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Therapy Today

March 2013

Volume 24

Issue 2


Copyright British Association for Counselling & Psychotherapy 2013

Contents


Features:
Some crusades need to be fought

Catherine Jackson explores the complex interplay of anger and grief in traumatic bereavement.


Retirement or renaissance?

Mary Russell and Val Simanowitz talk to fellow counsellors about how, when and why they decided to retire.


The language of healthcare

Rosemary Rizq warns that the language we use can start to dictate how we practise.


Counselling in Canada

Counsellors and psychotherapists in Canada have much in common with their UK colleagues, writes Lorna Martin.


Photographs in therapy

Laura Prins describes how photographs can provide counsellors with a powerful key to unlock the unconscious.

Regulars:
Editorial
News
Columns

Rachel Freeth

Jeff Johnson

Mel Perry

Barry McInnes
Talking point

Colin Penning


Dilemmas
The interview

John McLeod


How I became a therapist

Lucy Beresford


Letters
Reviews

BACP:
From the Chair
Divisional journals
BACP News
Professional standards
BACP Policy
BACP Research
Professional conduct

TherapyToday.net:

This month online: Colin Feltham in conversation with Rosemary Rizq; Annabel Wright discusses the ideas behind her illustrations; our ‘From the archive’ article explores four different perspectives of retirement; the latest weekly news; and the TherapyToday.net Noticeboard.

Editorial

When is the right time to retire – 60 or 90? This is a subject to which readers regularly return in letters and articles. For many, counselling is a second career, and if you’ve only just finished training in your early 50s you will barely have got into your stride before it might be considered time to stop. Thinking about work has evolved in recent years as we understand more about what it gives us, and this may be particularly pronounced with counselling and psychotherapy. Some people may simply need to continue working to pay the mortgage but, with the current lack of paid work, others may feel that they should make way for younger therapists.

There is no clear guidance about when to retire, apart from advice on fitness to practise. Health issues are regularly cited as a reason to stop practising, and memory problems – no longer being able to find the right word at the right time, as Mary Russell and Val Simanowitz found when they interviewed a group of therapists about their decisions to retire.
One reason therapists might choose to retire is to escape from a particular culture, perhaps in an organisational setting. The focus of the article by Rosemary Rizq is the language of healthcare – a lexicon created by what she calls the evidence-based movement – which we have all now adopted. Examples are ‘NICE-compliant interventions’, ‘patient wellbeing’ and ‘payment by results’. Rosemary compares this language to Orwell’s Newspeak and explores its tendency to narrow our range of thought, to eliminate feeling and, most significantly, to reduce the idea of relationship in mental health services. ‘They have already forced us into using certain words,’ she says, ‘already involved us in a... particular vocabulary. It’s already infiltrated our minds, our behaviour. We are already compromised.’ In an interview with Colin Feltham on our website (www.therapytoday.net), Rosemary further contextualises these developments and discusses what, if anything, we can do about it. We would like to hear your views.

Sarah Browne

Editor

News


BACP register gains accreditation
The BACP Register has become the first register to be awarded accreditation under the Professional Standard Authority’s accreditation scheme for unregulated health and social care occupations. The Authority is an independent body, accountable to Parliament.

The Accreditation of Voluntary Registers (AVR) scheme was set up by the Department of Health to provide assurance on the standards of voluntary registers of health and social care occupations.

All full members of BACP are being invited to join the register by meeting the standards and signing the Terms and Conditions for registration. Many members will become eligible by successfully taking the Certificate of Proficiency.
BACP is currently rolling out a national Certificate of Proficiency programme to enable eligible members to complete the assessment at a centre local to them (see BACP News on p49).
Registered members will be able to use the Authority’s accredited register quality mark to show that they are on an accredited register.
The voluntary registration scheme was launched in the House of Commons last month. BACP Chief Executive Laurie Clarke said: ‘This new safeguard provides a vital standard of service to help people select the very best counsellor or psychotherapist for them.’
Care and Support Minister Norman Lamb said: ‘The scheme will give people faith in the staff they employ, enhance the reputation of practitioners and raise standards across the board.’

Payday loan debtline calls rise


Calls to the National Debtline service for help with payday loans shot up by 94 per cent in 2012, debt charity the Money Advice Trust has revealed.
Last year the debtline took 20,013 calls for help with payday loans, nearly double the 10,301 calls received in 2011. In 2007, when the financial crisis began, the service took just 465 calls for advice about payday loans.
The Money Advice Trust says that in January alone National Debtline was taking calls for help with payday loans every seven minutes during the hours its phone lines were open. National Debtline advisers are currently getting calls at a rate of 100 per day from people needing help with payday loan debts. Some callers have taken out as many as 80 payday loans.

The Money Advice Trust wants the Office of Fair Trading (OFT) to make use of its new powers to suspend consumer credit licences with immediate effect where it identifies persistent bad practice.

Joanna Elson, Chief Executive of the Money Advice Trust, said: ‘Payday loans have come from nowhere to be one of the most common debt problems people face. We hear from thousands of people each year who have been lent money when it was clearly not the right option for them. Borrowing on this scale can have serious ramifications if not dealt with properly.’

Bereaved children need stability


Losing a parent in childhood can cause lifelong emotional damage if the child and family don’t get adequate support, new research shows.
The study, conducted by researchers at the University of Liverpool and published in the Journal of the Royal Society of Medicine, found that low self-esteem, loneliness, isolation and inability to express feelings can persist through adulthood and into old age.
The research found that bereaved children often suffer disruption, instability and lack of continuity in their lives after a parent dies. The researchers say it can make it harder for the child to adjust to their parent’s death and increases stress if the family moves home after the death, separating them from family and friendship networks. Long periods of disruption and unstable living arrangements make bereaved children more likely to experience emotional difficulties, insecurity and loneliness in adulthood.
Bereaved children should remain in their existing social networks, live in the same area, go to the same school and maintain the same friendships.
‘Our research suggests that if the social network addresses the necessary “mothering or fathering” then a child does not appear to be affected in adult life,’ lead researcher Professor Mari Lloyd-Williams said.

Relate calls for ‘male-friendly’ support

Relationship counselling services should be more ‘male friendly’, Relate says in a new report published with the Men’s Health Forum.

The report, Try to See It My Way, says men and women have different experiences of and react differently to major life events such as work and finance-related problems. They often don’t realise that their relationship is in trouble. Men also have different expectations of counselling; they go to counselling to solve problems, while women see it as a chance to talk about difficulties and review what’s happening in the relationship.
The report says that men are at greater risk of suicide in the aftermath of a relationship breakdown and are less likely to have a network of friends to support them. They also tend to make less use of counselling and psychotherapy services: just 36 per cent of IAPT referrals are male, and only 44 per cent of Relate’s clients.
The report says policymakers and service providers across health, education and social care need to deliver services in a more ‘male-friendly’ way and that personal, social, health and economic education (PSHE) should include sex and relationships education and should be offered to all young people as a statutory requirement.
Chief Executive of Relate, Ruth Sutherland said: ‘It is clear that some men need more practical and solution-focused help and the sector must find ways of adapting our services.’ Harry Benson, Director of Communications at The Marriage Foundation, said: ‘Men want to be taught how to make their relationship work. What is really needed is solution-focused relationship education programmes.’
Read this month’s ‘Talking point’ article for more details.

More people access NHS-funded therapy


Access to NHS-funded therapy has increased in the past two decades, research published in the British Journal of Psychiatry shows.

The UK-wide study of uptake of psychotherapy treatments for common mental disorders from 1991 to 2009 shows that more people on lower incomes have been able to access psychotherapy, particularly in the last five years of the survey period.

Two per cent of the quarter of the population (26 per cent) who reported having a mental health problem had accessed therapy over the 18-year period. Of these, 77.5 per cent were treated by publicly funded services and 21.3 per cent in the private sector.
The less affluent people receiving therapy tended to have more severe mental health problems, showing that talking treatments are reaching the people who need it most, the researchers say.

Older therapists cry more, new research shows


Older, more experienced therapists cry more often during therapy sessions, new research published in Psychotherapy journal shows.
In the US study of 684 qualified and trainee therapists, 72 per cent reported crying in sessions with their clients. Older therapists with more experience cried more in client sessions than more recently qualified practitioners, but cried less often in their daily life.
Psychodynamic therapists reported slightly higher rates of crying in therapy than cognitive behavioural therapists, but similar rates of crying in daily life. There was no different in in-session crying rates between male and female therapists but the women cried more often in daily life.
The researchers say that experienced therapists may feel more confident about allowing themselves to experience these emotions when working with clients.

New self-harm campaign


Four young people’s charities have launched a national campaign to raise awareness of self-harm.
Self-harm is estimated to affect one in 12 young people in the UK. Calls to ChildLine from young people who self-harm have risen by 167 per cent in the past two years and children as young as 13 are now seeking its help.

The charities, ChildLine, YouthNet, Selfharm.co.uk and YoungMinds, hope that the public awareness campaign will help to reduce the stigma attached to self-harming that prevents many young people from asking for help.



Visit www.therapytoday.net to read our weekly news bulletin.

In practice


Are we worthy of their trust?
Rachel Freeth

‘I’ve told you a lot about myself but I still don’t trust you.’ Joanne had indeed just told me a lot about herself, including some of the despair and suicidal thoughts that had led to her referral to my outpatient clinic.


Like a number of young adults I see, Joanne’s desire to live and persevere in a threatening world seemed fragile, along with her sense of identity. She had also, like many, described a story of abuse, neglect and abandonment in her early years and numerous unstable relationships subsequently. She had been profoundly let down by care-givers and those in positions of power. It is no wonder she struggled to trust people.
It is not unusual for me to encounter people who find it very hard to trust helpers. It is rare, however, that anyone expresses a lack of trust in me as directly and firmly as this. It was a powerful moment. And, while I welcomed her honesty and her highlighting something of how she perceived me, I also felt profoundly challenged.
This experience also opened up for me many questions about the nature of trust, particularly in the context of helping relationships. It has since occurred to me that we so often talk about trust as the bedrock of the therapeutic relationship or helping alliance but we rarely engage in in-depth exploration of what trust actually involves and consists of – psychologically, socially, philosophically and morally. We tend to assume we know what it is we are talking about. Yet coming up with a satisfactory definition of trust, or conceptual framework, is no easy task.

It has also occurred to me that we tend to talk about trust almost as a physical ‘thing’ – as something that a person either has or has not got. To me it makes more sense to refer to degrees of trust (while resisting attempts to quantify it), and as something that exists as a process, subject to fluctuations throughout the course of a relationship, or even throughout a conversation. It seems to me that Joanne might have had at least a fragment of trust in order to tell me something of her story, as well as to declare she didn’t trust me.

I have also become aware of how our professional discourse about trust and its importance in the helping relationship frequently focuses almost exclusively on the client. We talk about it as the client’s problem, about whether they are able to give us their trust, referring to the developmental and environmental factors creating distrust. But I wonder whether we talk enough about our own trustworthiness and what enhances or impairs it. Do we consider what we need to do or how we need to be with our clients to make us more likely to be perceived and experienced as trustworthy?
For me this is not about adopting particular communication techniques. It is deeper than this. I think my trustworthiness has something to do with my character, my beliefs and values. It relates to what I want for my client and what I want from our encounter. It concerns my feelings towards my client. Am I warmly disposed towards them and are my intentions essentially good ones? Am I willing to do everything I can to facilitate the best possible outcome for my client or will I just go through the motions?
Of course the client also comes with questions, many of which may be unspoken. When Joanne said she didn’t trust me, her perception of my trustworthiness could have been influenced by much more than my demeanour, attitudes and whether I listened attentively. She may have had questions about my competence, about whether I could actually help, and how. Could she trust me to deliver what she wanted and expected?

There is an important issue here, particularly for those of us who work in organisations. Our practice is influenced and at times constrained by the resources available – for example, time or number of sessions. Clients’ trust in us to deliver what they want in terms of outcomes will be inevitably influenced by what it is possible to deliver. This needs careful discussion and negotiation right at the outset of any therapeutic process.

I wasn’t all that surprised when Joanne did not attend for her next appointment, and I probably won’t see her again. I am nevertheless grateful to her for stimulating in me an enquiry into the nature of trust and for prompting me to think more about my own trustworthiness and what influences it, as well as how, for many people, trusting others is a tall order.

‘Do we consider what we need to do or how we need to be with our clients to make us more likely to be perceived as trustworthy?’

In the client’s chair
The person I want to be
Jeff Johnson

I led a criminal lifestyle for many years, involved in drugs and violence, football violence and things like that. I got the opportunity to sell some gear, some crack. Then I started taking it myself and I ended up subsidising my own use with selling it and everything got out of control. I made mistakes and I got caught.


In a way I’m glad I came to prison… No, I am glad I came to prison. It’s changed my life, this sentence. If I’d stayed out and hadn’t got caught, I’d have been a bigger dealer and would have been deeper into it all and f**k knows what would have happened. I would have lost my kids, lost my job, lost who knows what. I know what kind of attitude I had then.
I’d tried counselling before and fed them shit, told them what I thought they wanted to hear. This time it was different. I was ready for it. It was a window of opportunity and I went for it.

I wanted to find myself, to find who I was. It sounds stupid, but it’s true. I didn’t know who the real me was. I was aggressive and manipulative. I think I wanted someone to tell me I wasn’t as bad as I thought I was. To understand where I was coming from and to show me a different way than what my dad had taught me. The idea of the inner child – that I had a scared little child inside that lashes out to keep me safe… I dunno… I just wanted to sort my head out. Family, kids, relationships, and the other side, the violence. My dark side. The Shadow, my counsellor called it.

I clicked with my counsellor straight away. I couldn’t have done it otherwise. There was something about him being my sensible side. It sounds stupid when I say it, but it’s like my dad was my aggressive side and he was my other side.
It was like having a best friend to talk to, helping me to find the proper way to deal with things. I knew I had all that in me, it was just putting it all to work. Helping me to deal with the little child inside. It just made so much sense to me, the way he would say things. The first few sessions it was like he just listened. He wasn’t judgmental, not at all. I could tell he was kind, friendly, caring. An adult influence on my life. It brought out a side to me I didn’t think I was able to be. My adult I suppose. I’ve changed my attitude, my ideas. I’ve changed into the person I wanted to be.
Everything’s good at the moment – my relationship with my close friends, with my kids and my parents. I’ve learnt how to respond to things in a way that feels more real to me. I forgive my dad for what he did. He used to really beat me and my brother and lock us in a cupboard. I now realise he was trying to make us tough so we’d survive. I can see that now. I forgave him for my sake, not for his. I can’t undo things but I can change my way of thinking about it. I don’t need to punish myself for what he did. I don’t need to prove anything to him either. We’re actually getting on alright over the phone. It’s like my mum and dad have picked up on the changes in me. I’ve always punished myself for things that happened; blamed myself somehow. It was my fault. Now I know that’s not true.

I would never have got here without the counselling. It let me see everything in a different light. I was used to being a certain way. I was scared to change. I didn’t even know I could change. Counselling made me look inside me. It gave me the tools to become an adult, a better person, a better dad. I can feel my emotions and accept them. I can cry. I can feel happy. And proud. I’m proud of what I’ve done, what I’ve achieved, what I can do. Proud of me. And it doesn’t bother me what other people think about me. I know I’m going to be able to cope with my emotions.

Now I can think of things before they happen, before I do them. That comes through paying attention and listening to myself. I used to think all the bad things happen to me. When I look back, I was pathetic, looking to justify why I was taking drugs and all the rest. I was a violent, aggressive bully.
It’s not like that anymore. Life’s for living. I’ve got my kids, I’m a dad, there’ll be new friends. I remember this thing the counsellor said when we were talking about change and the point of it. He said, ‘If you change yourself, you change the world.’ I’m gonna get that tattooed on me when I get out.

Interview by Lee Partis.

‘I remember this thing the counsellor said... “If you change yourself, you change the world.” I’m gonna get that tattooed on me when I get out’

In training


Resources for all
Mel Perry

‘This is for everyone,’ Tim Berners-Lee tweeted on the stage at the opening ceremony of last summer’s Olympics. One of my heroes, he’s widely acknowledged as the inventor of the worldwide web and he gave it to us for nothing. Nearly 25 years later we can access the ‘hive mind’ and freely share our ideas, thoughts and feelings. Whether you’re in a Bolivian internet cafe, in Australia or in desperate need, someone, somewhere will have a voice and a view, however minority or niche the topic. Our profession is no different.


Like the Freudian iceberg, I am conscious of only some resources, from trusted sites, that have really helped me so far as a trainee. I know that other members will have found some gems so I’ve created a community page on the BACP members’ website, called ‘InTraining resources’, and it would be a Berners-Lee act if readers were to contribute to it.

At the start of my course I had a book list – a good list – but that was it. So I began searching the online resources at my fingertips. The internet, the smartphone and all the software we can access, for free, are incredibly powerful media, allowing us to tailor our training to our preferred way of learning. Apps such as iBooks and Kindle allow free or cheap downloads of books and articles. Search for the sometimes half-hidden ‘free books’ on their menus.

We all access education in different ways and for the auditory learners among us there are podcasts, downloadable on your computer or for your smartphone/mp3 player. There are many to choose from. One of the best I’ve found is the ACA (American Counselling Association) Podcast series. Aimed at students in particular, it takes you through the basics of many approaches, including Gestalt, Adler and existentialism, explores supervision and visits ethical issues such as confidentiality. The episodes are about 50 minutes long – perfect for a commute, a walk or the gym.
Early on I felt that I really needed to see some counselling in action. There are plenty of role-plays to view online and these are of some use, but I had to make a trip back in time to 1965 to find what I wanted. Gloria came to my rescue.
As I’m sure many of you will know, Gloria is an American client who volunteered to be filmed in sessions with various luminaries in the psychotherapy profession. Search YouTube for ‘Gloria, Rogers, Ellis and Perls’. Watching each of these masters in turn and how they conducted their first sessions with Gloria was illuminating, despite the contrived circumstances.




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