional universe and develop a better understanding of his frustration, anger and other feelings. His language and facial expression came alive, the occasional swear word found its way into the room, as did tender silences when raw spots were touched. Slowly, the client found his voice and broadened his ability to notice and express emotion, not only in the counselling relationship but also in other relationships. The anger outbursts became less as the fear of his anger receded. In the end, anger became a useful signal that something else needed to be looked at. Reflecting on this case, it appears to me that, where trauma is involved, many clients are so used to detaching from their emotions that they may initially appear non-clinical in CORE-34 assessments. It is only through the experience of a secure, safe and nonjudgmental therapeutic relationship that they start to connect with their feelings. I wonder if, for some clients, ending therapy with a higher CORE score could actually be seen as a therapeutic success. They feel safe enough to feel. My client walked away from therapy with a new-found ability to notice, respond to and manage emotion. According to the CORE results, this was not a therapeutic success, and the question this experience leaves me with is: how can we judge therapeutic success based purely on numerical outcome measures? Separating a client’s individual journey and their presenting problem from the COREform outcomes appears to risk missing the point.
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About the author Susanne Barthelmes is a counsellor in private practice and founder of Growing Space Counselling. She recently gained an MA in counselling and psychotherapy practice, specialising in the gut-brain axis and how counsellors can integrate current research into their practice. www. growing-space.com
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s I have no recollection of your name, I’m going to call you Jim. You were a teacher. I know that. I think, newly qualified. That fact, of course, made everything so much worse for you. I feel that I understood what happened. Who could possibly blame you? Just imagine what it would have been like for you. Going into that room and facing the world with all its prejudices would have been an ordeal. Like being in the stocks, but with words thrown at you, not rotten tomatoes. It was more than 30 years before I realised how selfishly I had acted and thought that day. There were, of course, mitigating factors. Few of us can look back on our past and claim that it is wholly unblemished. I’ll soon be getting my state pension, bus pass, cheap haircut, the lot. I was 29 then, and how different everything was. It was March 1983. The local magistrates court sat once a week, on a Monday morning. I had just started a new job as a litigation solicitor, based in the area, on the north-west coast. My job involved advising and representing clients in both criminal and matrimonial work. My wife and I were due to move north in the summer, but that day, the first day of my second week of a new job, I would have had to leave our home in the Staffordshire Potteries early in the morning for the drive up the M6 and M55. It was early March. I suspect it was cold and icy. I drove a clapped-out Triumph with a dodgy clutch. You were not my client. We had not met. I had been asked by the senior partner to cover for him in what should have been a short preliminary hearing. The court would have been busy, a hubbub of chatter and gossip. It
was almost exclusively male – magistrates, the court clerk, solicitors, police, probation officers and ushers. By 1983, there were women in all of those positions, but it was still the exception rather than the rule. Although ostensibly the court was run by the magistrates, it was in truth the fiefdom of the court clerk. And at that court, the clerk was a monster. Mean-spirited, shrewd, awkward and unsmiling, he was openly sceptical of all those unfortunate enough to appear before his court. You crossed him at your peril. He did not have a liberal bone in his body. Defence
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solicitors were wary of him. No, I would go further than that, we hated him. The final character in the dramatis personae that morning would have been Roy, the veteran newshound of the local paper. With his smoker’s cough, glasses pushed up on his forehead, crumpled jacket, notebook and pencil at the ready, he could smell a salacious story at a hundred paces. If he was lucky, it might be a piece he could sell on to a national. Seeing your name and the charge you faced that morning would have whetted his appetite. His notebook and pencil would have been poised. You were charged with committing an act of gross indecency with another man in a public place. To be specific, somewhere on the long sweep of sand dunes, a couple of miles from the town centre. As I was to learn, it was a notorious cruising area. Your reputation and career were on the line. It was a serious offence, punishable with a prison sentence. You were on bail, legally obliged to attend the court by 9.45am, climb the short flight of steps to the wooden dock and face the magistrates, the clerk and the rest of the court. I was there to request a short adjournment and whisk you out of court with the minimum of fuss and publicity. Jim, you didn’t turn up. There were no mobile phones then. As 10 o’clock came and went, sitting in the front
row of the court, with the other defence solicitors, facing the magistrates and anxiously looking over my shoulder to see if you had arrived, I hoped that other cases would be called on first. There would have been the usual jockeying for position. Short guilty pleas, adjournments. As a general rule, each defence solicitor wanted to get their case on first, except me, that day, as you, my client, had not answered your bail. I looked earnestly at my notes in front of me, pretending that I wasn’t really there. Being a few minutes late usually did not matter, but it was not a good start. The clerk, mercilessly, called your case on first of all. I had no answer to the inevitable request from the prosecution to the court for a warrant to be issued for your arrest for your failure, without reasonable explanation, to answer your bail. That was it. Remember, I had already driven more than 120 miles that morning, having left in the dark at about 7am. I would have been in a real hurry to get back to the office, to check my post, to see clients in the afternoon and prepare for the criminal court hearings for the following morning. Then I had a 50-minute drive home. Except, Jim, I did not go straight back. An impulse that I have never been able to fully explain led me to deviate from my route and drive to your house, adding perhaps an additional 10 or 15 minutes to my journey. I was not familiar with the area where you lived. I probably did not have a map. Sat-navs had not been invented. I had been fully qualified as a solicitor for, say, two years or so, and in that time I had never gone to a client’s home. It was, to say the least, an unusual course of action. Clients failing to attend court was not that uncommon. I’m sure that it had happened already a good number of times in my short career as a litigation solicitor. Having eventually found your house, I could see that there was a car in your drive. There was, however, no response to the doorbell. Jim, you may well be wondering what was going through my mind. I can’t tell you, but I am guessing that some instinct persuaded me to pursue this course of action rather than get in my car and drive to the office. I walked to the back of the new semidetached house. I found a top window of the kitchen was ajar. I was slimmer then. I managed, somehow, to squeeze through the
‘You will probably never read this, but if you did... there might be some final resolution for me’ narrow opening. I fell awkwardly on to the kitchen floor. I called your name but there was no response. There was no sign of you downstairs. With my heart hammering, I slowly climbed the stairs. Jim, I pushed open the bathroom door. You were lying motionless in a bath full of water streaked heavily with blood. Our eyes met for a second. You seemed to be alive. Neither of us spoke. I ran down the stairs and rang 999 for an ambulance. Jim, I never went back up the stairs to you. Your life was ebbing away in those precious moments before the ambulance arrived. Why did I do nothing? Why did I just sit there? Yes, I must have been in a state of shock. It had been an incredibly long day. But to that question I can offer no sound response. I’m sorry. My next memory is driving back to the house where I was temporarily lodging with a friend during the week – Freddie, who I knew from university. What do I remember? I frantically searched his house for a drop of whisky. He’s a Scot, for goodness sake. It was the first time I had tasted gin. It was all I could find. I needed a drink. I stayed in the house on my own. Freddie would have arrived in the evening. I must have phoned my wife. That’s it. After that fleeting moment when our eyes met, I never saw you again. To the best of my knowledge, there was no note. You had no reason to believe that I would have come looking for you. A few months later, more case-hardened, I probably would have driven straight back to the office. I have always believed that you wanted to die. That it was not a cry for help. Only you know the truth. The following morning, relating the story to my new colleagues, I was fêted as a hero. Stupidly, naively, selfishly, at the time I felt proud of myself. I never gave one single
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thought to you. I was even irked by the fact that you never contacted me to thank me for saving your life. I remember that feeling so clearly, and it makes me feel so uncomfortable now. Our senior partner worked in another office. I never found out how the court case was resolved. Jim, you might find that rather surprising. I was commuting a long distance every weekend. My wife was three months pregnant with our first child. I was looking for somewhere for us to live. I was trying to make a good impression in my new job. Life was very hectic. I forgot about you. Years later, Jim, when I trained to be a counsellor, what happened and how I reacted came back to me. During our training, we were asked to talk about our experience of suicide. The day that our paths crossed is a vivid memory. I talked about it openly for the first time. Also, nine years after the events I have been describing, our senior partner, your solicitor, took his own life. He had been facing financial ruin and public humiliation. It was a terrible and shocking event that had a profound impact on many friends, family and colleagues. Periodically, that day in 1983 floats to the surface of my mind. It would be overstating the case to claim that it continues to trouble me. It’s there, though. You might say that it’s on my conscience. You will probably never read this, but if you did by some unforeseen chance, there might be some final resolution for me if I learned that good things happened to you, and you do not condemn me for the manner in which I interfered in your life or, should I say, in your death.
About the author Chris Palmer MBACP has a diploma in person-centred counselling and is currently a voluntary counsellor at Ayrshire Hospice. This article won The Scottish Association of Writers’ Alastair Walker Award for non-fiction in 2019.
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Catherine Jackson: You are a qualified medical doctor, an internationally celebrated writer, speaker and trainer on trauma and addictions, and you worked for many years in addictions services. Counsellors and psychotherapists look to you for answers to the issues that turn up in their counselling rooms. Yet you have never crossed the line from medical into psychiatry or had formal training in talking therapies. Is that right?
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Healing the wounds of trauma
Catherine Jackson talks to Dr Gabor MatŽ about trauma and compassionate inquiry
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Gabor Maté: I’ve never had a stitch of training in talking therapies. But to say ‘crossing the line’ is making an assumption that there is a line to be crossed. There isn’t. I was a family physician for 32 years, a dozen of them in addiction medicine; I’ve delivered babies, looked after the dying and everything in between; I’ve worked in palliative care. What I’ve found is that, in virtually all chronic physical illness, there are deep-seated emotional issues that relate to people’s entire lives. There is no separation to be made between the psyche and the soma – between people’s emotional lives, their limbic systems, their life histories and their physiology. My medical practice was in a poorer part of Vancouver, Canada. People couldn’t afford to see private therapists, and the psychiatrists who were paid by the medical [insurance] plan were really inept at doing any psychotherapy. Hence, I began to talk with my patients myself. I found I had a bit of a gift for it, and that is when I developed my counselling approaches. I also did my own work. In my mid-40s, I found myself very depressed, very unhappy in my marriage, very frustrated in my parenting, so I had to do a lot of work on myself. That combination of what I observed in my patient population and dealing with my own issues made me realise that you have to talk with people. My work has been my training. CJ: One of the fields in which you have developed an international reputation is trauma. I sometimes worry that every ‘psy’ issue these days is attributed to trauma and people may feel, if they have no history of childhood trauma, their mental and emotional suffering isn’t valid. How do you conceptualise trauma and its impact? GM: If trauma is defined as horrible things having happened to you in childhood –
sexual abuse, neglect, physical, emotional mistreatment, severe parental dysfunction, loss of parents, divorce, bereavement – then it’s true, not everyone is traumatised. But if you look at the origin of the word ‘trauma’, it’s simply the Greek word for wounding. Trauma is a wound. You can think of a wound in two ways. One is that it doesn’t heal, and every time you touch it, it really hurts. Or it’s a wound that’s healed, leaving scar tissue. And what’s the nature of scar tissue? It’s thick, it has no feeling in it, it doesn’t grow. So the trauma is not what happens to you in terms of severe injury and harm – a lot of people are not traumatised in that way – but in the sense that you were wounded during your development because you were not seen for who you are, you weren’t understood, you weren’t held when you needed to be held. That’s a very common phenomenon. Trauma can be due just to relational misalignments that leave a mark on your psyche and in your body that impairs your functioning in later life.
CJ: Another point that I’ve heard raised about the trauma hypothesis is that it positions the person as a lifelong victim. It can disempower them, in the same way that a medical diagnosis does. It tells them they are ill and need someone expert to cure them. You could say, it allows them not to take responsibility for their own situation. GM: Even when it comes to medical illness –
if, say, I diagnose you with multiple sclerosis – I don’t see it as this entity that has somehow entered your body; I see it as a manifestation of your life. Trauma is a process, a part of your life, and therefore you have agency, you can do something about it. Trauma isn’t what happened to you, it’s what happened inside you. Recognising that you have experienced trauma and that the trauma is showing up in
‘Trauma can be due just to relational misalignments that leave a mark in your psyche and body‘
‘If I as a therapist am going to be a mirror to somebody, that means I’d better be pretty clear myself‘ your life right now doesn’t disempower you; in fact, it empowers you – ‘Oh really? Is that how it works? So, what can I do about it?’ As to healing, it’s obvious. The word for healing comes from the Anglo-Saxon word for wholeness, and the essential nature of trauma is that it’s a loss of wholeness. It’s the impact of what happened and how that’s manifesting as a disconnect right now in our lives, and how we can reconnect. A proper understanding of trauma actually says, ‘This happened inside me, it’s with me in the present, and because it’s with me in the present, I can do something about it.’
CJ: So what is the therapist’s role in that? GM: If you come to me and say, ‘I’ve got an addiction to… whatever,’ I could say three things to you. One is that you have a genetic disease, which is the mantra in most of the medical world. Or I could tell you, ‘You are an idiot, you made a bad choice, you are morally degenerate, you are lacking will power,’ or I could say, ‘Hmm, what is that addiction doing for you? Oh, it’s soothing your pain, is it? So how did you develop that pain? What happened to you? And how can we help you heal that pain and handle it in ways that are not self-destructive?’ So, the role of the therapist is in helping people understand that what happened to them has a role in what happens inside them, so they don’t see themselves as deficit, bad or stupid, or as diseased; they see that how they are functioning is actually a fairly reasonable and understandable response to what happened to them. Second, you help them realise that the very fact that they have come to you for help, whatever they think of themselves – and most people who come into my office have a core belief they are worthless at some level – shows that they do, on some level, believe they have some value, and that there is some possibility
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of healing. If they didn’t, they wouldn’t be in your office. In other words, they hold a set of contradictory beliefs – that they are doomed, stuck, hopeless and worthless on the one hand, and on the other, they are none of these or they wouldn’t be there. So you work with how they developed that first set of beliefs and how together you can strengthen the part of them that doesn’t accept all those negative labels. That is the role of therapists – to hold up an accurate mirror to that person. And, if I as a therapist am going to be a mirror to somebody, that means I’d better be pretty clear myself. Because nobody can see in a dirty mirror. This is where a lot of therapy goes awry. Many therapists think they can learn a technique or a method and just apply it, but they haven’t done the work internally. It’s particularly true of many psychiatrists, but it’s also true of therapists as well, which is why there’s some horrendously bad therapy out there – people haven’t done that internal work and they are not able to be that clear mirror that a lot of work with the client demands.
CJ: You talk very openly about your own life and how your drive to help others was driven by your own need for healing. You talk about the ‘rush to symptom control’, when a therapist is unable to sit with a client’s pain because they haven’t dealt with their own. Should the unhealed healer not be practising or can the unhealed therapist work with their wound or scar tissue, without it harming their clients? GM: If I had waited to be perfectly healed,
I would not be talking to you right now! I would not have written any books, conducted any programmes or counselled anybody. You can’t wait for that complete healing, even if it is possible. But, if you don’t recognise that you are wounded and that you need to keep working on it and that, whenever there is a block in the therapy, you had better look to yourself, then you can create a lot of problems. It’s not a question of waiting for some state of perfection; it’s a question of being alert to one’s own wounding and how that shows up sometimes.
CJ: You are currently writing a new book – The Myth of Normal: illness and health in an insane culture – a brilliant title. Can
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you say a bit about the book? What is the myth of normal? GM: The assumption in medicine is that illness
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is an abnormality, whether that’s physical illness or what is called mental illness. I am saying that these are actually normal responses to abnormal circumstances. That, in a society that’s not geared to meet human needs – in fact, a society that’s meant to frustrate and exploit and deny human needs – what we call illness is a normal response. What I am showing in this book is that a society that separates the mind from the body, that doesn’t recognise the multidimensionality of human existence and pretty much reduces it to the physical level, is going to create all kinds of dysfunction. Modern medicine, for all its genuine triumphs, separates the mind from the body and separates the individual from the environment. So, somebody comes to the doctor with, say, multiple sclerosis, and we see it as some terrible condition that somehow, for some reason, struck them by misfortune. But no, it’s actually a response to living their life in a certain context. I write about this in my book, When the Body Says No.1 We can mitigate the illness with our medical techniques, but actually I know lots of people who find, once they look at their whole life in context and structure it differently, their illness abates. There is nothing magical about that; it is what you’d expect if you understand the unity of everything. It’s only a mystery if you separate the body from the mind.
CJ: Would you say the same for psychiatric diagnosis? GM: Society is mad in the sense that it’s not
aligned with human needs. I have experienced depression. I was very grateful for the impact of antidepressants. I have seen people who tell me that the diagnosis of bipolar disorder and taking lithium literally saved their lives.
I don’t want to be evangelistic about any particular point of view. What I can say is that people’s psychosis and depression and bipolar tendencies all have meanings that are related to their life experiences and we can help people much better if we take those life experiences into account than if we just see them as having this ‘illness’. One doesn’t have to deny there is physiology involved in what we call mental illness, just as there is physiology in physical illness, but to look only at what we understand about the physiology – which, in the case of mental illness, is very little, by the way – is far from the whole story. Many British theorists, Joanna Moncrieff among others,2 make the valid point that no one has ever accurately identified any physiology when it comes to any mental illness. Having said that, we also know that, in some cases, medicine that changes people’s brain physiology can be of some help. I have experienced that myself and so one doesn’t want to be dogmatic one way or another. I am just saying it is so much more helpful to see every manifestation of what we call illness, whether physical or what we call mental, as a manifestation of a life, a life history and a multigenerational life history, in the context of a certain society. If we reflect on all that, we can be much more effective in helping people, no matter what their issues are. Biology rarely provides the full picture, least of all in what we call mental illness.
CJ: The model you use to work with trauma is ‘compassionate inquiry’. Can you tell us a bit about how it works and achieves what it does? GM: First, it’s just a name. For a number of
years, people kept telling me I had to teach the method of how I worked, and I said, ‘I can’t teach it because I didn’t learn it. I didn’t consciously develop it. I just do it.’ Finally, they convinced me and, with the help of others, we developed a formal training that hundreds of people are now taking online, internationally.3 So I had to call it something. It’s not like I sat down to design a programme called ‘compassionate inquiry’. But it seemed to fit the bill, because it is an inquiry – it’s asking, ‘What is this all about, what does it represent?’ And it’s compassionate in that it totally eschews any kind of judgment. It’s not, ‘Why did you do this?’ it’s, ‘Hmm, I wonder why you did this?’
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One of the ways it works is that it very quickly drills down to what the issues are – it’s a way to very quickly get at the heart of the issue and help the person develop compassion for themselves. But it’s not, ‘Here’s this method, that is all you need to know.’ It’s entirely about how you approach people and help them to recognise that, if they did develop that pattern of behaving, there is a very good reason for it; that is how they survived, that is how they coped, and to ask themselves, ‘Is it still helping?’ If the answer is no, then it’s, ‘Let’s see how it is showing up in your life and how you can drop it.’ That’s the intent of compassionate inquiry.
CJ: It has a lot of resonance with person-centred counselling – the listening, unconditional acceptance, non-judgmental positive regard – what you call ‘presence with acceptance’. I’m also interested that you also say, ‘We are hurt in relationship, so healing will happen in relationship.' Is it all about relationship? Is there no place for technique in healing? GM: Yes, the wounding happened in
relationship so the healing for the most part has to happen in relationship. Stephen Porges says, ‘Safety isn’t the absence of threat but the presence of connection.’ That is what I apply in my compassionate inquiry work. The vast majority of what makes therapy effective, according to the research, is about the relationship itself. Therapy is not a surgical technique; the patient is not unconscious and we are not operating on them. We don’t do therapy with people who are asleep. They may be psychologically unconscious of all kinds of things but all I do is wake them up to what is going on. But to be able to look at themselves, they have to feel very safe, because when they are safe, their own natural healing process can unfold. That is the nature of life – there is
‘People’s psychosis and depression all have meanings that are related to their life experiences’
healing capacity but what is needed for that to unfold is safety. I’d rather be with somebody who is capable of being present with me and compassionate, and can give me that connection, than with somebody who is superclever, with all kinds of insights and techniques, but is disconnected from themselves and therefore can’t connect with me.
CJ: You also talk about fierce compassion. What’s that? GM: Ordinary human compassion is, ‘I am
suffering and you feel bad for me and wish I wasn’t suffering.’ That’s not enough. You might feel bad to see a drug addict injecting in the street, but if you are not curious about what happened to them, you can’t really help them. There has to be some desire to understand, which means having to drop your judgments and look at what happened to this person. That means going to the next, deeper level. You also cannot help them much if you are not ready to understand that you are just the same as that person; the same dynamics are going on inside you, you are just more fortunate, perhaps. You are not as able to help them because you see them as ‘other’. Then on the deepest level, you want this person to recognise the truth about themselves, and that’s what I mean by fierce compassion. The truth hurts. The fact that your mother and your father didn’t love you the way you needed to be loved – that’s painful. A lot of people spend their whole lifetime running away from that pain, including with addictions, for example.4 This whole society is based on people running away from pain, using all kinds of distractions. But, if I am afraid that you are going to experience pain, I can’t help you. Compassion is not about helping people avoid the pain. It’s about helping people face it. People say, ‘Oh that will hurt, it will retraumatise people.’ No, it won’t. The trauma happened in the first place when people, usually in childhood, tried to deny and escape from their pain because there was no one to support them. The point of therapy is not to deliberately cause pain but to understand that, when you are doing it right, the pain will emerge. In fact, if it doesn’t emerge, you are not helping. So fierce compassion is not being afraid of people experiencing pain. It is about being there for them in a way that can help them face that pain, which as children they couldn’t and
‘The question is, are we going to learn the lessons that have been here to be learned all along?‘ that’s why they developed the problems in the first place.
CJ: Finally, I’m interested that you apply these same concepts of trauma and its effects to communities and societies in general. How should we be acting after the ‘awakening’ of COVID-19 and the Black Lives Matter protests? GM: My first question is – why did we need
this to wake us up? What is new about American police brutality towards black people? Why did it take the death of George Floyd for the people of Bristol to recognise that they had a monument to a slave owner in their city’s midst? The real question is not what should people do but will people go back to sleep or not? Will we have learned? Will we be able to look at ourselves compassionately, not blaming ourselves for being racist but asking, ‘What was it that put me to sleep to those dynamics?’ In the UK, as you know, the first 10 doctors to die of COVID-19 happened to be from the BAME community. What a coincidence. First of all, often those people are in the front line; second, they are the most stressed, and the more stressed you are, the more likely you are to get ill. So COVID-19 is not uncovering anything new. It’s lifted the veil, but this society has a tremendous capacity to draw the veil back down over uncomfortable truths. So it’s about what capacity do we retain to keep looking at uncomfortable truths. If we are willing to look truth in the face, we’ll know what to do. The question is, will we just retain this time as a bad memory and go back to ‘normal’ business, or are we going to learn the lessons that have been here to be learned all along?
CJ: Thank you, Gabor, for your time. GM: It’s my pleasure.
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About Gabor Maté Dr Gabor Maté is a speaker and teacher with more than 20 years of family practice and palliative care experience and knowledge of research. He has written several books, including the award-winning In the Realm of Hungry Ghosts: close encounters with addiction; When the Body Says No: the cost of hidden stress; and Scattered Minds: a new look at the origins and healing of attention deficit disorder. Dr Maté will be headlining the international speaker line-up at the AD4E Online Festival on 18 September. www.adisorder4everyone. com
About the interviewer Catherine Jackson is a freelance journalist specialising in counselling and mental health.
REFERENCES 1. Maté G. When the Body Says No: the cost of hidden stress. London: Vermilion; 2019. 2. Moncrieff J. A Straight Talking Introduction to Psychiatric Drugs (2nd ed). Monmouth: PCCS Books; 2020. 3. https://compassionateinquiry.com 4. Maté G. In The Realm of Hungry Ghosts: close encounters with addiction. London: Vermilion; 2018.
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Coaching has joined the fight for social justice, helping clients challenge disadvantage one step at a time, says Carolyn Mumby
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one are the days when coaching was only seen as an executive perk, an expensive privilege focused on performance management. Coaches now work across all levels of organisations, small and mediumsized enterprises, start-ups and the third sector. But what’s less well known is that a growing number of coaches are using their skills to reach and work at depth with groups disadvantaged by society, whose circumstances may be complex and chaotic. And leading the wave are dual-trained practitioners, therapists who have gone on to qualify in coaching, often driven by a sense that clients need more than just a ‘safe place to talk’. Many are setting up coaching projects to tackle both individual growth and broader social change. Coaching is appearing alongside counselling provision, supporting recovery from substance misuse and eating disorders, and early research suggests an integrated coaching and counselling approach can work well for young people, particularly in services that offer a variety of provision for them under one roof.1 Part of the appeal of offering coaching is that it comes with less stigma attached than counselling, says Katharine Collins, BACP registered therapist and coach, who set up the Out and About project in Hackney, east London, to offer coaching to older LGBTQ+ people at risk of social isolation. ‘Counselling
is still associated with weakness and failing by many people,’ she says. Coaching can also offer more flexibility in terms of number and frequency of sessions. As Collins points out, ‘For people struggling with multiple disadvantages and often chaotic lives, it does not require a weekly commitment.’ Coaching’s flexibility also extends to its remit, allowing coaches to help clients find solutions to practical problems in a way that some counsellors may feel is at odds with their modality. ‘Coaching is about building a sense of agency and control in relation to what is happening around you,’ says Catherine Macadam, co-founder of Coaching for Unpaid Carers, a community interest company. ‘At our project, this combination helps carers to manage stress, maintain motivation and resilience, improve their quality of life and continue caring, if that
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is what they choose to do. It teaches people strategies and techniques that they can continue to use to coach themselves once the coaching is finished.’ Coaching’s focus on positive qualities rather than perceived deficits means it can empower people in ways that counselling does not, believes David Britten, therapist and coach and a senior lecturer at York St John University. He led research into a mental health recovery project set up by Mind in York that provided coaching for people with serious and enduring mental health problems. ‘Coaching has been seen as only for the mentally robust, but mental health and illness is not on a one-dimensional continuum,’ he says. ‘The emphasis of the project was not on clinical cure but on personal recovery, on finding a way to live a meaningful life, even while still experiencing
significant mental health problems. We chose to use coaching rather than counselling because my experience and my research suggest that coaching can empower people in ways that counselling does not necessarily achieve.’
Broad reach Coaching can also reach clients who would be reluctant to come to counselling, believes David Weaver, senior partner at DWC Consulting and President of BACP. As well as being an executive coach and consultant, Weaver works pro bono with young black men involved in or at risk of serious violence in London. ‘Coaching appeals to younger people because the name “coach” has an alignment with sports coaching and improving personal and team performance in a positive way,’ he says. ‘This sometimes appeals more than sitting down and engaging in therapy that doesn’t seem to take them anywhere and may feel more like something being done to you rather than with you.’ Clients find Weaver through word of mouth in communities
where the established structures aren’t providing access to therapeutic support. ‘Young boys at risk of involvement in serious violence are often suffering from and exhibiting some of the effects of trauma, for a whole host of reasons,’ Weaver says. ‘From school onwards, people aren’t imagining they will achieve. This is compounded by deprivation, alienation, discrimination, including high levels of Stop and Search and poverty. As they grow up, they increasingly feel let down and unable to engage with institutions. But if, when you’re engaging with them, those young men realise that you understand what they’re going through, you become
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relatable on that fundamental level, and they are more likely to engage. I think that’s what coaching can do, and what counselling could and should do more of, and doesn’t always do.’
Values and strengths Recognition of the client’s own expertise and equal worth is core to coaching’s appeal and its effectiveness, particularly in circumstances where they may feel that society judges them as less deserving or able. In this ‘partnership of equals,’2 the coaching client is seen as the expert on themselves and their world, and the coach as an expert in guiding the process. As well as creating a working relationship based on equality, coaches support clients to identify their values, existing strengths and purpose, which forms a strong foundation for creating change. ‘Clients invariably leave coaching feeling good about themselves, and with a greater sense of power and self-agency,’ says Collins. ‘This allows them to tackle the problems they encounter from a stronger and more resilient place. Being able to see that they can effect change in their own lives naturally leads to the belief that they can effect change in their wider communities.’
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Working from values and strengths does not mean that problems and difficulties are ignored. At the York Mind project, many clients were long-term users of mental health services, with multiple diagnoses that often affected their ability to function in everyday life. Despite this, there was an emphasis on seeing the potential in the person rather than seeing and approaching them as fundamentally broken. ‘To be consciously aware of our personal values and how they might shape the way we are in the world contributes to a positive sense of identity,’ says Britten. ‘Identifying and using strengths and finding ways to exercise them in the world is a key aspect of coaching.’ Within black communities, people often find themselves in situations where the narrative is about how bad it is – and currently it is, says Weaver. ‘The disproportionate impact of COVID-19 and the stress of this has created trauma in our communities, along with the wider narrative around race equality, as a result of the murder of George Floyd. Coaching can enable people to realise “we are better than this” because of that focus on looking at – but also beyond – the condition or the situation that you find yourself in now. Coaching can work with individuals and within communities by asking, “How do we move forward?” In coaching, we identify achievable steps and that has been shown to develop a sense of self-efficacy and possibility. There may be less emphasis initially on conventionally high achievement when clients are starting from a place of disadvantage due to their health or circumstances. Nevertheless, the gains can be powerful.’ Britten also emphasises the impact of an improved sense of agency. ‘There might be relatively small gains where people are significantly impaired in their ability to function but those changes for them are incredibly important. Some of the changes represent a massive change to the quality of their lived experience. ‘The research3 showed that the coaching outcomes in the mental health project included a greater sense of hope in the clients and the belief that it is possible to live a different and better life. Clients were able to separate their sense of identity from the mental health condition and gained greater self-awareness and self-acceptance. They became more assertive and developed more
’Being able to see that they can effect change in their own lives naturally leads to the belief that they can effect change in their wider communities’ agency, feeling less like they were a cork in the sea of life.’
Political process Dr Hany Shoukry, an honorary research associate at Oxford Brookes University who writes about coaching for social change, argues that in every situation where coachees are part of an oppressive social structure, coaching becomes a political process, even when it takes place under the banners of life, career or development coaching.4 Coaching ‘helps resist oppression from the inside out’ because of its capacity to enable personal transformation and action, but coaching services informed by social justice also aim to go further and challenge the traditions that have portrayed social problems as individual problems with individual solutions, he argues. Collins thinks that ‘one of the most brilliant and beautiful tools of coaching’ is to uncover and rewrite untrue limiting assumptions.5 ‘Nowhere is this more powerful than when working with disadvantaged social groups, who cannot help but internalise some of the messages they receive that they are not good enough, inferior, unacceptable, or undeserving,’ she says. ‘This may show up as internalised homophobia, biphobia, transphobia, racism or misogyny.’ Being able to connect personal struggles to wider issues of prejudice and social injustice can be very freeing and empowering, says Macadam, because it moves the conversation away from perceived personal failure or weakness. ‘Coaching can enable people to work out how to juggle the demands of
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work and caring, develop their careers and become or remain economically active,’ she says. It’s fine to say you ‘work with what happens in the room’, says Weaver, but ‘if you’re limited by that, and you’re not acquiescent with what really matters out there, it’s not going to be effective. I’m not saying models don’t matter; of course they do, and there’s nothing wrong with being committed to your particular approach. But if it’s at the expense of really looking at the new world that we’re living in, there is that dissonance. If we don’t do that, I think it’s professionally irresponsible.’ Macadam is in the early stages of researching client outcomes from Coaching for Unpaid Carers, in order to build a case for coaching to be made more widely available to support social justice. ‘We have chosen Realist Evaluation,5 a mixed methods approach that allows us to collect and analyse a range of data to explore and explain what works, for whom, in what respects, to what extent, in what contexts, and how, and test our hypotheses about these questions.’ The coaching community is increasingly engaged in thinking about why circumstances are making many in our communities feel anxious and the increasing rates of depression, says Weaver. ‘I think too often we start from seeing that people have a need for support, but we don’t talk about the “why”.’ As Shoukry says, in order to create social change, coaches must see experiences and meanings as socially constructed and try to ‘balance a belief in human agency, and awareness of social structure’.4
Coaching those with power Meaningful change needs to happen at organisational as well as at a local community level, and for years coaches have been talking about the ‘volatile, uncertain, complex and ambiguous’ (VUCA) world, challenging old leadership paradigms of command and control. Hetty Einzig, an executive coach in leadership development and author of The Future of Coaching,6 challenges coaches to act ‘as positive deviants’ when organisations have become corrupted by denial and unethical behaviour, in the service of a more dynamic inclusivity that is needed to face the challenges of a VUCA world. Ideas for change include dynamic circle leadership, where leadership resides not in
embedded as ‘part of the daily micro-battles of emancipation and social change.’4
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one person but in the centre of the circle, encouraging collective power rather than top-down authority. By paying attention to how clients may be acting like ‘canaries in a mine’, instead of focusing just on individual distress and performance, coaches are asking themselves what is being said about and by the organisation, and wider social structures. Coaching can play a role in creating reflective learning organisations that expose ‘inequality and biases rather than perpetuating them’,4 if it is seen as a resource available throughout the organisation and placed in a context that is beyond performance management. ‘Where there are allegations around bullying and harassment, a council will typically come up with recommendations, create policy frameworks and kick it into the long grass of policy development and analysis,’ says Weaver. ‘But the key thing required is empathic leadership: stepping into the other person’s shoes, really understanding them in a deep way, by engaging in deep listening.’ A recently published paper7 by A Blueprint for Better Business, an independent charity that works as a catalyst to help businesses be guided and inspired by a purpose that benefits society, challenges companies to be a force for good and contribute to a better society. It argues that ‘PLC boards must step up now to meet the challenge of societal expectations and to do this, they need to commit seriously to becoming “purpose-led”.’ To this end, A Blueprint for Better Business has produced a document with six questions for boards to ask themselves. By impacting at every level in the system and recognising both the significance of social structure and the client’s ability and agency, coaching is
Collins believes coaching can widen the way we see ourselves and others, challenge our thinking and beliefs and call us to take greater responsibility for ourselves and our impact on the world around us. ‘It is not the job of those who are socially disadvantaged to create change. That responsibility lies in all our hands. We all benefit from living in a fairer and kinder society,’ she says. Britten advocates for a more widespread adoption of a coaching approach by professionals working at the interface of state and society. ‘York City Council has been exploring using coaching skills as an approach to facilitating people’s ability to access services in a less dependent way,’ he says. When we talk about social justice we are talking about difference, says Collins. ‘So key for me is that the coach has done some work on their relationship to their own and others’ difference.’ Weaver has been working with a local authority to enable it to identify the groupings that are being disproportionately impacted as a result of COVID -19 and to help them create more holistic models of support. ‘Not just looking at what does this mean for you back in the workplace, but how are you as an individual being impacted by what’s happening out there? It’s not just around the depression and anxiety, because some of them have been more impacted by Stop and Search, which has gone up in lockdown for those in the BAME community. In some communities, numbers of serious youth violence went down in lockdown, but as lockdown eases there’s a strong likelihood this will increase and impact those communities.’ There is an advocacy role to play, he says: ‘Extol the virtues of coaching innovation in communities, work alongside, encourage them into the profession, show it actually works. Coaching is such a powerful entry point. And we’re not saying that it stays at coaching, because it may move towards counselling interventions, and if it’s too compartmentalised, there’s no crossfertilisation. But coaching, like counselling, is changing lives.’ Extended interviews with the coaches in this article will appear in the October issue of Coaching Today. See www.bacp.co.uk/bacp-divisions/bacp-coaching
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REFERENCES 1. Flynn AT, Sharp L, Walsh JJ, Popovic N. An exploration of an integrated counselling and coaching approach with distressed young people. Counselling Psychology Quarterly 2018; 31(3): 375-396. 2. Rogers J. Coaching skills: a handbook. Maidenhead: McGrawHill, 2012. 3. Pendle A, Rowe N, Britten D. Coaching in a non-clinical setting with coachees who access mental health services. International Journal of Evidence-Based Coaching and Mentoring 2017; 15(1): 78-93. 4. Shoukry, H. Coaching for social change. In: Bachkirova T, Spence G, Drake, D. The Sage handbook of coaching. London: Sage; 2016. 5. Kline, N. More time to think: the power of independent thinking. London: Cassell; 2015. 6. Einzig H. The future of coaching: vision, leadership and responsibility in a transforming world. Abingdon: Routledge; 2017. 7. Blueprint for Better Business. Purpose for PLCs: time for boards to focus. London: A Blueprint for Better Business; 2020. www. blueprintforbusiness.org/wp-content/ uploads/2020/07/Purpose-for-PLCs_ Blueprint.pdf
About the author Carolyn Mumby is a coachtherapist, supervisor and trainer in private practice in London, and the Chair of BACP Coaching. Carolyn is also trained in using the Thinking Environment® to enable organisations to access the best independent thinking of all their people. Her writing about coaching includes a chapter on working with young people using an integrated approach in Personal Consultancy: a model for integrating counselling and coaching by Popovic and Jinks (Routledge). www.carolynmumby.com
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Using neuroscience to map the whole person
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herapists now have a map of the whole person that is rooted in human biology. More precisely, we have a series of maps derived from the work of various neuroscientists that combine to form an overview of the psyche, mind and body. Neuroscience shines light on the heart as well as the head, on feeling as well as thinking, and on what happens in relationships. It offers fresh insights into what can go wrong in human development and what can go right. Like maps we use to navigate the world, these neuroscience maps are not the territory. Rather, they are a means to orient ourselves in the therapy room. Once oriented, we can put them aside and explore the nature of the particular landscape we find ourselves in with individual clients. Neuroscience can open up the territory in illuminating ways. I will outline six maps that, together, I believe, give us this comprehensive view of the person. I will then describe their relevance to some features of the landscape often encountered in therapeutic journeys.
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and fuelling our emotional life. The other, the parasympathetic nervous system, does the opposite, slowing us down so we unwind, relax and sleep. We need a balance of both – enough sympathetic arousal to function and find life meaningful, and enough parasympathetic calming to rest and recover from life’s stresses. Imbalances in the autonomic system bring people to therapy. Examples include the excess of sympathetic arousal that occurs in anger that wrecks relationships, or the excess of parasympathetic slowing and shutdown involved in dissociation or chronic fatigue.
MAP 2: Neural architecture across three axes
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MAP 1: The nervous system Neuroscience concerns the nervous system – or systems, because to understand the whole we need to know the parts. The nervous system shows us the body as well as the brain. The latter is part of the central nervous system that includes the spinal cord. So, in discussing the brain, we are looking at an anatomical structure that descends deep into the body. The rest of the body is animated by the peripheral nervous system that links the brainstem (at the base of the brain) and the spinal cord to every corner of the body. Restricting our gaze to the brain in the head means missing the reality of brain and body working together. A substantial chunk of both central and peripheral systems is the autonomic nervous system. This determines what happens in our body that we cannot control directly: heart
rate, blood pressure, arousal, digestion and so forth. The exception is breathing, which is both autonomic and consciously controlled; hence the value of breathing techniques to calm the body and thereby calm the mind. To understand the autonomic system, we must follow its anatomical division into two branches. One, the sympathetic nervous system, raises arousal levels, waking us up in the morning, energising whatever we do
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From this brain and body starting point, we can appreciate the brain itself in terms of three structural axes. The first is the topbottom axis, although it’s also a bottom-top one, since the brain evolved bottom-up and neural development in childhood follows the same direction. The top is the cortex, the familiar wrinkly stuff in brain images, while the bottom is the collection of oddly shaped areas (including the amygdala, hippocampus and brainstem) that sit underneath and that comprise the subcortex. A rough way to characterise what they do is that the subcortex generates possible actions and the cortex sifts these and chooses the best one. A client’s chaotic behaviour may reflect an untrammelled subcortex, whereas his coherent behaviours, including defensive ones, may reflect his cortex fine-tuning subcortical impulses. The second is the front-back axis in the cortex between the frontal lobes and the three posterior lobes (occipital, temporal, parietal). The latter receive sensory signals from eyes, ears and viscera (bodily organs and so forth), while the former receive the fruits of sensory processing in order to integrate them into a ‘higher-order picture’. The more sophisticated a creature’s social life, the bigger their frontal
lobes – hence humans and dolphins have particularly large ones. A simplified way to describe the front-back axis is that the posterior lobes enable fast, habitual reactions and the frontal lobes enable slower, reflective responses. In therapy, we bring the frontal lobes to bear on experience and behaviour so the client learns to inhibit habitual reactions that lead to unhappiness. The third is the left-right axis that reflects nature’s most visible divide in the brain – the one between the cerebral hemispheres of the cortex. Why has evolution opted for two brains instead of one? McGilchrist believes that dividing the brain in two enables both focused attention to the foreground (left hemisphere) and, simultaneously, open attention to the background (right hemisphere), allowing a creature to focus on its prey so it can eat, while being alert to predators lest it is eaten itself.1 The divide also allows the right hemisphere, which has richer connections with the subcortex and body than the left, to work as an ensemble with the bodily viscera, while the left can function more independently from the body. The brain gets the best of both worlds: the right keeps inner and outer (including other people) worlds in sync with each other, freeing the left to focus on specific tasks (such as constructing sentences). Hence the left hemisphere says ‘I have a body’, while the right says ‘I am my body’. In one, we can feel disconnected inside; in the other, we can feel at one with body and feeling. The left-right axis is of great significance in therapy. It helps us to understand the fragmentation of traumatic experiences and points to the need to balance cognitive work with affective work. The therapist can guide the client towards the inner world of his right hemisphere where the felt sense of the whole situation and his emotional vulnerability, unresolved trauma and ‘real self’ await him. Understanding the left-right map requires both hemispheres. We may think we have understood something when, in reality, only our left hemisphere has. Real understanding requires reflecting on our experience over time so that the right hemisphere gets a feel for the nature of the divide.
MAP 3: Polyvagal theory Our nervous systems must relate to other people’s nervous systems if they are to thrive and prosper. Stephen Porges’ polyvagal
theory elaborates the two-way division of the autonomic nervous system into a three-way division, involving the vagus nerve, that explains autonomic states in relationships:2,3 • safety – the ventral vagus (cortically controlled) balances sympathetic and parasympathetic nervous systems, enabling rewarding social engagement and a good therapeutic relationship • danger – the sympathetic nervous system (triggered subcortically) dominates, fuelling human versions of fight-flight behaviours, defensiveness and conflict • life threat – the dorsal vagus (evolutionarily old and controlled from the brainstem) brings on freezing, shutdown, dissociation and overwhelming shame. The three states can overlap. Therapy requires safety, but danger can lead to breakthroughs, and there can be recovery from life threat. Much human behaviour that is considered normal is actually an enactment of fight-flight reactions, yet nothing creative in human affairs happens without social engagement. Polyvagal theory helps us to see the distinctions.
MAP 4: The window of tolerance Relationships evoke feelings, and polyvagal theory aligns with the window of tolerance that maps our emotional arousal levels.4,5 Safety is found within the window, where we can tolerate our emotional reactions to each other without losing our sense of self and other (the technical term is ‘affect regulation’). Outside the window, danger threatens in the form of hyper-arousal: we are overwhelmed with emotion and act out. And danger can become life threat – a state of very low arousal where we collapse inside and emotions shut down. The window of tolerance and polyvagal theory are concepts that can both be simply explained to clients. They normalise a lot of distressing experiences and may make more sense than psychological explanations.
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MAP 5: Core emotional systems Neuroscience looks for emotions among specific neural pathways and neurochemicals. Panksepp outlines seven primary emotional systems, as follows:6 • SEEKING – the motivation to get what we want, including seeking help from therapists and meaning in life • RAGE – our anger when we don’t get what we want, sometimes enacted in the transference in therapy • FEAR – our reaction to threat, and a part of traumatic experience • CARE – our instinct to care for our children and for each other, central to intimate relationships, including the therapeutic one • PANIC-GRIEF – separation anxiety and grief when we lose a loved one, key to mourning our losses • LUST – the urge to continue the species, sometimes felt in therapy but not acted out • PLAY – how young mammals develop their social skills and older ones enjoy life – and an aspect of creativity in therapy. This is a bottom-up and evolutionary view of our emotions. A top-down, psychological perspective might lead us to a different basic set, but Panksepp’s biological schema covers the emotions we might hope to evoke in therapy.
MAP 6: Different levels of emotional control Another contribution from Panksepp is a three-level mapping of emotional control in the brain. The primary level, centred in brainstem areas, comprises the seven emotional systems just described. This is where fear, rage, grief and so forth are triggered in their raw state, as when catharsis erupts in the therapy room. These primary emotions lie waiting in the wings for even the most shutdown clients. The secondary level is centred higher in the subcortex, in areas such as the amygdala. Here lie engrained emotional habits that we struggle to control, such as over-anxious reactions or difficulties saying ‘no’. This is where primary emotions are elaborated into the spread of all our other feelings. Shame is a good example: a fundamental feeling and state, but not a primary emotion. Where we can exercise control is at the tertiary level in the cortex. Here, we can choose to bring our emotional lives and
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behaviours into awareness, reflect on them, and experience them in the presence of another. Therapy can only work directly with this level, but the primary and secondary levels manifest when the dialogue is meaningful, and then our frontal lobes can get to work.
‘Some things that happen in therapy are better seen from a biobehavioural angle’
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How can the neuroscience maps help us orient ourselves in the therapy room? Here are some suggestions.
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Conscious–unconscious. Most brain activity is unconscious, and probably always will be. But a line dividing the conscious mind from an unconscious one cannot be found in the brain. The left-right axis is not such a divide: left hemisphere activity is more foreground and right hemisphere activity more background. But if we turn our attention to the background (felt sense, non-verbal communication and so forth), whatever is there can come into awareness. The notion of the unconscious risks confusing background feelings with dissociated sensory and emotional fragments of experience following trauma. They should be kept apart; clients can be encouraged to bring background things into the foreground, but trauma fragments must be allowed to appear in their own time, lest the client become retraumatised. Unconscious works better as an adjective than as a noun. Unconscious feelings can come into awareness, and forgotten memories may be remembered, but there is no unconscious mind as a place to search for supposedly ‘repressed’ feelings and memories. Defence–dissociation. Psychological defences are left hemisphere devices – suppression, avoidance and denial of what is rooted in the right hemisphere, such as painful feelings and interpersonal situations that might pitch us from polyvagal safety into danger. Dissociation, by contrast, is a right brain phenomenon in which the normal integration of the sensory, emotional and cognitive aspects of experience turns to fragmentation, leaving us adrift inside. Dissociation is often described as a defence, but this, in my opinion, is surely wrong. We have a degree of choice over whether to be defensive, but none when we dissociate. Defences can be challenged,
but clients can be helped to recover from dissociation. The two concepts overlap in that we defend against experiences in which we risk dissociating (again) and experiencing the accompanying shame. Psychological–biobehavioural. Some things that happen in therapy are better seen from a biobehavioural angle than a psychological one.2 For example, when dealing with trauma and dissociation, old emotions erupt and need support rather than interpretation, and dissociative states require the therapist to help the client come back into their body. Therapists can psychologise anything, but it may not always be helpful to do so. Explicit memory–implicit memory. Explicit memory is our autobiographical memory of our life story and of facts we have learnt. Implicit memory is of our somatic and emotional experience that we can never recall but which we enact on a regular basis. The former is only available from around the age of two because it requires the hippocampus, which is insufficiently developed until this point. Implicit memory, on the other hand, starts in the womb, and plays out in patterns of attachment and affect regulation that clients enact in their relationships, including the therapeutic one. Therapy involves both kinds of memory but working with them is quite different. Foreground mind–background bodymind. Instead of the fundamental divide in the psyche being between conscious and unconscious minds, I think neuroscience supports one based on nature’s divide between the hemispheres. Our left hemisphere mind is generally foreground – speaking, interpreting situations, puzzling things over, inventing excuses, rationalising and so forth. Our right hemisphere mind is more entwined with the inner life of the body, so can
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be described as a bodymind in the background of our experience. Emotional body states, the felt sense of what’s happening, our capacity for images, transference and countertransference and much more arise here. Therapists have been hearing about bits of neuroscience for some years now, and many trainings and workshops include some. But bits tend to be bitty – a neurochemical here, a brain area there. What is lacking is an overview, a contextual understanding into which we can fit the details. Having taught and written about neuroscience for many years, I think such an overview exists. It requires us to do what neuroscience itself, with its research specialisations, seems reluctant to do: to weave together a map of the whole person. Given our wide-ranging engagement with human nervous systems in our consulting rooms, I think we may be better placed than neuroscientists to do this.
About the author Peter Afford is a counsellor and therapist in south London with more than 25 years’ experience in private practice. He has been developing courses in neuroscience for counsellors and therapists since 2004. He is the author of Therapy in the Age of Neuroscience, recently published by Routledge. www.peterafford.uk
REFERENCES 1. McGilchrist I. The master and his emissary. London: Yale University Press; 2009 2. Porges S. The pocket guide to the polyvagal theory. New York, NY: Norton; 2017. 3. Porges S. The polyvagal theory. New York, NY: Norton; 2011. 4. Siegel D. The developing mind. New York, NY: Guilford Press; 1999. 5. Ogden P. Emotion, Mindfulness, and Movement. In: Fosha D, Siegel D, Solomon M (eds). The healing power of emotion. New York, NY: Norton; 2009 (pp204-231). 6. Panksepp J, Biven L. The archaeology of mind. New York, NY: Norton; 2012.
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‘The presence of gentle masculinity was crucial to my finally realising I didn’t have to run away anymore’
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or a long time, I both sought out and avoided men in equal measure. My relationship with my father had never been good and this was compounded when I started having sexual relationships. By the time I was in my mid-20s, I had completely lost my trust in men. Unsurprisingly, this didn’t make my relationships improve. I would doggedly pursue the most avoidant men I could find and still feel surprised when they avoided me. I was so terrified of being abandoned that I would dare my partners to do it anyway – a horrible game of emotional chicken. I wasn’t completely without self-awareness, and I knew there were deep problems with my relationships and the way I saw the world. But there was some reality to how I felt – it wasn’t stupid or without grounds: men had harmed me, why would I trust them? So, when I decided to go back into therapy in my late 20s, I was sure I would work best with a woman. I felt safer with women, I reasoned, so it made more sense. Working with a man would only have added resistance to a process I knew was going to be difficult anyway. Could I talk about trauma with a man? I couldn’t imagine it, and that was enough to stop me considering it as an option altogether. I was serious about the work I wanted to do, so I spent some time shopping around, surfing websites and emailing questions to ensure I found the right fit. My first meeting didn’t go well. The therapist and I clearly had different outlooks, and I experienced her tone as irritable. Perhaps I was being irritating, but it still felt wrong. Back at my computer that evening, I came across another profile that appealed to me, even though he was a man. I sent a message. What developed, in the end, was the most profound therapeutic relationship I’d ever had. On some level, I’d always known the equation in my head of ‘men equal harm’ was simplistic, but I hadn’t quite got to the point where I really believed it. The fact that this therapist was a man helped, not hindered. Here was a man who was gentle, who listened to me, and who was as far from harmful as you could imagine.
I also started unpicking more of my assumptions around my family history and the reasons behind my dysfunctional relationships and disorganised attachment style. There was no doubt that my relationship with my father had been deficient – I barely saw him and when I did, it felt distant and disappointing – but in my head, he’d started to take on disproportionate importance. Maybe that was down to the fact I didn’t want to take responsibility (‘my relationships are bad because my dad wasn’t there for me’); maybe it was because I simply didn’t like him as a person and found that hard to bear. His mother, like me, had been diagnosed with bipolar disorder, so there was always a murky feeling around that legacy, too. Plus, there was that popculture, warped echo of Freud: I had ‘daddy issues’, didn’t I? Working with a male therapist, and one around the same age as my father, softened some of these broad-stroke assumptions. I found I didn’t feel as bad as I thought about the fact that our relationship was bad. Actually, maybe there were other members of my family who had affected the way I moved through the world in a less obvious, more pernicious way? Before I started the therapy, I was worried about what I’d project and how it would colour the work. To my surprise, though, I didn’t see my therapist as a stand-in dad at all, and I realised that my relationships didn’t have to permanently mirror that dynamic either. Some of what worked was inherent to therapy itself, of course: going to the same place at the same time every week and knowing it was somewhere I was safe and would be listened to. It’s easy to romanticise these relationships, and I’d never want to imply that therapy was some magical process in which my trauma was simply excised like it was nothing. Some things you live with forever. Acknowledging the harm that had been done to me over the years seemed impossible with a man. But it turned out that the presence of gentle masculinity was crucial to my finally realising I didn’t have to run away anymore.
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About the author Emily Reynolds is a writer from London. She works at the women’s mental health charity Wish, is a trustee of the National Survivor User Network, and is studying for a master’s in psychosocial studies at Birkbeck, University of London.
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It changed my life
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The River of Life
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Rachel Dyer-Williams describes a person-centred response to COVID-19
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n the early days of lockdown, many of my clients clung to the hope that the pandemic would be a shortlived affair. While being mindful of the pitfalls of parallel processing at this strange time, I must admit to having similar personal hopes myself. The rainbows stuck to living room windows encouraged me on with this hope while I went about my daily walks. However, despite this initial optimism, we now understand the battle against COVID-19 will take longer than first expected. Lockdown may have been slowly eased but our hopes of a speedy return to normal seem to be fading. Instead, the chalked rainbows on the pavements have been washed away by the rain and politicians are telling us to prepare for a ‘new normal’. A ‘new normal’ may sound like a strange idea; if it’s ‘normal’, how can it be ‘new’? And if it is ‘new’, how can it be ‘normal’? Although I’ve just set up my own private practice, I currently volunteer as a counsellor for Treetops Hospice Care in Derbyshire, where person-centred therapy is provided for people who are bereaved or who have a life-limiting illness. At Treetops, a therapeutic concept developed by Dr Richard Wilson called the ‘Whirlpool of Grief’1 is sometimes offered to clients who are struggling with feelings of stuckness. Wilson, a consultant paediatrician at Kingston Hospital, worked closely with parents who had lost children through sudden infant death syndrome. He first devised the Whirlpool of Grief in the 1980s, when he became increasingly aware that conventional bereavement models used at the time were not supporting families adequately in their grief process.2 Wilson was well aware that grief can be turbulent, that the journey is uniquely personal, that feelings and progress can fluctuate and there isn’t always a straightforward route out of it. Therefore, instead of adopting a fixed treatment plan, he simply advocated listening to parents as they attempted to reorganise their lives. This concept, customarily known to colleagues at Treetops as the ‘River
of Life’, is offered to a wide range of clients, young and old alike, regardless of the type of bereavement they’re experiencing. It has been used at Treetops and other hospices around the UK for many years and I myself have seen how it can help clients to eventually accept their loss and move forward after the death of a loved one.
Life is a river Having witnessed the power this simple concept can have, I’ve come to reflect on its therapeutic benefits for any sudden change or trauma, be that the loss of a job, a romantic relationship, a home or physical health. During this time of pandemic, personal losses seem to be everywhere: from tragic bereavements with no chance to say final goodbyes and the burnout experienced by key workers, to losses of jobs, financial security, freedom, sense of self and purpose. I am beginning to believe, therefore, that the River of Life may be a helpful concept for counsellors once the inevitable outpouring of grief begins in earnest. The idea behind the River of Life is that our life is represented by a river and we are the boat. There we are, sailing along quite happily. Sometimes the weather can rock us about a little, sometimes the waters can be stormy, but, on the whole, everything seems OK. Everything is familiar to us on our river and we feel relatively happy, calm and secure. All is well. Then, suddenly and without warning, we sail over the edge of a waterfall and into change, and there’s nothing we can do about it. We suddenly have no control, as we are pulled from the waterfall into a whirlpool of emotions and are dashed against the rocks. Some waterfalls are bigger than others, but it’s
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perhaps fair to say that the COVID-19 waterfall has been significant for us all at some point this year. It’s probably also true that, in recent months, most of us will have felt pulled into a coronavirus whirlpool at some time or another. Both we and our clients may have experienced many different emotions as we are dragged into the torrent; fear, denial, shock, confusion, anger, frustration, anxiety and sadness are perhaps a few of the emotions we may have grappled with.
Emotional tumult Alex* was a 32-year-old client who’d recently been made redundant from his long-standing job. While he’d found his workplace atmosphere increasingly difficult, his feelings of relief soon gave way to a myriad of other emotions: rejection at being the only member of his team to leave, frustration at the loss of his career and income, fear of losing his home, anger at the benefit system he was now plunged into, anxiety for the future, and sadness that none of his former colleagues had contacted him to say goodbye. In hindsight, this was the whirlpool Alex was struggling with at the point we first met. The whirlpool can be a scary place, as clients grapple with their feelings. It’s no surprise most of them want to get out of this horrible emotional tumult as quickly as possible, but going forward is difficult when they don’t know how to proceed. Even when they do try to move on, the whirlpool of emotions often lies in wait, ready to pull them back towards issues they’ve not yet come to terms with. Sometimes clients don’t want to move forwards at all; they’d prefer to go back to their old river. Even though he knew it wasn’t possible to return to his job, Alex struggled with the uncertainty that losing his career triggered. Despite the toxic atmosphere, he would have gladly gone back in the early days of his counselling, because at least then he’d have been in familiar waters. Unluckily (and luckily) Alex couldn’t go back up his waterfall, so despite
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being in emotional anguish, he was stuck in the whirlpool. I listened with empathy and unconditional positive regard as Alex poured out his feelings to me each week. He had strong beliefs about people on benefits and those who didn’t ‘work hard’ or ‘succeed’ in life and, because his own situation had changed so dramatically, he now judged himself against these values. As the weeks went by, it became apparent there was a belief underlying his feelings: he felt a failure because he’d lost his job and couldn’t find new work. Being in the whirlpool enabled him to consider more deeply his ideas and to reflect on his childhood, where he’d often been in competition with his cousins over school grades and university offers. These same cousins now had secure, high-flying jobs, which added to his sense of failure. It transpired that Alex had denied and distorted for years a feeling of shame; even when he’d been working, he’d often felt not good enough in comparison with others who, seemingly, had better jobs than him. By working through his early experiences, Alex was able to consider how he’d learned to measure himself against these values. Staying with Alex as he explored in depth these issues was important, but not just in enabling him to overcome the experiences of redundancy. From this place of emotional anguish, he was able to get a handle on his underlying conditions of worth, which not only helped him to see his current experiences in a different perspective but enabled him also to re-evaluate the beliefs he’d been checking himself against. As Rogers said: ‘It seems to be true that early in therapy the person is living largely by values he has introjected from others, from his personal cultural environment.’3 In time, Alex came to reconsider his own values around success and failure, becoming more accepting of himself as well as more tolerant towards others. I wondered at the time whether, had he not experienced redundancy, he might never have had opportunity to actualise more healthfully for himself.
‘Time is an important factor... processing grief and loss should never be rushed’ It can be hard for us – clients and counsellors alike – to accept big, sudden changes but, according to the River of Life, the only way out of the whirlpool is to create a new river. We may well not want to; we may resist and refuse, or we may take a few tentative steps into the new river before retreating back, because it seems so unfamiliar. My experience of working with clients who’ve encountered loss and change is that time is an important factor. Having space to explore and accept all the feelings around their loss is key to making a new life, when the time is right for them. Processing grief and loss of any kind should never be rushed. How long this process takes is part of everyone’s personal journey, but it’s at this stage that counselling can be particularly useful, especially if clients find their own responses differ from those around them.
Overcoming guilt I worked with Michelle* for more than a year as she came to terms with the death of her partner, Jon. Although she’d been a loving and dutiful carer for many years, circumstances prevented her from being there in the last moments of Jon’s life. Guilt was one of the harder emotions for Michelle to come to terms with, particularly because her family couldn’t understand why she was so upset. Each time she tried to explain her feelings, they’d tell her she’d been a wonderful carer and she had no reason to blame herself. While this was clearly true, this external evaluation had no impact on Michelle, whose feelings of guilt seemed stubbornly unmoving, as week after week she attempted to
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tackle them, without success. I worked with Michelle in the early period of my training and my supervisor encouraged me to stay with her process. In personcentred terms, Michelle’s behaviour was purposeful; she was in the whirlpool for a reason. As Rogers found:3 ‘All needs have a basic relatedness… these needs occur as a physiological tension which when experienced, form the basis of behaviour.’ There were times when Michelle felt indefinitely stuck, but she arrived for counselling one day and suddenly announced that she couldn’t keep blaming herself; that forgiving herself was the only way she could move forward with her life. Time in the whirlpool had enabled Michelle to consult her internal locus of evaluation, in her own time and on her own terms, which, as Rogers says, can be ‘recognised not by what others say, but by examining one’s own experience’.3 And so, Michelle eventually determined that it was OK to feel guilt, but that it was OK to forgive herself too. While the whirlpool still had the power to occasionally pull her back, it was from this point that she was able to start taking steps into her new river. I have found that clients will gradually become more familiar with their new river in time; the more they’re able to paddle experientially within it, the less strange it begins to feel for them. They may even start to prefer parts of their new river to their old one. When they look back, they sometimes begin to consider that some parts of their old river weren’t as good as they’d previously thought. It would seem that, in the River of Life, there can be gains to discover as well as losses to mourn…
Betrayal and acceptance When I first met Rebekah,* she was recently divorced. She and her husband had been childhood sweethearts and had married young. One of the issues that was particularly difficult for Rebekah to accept was her sense of betrayal; she had bought into the notion of a ‘happy ever after’, while he’d turned his back on this ideal – and her – by leaving her for a younger woman.
several changes to her life in ways that enriched it and enabled her to feel fulfilled. With her newly acquired reflections, she had also begun a new relationship founded on mutuality.
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New normal
However, as Rebekah began to work through her feelings, she found herself reflecting on aspects of her marriage she’d previously denied, that perhaps hadn’t been as ‘perfect’ as she’d wanted to believe. She’d always taken part-time, less well-paid work so she could fulfil her role as a wife and mother. But in secret she’d denied her true feelings of unhappiness at being the ‘skivvy’ who always looked after everyone else. For years she’d told herself that she wasn’t clever enough to understand the household finances, which her husband kept in tight rein. She’d told herself repeatedly that it didn’t matter when he always chose the holiday destination. Rebekah really was adrift; not only had she lost her relationship; she’d lost her sense of self. Yet, as she began to take tentative steps into her new river, she was able to consider what she might do differently for her future. Rogers recognised that one aspect of becoming more fully functioning is the ability for the client to become more open to their experiencing – that a ‘woman may see only the good qualities of her prospective male, where an openness to experience would indicate that he possesses faults as well’.4 By the time we concluded our work together, Rebekah had the opportunity to make
The new normal in this world of pandemic is likely to create challenges for us all. There is no getting away from the personal ramifications for us, even though we are the counsellors. Of course, there will be professional challenges for us too. It was certainly never part of my plan to open a private practice during a pandemic! However, coronavirus isn’t the first challenge I’ve experienced in my 40-something years of life. I guess it won’t be yours either. But perhaps, by coming to terms with our own sense of change and loss, we will be better placed to meet and engage with our clients’ altered lives as the months unfold. Being more accepting of the situation ourselves will naturally allow us greater congruence when we sit with our clients. I don’t pretend the way forward is easy, or suggest that we deny or distort our clients’ COVID-19 experiences. But I’m beginning to wonder if we may, in time, consider the pandemic a watershed moment, where gains as well as losses were experienced, alongside endings, new beginnings and changes in direction. This might help us to hold a sense of hope for our clients during this time. As my own experiences in my work suggest to me, it might be an opportunity for clients to explore long-term issues that have lain dormant for many years, so that they can move towards greater actualisation and live their lives more congruently. I wonder what your own river of life was like before you slid down the COVID-19 waterfall? I wonder how you and your clients are coping in the coronavirus whirlpool? And, as we begin to reflect more deeply for ourselves and with our clients, I wonder whether there might be an increased sense that we have done all this before… ■ * The names and details of all clients have been changed to protect confidentiality.
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About the author Rachel Dyer-Williams trained at CTTM, a person-centred CPCAB centre of excellence in Nottinghamshire. She currently works part time in radiology at Nottingham University Hospitals and continues to volunteer at Treetops Hospice Care by video and telephone. She recently launched a private practice providing remote client sessions and also offers training on the River of Life. www. racheldyercounselling.co.uk
REFERENCES
1. Ward B et al. Good grief: exploring feelings, loss and death with overelevens and adults. London: Jessica Kingsley Publishers; 1996 (p69). 2. Hindmarch C. On the death of a child (3rd ed). Oxford: Radcliffe; 2009 (p47) 3. Rogers CR. Client-centered therapy. London: Robinson; 1951 (pp149-150; p491) 4. Rogers CR. On becoming a person. London: Robinson; 1961 (p119). © Rachel Dyer-Williams, 2020
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Counselling changes lives
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1 Physical presence (also known as light presence), including contact with other (superficial small talk), settling into the room/ chairs, awareness of own body 2 Psychological presence (partial presence), including hearing the story, checking in, listening, attending, attunement, caring, openness, and interest 3 Emotional presence (with and for the other), including understanding, compassion, acceptance, unconditional positive regard, responding or providing intervention or empathic response in resonance to what the client is sharing, transpersonal presence (presence with spirit), and contact with deeper intuition 4 Relational therapeutic presence (all the levels), including mutual contact as the goal, and vacillating (dancing) between what is needed in the moment of deep contact with self, with the client, and with a deeper intuition.
SUBS ART
Being there
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What does presence have to offer the supervisory relationship? asks Zoë Chouliara
CLIENT
I
am curious about the concept of presence. Presence is now widely accepted as an integral part of the therapeutic relationship. Less is known, however, about presence in the supervisory relationship. In this article, my aim is, first, to summarise current knowledge on presence, especially in the therapeutic relationship, and second, to highlight and reflect on the importance of supervisory presence, with reference to my own practice. Presence was first described as a phenomenon by Carl Rogers in 1986.1 He saw it as ‘one more characteristic’ of the therapeutic relationship, yet at the core of his therapeutic work. ‘When I am at my best... closest to my inner, intuitive self, when I am somehow in touch with the unknown in me, when perhaps I am in a slightly altered state of consciousness in the relationship, then whatever I do seems full of healing. Then simply my presence is releasing and helpful.’2 Reflecting on the above quote, Sanders3 commented that Rogers’ thoughts have
been interpreted in a number of different ways. They were seen by some as evidence of a spiritual connection between counsellor and client, and by others as an additional quality, or even an additional therapeutic condition. Presence can also be taken to be a kind of momentary ‘super psychological contact’. Similarities with the concept of relational depth, which is more systematically articulated by Mearns and Cooper,4 could also be drawn. They argue that presence and trust are more or less part of, or preconditions for, ‘relational depth’ experiences.
Skill versus presence? In the 1990s, Osterman and SchwartzBarcott5 developed and published a model of presence rooted in nursing, rather than counselling practice. Although this was not a therapeutic model as such, it is strongly relational and highly clinically applicable. According to Osterman and Schwartz-Barcott, there are four aspects of presence:
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Self and spirituality Therapists (unavoidably and thankfully) bring their personal qualities into the therapeutic work. This is often referred to in the literature as ‘use of self’. Presence is part of the therapist’s use of self in a therapeutic and multidimensional way. However, the model of evidence-based practice, the grading of evidence and NICE guidelines as the gold standard of practice, leave limited space in formal training and practice for presence. This is despite strong evidence for the pre-eminence of the therapeutic relationship over the theoretical model in relation to the effectiveness of therapy.6 There is the question of whether presence is a skill that can be taught. According to Geller and colleagues, who have done the bulk of work in this area, therapeutic presence is ‘... more than the sum of its parts. It is more than just being congruent, more than just being real, more than just being accepting of the client, more than being empathic, or attuned or responsive. It is a complex interplay of therapeutic skills and [the therapist’s] underlying intention of fully being in the moment and meeting that experience with the depth of one’s being’.7 Therapists’ intention and ability to be present with their clients provides an invitation to the other to feel met and understood. It is an offer to stay open and
become present within their own experience, as well as in the interactions with their therapist. Thus, presence has often been linked to relational depth because it allows for moments of deep connection.
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Grounded, immersed and expanded Geller and Greenberg have identified the components of presence.8 According to them, therapeutic presence involves being in contact with one’s integrated and healthy self while being open and receptive to what is poignant in the moment, and immersed in it, with a larger sense of spaciousness and expansion of awareness and perception. This grounded, immersed and expanded awareness occurs with the intention of being with and for the client, in service of their healing process. The authors conducted a study with experienced therapists, who were proponents or had written about presence and its importance in psychotherapy. Based on a qualitative analysis of therapists’ reports, a working model of therapeutic presence was developed. The model included three emergent domains: first, preparing the ground for presence, referring to the pre-session and general life preparation for therapeutic presence; second, the process of presence, such as the processes or activities the person is engaged in when being therapeutically present; third, the actual in-session experience of presence. According to Geller and Greenberg, presence is the foundation of Rogers’ basic conditions of empathy, congruence and unconditional positive regard and is the overarching condition that allows them to be expressed. The supervisory relationship We would expect that much of this knowledge about presence in the therapeutic relationship could be applied to supervision. However, according to Mullaly,9 presence and power within the supervisory relationship are not often reflected on, acknowledged or openly addressed. They do, however, exist and influence the individuals involved in both a conscious and a subconscious way. Mullaly found that the existence of these dynamics can affect the processes of communication, vulnerability and transparency, which in turn can determine the depth of the trusting
relationship and consequently affect the supervisory experience and benefit. While this research originates from pastoral work, rather than counselling or psychotherapy, given the overlap, the learnings can be highly relevant. Mullaly raises the key role of presence in regulating the power dynamic in the supervisory relationship. This is understandable, given that being fully present and congruent in the relationship can minimise overpowering and facilitate congruence and authenticity, as suggested by Natiello.10 McMahon11 has identified four guiding principles for supervisors’ engagement with supervisees. Presence features among those principles. The principles are: offering emotional presence and sensitivity; valuing both vulnerability and competence; offering knowledge and experience with humility, and developing a relationship to support continued personal and professional growth. According to McMahon, supervisors need both sensitivity and courage while engaging with supervisees’ personal and professional personas and their vulnerability and competence, in order to support the development of personally grounded, humble but confident practitioners. The links between presence and getting in touch with and accepting vulnerability, as identified both by Mullaly and McMahon, are of great interest in supervision. This is especially so as being in touch and in peace with your own vulnerability as a supervisor could potentially help identify parallel processes.12 In addition, it is bound to give permission to the supervisee to accept and integrate their own vulnerability. This, in turn, is key to organismic change and growth on self-level in clients. This is achieved by lowering defences and allowing integration of experience to self.
‘What you may lack in skill, you can make up for with presence. Skill without presence is not only ineffective but can also be risky and non-therapeutic’ THERAPY TODAY
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Reflections One of the main challenges I encountered in my own therapeutic training was to transition from an attitude that ‘skill is everything’ to the person-centred stance that ‘being’ is more important than ‘doing’, or – even more accurately – that being is the ultimate skill. I happen to disagree with Geller that presence cannot replace skill. I actually believe that what you may lack in skill, you can certainly make up for with presence. I think skill without presence is not only ineffective but can also be risky and non-therapeutic. My exposure to ‘action work’ through my supervisory training has challenged my stance and definition of skill, to a large extent. In my limited experience, action work seems to demand skill and presence in equal measures. It tends to deepen empathy quickly and require congruence – in other words, it demands an authentic presence. When I started my supervisory practice eight years ago, I became even more aware of the importance of the use of self, especially because of the multiple levels at which we have to work in supervision, and therefore the higher chance of encountering multiple parallel processes. I also became more in touch with the developmental element of supervising trainees.13 Through my supervisees’ development, I could see more clearly and reflect on my own journey through my training, practice and supervisory practice. The choice of this topic therefore reflects and is part of this ongoing process. Going into spirals Essentially, to me, the issue of presence comes down to the issue of connecting with the self. Therefore, I would like to bring this article to a close by briefly presenting a recent session with a supervisee, Clara.* I had been working with Clara for many years and we had built a strong supervisory relationship. She was in the final year of her training and wanted to discuss a difficulty she had with ‘being present’. I commented that my experience of her in the supervisory relationship was the opposite. She clarified that she felt she was fully present in supervision, but she sometimes could not be present in her therapeutic work. We moved into action to explore this further by using pebbles/seashells.
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Best Practice, 1
Best practice
Best Practice, 2
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Clara chose a round seashell with a big hole in the middle to concretise her struggle with being present with clients. She said she felt as if she was there but she was ‘brittle’, as if ‘clients’ words were going through and out of her’. I asked her to choose another stone to represent what stopped her from being present. She chose a ‘spiky’ seashell. She said that this represented her critical self, who judged herself harshly. She remembered that, when she was younger, she was more edgy, more argumentative, more forceful in her presence, a bit like the shell. She pointed to the hole, saying that the hole was still there, despite the spiky exterior, thus highlighting an incongruence in that way of being. She also chose another seashell, smoother and with a smaller hole. This represented her more sensitive side, which was more able to receive, despite feeling vulnerable. We discussed these two sides in her, these two configurations, and how they could be conflicting at times and obstruct her presence. She realised that the conflict between these two sides of her were ‘making an awful lot of noise’. In an attempt to help the transition from fragmentation to integration, I asked Clara what she would bring in to represent a more integrated presence – in other words, how her integrated self would look. She brought in a big, glass, heart-shaped object. She said that, if she was integrated, she would be transparent and ‘work from a heart place’. She continued and brought in a small, colourful, smooth, egg-shaped object. She said that if she was working from the heart, she would ‘roll’ happily, ‘following the clients’. She would find balance no matter what, because she would feel in touch with herself, connected and flexible. She also chose a big, shiny, mother-of-pearl-like shell, shaped like a big snail, to represent our supervisory relationship. She felt that, although we often ‘went into spirals’, we always got where we needed to go. She felt held in the supervisory relationship, yet allowed to go and explore her spirals. I asked her if she needed to change anything in our supervisory relationship to make it more supportive of her quest for integration and presence. She said she didn’t need anything to change in supervision at the time. I wondered first of all whether Clara’s feeling of not being present extended into
‘She said she felt as if she was there but she was “brittle”, as if “clients’ words were going through and out of her”’ our supervisory relationship. Could it be that I was not present with Clara in our sessions or even with other students? However, her concretisation of our work dissolved these concerns. I also thought of my journey through supervision and therapeutic work, and I can now see clearly that it is a process of moving from fragmentation to integration. In other words, it is a process of reclaiming all the different aspects of me, holding them and integrating them in my work. And the more I do this, the more therapeutic I am, but also the more whole I am. I also realise that this is a work in progress and that, in this process, there are forward and backward steps. And this mirrors exactly the process the clients and supervisees go through, which is not necessarily linear but dynamic, as is everything human. The supervisory relationship is an integral component in almost all supervision orientations, although important differences exist in quality, function and stance. Presence seems to be an important factor in both the therapeutic and the supervisory relationship. It appears that the more comfortable we are to grapple with the interplay between self and experience, the more present we will be as therapists and supervisors. Accepting and embracing our own vulnerability gives permission to others to do the same and helps remove the obstacles to being present. * Clara’s name and identifying details have been changed.
‘The more comfortable we are to grapple with the interplay between self and experience, the more present we will be’ THERAPY TODAY
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REFERENCES 1. Rogers CR. Reflection on feelings. Person-Centred Review 1986; 1(4): 375-377. Reprinted in: Cain D (ed). Classics in the Person-Centred Approach. Ross-on-Wye: PCCS Books, 2002. 2. Kirschenbaum H, Henderson VL. The Carl Roger’s Reader: London: Constable; 1990. 3. Sanders P. The Person-Centred Counselling Primer. Ross-on-Wye: PCCS Books, 2006. 4. Mearns D, Cooper M. Working at Relational Depth in Counselling and Psychotherapy (2nd ed). London: Sage, 2017. 5 Osterman P, Schwartz-Barcott D. Presence: four ways of being there. Nursing Forum 1996; 31(2): 23-30. 6. Horvath AO, Symonds BD. Relation between working alliance and outcome in psychotherapy: a metaanalysis. Journal of Counselling Psychology 1991; 38(2): 139-149. 7. Geller SM, Greenberg LS. Therapeutic Presence: a mindful approach to effective therapy. Washington, DC: APA Publications, 2012. 8. Geller SM, Greenberg LS. Therapeutic Presence: therapists’ experience of presence in the psychotherapy encounter. PersonCentered & Experiential Psychotherapies 2011; 1(1-2): 71–86. 9. Mullaly B. The effect of presence and power in the pastoral supervisory relationship. Holiness 2017; 3(1): 5–34. 10. Natiello P. The Person-Centred Approach: a passionate presence. Ross-on-Wye: PCCS Books, 2001. 11. McMahon A. Four guiding principles for the supervisory relationship. Reflective Practice 2014; 15(3): 333–346. 12. Sumerel MB. Parallel process in supervision. ERIC Digest, 1994. www. ericdigests.org/1995-1/process.htm 13. Ronnestad MH, Skovholt TS. Supervision of Beginning and Advanced Graduate Students of Counseling and Psychotherapy. Journal of Counseling and Development 1993; 71(4): 396–405. 14. Chouliara Z, Karatzias T, Gullone A, Duncan E. Acts of recovery: moving on from childhood abuse. Edinburgh: NHS Lothian; 2011.
About the author Dr Zoë Chouliara is a practitioner counselling and health psychologist, psychotherapist, counsellor, supervisor and trainer. Her research and clinical expertise is on recovering from extreme adversity, and she is lead author of the Acts of Recovery,14 the first research-based, survivor-centred, self-help resource for survivors of childhood abuse. She is a Past Chair and Associate Fellow of the British Psychological Society.
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Keeping it social
Please join our ‘Talking point’ panel! Email therapytoday@ thinkpublishing.co.uk
SUBS
Should therapists engage with social media?
ART
‘I’d rather use my time to do other things’
PRODUCTION CLIENT
While I am aware that social media is allpervading for a vast number of people, I try to avoid it, personally and professionally. A friend has suggested I use Twitter and Instagram to further promote my ideas and my blog on my website. I can see where he’s coming from, but I’m concerned about the potential damage social media can cause to mental health. It would feel somewhat disingenuous to start using it. I’m aware that it takes a fair amount of time to build a well-followed profile and that I might need to put in a few hours each day to start to have a usable presence. Personally, I feel I’d rather use the time to do other things. I might well be missing a trick here, but at the moment my business doesn’t seem to need the additional coverage. I’m not looking to become a ‘celebrity’ therapist and I’ve seen various high-profile therapists getting drawn into all sorts of social and political commentary. That isn’t what I became a therapist for. At present, I see the use of social media only in terms of drawbacks for my business and the ethos I’m looking to promote.
‘Social media is an opportunity for connection and activism’ Freshly graduated as a person-centred counsellor from Metanoia Institute, I wondered what tools I might have to be seen by potential clients. I decided to engage with Facebook, Twitter and Instagram. I want to promote my non-directive approach and client autonomy. But I would have concerns that there could be a risk of adding weight to the power that society already gives to me, as a white, trans-masculine therapist. Beyond self-promotion, I see social media as a powerful resource for connection, activism and a place to elevate the voices of those suffering from oppression and violence. It offers platforms for exchange and organisation in important movements like Black Lives Matter. Currently, my main focus in social media is elevating these, and queer/trans voices via Instagram Stories. I am aware that it is nowhere near enough to share posts about dismantling white supremacy without actively challenging my own internalised racism, and/or any white saviour complexes that I may have. Black trans lives matter, and I want to use my white privilege and the power that society gives me as a therapist to fight for equality. Raising these voices, I feel, is the best use of my social media presence. Noosh Manduk-Cheyne, person-centred therapist
‘It’s a way of exploring my creativity’ I have professional profiles on Facebook and Instagram that are separate from my personal profiles. I decided on these platforms as they’re the ones I am most familiar with. As I don’t do any sponsored posts at the moment, I don’t think it has brought me new clients. I also find it difficult to post things consistently. I go through very active periods where I can be very inspired to write posts, select imagery and create content. And then I go through phases where I don’t post much or don’t feel particularly motivated. I try to see this as a natural part of the process and do my best to not give myself a hard time. I have a background in marketing, where I learnt that people and institutions should only communicate their true essence. I believe that trying to project an image that doesn’t correspond to reality is pointless. Honesty is key for me as a therapist and as a human being, so I try to be honest when posting on social media or working on my website. I see producing content for social media as a way of exploring my creativity and what kind of therapist I am and expressing my thoughts. Marina Lorenzato, integrative therapist in private practice
Nick Stagg, integrative therapist
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Talking Point, 1
Talking point
My motivation to have a public profile on social media was predominantly to normalise talking about mental health and seeking help for mental health issues, particularly for children and teens. I often have it said to me that I deal with ‘kids with problems’, which troubles me, as it seems to stigmatise needing therapeutic support. I believe we could all benefit from support at some point in our lives, and promoting that message is one purpose of my social media pages. Another is to demystify ideas people might have about therapists. As a black therapist, I believe my public profile addresses the common misbeliefs that therapists all fit into a certain category. I don’t necessarily use my social media to get clients and I still get most clients through the usual channels. I make my boundaries very clear – I do not follow any of my clients, although I have very little control over whether clients follow me. To my knowledge, none of my current clients do. It hasn’t been raised in sessions but I am prepared to address it, if and when it comes up. My priority and concern are maintaining my clients’ confidentiality and the therapeutic relationship, so I have to bear this in mind in my response, should clients come across my public profile. I have yet to experience any significant negatives.
ALICE MOLLON/IKON IMAGES
‘Social media is part of my working day’
Kemi Omijeh, psychodynamic and CBT therapist working for a local authority and in private practice
Social media gives me an opportunity to share my work, engage and connect with peers, advertise my events, workshops and services and raise visibility and awareness about counselling to the general public. I also use it to campaign about the need for diversity in counselling and for clients to know that there are therapists out there who represent and reflect their identity, whether that be ethnicity, faith or culture. I use quite a few different social media platforms, including Twitter, Facebook, Instagram and LinkedIn. I’m also a member of therapist groups on Facebook and LinkedIn. Social media is part of my working day, so I don’t see it as extra work. I see it as a huge positive. A lot of clients find me via social media and so it’s often mentioned at the point of contact or enquiry. Quite often clients will start to follow me after we’ve finished working together. I have my own clear boundary not to follow clients back or comment on their posts. Our profession needs to see social media as a huge opportunity to be creative in how we share our work, publicise our services, raise awareness around the topics of counselling and mental health and educate. Myira Khan, counsellor, coach and supervisor working in private practice and founder of the Muslim Counsellor and Psychotherapist Network
THERAPY TODAY
THIS MONTH’S TALKING POINT IS COMPILED BY NADINE MOORE
‘My public profile addresses the common misbeliefs’
‘It allows clients to “know” something about me’ I keep an up-to-date personal blog on my website and find that clients read it and use it as a way to decide if they’d like to try me as their therapist. It feels like an important way to allow clients to ‘know’ something about me. After attending a BACP/Welldoing.org CPD day on working with millennials earlier this year, I felt inspired to embrace Instagram as a way to reach clients and other colleagues in the counselling profession. I have enjoyed getting to grips with a pictorial form of communication and understanding the power of imagery. As someone who also works as an academic, I am more comfortable with words, but I now realise that apps like Instagram have the power to represent metaphor, which is so important in counselling. I also appreciate that young adults use Instagram a lot and, as they are my specialist client group, I felt it important to include Instagram in how I communicate. I manage boundaries by keeping my personal and professional media separate. This is a habit I developed while working in academia, where students like to exercise their ‘natural curiosity’. I believe more attention should be given to social media training for counsellors so they can make informed decisions about their own use. Maria Morahan, integrated psychotherapist
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The bookshelf
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Large-Group Psychology: racism, societal divisions, narcissistic leaders and who we are now Vamik D Volkan (Phoenix, £17.99) SUBS ART PRODUCTION REVIEWS COMPILED BY JEANINE CONNOR
CLIENT
Volkan is a distinguished psychoanalyst, psycho-political writer and leader of international dialogue initiatives. The book’s subtitle describes it better than the title. The chapter on largegroup psychology is informative, demonstrating roots in Freudian writing and touching on ‘we-ness’, shared prejudice, externalisation, the ‘other’, transgenerational transmissions, large-group mourning, trauma, entitlement and regression. Volkan charts a developmental path from childhood to adulthood identity formation. He looks subsequently at how decisions are made and the dynamics of leading and following, before focusing on the nature of propaganda. The book reveals a distinct but expected liberal-leftist leaning and a tendency to focus on overworked targets, such as Hitler and Trump, as narcissists. He also, in my view, demonstrates a lack of political nuance in his pronouncements over, for example, Brexit. A strength of the book is its many examples of regional conflicts. There are some vivid, first-hand observations of racism, based on the author’s time in Charlottesville, as well as an interesting addendum on COVID-19. It is too slim a book for such large topics, but conciseness was probably the author’s aim. Despite some personal reservations, it should appeal to a wide range of students of psychotherapy, psychology and sociology. Clearly there is a pressing need to attempt to resolve the large social problems of our troubled time. But, unfortunately, in my opinion, Volkan’s book does not meet the needs of our present bitter crisis, where only truth will heal our polarised wounds. Colin Feltham is emeritus professor of critical counselling studies at Sheffield Hallam University
Building Sensorimotor Systems in Children with Developmental Trauma: a model for practice Sarah Lloyd (Jessica Kingsley Publishers, £22.99) In her career as a CAMHS occupational therapist, Sarah Lloyd became aware of the impact of developmental trauma on the sensorimotor systems of the children she was working with. Lloyd has developed the Building Underdeveloped Sensorimotor Skills (BUSS) model, which helps those who, because of their early adverse experiences, have not only missed out on healthy, nurturing relationships, but have also missed out on the sorts of physical movements that come from those relationships and that allow them to develop and master their own bodies. The book is written for both practitioners and parents/carers. It starts with an explanation of the foundation systems – the vestibular, proprioceptive, tactile and limbic systems – and looks at what can happen if they are underdeveloped and how and why that can occur. Lloyd then takes us through her assessment process, which is the start of the BUSS model. Then she moves us on to ideas she has found useful in helping to rebuild the undeveloped parts of the foundation systems. The book is full of vignettes and we follow the progress of several children and their challenges and experiences. The final part of the book gives us the parents’/ carers’ experiences of using this model with their children. This book reminded me of the many times that I have worked with children who are floppy, or rigid or who charge around without knowing where they end and the outside world starts, or who move in unexpected ways. Having read this book, I am aware that there is hope of repairing early deficits, so that children can be helped to move more happily, carefully and confidently. Mel Kinross is a counsellor and supervisor
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This Too Shall Pass: stories of change, crisis and hopeful beginnings Julia Samuel (Penguin, £14.99) This is a timely publication, coming in a period of enforced change and restrictions due to COVID-19. Samuel’s main theme is the inevitability of change and how we are mostly ill-equipped to deal with it. The book is divided into sections headed Family, Love, Work, Health and Identity. It aims to make us better able, as therapists and human beings, to respond and adapt positively to challenges in all these realms, in part through the application of self-compassion and by cultivating better relationships. Although Samuel states that the book is ‘therapy light’, in not referring to psychological theories or jargon, she provides a number of fascinating case studies, together with interesting observations on Western society, which she backs up with statistics. Her client group is impressively wideranging, including a Kurdish client who experienced harsh persecution and a nonbinary client working on gender issues. Samuel is refreshingly honest about what she describes as her own, occasional shortcomings as an ‘imperfect’ therapist and human being. Her obvious skills and integrity, as well as welcome flashes of humour, shine through and enliven the text, and also serve as an excellent demonstration of the power and effectiveness of the personcentred approach that she embraces. She is also able to state such truisms as ‘feelings are not facts’, yet lend them depth and complexity from the context of client work. Although her outline of a model of change, ‘the eight pillars of strength’, is a little sketchy and insubstantial, the book is both inspiring and informative and should enrich the practice of both experienced and newly qualified practitioners. Rosemary Pitt MBACP (Snr Accred)
The Bookshelf, 1
Reviews Beginning Your Counseling Career: graduate preparation and beyond Mary Olufunmilayo Adekson (ed) (Routledge, £36.99) This guide is written predominantly for a US audience, and refers to US-specific training routes. Some of the chapters will therefore be of less relevance to UK readers than others. For example, the chapters on getting onto master’s training programmes, gaining post-qualification clinical experience and ‘Critical steps in obtaining licensure’ are of almost no relevance to readers outside the US. Nonetheless, the positive, commonsense approach advocated throughout the book, along with its advice to do your research, consider all training routes and gain as much practical experience as possible, while not groundbreaking, are all very transferable. Less geographically dependent, a chapter on the ‘Benefits and challenges of balancing a professional counselling identity with doctoral studies’ addresses the demands of juggling academic study with clinical practice, which is something I am certainly familiar with. I was particularly interested by the idea that those who have ‘multiple intersectional marginalised identities’, be it in the areas of ‘race, gender, ethnicity, sexual orientation, special needs, or socio-economic status’, are in a certain sense better equipped to undertake this balancing act. Those considering submitting research to peer-reviewed journals might also be interested in the chapter on ‘Writing etiquette for doctoral students’, which demystifies and democratises the process with a step-by-step manual that is applicable internationally. As a student member of BACP and psychotherapist in training, I found much here that was both interesting and useful, but quite a lot more that was simply interesting. Emmanuelle Smith is a trainee psychodynamic psychotherapist
The Jewish Thought and Psychoanalysis Lectures Harvey Schwartz (ed) (Phoenix, £23.99) In exploring these six lectures delivered by a number of analysts, Harvey Schwartz tries to discover why so many psychoanalytic practitioners, even today, are Jewish, and what the connection is between their ‘Jewish thought’ and psychoanalysis. I was fascinated to learn that the dilemmas Freud faced as an ‘atheist Jew’ are echoed in the identity conflicts facing many secular Jewish therapists today, including me. Freud saw himself as an atheist whose essence was Jewish. While rejecting the religious beliefs, he valued the legacy of his Judaism and his ability to understand the alienated ‘other’. However, he was also eager to disassociate the field of psychoanalysis from the perceived ‘taint’ of being a Jewish practice, which is why he invited Jung (Christian) and Adler (socialist) to join his radical new approach. Similarly, Frosh, in his lecture on forgiveness, notes how, even recently, psychoanalysis has tried to distance itself from its Jewish connections. He observes that uncomfortable feelings about the Nazi past were not voiced at the first psychoanalytic conference in Germany following World War II. Rolnik, in his reflections on being a Jewish psychoanalyst in Israel today, voices the sadness and discomfort felt by Israeli practitioners, conflicted over the values behind psychoanalytic practice. He concludes that this is unacceptable and states: ‘There is no right way to lead a life that isn’t right.’ These lectures are very dense and sometimes hard to understand, but they are also fascinating in pointing out the history of psychoanalysis, its trajectory and its strong links to Freud’s Jewish identity and Jewish thought. Many of these concepts continue to influence therapeutic practice today. Val Simanowitz is a counsellor, supervisor and ex-trainer
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The book that shaped my practice
Back to One: a practical guide for psychotherapists Sheldon Kopp (Science and Behavior Books Inc, 1977) Working in therapeutic communities for the first decade of my working life, I was immersed in an eclectic mix of therapeutic ideas and approaches. As I prepared for the next phase of my career – the move into private practice – it was this book by Kopp that confirmed my instinct that I needed to develop a clear sense of my core therapeutic approach. This is the ‘one’ of the title – know which ‘one’ is for you and be willing and able to return to it, time after time, wherever your journey with your client takes you. The author offers useful, practical information about being a therapist and the therapy process in a delightfully personal and authentic style. He also helped me conceptualise how my personal spiritual practice could (and still does) underpin and support my work with clients. Has a book contributed to shaping your practice? Steve Page is a therapist Email a few sentences to and coach reviews@thinkpublishing.co.uk
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OUR ETHICS TEAM CONSIDERS THIS MONTHÕS DILEMMAS:
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WORKING BEYOND YOUR COMPETENCE Competent with couples?
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I am increasingly interested in couples work and have done a lot of reading on it. I get many enquiries for this in my private practice but, until now, have referred them on to colleagues. But recently I found out that one of the local counsellors I refer on to, who advertises as a couples counsellor on their directory profile, has had no specialist training in it. Do I need this training to take on couples? If I do so without training, what kind of problems might I run into?
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IN OUR ETHICAL FRAMEWORK , BACP members make a commitment to ‘work within our competence’ (Our Commitment to Clients, 2a) and to be competent to deliver the services we offer ‘to at least fundamental professional standards or better’ (Good Practice, point 13). It may be tempting to believe that there is little difference between counselling individuals and couples. After all, some clients fill the session with talking about their partner, who may already seem as present as the client in front of you, so why not just invite them to come along too? However, regardless of how confident you may feel and how much experience of one-toone work you may have, it is naïve to think that no additional skills are required for couples counselling. When counselling a couple for the first time, it can come as a shock to observe the speed and intensity with which strong feelings flare up, seemingly from nowhere, and the unwary counsellor can suddenly feel out of their depth, as if they have stepped into a battlefield. The kind of situations that might be calmly and objectively described by an individual client are actually being played out by a couple, before your very eyes, in the counselling room. Then there’s the partner who doesn’t turn up for one session, or who
wants to see the therapist alone, or who emails between sessions, telling ‘their side of the story’. There are many significant differences between individual and couples work, including the need to be working with the relationship rather than with two individual clients; to explore the clients’ history of relating and the modelling they have been shown; to ensure impartiality; to be alert to the dynamics that will be in operation in the room (who is siding with whom, for example); to be on the lookout for signs of coercive control or abuse, and to be assertive enough to manage the session and create a safe space for both partners. It’s good that you have done a lot of reading on couples work, but there’s no substitute for training courses that provide the opportunity to practise safely, to develop those necessary skills and to reflect on your own experience of relationships. Years ago, the availability of training in couples work was limited, but today there is a wealth of training and CPD in relationship counselling that can be accessed. You may be wondering how much CPD is necessary, and to help you answer that one, you might usefully ask yourself and discuss with your supervisor, ‘[Am I] providing an appropriate standard of service to my clients?’ (Our Commitment to Clients, 1b). If you choose to go ahead with couples work, your supervisor would also need to be sufficiently competent, experienced and confident to supervise your couples practice. To offer couples therapy might be a natural progression for some, but it’s definitely a whole new ball game, and not for the faint-hearted.
Beyond me? I work as a volunteer counsellor in a charitable counselling service. I am feeling under increasing pressure to
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see clients with severe mental health issues, yet I don’t want to say to the management that I’m not up to it, or to explain to clients that they would need to go elsewhere, especially as they have waited a long time for an appointment. I worked hard to get to this point and I need the experience, so I’m reluctant to leave. What should I do? THIS IS BECOMING an increasing problem for the voluntary sector, where small charities and services are trying, and being asked, to fill the gaps left by cuts in public health services. There may be no obvious onward referral route for clients, at least not without yet another long wait, and the organisation may be reluctant to turn work away if its funding is dependent on outcome measures and the numbers of sessions provided. However, as in your case, opportunities to practise may be limited, so naturally you do not wish to leave the organisation. Nevertheless, to be working under pressure and possibly beyond your competence is likely to result in your feeling resentful and/or exhausted. You need to be feeling resilient and practising good self-care if you are to be effective in your practice. Sometimes a client’s presenting issue is not the central issue, and severe mental health difficulties might not have been detected at the assessment stage. This can leave us with a dilemma when we come across it: do we stop working with that client and try to refer them on, or do we do our best, with our limited resources, experience and knowledge? It could be a case of working at one’s ‘growing edge’. With appropriate support (from the organisation and from supervision), it might be possible to continue working successfully with the client, rather than panic and assume that someone else would be better equipped than you. Sometimes it’s a test of our trust in ourselves and our trust in the process. It is important not to drop the client suddenly, so they feel abandoned or that they are too much or a hopeless case. On the other hand, it would be unethical to be working beyond your competence and unfair both to your client and yourself. For each one of us, there will be certain issues that we are not equipped to deal with and for which specialist knowledge and training would be necessary. Discerning exactly where that line is to be drawn can be a difficult judgment call, and we might not always get it right. Sometimes
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it may be obvious that a client would be better off seeing a more experienced practitioner or a specialist in mental health services, if they are presenting with a diagnosed condition such as bipolar disorder or dissociative identity disorder. Taking PTSD as an example, without some training in grounding techniques, stabilisation and self-soothing, there could be a danger of re-traumatising the client. However, the presence of PTSD might not always emerge until some way into the counselling process, when great care has to be taken if we do have to bring the work to a close. One of Carl Rogers’ necessary conditions is that the counsellor and client should be in psychological contact, so if you work in a person-centred way, that might be a useful indicator as to whether the work can continue. Another guide is your supervisor, who should be able to help you think through whether you can work with this client or need to refer them on. Ideally, the counselling service in which you work will have a list of contacts to help you with your signposting. Even if local mental health services are inadequate and you’re desperate for the work, there’s no shame in acknowledging when you’ve reached a limit.
Extending the age range I have always worked with adults in private practice but am getting an increasing number of enquiries from parents asking
me to work with their teenage children, often for anxiety-related issues, which are my specialty. Many are desperate for help, and I feel bad when I turn them away. Is it OK to take on clients aged under 18 if you don’t have specific training to work with children and young people? GOOD PRACTICE, POINT 27 guides us in answering your question. It requires us to give careful consideration when working with children and young people (CYP) to take account of their capacity to give informed consent, consider whether it is appropriate to seek the consent of others who have parental responsibility, demonstrate knowledge and skills about ways of working that are appropriate to the young person’s development and a sound knowledge of the law relevant to working with this age group, and so on. It makes it very clear that working
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with CYP requires specific training, knowledge and skills, over and above the more generic skills used in counselling adults. BACP has published the required competences for CYP counsellors, setting out the necessary knowledge, understanding and skills, together with the training curriculum for CYP courses (see Support and Resources, page 54). There are many special considerations to be borne in mind when working with this age group. Here are just a few: the use of age-appropriate language and interventions; ability to work creatively; understanding of a child’s limited autonomy; communication with others, such as parents and school staff; attention to safeguarding, and the issue of parental consent (especially tricky if one parent wants their child to go to therapy and the other does not). For children under the age of 16, a Gillick assessment needs to be carried out to gauge the client’s competence and capacity to enter into a therapeutic contract, and to consider whether, and to what extent, to involve others, such as those with parental responsibility. It sounds as if you are under some pressure to take on CYP clients, since parents are asking you to, you specialise in anxiety-related issues and you feel bad when turning them away. Maybe you need to take the pressure that you feel to your supervision, or your personal therapy. If you are really motivated to work with CYP, then you might consider how best to train and prepare yourself for the work. A whole range of training courses is now available. No doubt you would be drawing on your expertise in working with adults and with anxiety-related issues, but you would be learning how to adapt your approach to work in a way that is appropriate to a younger age group.
Anything to declare? I am a trainee on placement. All clients are assessed before being allocated to me, but I feel uncomfortable because they are not told that they will be seeing a trainee. I have questioned the organisation about this, and they said it was OK, as the website and literature states that ‘clients may be allocated to a trainee counsellor’. Shouldn’t clients be given a choice? THE ETHICAL FRAMEWORK STATES, in the interest of openness and honesty with clients, ‘trainees on a practitioner-qualifying course
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working with clients will inform clients (or ensure that clients have been informed) that they are trainees’ (Good Practice, point 82). In general, whenever we communicate our qualifications, professional experience and working methods, we will do so ‘accurately and honestly’, and ‘all reasonable requests for this information will be answered promptly’ (Good Practice, point 45). Including a line on a website or in printed literature is not enough to assume clients have given informed consent. Ideally, they should be told verbally that they may be allocated to a trainee, and given the opportunity to consent or refuse. One approach used by many services is to ask clients at the initial assessment whether they would be happy to be seen by a trainee. They would then be enabled to make an informed choice. Those that say no should be allocated to a qualified counsellor, and those that say yes are aware that their counsellor may be a trainee. A policy of transparency in relation to trainees should form part of the agreement between the training organisation and the placement provider. As this does not seem to be the case in your placement, your best course of action may be to discuss the situation with your training organisation. It is their duty to ensure you have an ethical and appropriate placement, and they are in the best position to intervene on your behalf.
Claiming ‘specialisms’
I have noticed that some counsellors claim on their advertised profile that they can work with almost every ‘speciality’ or issue that there is. I did a one-day session on bereavement in my diploma course, so does this mean I can say I specialise in bereavement? LISTED AMONG OUR ‘personal moral qualities’ in the Ethical Framework are diligence, integrity and sincerity. Our Commitment to Clients says that we have agreed to ‘put clients first by… providing an appropriate standard of service to our clients’ and ‘work to professional standards by working within our competence’. The challenge is knowing where to draw the line as to what is within and beyond our competence. Some specialisms already have a set of published competences, which provide a kind of checklist to guide therapists who claim a
SUPPORT AND RESOURCES BACP’s competences for working with children and young people can be found at: www.bacp.co.uk/ events-and-resources/ethicsand-standards/competencesand-curricula/children-andyoung-people You can find more information and guidance in BACP’s Good Practice resources, which are all available online at www.bacp.co.uk/gpia. Here is a selection: Fitness to practise in the counselling professions (GPiA 078 and 094) Self-care for the counselling professions (GPiA 088)
particular competence, or at least can help them to identify the gaps where further skills, knowledge and training may be needed. For example, BACP has been involved in devising competences for counselling children and young people, supervision and telephone and online counselling. Cruse Bereavement Care has produced its own set of bereavement care service standards. However, there remain many presenting issues for which there is still no template. These questions might help in assessing your own competence: • Are the core principles of my therapeutic approach sufficient to guide the way I should work with this particular issue? • How confident am I that I am capable of delivering such services? • Would my supervisor feel able to support my claim regarding this specialism? • Is my supervisor competent in this area, in order to provide me with the necessary support and guidance? • Is there any particular specialism or issue that I would be uncomfortable working with at this point in time (for example, because of personal bereavement)? • Am I in danger of focusing on the issue and failing to see the person behind it? • Do I have more faith in my expertise than in the client’s?
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Mental health in the context of the counselling professions (GPiA 112) Working with children and young people (GPiA 046) Counselling children and young people in school contexts in England, Northern Ireland and Wales (legal resource) (GPiA 002) Counselling children and young people in school contexts in Scotland (GPiA 026) Managing confidentiality within the counselling professions (GPiA 014) Counselling placements: a trainee’s guide (GPiA 090) Counselling placements: an organisation’s guide (GPiA 082) Workloads (GPiA 099 and 109)
• What is my motive for advertising this speciality? • Would I be covered by my professional indemnity insurance if I were to claim competence in this specialism? We cannot expect to be a specialist in every potential issue that clients present, and we are forever learning and gaining in experience. However, clients put a lot of trust in us, and we do need to be worthy of that trust. ABOUT THE AUTHOR Stephen Hitchcock is BACP’s ethics consultant. He is a senior accredited counsellor and supervisor with 20 years’ experience, and he has a private practice in the Lake District. Stephen previously worked with BACP’s Professional Standards department as an accreditation assessor and moderator. This column is reviewed by an ethics panel of experienced practitioners.
The dilemmas and responses reported here are typical of those worked with by BACP’s Ethics Services. BACP members are entitled to access this consultation service free of charge. Appointments can be booked via the Ethics hub on the BACP website.
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What is your favourite piece of music and why? I’ve been consistently inspired
by Prince’s genius and fearlessness since I was 12 years old. I acknowledge him at the start of my book, and my practice name, This Trusted Place, comes from his song ‘U Make My Sun Shine’. While writing it, I often listened to ‘Space (Universal Love Remix)’, with its themes of space and the choice between pain and love.
me Analyse
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What motivated you to become a therapist? I’d been in therapy for a
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while when I was a solicitor and took a year’s career break to reassess life. Having really benefitted from my own therapy, I completed a foundation year in psychotherapy during the break, as well as a screenwriting course and volunteering. I enjoyed the psychotherapy so much, my career break turned into a career change.
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What advice would you give to someone interested in entering the profession? I’d most likely
encourage them to go ahead, emphasising the importance of working on self, rather than just a focus on others. I’d also say it’s worth finishing the training, because you can then really go on to work in the way you enjoy. How has being a therapist changed you? To list a few,
it’s changed my values, how I communicate, think, feel and behave. It’s improved my health and meant deeper relationships with self and others. I’m calmer, more grateful and less fearful and impulsive. I do make lower pension contributions, but you can’t have everything! Where do you see yourself in five years’ time? I’ve recently
contributed to various media, including magazines, websites and podcasts, and have enjoyed building a social media profile. It’s fast moving
and challenging and complements the depth, space and pace of therapy. I hope I’ll be doing more of this in the future. What do you find challenging about being a therapist?
I sometimes struggle with how much therapy seems to be based on individual therapists’ personal opinions and idiosyncrasies. I think more widely agreed and implemented theories and practices would benefit clients and improve the profession’s reputation generally. And rewarding? I’m grateful I
spend my working day prioritising much of what seems to bring human happiness: meaning and purpose, the importance of feelings and more compassionate, honest, trusting, connected relationships with self and others. Psychotherapy feels like home for me and can make the difference between actually living life and just getting through it.
What is the most recent CPD you’ve undertaken? Was it worthwhile? An online talk by
John Gottman about working with trauma and betrayal in relationships. I don’t work with couples but I see the powerful effect on relationship dynamics if just one party takes responsibility and changes. The talk had a great section on the predictors of successful relationships, which has stayed with me.
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What’s the longest you’ve seen a client? I have some clients who I’ve
seen for more than seven years, since I started practising. Being with them through all the changes over this time period has been an honour. The variety that comes from working with both long-term and newer clients is also another reason I enjoy the work.
What’s the most recent book on therapy you’ve read (and can recommend)? I usually listen to
podcasts by people like Rick Hanson, as well as online CPD lectures, and I prefer reading shorter articles, on sites like LinkedIn, to reading books. What book/blog/podcast do you recommend most often? I tend
to suggest clients go inwards, in the direction of their own internal wisdom. I do, however, recommend the meditation app Insight Timer, to help establish a mindfulness/ meditation practice. To me, the messages and information they get from their own feelings and body are the most helpful for the client’s future.
About John-Paul Now: Integrative therapist working in full-time private practice from home. I also write and contribute to articles and podcasts on psychology and wellbeing, and recently self-published a self-help book called Finding a Balanced Connection. Once was: A projects solicitor in the City of London. First paid job: Admin assistant – I could make photocopying a letter take 30 minutes, which stood me in great stead in my legal career.
What do you do for self-care?
For me, self-care means making sure I feel ‘calm and alive’ as much as possible. Mindfulness, music, writing, exercising, socialising and holding boundaries all help me with this. What gives your life meaning?
Doing things, and being around people, I love.
Who would you like to answer the questionnaire? Email your suggestions to the Editor at therapytoday@ thinkpublishing.co.uk
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