Category Archives: Andrew Samuels

Andrew Samuels on Jobcentre Therapy and the Psy-Organisations

Letter submitted to Therapy Today (the BACP journal) but not published.


I’d like to respond to Catherine Jackson’s interesting article Colocation or collusion? How ethical are the Government’s proposals for closer working between IAPT services and Jobcentre Plus?’ (Therapy Today, April 2016, pp.8-9).

Catherine’s title suggests that the issue is generating heat and, at the end of this letter, I make a suggestion for a dialogical, relational next step.

What Catherine wrote illustrates the usual dilemma that the large professional organisations find themselves in with regard to Government policies – in this case, the many linkages between employment on the one hand and psychological therapies on the other. If bodies such as BACP, UKCP, BPC, BPS and BABCP are too robust in their criticism of Government policies, they will be labelled as ‘the awkward squad’ and ‘the usual suspects’. Doors in Whitehall close, requests for meetings go unanswered or evaded. That doesn’t serve the interests of the members. But what if they are too compliant, too accepting and even collusive with Government policy? What if the Big Five (as I call them) have inadvertently fallen into a role as being one of passing on reassurance to their memberships about the reassurance they themselves have received from the Department of Work and Pensions? That isn’t what members expect either.

I suspect that getting this particular balance right matters a lot to BACP members – it certainly did at the UKCP when I was Chair and the conundrum continues to be frequently discussed there. It is a really difficult balance to achieve. Be that as it may, Catherine’s article describes a significant new development in the field, in which 17 separate organisations have united to make the claim that the Big Five professional bodies referred to may need to do more to bring to the attention of their members what the overall thrust is of the linkages being made at many levels between employment and ‘mental health’. These 17 organisations include service user/survivor groups working alongside organised groups of professional counsellors, psychotherapists, psychologists, social workers, mental health nurses and academics. In all my 44 years as a therapist involved with public issues, I cannot remember anything like this happening before. It’s really important that BACP, in particular, with its deserved reputation for being the most outward-oriented of all the big professional bodies, clocks the significance of what has happened; I hope that the recognition of the importance of user-professional co-operation is not being too slow to arise. (See Note 1, below, for a roll call of the organisations concerned; the names tell their own story.)

In the public correspondence between the Big Five and the 17 organisations challenging them, there seems to be one point of agreement – at least in the abstract, at the level of principle. This is that therapy which has employment as a specific goal stated in advance is questionable from clinical and ethical standpoints. This is what the memberships of the Big Five believe, I think, and hence it is what they expect their leaderships to support.

But there is an increasing amount of ‘therapy-for-work’ being offered in Britain today and the Big Five know about it. Not least, their websites carry adverts whose job descriptions make it clear that the client’s employment is to be the clinical goal of the therapist that will be appointed. To be clear: the main issue here is not that our organisations carry the adverts. The thing is, now it has been pointed out, it is a little problematic to go on saying that this is not happening on the ground. The evidence is very close to hand. Or, to give a further and more general example, the New Savoy Conference, of which four of the Big Five are members, has been explicit that the stated clinical goal of psychological therapy should be employment. IAPTs, too, follow the same line, as Catherine mentions.

Counsellors and psychotherapists, who bring psychological perspectives to bar on public affairs, will understand that the proposals to locate ‘therapy’ in job centres will have (and has already had) a profound emotional impact. Counsellors and psychotherapists all know that the line between ‘suggestion’ and ‘compulsion’ is a very difficult one to demarcate. Vulnerable people can and often do say ‘No’ to what they believe will damage them, no matter how well intended. But, as therapists, shouldn’t we be concerned at what a false compliance does to the emotional state of an individual going through a difficult time?

Returning to the suggestion I flagged up in my opening paragraph, how about BACP convening a Stakeholders’ Meeting at which these matters can be more deeply explored. The Big Five plus the 17 smaller organisations would be at the core of such a gathering. Whether the Department of Work and Pensions would attend is something to discuss.

Andrew Samuels

Professor of Analytical Psychology, University of Essex; former Chair, United Kingdom Council for Psychotherapy


Note 1

The organisations referred to are: Mental Wealth Foundation, Mental Health Resistance Network, Disabled People Against Cuts, Recovery in the Bin, Boycott Workfare, The Survivors Trust, Alliance for Counselling and Psychotherapy,  College of Psychoanalysts, Psychotherapists and Counsellors for Social Responsibility, Psychologists Against Austerity, Free Psychotherapy Network,  Psychotherapists and Counsellors Union, Critical Mental Health Nurses’ Network, Social Work Action Network (Mental Health Charter), National Unemployed Workers Combine, Merseyside County Association of Trades Union Councils, Scottish Unemployed Workers’ Network, National Health Action Party

Advertisements

Alliance Meets the Shadow Minister for Mental Health

Report of the meeting between Luciana Berger, the Shadow Minister for Mental Health, and representatives of the Alliance for Counselling and Psychotherapy, 8th December 2015

Andrew Samuels, Jay Watts and Jeremy Weinstein met with Shadow Minister for Mental Health Luciana Berger MP on behalf of the Alliance for Counselling and Psychotherapy. This is the second time we have met with Luciana, and we congratulated her on her appointment and work in mental health. We then raised four areas of discussion.

IAPT

We asked if Labour would consider an urgent review of the Improving Access for Psychological Therapies (IAPT) scheme. We discussed the need for increased service user choice, given its effect on engagement and recovery. We proceeded to raise concerns about the planned roll-out of IAPT-SMI (IAPT for those with psychosis and so-called Personality Disorders), fearing that it will take precious resources away from already decimated secondary mental health services. Psychosis services in the NHS and voluntary sector already struggle to get financing to offer the long term services needed for those with the most chaotic lives; moulding services into an IAPT outcome-obsessed shape will work against these clients who demand heavy investment of time and patience. This is because winning an Any Qualified Provider (AQP) contract demands showing quick, efficient treatment with good outcomes creating a desire to cherry pick cases which look good on paper. This would leave those most in need of society’s help without services.

Lastly, we provided a rereading of the figures on IAPT, showing the hundreds of thousands who are referred but who never experience a reliable recovery. We emphasised how being referred is not a neutral act, but brings a disappointment if no help is then available. Most importantly, we emphasised that IAPT has had an effect on the widespread closure of other services – especially for long-term psychotherapy – with organisations like MIND working increasingly from an IAPT model, leaving those with the most distress alone. Luciana shared her concerns about the effects of IAPT on wider mental health provision, and mentioned her recent visits to innovative crisis and day centres in precarious financial straits. She noted that she had asked a Parliamentary Question on the numbers who get referred but never actually receive a therapy, and registered our demand for an urgent review of IAPT.

Alternative Sources of Funding for Talking Therapies

We spoke to Luciana about the erosion of long-term and in-depth counselling and psychotherapy of a relational nature, both in the NHS and voluntary services, giving examples of innovative service provision which we can ill afford to lose. Of particular note, we emphasised that a two-tier system is emerging whereby the poor and disenfranchised have access to a very brief, highly manualized form of treatment (at best) – whilst the middle-classes who have resources continue to access and benefit from traditional counselling and psychotherapy. We were glad to note that Luciana agreed this is highly problematic, socially divisive and against Labour Party principles. The Alliance suggested various ways of tackling the problem with minimal cost including the provision of a small budget to inject into existing and new services for counselling and psychotherapy.

Social Work Action Network Mental Health Charter

We presented the Charter, explaining its identification of key problems such as the crisis facing service users, the role of the market, and the preoccupation with negative risk. We told Luciana about the support the Charter has received from a number of campaigning organisations such as Disabled People Against the Cuts (DPAC) and other service user led organisations, as well as practitioners involved in the Critical Mental Nursing Health Nurses Network and Psychologists against Austerity and, of course, the Alliance. Most importantly, we emphasised the positive steps of redress suggested in the Charter, including a renewed emphasis on User-run services, and the importance of hope. We hoped that the Charter’s vision might be incorporated into Labour policy on mental health.

A National Debate on Mental Health

The Alliance argued that the UK desperately needs Labour to initiate a new debate on the causes of ‘mental health’ and ‘mental illness’ based on the considerable evidence that there is no biogenetic cause of mental distress. There is a need to challenge all that might be depicted as ‘the medical model’. We argued that evidence shows us that human suffering is shaped by the society we live within, impacted by factors such as austerity measures, the breakdown of community and increased individualization at the expense of social cohesion. Luciana agreed that there is a fundamental problem with the language around ‘mental health’ and ‘mental illness’ and herself used the example of changes in the language in which suicide is discussed.

The Alliance suggested categories such as ‘anxiety’ and ‘depression’ are deeply problematic, and presented evidence that the public prefers stigma-busting campaigns based on psychosocial understandings of distress as opposed to illness models. We suggested that reshaping the narrative to include the importance of community, helping one another, listening and a relational  understanding of the self and soul fits with core Labour values.

We then all discussed how innovative projects based on community models of mental suffering could not only save money, but inspire different ways of viewing the self away from the national purse. Luciana informed us of details of the Opposition Debate on Mental Heath the following day. She stated that she appreciated our time and input, and welcomed on-going contact between the Alliance and the Shadow Ministry.


Report by Professor Andrew Samuels, Dr Jay Watts and Jeremy Weinstein (on behalf of the Alliance for Counselling and Psychotherapy)

Therapy as State Sponsored Brainwashing?

Unpublished letter to The Telegraph by Professor Andrew Samuels, Centre for Psychoanalytic Studies, University of Essex.

‘As Chair of the UK Council for Psychotherapy 2009-12, I very much hope that all the psychotherapy and counselling registering bodies, particularly those held under the accredited voluntary register scheme of the Professional Standards Authority (PSA), will pay heed to what Sarah Wollaston has said (Stripping benefits claimants if they refuse depression treatment is ‘unethical’, The Telegraph, 13 July 2014).

For any registered member to participate in this Government scheme would constitute serious professional misconduct and lead to serious sanctions. The PSA and the registering bodies that it accredits should immediately issue a joint statement to this effect. From Freud’s idea of ‘free association’ to Jung’s concept of ‘individuation’ to Carl Rogers’s idea of ‘person-centred’ therapy, counselling and psychotherapy are practices that rest entirely on the autonomy of both parties being recognised. That is why, in the contemporary lexicon, therapy is referred to as a ‘co-created’ activity. It can never be allowed to become state sponsored brain-washing.’