Category Archives: Andy Rogers

Maps, Languages & Lost Continents: Person-Centred Therapy and the SCoPEd Project

Andy Rogers takes at look at the telling absence of the Person-Centred Approach in the development of the SCoPEd project.


There is so much to say about SCoPEd that it can be hard to know where to start. Fortunately, many elements of the project – the motivation, methodology, evidence-base, hierarchical structure, consultation process, conflicts of interest and so on – have been closely examined elsewhere, particularly on blogs and social media. So here I want to home in on a few core issues for person-centred practitioners.

Person-Centred Therapy (PCT) has been a major force in the UK therapy landscape since the 1980s. Leading practitioners were influential in the development of counselling services in education and contributed much to the growth of counselling training and professional organisations. The book Person-Centred Counselling in Action (Mearns & Thorne, 1988) is still a core text on many counselling courses and remains one of the UK’s best-selling counselling titles of all time.

Note that already I am referring to ‘counselling’ rather than ‘psychotherapy’. This is important for the SCoPEd project because its draft ‘competency framework’ explicitly differentiates ‘counsellors’ and ‘psychotherapists’, albeit with a third intermediate category labelled ‘advanced qualified/accredited/psychotherapeutic counsellor’. This differentiation, which the largest professional body involved, the British Association for Counselling & Psychotherapy (BACP), had argued previously there was no evidence for, has come in for much criticism; mostly – but not exclusively – from counsellors whose work has been downgraded, with newly qualified psychotherapists defined in the framework as more competent across a range of practice areas.

Inconvenient histories

Before I get side-tracked into the many overlapping issues here – not least around the organisational politics that feed this project – let’s just step back into the world of the person-centred therapist.

In PCT, there is not, and never has been, any meaningful differentiation between counselling and psychotherapy. A contemporary practitioner might be attuned to how others use these terms in a differentiating way and to the tendency for trainings with these labels to meet the differing requirements for professional organisations that cater mostly for either ‘counsellors’ or ‘psychotherapists’. They might also note wryly the way this division operates in the field of employment, with differences in pay, fees, context, status and so on. As Thorne (1999) writes, we need to ‘face the unpalatable truth that the business ethic is all-pervasive… In such a marketplace it is not politic to affirm that counselling and psychotherapy are indistinguishable’ (pp.229-230). Yet, in terms of the therapy itself, i.e. what happens between practitioner and client, there is no substantive case for differentiation within person-centred working.

In the academic literature, the tendency is to refer simply to ‘Person-Centred Therapy’ or to use the terms ‘counselling’ and ‘psychotherapy’ interchangeably. I was going to reference some texts here to illustrate the point but it makes more sense to throw out a challenge: find me a book or paper that articulates the difference between person-centred counselling and person-centred psychotherapy. If any exist, they will still be contradicted by almost all the other person-centred literature.

Much of the contemporary person-centred attitude to these terms has evolved from the position of the approach’s originator, Carl Rogers, who clearly viewed PCT as a form of psychotherapy (just browse his book titles), yet made no distinction between ‘psychotherapy’ and ‘counselling’. As far back as 1942, Rogers was using the terms interchangeably, writing that, ‘intensive and successful counseling [sic] is indistinguishable from intensive and successful psychotherapy’ (Rogers, 1942, p.4, my emphasis). Poignantly for the current debates, the general use of ‘counselling’ for the work of therapy also has its roots in Rogers’s life and work. As a clinical psychologist with no medical training, he made a tactical switch to ‘counselling’ in the mid-1950s in Chicago, when legally the practice of psychotherapy required medical qualifications.

Whatever the pragmatic motivations at the time, it is important to note that the person-centred approach was already becoming a direct challenge to the hegemony of the medical model (and would continue to be so, with increasing vigour and depth), so the switch also made sense politically and philosophically. Clearly, 1950s Chicago is a world away from the UK in 2019, but it is interesting how relevant this moment remains, how the terms continue to have a political potency: are contested, subject to claims of ownership and find themselves jostled into a status hierarchy that serves the interests of those who already have more power in the field by bolstering their portrayal of superior legitimacy, skill, depth or competence.

And there is another more recent historical nugget to unearth here too, which is that PCT’s association in the UK with ‘counselling’ rather than ‘psychotherapy’ could easily have gone the other way. In the early 1980s, as the United Kingdom Council for Psychotherapy (UKCP) developed in parallel with the BAC (then without the ‘P’ for psychotherapy), the person-centred approach had not yet established national organisational representation. So, as Mearns & Thorne (2000) write, there was,

‘no institutional process by which the approach could be involved with the developing professionalisation of psychotherapy/counselling. The result was that the work of engaging with professional organisations was left very much up to individuals, […] person-centred specialists [who] made the pragmatic choice of investing their time in BAC.’ (p.26)

Importantly, the decision not to go with UKCP was not made because PCT failed to qualify as ‘psychotherapy’. In fact, ‘it was only small matters of difference which inspired this choice’ (ibid.), mainly around personal therapy requirements and the approach’s potential positioning within UKCP’s humanistic section.

This alignment with BAC(P) would inevitably lead to an association with ‘counselling’ rather than with ‘psychotherapy’, so it is intriguing to wonder about how the field would have looked had PCT found its professional home within UKCP instead. Who knows how the approach – and indeed UKCP – would have evolved? But the SCoPEd project washes its hands of these inconvenient histories and their attendant complexity and illuminating angles.

Undoubtedly times have changed but PCT has never reneged on its philosophical, political and practical position in relation to ‘counselling’ and ‘psychotherapy’. As one of its leading thinkers in the UK has argued, the case for differentiation – inseparable as it is from professional politics – demands close scrutiny:

‘there is no essential difference between the activities currently labelled “counselling” and “psychotherapy”… [T]o suggest that there is is the result of any one or a permutation of the following: muddled thinking; a refusal to accept research evidence; a failure to listen to clients’ experiences; a lust for status; needless competitiveness; power mongering; a desire for financial gain; or some other unworthy motive prompted by professional protectionism.’ (Thorne, 1999, p.225)

Maps and missing territories

The fact that one of the most established therapeutic traditions in the UK has a lot to say on these matters – not only differentiation but manualisation and professionalisation generally – has been of such little interest to the SCoPEd project that there was no PCT representation on the teams tasked with developing the framework. Even the humanistic modalities more broadly were grossly underrepresented in the Expert Reference and Technical Groups, which were dominated by psychoanalytic practitioners. Statements from BACP following the outcry amongst members about this blatant bias have made small admissions that they got some of the language wrong and were endeavouring to recruit new people to better balance the team.

But how can this have been so overlooked at the outset? What does it say about a project which wants to ‘map’ the world of counselling and psychotherapy that it would erase a whole continent of thought and practice and then, when the inhabitants are outraged, desperately try to patch things up with reassurances that they are ‘listening’ and want to get it right?

What does it say about a project which wants to ‘map’ the world of counselling and psychotherapy that it would erase a whole continent of thought and practice?

Why has the person-centred approach been ignored in this way? Perhaps part of the answer lies somewhere in the SCoPEd organisations’ uncritical embrace of a ‘competency framework’ methodology derived from UCL’s manualisation of CBT for the IAPT project (IAPT, 2007; Roth & Pilling, 2008). While these frameworks might have some uses, it is difficult to understand the perception of the supremacy of this specific method for resolving difficulties in the field and promoting the profession, unless you actually want to bulldoze nuance and erase complexity in order to ‘clarify’ things. But BACP especially seems heavily invested in this approach, having already used it to create frameworks for a range of practice areas (including, it should be said, an IAPT-compliant, manualised version of PCT). Indeed, the organisation is so attached to the Roth & Pilling methodology that in a statement in Therapy Today, the Chief Professional Standards Officer and Chair of the SCoPEd Technical Group, Fiona Ballantine Dykes, claimed that the alternative to developing the SCoPEd framework is ‘doing nothing’ (Therapy Today, May 2019, p.51).

Given this single-minded, blinkered commitment to the competency framework process, it is hard not to conclude that person-centred perspectives – with their critical takes on both the manualisation of therapy and the associated alignment with healthcare values and medicalisation – are simply too awkward, too inconvenient, too damned political. As if a project like SCoPEd could not be political! As if, in its much-trumpeted spirit of collaboration between competing organisations, it could magically transcend all the history, politics, power struggles and diversity of thought and practice in order to objectively ‘map the competences’ of ‘counsellors’ and ‘psychotherapists’, without in the process distorting the field to shoehorn it into such a simplistic hierarchical structure.

I am not suggesting a deliberate conspiracy here, more that a number of professional interests converge around the adoption of these frameworks, whose politically expedient effect – in the apparent coherence of their efficiently organised categories and columns – is to eliminate awkward truths, not least in the profession’s sales pitch to governments and the NHS.

From this perspective, the SCoPEd project is so full of holes that, in one sense, it is hardly there at all. Part of me wonders whether, for all the fanfare and controversy, it will end up – like so many other documents – parked on our hard-drives or floating in the digital cloud, read more than once by almost no one outside of the organisational players, ignored by most of the public, of little interest to potential clients, perhaps skim-read by other stakeholders in the mental health field and then… what?

Well, it is how these things linger on the edges of awareness that says something about their potential power, about how – once installed – their unspoken values seep almost unnoticed into all sorts of areas of our lives as therapists (practice, training, supervision, organisational procedures, government policy). In person-centred terms, they begin to form a hard-to-grasp but nonetheless influential set of conditions of worth for therapeutic practice, which further externalise our professional loci of evaluation.

This is particularly problematic for PCT because, as I wrote in my own submission to the BACP consultation, the draft SCoPEd framework is alarmingly ignorant of person-centred working. Some of the exclusively ‘psychotherapist’ competences, for example, are almost the bread and butter of person-centred therapeutic relationships, which in the real world are often engaged with under the banner of ‘counselling’. Check out 3.5.c:

Ability to negotiate issues of power and authority experienced in the inner and outer world of the client or patient as part of the therapeutic process.

As I say in my response, for person-centred counsellors this would be a central principle of everything they do. Yet ‘qualified counsellors’ are deemed only to have the:

Ability to recognise and understand issues of power and how these may affect the therapeutic relationship.(3.5)

They are perceptive but passive witnesses to issues of power, which for me edges into an unethical disavowal of both the potential impact of their role and the asymmetry of the therapeutic encounter.

Read on and we find that only trained ‘psychotherapists’ have acquired the:

Ability to evidence reflexivity, self-awareness and the therapeutic use of self to work at depth in the therapeutic relationship and the therapeutic process.(5.1.c)

Which, again, is at the very heart of person-centred working (e.g. Mearns & Cooper, 2017). Yet ‘qualified counsellors’, we are led to believe, have only an:

Ability to demonstrate a commitment to personal development that includes self-awareness in relation to the client or patient to enhance therapeutic practice. (5.1)

Elsewhere, other competences make ‘psychotherapist’ the sole territory of those who lean heavily towards medical or psychoanalytic thinking, e.g. Ability to demonstrate the skills and critical awareness of unconscious process (3.10.b), which further alienates and excludes person-centred therapists.

Language barriers?

In response to the criticism attracted by the draft framework, BACP has suggested it will attempt to iron out some of these issues with language tweaks in future iterations, but such errors are extremely revealing of the way the unique theory and practice of PCT is invisible in the project, subsumed and submerged within generic statements around counselling practice while its more challenging perspectives have been redacted or just ignored into oblivion.

In any case, we should be wary of the reassurances from the SCoPEd teams that they just need to get the language right. For one thing, this smacks of PR rather than full engagement with the critiques (as in the infamous politician’s or corporate CEO’s defence, “I misspoke”). Furthermore, in this focus on language, BACP et al seem (wilfully?) to misunderstand the various challenges and objections, which are not only about words – as if swapping them with others would make it all better – but rather see language as the most obvious manifestation of deeper flaws in the project.

Something else I find troubling here is my own personal experience of having the same conversations with senior individuals at BACP about another competency framework, one drawn up for university and college counselling in 2016, which I had criticised as inappropriately redefining the sector as a branch of manualised healthcare (Rogers, 2019). In a face-to-face meeting and follow-up emails, it was acknowledged that BACP did not ‘get the language right’ and I was offered reassurances that this would be taken on board for future frameworks. Yet here we are again. I have no idea what the people I spoke with took away from our chat but somewhere in the subsequent organisational processes these reassurances evaporated into nothing and PCT once more finds itself ignored and excluded.

The person-centred approach, arguably, is not blameless in all this. Perhaps we have not been great at organising; perhaps we have felt so compelled to make concessions to the dominant narratives in ‘mental health’ and the therapy professions that we have our lost ourselves a little along the way, woozy with disorientation and gripped by a fear of judgement if we defy the trajectory of our own field. Nevertheless, the fact that a voice speaks with less assertiveness amid the noise of our culture’s deepening conversation with psychological distress is no excuse to ignore it, and it is troubling – and disturbingly ironic – when therapy organisations fall into this trap.

Perhaps my own tiny sketch of PCT’s political difficulties does it a disservice too. While I have drifted away from person-centred forums (journals, organisations, conferences etc.) over the years, social media – for all its flaws – has reminded me recently that there is a vibrant community of practitioners out there and PCT still has a unique and vital contribution to make to our field, to ‘mental health’ thinking generally and to our culture more widely. As ever, what the person-centred approach has to say is not always easy listening for those with professionalising aspirations and intentions, but surely it is our job as therapists to hear the things that others cannot bear, to listen to the most difficult truths, to welcome their complex, quietly spoken messages, to meet and fully engage with the challenges they present – why can’t our organisations do the same?

Tipping point

 As I researched the background to PCT’s early alignment with counselling and BACP (as discussed above), I stumbled across another passage in the same book (Mearns & Thorne, 2000) that, although written in my early days as a person-centred therapist twenty years ago, rings as true now as it did then:

‘It would be a tragedy… if person-centred therapists lost heart at this stage when, precisely because of some of the unfortunate moves towards a sterile professionalism… there is a greater thirst than ever among therapists and would-be clients for an engagement with what is truly human’ (p.218).

Whatever happens as SCoPEd ploughs on, we urgently need to find our voices. There are shifts in the mental health sector across disciplines and hierarchies. The medicalisation of distress, the dominance of biomedical psychiatry/pharmacology, the related mechanisation of therapy as another manualised treatment for discrete psychological ‘disorders’ and its subsequent co-option by the State in health and welfare policy are all coming under increasing pressure from a range of critical standpoints.

We may be at a tipping point. The more people experience this rigidly medicalised ideology in practice, the more they become aware of a need for something else and actively begin to seek it out. With IAPT’s legitimacy crumbling (Jackson & Rizq, 2019), the promises of psychopharmacology unfulfilled and psychiatric diagnosis itself falling further into disrepute, it is starting to look as if Person-Centred Therapy was on the right side of history all along.

Our professional organisations might want to listen more closely to what we have to say; not to assist their PR blitz around contentious projects, but to reset the course of the professions in ways that more authentically respect and promote the core values and diverse perspectives found in our field’s rich ecology of practitioners.


Andy Rogers has been a BACP member and counselling service coordinator in further and higher education for 20 years. He also works in private practice in Basingstoke, Hampshire.


References

IAPT (2007) The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. https://www.ucl.ac.uk/drupal/site_pals/sites/pals/files/migrated-files/Backround_CBT_document_-_Clinicians_version.pdf (accessed 05 July 2019).

Jackson, C & Rizq, R (2019) The Industrialisation of Care: Counselling, Psychotherapy and the Impact of IAPT. Monmouth: PCCS Books.

Mearns, D & Cooper, M (2017) Working at Relational Depth in Counselling and Psychotherapy. 2nd edition. London: Sage.

Mearns, D & Thorne, B (1988/2013) Person-Centred Counselling in Action. London: Sage.

Mearns, D & Thorne, B (2000) Person-Centred Therapy Today. London: Sage.

Rogers, A (2019) ‘Staying Afloat: Hope & Despair in the Age of IAPT’ (pp. 142-155) in Jackson, C & Rizq, R (2019) The Industrialisation of Care: Counselling, Psychotherapy and the Impact of IAPT. Monmouth: PCCS Books.

Rogers, C (1942) Counseling and Psychotherapy: Newer Concepts in Practice. Boston: Houghton Mifflin.

Roth, AD and Pilling, S (2008). ‘Using an evidence based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders.’ Behavioural and Cognitive Psychotherapy, 36, pp. 129-147.

Thorne, B (1999) ‘Psychotherapy and counselling are indistinguishable’ (pp. 225-232) in Feltham, C. (1999) Controversies in Psychotherapy and Counselling. London: Sage.

 

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SCoPEd: Denial, Distortion & Deception

The British Association for Counselling & Psychotherapy (BACP), the British Psychoanalytic Council (BPC) and the United Kingdom Council for Psychotherapy (UKCP) – collaborating under the banner of the SCoPEd (Scope of Practice & Education) project – recently published a draft ‘competence framework’, which attempts to differentiate counselling and psychotherapy.

Andy Rogers (BACP member and counselling service coordinator in further and higher education for two decades) submitted the following response to BACP’s consultation survey.


 

It is astonishing that the SCoPEd project claims this document will improve clarity for clients, employers, trainers and other stakeholders. I can only assume the competence framework exists for other political purposes, because there is certainly no clarity here, which might be forgivable if the document was at least more truthful.

But, as one of a number examples of the confused (unintentional?) deceptions in this framework, it is completely erroneous to identify 3.5.c (Ability to negotiate issues of power and authority experienced in the inner and outer world of the client or patient as part of the therapeutic process) as a ‘psychotherapist’ competency (one therefore presumably not held by mere ‘counsellors’), when for any person-centred counsellor worth their salt, this would be a central principle of everything they do! The same could be said of another ‘psychotherapist’ competency, 5.1.c. (Ability to evidence reflexivity, self-awareness and the therapeutic use of self to work at depth in the therapeutic relationship and the therapeutic process).

These examples demonstrate how formal differentiation between the adopted titles often means the imposition of something (i.e. simplistic, hierarchical separation and compartmentalisation) that isn’t actually there in practice among the human beings entering into therapy as practitioners and clients. In reality, there is much fluidity and complexity, which the framework attempts to iron out by positioning psychotherapists as doing the really deep stuff, counsellors as merely dabbling, and then a mysterious in-between group that does more than the basic counsellors but isn’t quite at the psychotherapist level.

“it is not the practitioner’s title that determines what happens in the therapy relationship.”

As most of us know, these levels – assumed in the document to be clear-cut enough to be separated into columns and boxes – are manufactured. At best they are only partially truthful, some of the time, in some situations, for some individuals. They certainly do not accurately represent the field, within which many practitioners who identify as counsellors will see their day-to-day work in the ‘psychotherapist’ column; while there will be plenty of ‘psychotherapists’ who have not yet developed the depth of practice (if we describe it that way) of some ‘counsellors’. After all, it is not the practitioner’s title that determines what happens in the therapy relationship.

That we end up working under one label and not the other is subject to all sorts of choices, influences, values, historical precedents and contextual factors, and often says little to nothing about what the experience of therapy will be like for clients, which could be vastly different between any two ‘psychotherapists’ or any two ‘counsellors’. For a whole swathe of the field, such as the humanistic section – and particularly in person-centred therapy – there is no distinction at all made between ‘counselling’ and ‘psychotherapy’ in terms of the actual work (which this framework purports to articulate); the different titles merely refer to the traditions and histories of various training programmes, professional organisations/groupings and work contexts (and the job titles therein).

“When did therapists become so uncritically disengaged from the roles of history and power in the narratives we hold about ourselves?”

The therapy field is a diverse and complex ecology, which, rather than celebrate, the framework appears to want to eliminate by reasserting hierarchies that are well past their use-by date. A historical aside here is that counselling as an alternative word for psychotherapy has roots in Carl Rogers’ mid-twentieth century tactical switch from the latter to the former at the University of Chicago, which was necessitated by a law that ‘psychotherapy’ could only be practiced by medical professionals. From the very beginning of ‘counselling’, then, the different words were not functional descriptors of differing activities, roles or levels of ‘competence’, depth, ability, skill or experience but were value-laden, politically charged and subject to the operation of power and professional (self-)interest. This is no less true today, but the SCoPEd project is in complete denial about it. When did therapists become so uncritically disengaged from the roles of history and power in the narratives we hold about ourselves?!

It’s notable in sections of the framework that ‘psychotherapist’ is apparently equated with greater alignment with psychoanalytic theory. Is the field not done yet with this power struggle, with the idea that psychoanalytic theory sits at the top of a hierarchy? The ‘note on terminology’ almost acknowledges this tension but concludes, absurdly, “Where terminology has been used that could be interpreted as being modality-specific, this is not the intention.” Oh, that’s okay then – it’s the thought that counts, eh? Being ‘expert’ therapists, I thought the Expert Reference Group (ERG) might have a bit more to say about the importance of language and the power that runs through it, looking beyond stated intentions towards the deeper meanings and influences when we choose one way of saying something over another (especially in a potentially influential document such as this). No?

I was also wondering how this apparent pro-psychoanalytic bias – with its implicit discrediting and delegitimising of humanistic/existential/person-centred counselling/psychotherapy (and their associated values, not least around language) – came about. Then I noticed the ERG was made up of 12 practitioners, 7 of whom were identified as psychoanalytic, whereas only 1 was clearly identified as humanistic (and even then, only as part of an ‘integrative’ model) (see pp.72-73 of the SCoPEd Methodology document). How can the framework produce an accurate picture of the field, when the ERG does not represent the diversity within it?

But the whole project is also skewed by other assumptions and value systems around therapy, which are perhaps even more important for the future of our professions. The Roth/Pilling UCL methodology used here was developed originally by manualised CBT proponents for the CBT competence framework, which was commissioned by the Department of Health as part of IAPT’s development. As this history suggests, breaking down the relational art of therapeutic work into lists of discrete ‘competences’ is not a neutral or objective activity (however ‘evidence-based’ it disingenuously claims to be); it is a technocratic pursuit that clearly derives from the NHS-appeasing assumption that therapy can be manualised into specific skills that, if applied in accordance with the manual, provide ‘effective’ ‘treatment’ for specific ‘disorders’. In other words, the project inevitably – via its very form – aligns therapy with an instrumental and medicalised healthcare model, again potentially delegitimising approaches that see therapy as, say, a meaning-making dialogical encounter or principled way of being.

That none of these biases or agendas, and the political expediency from which they spring, are acknowledged in the framework, highlights its failure to take a therapeutically informed, self-reflective, critical thinking approach to its own motivations, intentions, guiding principles, methodology or articulation. Presumably none of this matters much if your goal is to air-brush the imperfect, fallible, human complexity of relational therapeutic work, in order to prepare for the distribution of power that statutory regulation would involve for the organisations that have composed this empty but highly potent document.

andyrogerscounselling.com

@AndyCounsellor

 


 

 

UEA Course Closures – An Attack on Values

The University of East Anglia (UEA) has decided to axe its renowned counselling courses, including the flagship intensive Post-Graduate Diploma in Person-Centred Therapy, from which I graduated in the late 90s.

It is twenty years since I applied for a place on this course, two decades since I first held the role of ‘counsellor’ in a conversation, and I’ve worked in and written about counselling and psychotherapy ever since, with many formative experiences along the way. Yet UEA, the course, the staff and students, the Centre for Counselling Studies and the University Counselling Service are all tattooed onto my psyche as a practitioner.

The psycho-geography hums with resonance – the flattening lands around the A11 up to Norwich, the walk into campus from the Unthank Road, the iconic ziggurat buildings, high up from which the counselling rooms once gazed. I sat with my first clients in those stacked glass and concrete boxes, held and encouraged and distracted and moved by the big-skied view across the lake and the acres of shifting weather, which would nonetheless dissolve into irrelevance most sessions.

I attended personal development groups in these rooms too, grappling with the entwined attitudes of acceptance, empathy and authenticity. Seeing the value of the form, I once plumped for a private weekend encounter group in the same space – hours with a bunch of strangers from beyond the course, the first day running open-endedly into the evening as the room’s squared windows blackened to an array of mirrors. Given the intensive, full-time nature of the training programme either side of that weekend, I realise now I must have spent 12 days straight completely immersed in varying forms of experiential work, plus supervision, counselling practice and skills and theory sessions, with only two days break at each end (when assignments would’ve been emerging from my primitive word processor).

Later, after the diploma ended, I would return to co-facilitate a similar group experience and occasionally visited Norwich semi-socially, but always via my connection with the training and the therapy community around it. Although I no longer have contact with most of my fellow students, I gained one deep and ongoing friendship and still speak here and there with people connected to UEA.

But so what? Perhaps my disquiet at UEA’s decision to scrap the courses might be construed as nostalgic. Things change, don’t they? Tattoos bleed into the surrounding skin, lose their vibrancy, and whatever meaning they hold for the subject – and sometimes it is a sense of a long since departed self – they are at best curious adornments to everyone else.

Perhaps. But I think the loss at UEA has a significance beyond my own idiosyncratic history.

‘Say the right things, when electioneering…’

In the same year that I applied to UEA, Tony Blair’s New Labour swept to power on the back of a desire for change. It was 1997 and pop culture fizzed with champagne bubbles and cocaine-dashed nostrils. A rampant patriotism – initially art-school-ironic and then stadium-flag-literal – was busy ignoring or shouting down the prophetic gloom of Radiohead’s latest album, OK Computer, released that same year. In spite – or perhaps because – of its incongruence with the times, the album was nonetheless lauded critically and was wildly successful commercially – it’s anguished cry from Britpop’s shadow cutting through the din of the party.

I heard OK Computer to death in my job at what we optimistically still called a record shop (actually a video and CD chain store) but just recently, in advance of the album being re-issued next month, I’ve been giving it another spin, which is where – unexpectedly – our nostalgia thesis begins to unravel. Because there is little rose-tinted comfort in revisiting these songs. As they hit their twentieth anniversary, we – the citizens of 2017 – find ourselves not in Blur’s chirpy Parklife or in a big-hearted mass sing-along at an Oasis concert, but in the very atomised, alienated, divided and tech-engulfed times that Radiohead’s stunning, if overplayed, work of art-rock predicted, and about which it voiced a bleak but very human form of protest.

‘One day, I am gonna grow wings…’

The Person-Centred Approach (PCA) was – and arguably still is – another protest against the state of things, albeit one rooted in a model of potentiality and growth, rather than alienated despair. It emerged in the US as a critique of – and embodied alternative to – the psychoanalytic and behaviourist strangleholds on individual subjectivity, and spoke of a ‘quiet revolution’. It certainly challenged the power of the highly medicalised psychiatric and psychotherapeutic establishments, both theoretically and in practice.

As counselling gradually grew in legitimacy here in the UK, establishing its own organisations, literature and courses, the development of UEA’s person-centred training in the early 90s had a similar sense of creative protest. While the PCA had become a mainstream approach in the British therapy field – with one of its core texts (co-authored by the UEA course director) on the way to being one of the best-selling counselling books of all time in the UK – it still stood in counter-cultural contrast to some of the evolving norms of the emerging profession, which in any case remained relatively – by today’s standards – on the margins of our culture.

It was (and still is) rare for the PCA to be taught in a university setting, yet the UEA programme offered post-graduate training that remained defiantly values congruent: it had a deeply experiential approach; it was highly focused on the personal development of the practitioner; the spiritual and political dimensions of therapy were core themes; and completion of the course was through self- and peer-assessment. And this congruence between theory, principle and practice was also expressed socially through its embeddedness within the campus and city communities: trainees had placements within the university student counselling service and were encouraged to take up linked placements within the city. In my time there, students offered counselling in a diverse range of settings, from an insurance company, to voluntary sector services, to my own placement working with inmates at Norwich prison.

Following the 2003 retirement of the founding director, a prominent figure in the professions, the Centre for Counselling Studies maintained a high profile internationally within both the PCA and the counselling field generally. It staged a number of conferences and developed a successful Masters and PhD programme and towards the end of the noughties was undertaking qualitative and quantitative research into ‘outcomes’ at the University Counselling Service.

But sources at UEA suggest that this research was effectively ‘buried’. Then, around 2011-12, the university withdrew the team’s ‘Centre’ status and some of the associated funding, reducing it to little more than a teaching operation for the courses. The ‘Centre’ title, I’m told, was reinstated around 2014 as a branding exercise for the trainings but the staff budget allowed for no research or enterprise remit to expand its international profile. Then, in a typically Kafka-esque turn, the diminished Centre’s lack of research and enterprise was taken by the university as a sign of its ‘failings’, which brings us to the recent decision to axe it completely.

Many people, not least the students themselves and the local MP, have rightly challenged the wisdom of this decision on the grounds that it is unfair to existing trainees who were hoping to progress onto the higher level courses and – crucially – that it will drastically cut the availability of the real, in-depth counselling provided by diploma students, both in the wider Norwich community and at the university itself, where short-term CBT-based mental health support and group work is little compensation, as this moving post from a person who used the service makes crystal clear.

‘It’s just business…’

This is exactly what’s been happening in other sectors, of course, particularly the NHS, where instrumental, short-term models (therapy-lite, if you will) have become dominant. These are ideally adapted to the current, highly medicalised regime around mental health, with its diagnose-treat-cure approach to human distress. In its atomised conception of people and quick-fix mentality, this is in turn ideally suited to our current political and socio-economic conditions – often referred to as ‘neo-liberalism’ – in which therapy’s role is perceived by the State and its agencies to be simply to return ‘ill’ workers (or students) to their jobs (or studies) after a short course of ‘evidence-based treatment’.

In all levels of education, one impact of this neo-liberal order has been to prioritise the needs of business over both critical thinking and holistic personal development. In higher education (HE) especially, organisations are run as businesses themselves, with students considered consumers and staff expected to be compliant employees. The institution’s branding must not be tarnished because it needs to compete with rivals in the marketplace and generate as much income as possible. This can create a climate of fear, particularly when the organisational agenda begins to turn against a specific department or area, as appears to have happened at UEA.

These aren’t the kind of conditions in which in-depth counselling trainings are likely to thrive. While the courses might be in demand and over-subscribed, they can also be costlier than some other programmes, due to the intensive, experiential element, which requires plenty of contact time between staff and students. In discussing the events at UEA with colleagues, I learned that a number of other long-established counselling courses in HE have closed or been threatened with closure in recent years.

How does this fit with our culture’s contemporary interest in addressing ‘mental health’? Well, in one sense, it’s obviously completely at odds with it; but it also highlights how not all ways of responding to psychological distress are valued within the cultural and economic conditions I sketch above. While we are talking about mental health more than ever – which part of me welcomes because a decrease in shame, embarrassment or toxic silence is a good thing – unfortunately most of the talk is funnelled through a very narrow channel of acceptability: our distress must be seen as ‘just like any other illness’ and therefore the treatments must be medicalised and efficient. This is therapy as a drug-like healthcare intervention (with the reductionist ‘evidence’ to match) rather than it being a relational, exploratory dialogue – a meaning-making human encounter.

So courses such as UEA’s person-centred training are not only a bit expensive to run, in a highly competitive and monetised system, but also they represent a direct challenge to the prevailing ideology in education, mental health and the culture at large. I’m sure many of us would hope that this kind of critical, creative and counter-cultural thinking and practice would be encouraged by our universities – even when it’s not much of an earner – but clearly this is no longer the case.

‘Fitter, happier, more productive…’

Tellingly, UEA is maintaining its training programmes in a highly manualised form of Cognitive Behavioural Therapy (CBT), which feed directly into the NHS Improving Access to the Psychological Therapies (IAPT) programme. The training resides in the Clinical Psychology department of the university’s Medical School. If you look at the web page, there’s a link for ‘IAPT and Other Modalities’ (meaning non-CBT approaches), which leads to an otherwise blank page saying, Coming soon. Let’s not hold our breath on that one.

IAPT has come in for heavy criticism on many fronts: using an overly manualised and bureaucratised (i.e. de-humanised) healthcare approach; discriminating against other therapies (and the clients who want them) due to a narrow and inappropriately medicalised understanding of evidence; massaging data to claim greater success; having absurdly long waiting lists and a dysfunctional triage system; not taking care of its staff, who burn out quickly; unethically colluding with the efforts of the Department for Work & Pensions to reduce the welfare bill; and more.

In my own work, I fairly regularly hear from people with unhelpful experiences of IAPT, not least that a person’s history – their childhood experiences particularly – are barely considered. Huge losses, abuses or other deeply significant events that clients begin to explore in counselling within the first session or two, might never even have come up with their IAPT practitioner. Yet across all therapy sectors outside of the private sphere, the pressure is to follow the NHS model, as if its legitimacy is unquestionable, as if its version of what distress means, and how we should respond to it, is reality itself.

This then delegitimises all other responses to distress, however valued they are by the people who use them. In my own sector, counselling in further and higher education, I have seen this creep occurring first-hand. The professional division for the field (BACP UC) recently followed its parent organisation’s desires by creating a ‘competency framework’ based on the same CBT-derived Roth & Pilling/UCL methodology that we see in UEA’s IAPT training. This despite the fact that relational work – humanistic, person-centred, psychodynamic, integrative – is far more widely practised in the sector. While the framework apparently welcomes all models of therapy, it is nonetheless skewed to a technocratic and instrumental healthcare approach, and has alienated a number of highly experienced practitioners in the sector who do not recognise their work in the final document.

‘We are standing on the edge…’

Where, then, do we go from here? On the brink of a general election, with a very different Labour opposition to that of 1997 but a very familiar Conservative government, which is apparently emboldened by the country’s divisions, how do we shift the language and practices around ‘mental health’ away from the thin comforts of ‘illness’ and ‘treatment’? How do we take back human distress from its enclosure by neoliberalism, healthcare and the State, and re-integrate it into our everyday lives and relationships so that we can respond with ordinary compassion, rather than professionalised diagnosis and treatment, even (or perhaps especially) when we seek out a therapist to discuss our concerns?

What still excites me about the spirit of the Person-Centred Approach, is its deeply respectful commitment to the right to self-determination; to the inherent value and potential in subjectivity; to honouring the connectedness between us as persons in a social world; to witnessing, exploring and embracing all of this with a principled and creative not-knowing, rather than dogmatic expertise. It is these precious things – despite all the mental health policies, initiatives and media campaigns – that we see being lost at UEA and beyond.

Recently, a small controversy bubbled up at UEA about the appearance of Anthony Gormley’s life-size human statues on the roofs of its concrete structures. One looks out from a building behind the ziggurats, gazing across the same land and skies as the view from the counselling rooms. It is mesmerising, unsettling, challenging. Some have complained they are reminiscent of suicide.

In a BBC interview, Gormley said,

‘These works are nothing to do with suicide, they’re actually to do with life… Universities are places where people spend a lot of time thinking about the thoughts of others… I think it’s a wonderful place to balance that intellectual life with an object that is silent. It doesn’t need to be read. It has to be felt, it has to be lived with.’

Let’s hope the statues are a defiant symbol of the persistence of these values and aspirations, rather than a memorial to their passing.

(Song lyrics from Radiohead’s OK Computer.)

Andy Rogers is a counsellor and service coordinator in a large FE and HE college and works in private practice in Basingstoke, Hampshire. He is a registered member of BACP and has written about the politics of therapy and the person-centred approach for the best part of twenty years.

andyrogerscounselling.com

@AndyCounsellor

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The Ethical Dilemmas of Back-To-Work Therapy

This dialogue is taken from an email conversation held in 2015 between Paul Atkinson and Andy Rogers and was inspired by the dilemma described in the vignette below.

An earlier version was published in the journal Self & Society – An International Journal for Humanistic Psychology , Vol 43, Issue 4, 2015. Subscribe to Self & Society here.


Izzy is a qualified psychodynamic counsellor, with a supplementary training in CBT. She has a small but growing private practice working from home and recently began a part-time job as a mental health advisor in a Well-Being Hub located above a Jobcentre Plus. She feels increasingly caught in a conflict of feelings and loyalties between the two settings of her working life.

Her Hub clients are nearly all working class, on welfare benefits and from a variety of ethnic minority communities. Many are on medication and have patchy experience of work. Some have been sanctioned by the Jobcentre staff downstairs and have had to survive on reduced benefits for weeks or months. Via the Hub, she can offer a maximum of 12 weeks support. Meanwhile, her private clients are predominantly white and broadly middle-class, and she sees them once or sometimes twice a week for open-ended therapy on a sliding-scale of £15 to £55 per session.

She feels a profound ethical and social commitment to her Hub clients and the value of their work together, but is concerned she might be supporting an inadequate and potentially punitive system of mental health provision, on an hourly rate of about one sixth of her average private practice fee.


Andy Rogers: Can you say a little about your own work in and around the therapy field, Paul, and what first strikes you about Izzy’s situation and her ‘conflict of feelings and loyalties’?

Paul Atkinson: I have been involved with therapy and left libertarian politics since the early 1970s. I’ve worked in private practice as a Jungian analytical psychotherapist and supervisor since 1990, and chaired two training organisations along the way. As a member of the Alliance for Counselling & Psychotherapy and the analytic college of the UKCP I campaigned against state regulation and the ‘medicalisation’ of the therapeutic relationship. Most recently I have been working to undo the separation of psychological life and social and economic life, a separation through which psychotherapy has played its part in neoliberalism’s growing capture of subjectivity. I helped set up the Free Psychotherapy Network (FPN), and am working with mental health and welfare campaigners to oppose the Department for Work and Pensions’ (DWP) psychological coercion of benefits claimants.

Izzy’s situation and her ethical dilemmas feel very familiar. I think many therapists experience a tension between wanting to work with ordinary people in psychological difficulty through the public and voluntary sectors, and the potential freedoms, satisfactions and income of private practice and its largely white, middle-class clientele. Over the last two decades, these two worlds have become increasingly polarised – in parallel with most other trends in social cohesion and the distribution of resources. As we all know, most counselling and psychotherapy in the public and third sectors is now very short-term, instrumental and behavioural. In the self-employed private sector, open-ended work is the norm, but is affordable to the more well-off only.

My fantasy is that Izzy wants to build up her private practice but is experiencing a lot of anxiety about getting enough clients, setting herself up as a self-employed business and bearing in relative isolation the responsibility she feels for her private clients. The part-time job at the Hub gives her a reliable if modest income and places her in a team with a framework of guidelines, shared responsibility and focussed goals and outcome measures – alongside the satisfaction of working with people experiencing social and economic deprivation and considerable psychological suffering.

The trouble is her job at the Well-Being Hub places her right on the cutting edge of the most vicious campaign in post-war Britain of state violence against welfare claimants, and especially people on mental health disability benefits.

AR: So Izzy’s anxieties, comforts, conflicts and satisfactions aren’t just individual or interpersonal matters, but are in direct relationship with the push and pull of the political and socio-economic environment. Most starkly, she finds herself involved with a government policy that’s having a direct and devastating impact on some of the least powerful people in society.

What really stands out here to me is the mention of Izzy’s ‘profound ethical and social commitment’ to her Hub clients. This brings with it the dilemma of whether or not she can honour – or do justice to – that commitment in such an environment; or is it just too contaminated? How do we begin to answer that question?

PA: Well, there are surely conflicting ethical perspectives for Izzy to wrestle with, and as always the realms of ethics and politics are interwoven.

There is a broad ethical debate about the difference between working in the public and private sectors, a debate which has deepened with the replacement of most NHS talking therapy with the Improving Access to Psychological Therapies (IAPT) programme. As a private practitioner, I would say the primary scene of ethical action is the quantum flow of the intersubjective moment. The existential, let’s say ‘Levinasian’ space of interpersonal encounter is undoubtedly relevant to any institutional setting, but has become increasingly circumscribed by neoliberal utilitarianism and the devastations of austerity ideology. Private practice potentially offers more scope for ethical integrity, say in relation to respect for unconscious process, but it is slave to the market in its own way, and can hardly make more than a limited, individualised claim to serve social justice.

Many therapists in Izzy’s position would argue that something is better than nothing, that the value to her Hub clients of several hours of empathic attention, a taking seriously of their very personal experience of distress and an attempt to offer some kind of useful perspective on how to better live with that experience is primary in the ethical balance. The exponential growth of short-term, outcome oriented therapy over the last decade and more has appalled many practitioners, while others claim the ethical core of the relational encounter remains viable.

In general, I hesitate to make principled judgements on the ethics of someone’s work based on the restrictions of their setting and job description. A practitioner’s capacity for ethical work can overcome, or at least survive all sorts of environmental enclosure. The ethical environment of Izzy’s mental health Hub, however, has and is being deeply undermined under the Coalition and Tory governments, especially in relation to the increasing collaboration between the NHS and the DWP to get claimants suffering mental health issues off benefits and into work.

AR: What’s some of the recent political history around these developments?

PA: From the start, the IAPT scheme promised to pay for itself by reducing the welfare bill. Richard Layard was clear in his Depression Report 2006 that more people were claiming benefits with a mental health diagnosis than for any other reason, including unemployment.  Getting people off benefits and into work was to be a major outcome goal of IAPT provision.

From 2010, DWP welfare policies have become increasingly punitive towards anyone claiming social security benefits, and the pressure to get claimants off benefits has created a toxic environment of fear and coercion, fuelled by a massive increase in benefit sanctions, work preparation courses and compulsory workfare.  The number of claimants sanctioned doubled within a year of new rules introduced in 2012.  Thousands of people with mental and physical disabilities have been subjected to repeated rounds of Work Capacity Assessments and declared fit for work. Deaths through suicide or other causes associated with people being sanctioned or declared fit for work have climbed.  On October 14th 2015, responding to an approach from Disabled People Against Cuts, the UN launched its first ever investigation in a developed economy into the effects of UK welfare cuts on people with disabilities.

Following the Rand Report of 2009 on the value of work as a treatment for mental health sufferers and its recommendations for the joint Department of Health/DWP piloting of a number of return-to-work programmes offering psychological therapies and well-being courses to benefit claimants, return-to-work therapy has begun to dominate the discourse of ‘treatment’ approaches for mental health service users on benefits.  In his 2015 spring budget statement, George Osborne announced the ‘co-location’ of IAPT teams in 350 Jobcentres around the country. The Conservative Manifesto a month later suggested compulsory treatment for benefit claimants with obesity and substance misuse issues.  As I write, Ian Duncan Smith is putting job advisors in food banks.

I want to ask Izzy what she thinks about the ethics of mental health work located in the same building as a Jobcentre Plus? What does she think about working with clients, many of whom will be claiming benefits and will be subjected to a regime of sanctions, workfare, fit-to-work assessments and so on? Does she not think that her work is becoming profoundly contaminated by a “get to work” ideology that is a major source of distress, anxiety, fear and humiliation for many of her clients?

Part of the response from the Hub’s management will be that their work and the DWP’s work are separate, that sharing a building does not mean that they are collaborating in any way, that any course of treatment or support they are offering is strictly by the informed consent of the client, and in so many cases their clients want to work – in fact are desperate to get out into the world of work and all the benefits of self-respect, feeling useful and having a bit more money a job brings.¹

But what does Izzy think as a therapist?

AR: I wonder whether part of the difficulty here is that a practitioner such as Izzy might ‘think as a therapist’ a bit too much! That her commitment to therapeutic process and the assumed value of therapy discourse and practice, and its associated conventions (we sit in this room and we talk in this way about you etc.) might narrow her field of vision when trying to see a way through her dilemma.

Perhaps Izzy and the rest of us need to think more like sociologists or political theorists, or at least apply our critical faculties not just to what happens ‘in the room’ but to the relationships and structures beyond. Interestingly, this seems almost fashionable to say at the moment, which is rather incongruous with our field’s ever more cosy relationship with the State!

Yet even with a fairly conventional therapist hat on, it’s pretty clear that a coercive context (or a physical location and referral  process that directly links therapy with coercive practices nearby) will influence what is going on in the therapy relationally, however noble our intentions to provide a facilitative space for personal exploration.

PA: I imagine all therapists recognise that work is an important issue for most people, whether they are in paid work or not. Work and family are probably still the primary sources of meaning, identity and social connection for most of us. Everyone needs the means of keeping body and soul together, and we live in a society that puts a high value on individuals and families taking responsibility for those needs, mainly through paid work. What is going on for a client in relation to work and money is going be an important arena of therapeutic endeavour, and an endeavour which forcefully brings the world into the room with the client and the therapist.

Obviously, not everyone can work, wants to work or needs to work. Having a job is not a goal of psychotherapy.²  If there is a therapeutic desire around the issue of work, it is surely to explore and open out what work means to someone. The individual complexity of those meanings, as every therapist knows, can be dense, contradictory and fascinating. Ideally, the ethics of the profession call for as open an exploration as possible of the meanings both the client and the therapist associate with work.

If I were offering Izzy supervision for her Hub work, we would inevitably be thinking together about the restrictions of the setting for exploring what things mean to her clients – including work. I have no doubt she will be seeing people who want to work, have a history of difficulties finding and holding down a job, and perhaps find it hard to identify and articulate what kinds of working conditions would be best for them and so on. Izzy and her colleagues in occupational therapy, confidence training and practical support may well do a great job supporting these people, including offering some insight into the clients’ difficulties around work.

“It is impossible to imagine how the toxicity of the DWP culture would not undermine and contaminate Izzy’s hope”

But she will also be seeing people for whom the whole process of being in work or looking for work has been a traumatic nightmare alongside coping with combinations of housing problems; bouts of depression; panic attacks; family breakdown; single parenthood; low wages and benefit claiming; excruciating feelings of uselessness, failure and despair; domestic violence; physical disability; caring for dependents; self-harm; substance misuse; psychosis. Many people with this kind of experience of emotional and social problems will be on benefits and will be in the hands of the DWP regime in the Jobcentre Plus downstairs from her Well-Being Hub.

It is impossible to imagine how the toxicity of the DWP culture would not undermine and contaminate Izzy’s hope to offer a space in which someone’s feelings and associations about work or anything else can be explored.  How in these circumstances can anything approaching an ethical frame for counselling or psychotherapy be tenable? On the contrary, return-to-work and any real therapy will be at loggerheads.

What should Izzy do? This is where your question comes in, Andy. ‘Do we therapists need to think more like sociologists or political theorists, or at least apply our critical faculties not just to what happens ‘in the room’ but to the relationships and structures beyond?’ Yes of course, but what does that mean? Thinking critically about the interplay of the social, political and psychological dimensions of a person’s life, and working within that interplay as a therapist are not necessarily the same thing.

Most of our trainings will include reading and thinking about ‘social diversity, inequality and social justice’. Some make a lot of post-modern critical thinking. There is a growing literature on psychotherapy and politics.  A therapist’s background in terms of class, race, gender, sexual orientation and life experience generally is likely to have a crucial influence on how socially-minded they are and therefore how social and political understandings get into their work. In reality, though, I think the psychodynamics of social difference remain primitive everywhere. Among therapists – because of the intensity and depth of the encounter – fear of difference and associated defensive strategies can be especially powerful. For example, thinking of Izzy, how much thought do we give to our fear of poverty and the poor?

“As a profession, we are more part of the problem of neoliberal capitalism than we are part of the solution. “

At the same time, the separation of the psychological from the socio-economic is at the foundation of psychotherapy and counselling. As a profession, we are more part of the problem of neoliberal capitalism than we are part of the solution. Psychotherapy’s creation and marketing of the intra-psychic individual, like Big Pharma’s creation of the depressed and anxious brain, represent very successful enclosures of lived experience as marketable solutions for the failing denizens of “modern life and its challenges”.

Izzy has some kind of political take on her work, expressed as an ethical tension within her. I would encourage her to experience this ethical discomfort as a guide in her development as a person, a citizen and a therapist. I would want her to allow the unfolding of her discomfort and her effort to work, think and live with its nagging voice to become a passion in her life. Where it takes her is not really the point.

She may think that the ethical environment of her Hub work is too toxic to bear, and leave as soon as she can. Many newly qualified therapists who take up work in the public or voluntary sector and find themselves doing very short term, regulated, outcome-driven therapy can’t stick it for long. It is not what they have trained to do and can accept as real therapy. A recent blog on the Critical Mental Health Nurses Network tells the moving story of a student nurse who decided to leave his training in the face of what he discovered to be the political context of the profession: ‘In short, I felt more like a prison guard than a nurse. Mental health nursing is much more of an authoritarian role – which made me feel more like I was more part of the problem than the solution.’

Izzy may feel she wants the experience of working with and getting to understand the experience of the people she meets in the Hub work – people she is unlikely to meet in private practice. With a growing awareness of how the politics of mental health operate, she may want to explore how to find trust between herself and service users, how she might begin to challenge the Hub’s ethos, and get involved in arguing for changes in the service and in the DWP policies whose impact she is experiencing first hand. She may find herself in deepening conflict with her employers, looking for support from sympathetic colleagues and her union. She may end up losing her job. But in the process she will deepen her understanding of the politics of mental health and of how to work more creatively with people who want positive change.³

But as I say, where it actually takes her is not really the point.


References

  1. In June 2015, the Mental Health Resistance Network and a number of claimants’ organisations and psy-professionals protested at the location of a Well-Being Hub being located above a Jobcentre Plus in Streatham: http://www.swlondoner.co.uk/protesters-rally-against-streatham-jobcentre-forcing-unemployed-people-into-mental-health-treatment/. The Hub staff and representatives of the protesters met a few months later to talk about issues raised.
  2. The moral power of work in our wealthy society is unrelenting. However meaningless, under-paid and demeaning, with a labour market increasingly dominated by ‘voluntary’ and unpaid, low-paid, part-time, zero-hour contract and desperate self-employment work, we are to obey a moral duty to want to work. Benefit claimants are regularly declared to be scroungers, cheats and liars. On the debilitating influence of the current ethos of work, see: http://www.theguardian.com/commentisfree/2015/aug/25/work-cure-disability-benefits-sickness and for a refreshing rebuttal of the return-to-work philosophy, see http://freepsychotherapynetwork.com/2015/03/05/middle-class-solutions-to-working-class-problems-is-why-charities-like-mind-keep-getting-it-so-wrong/
  3. For the beginnings of a discussion in Therapy Today on the ethics of return-to-work therapy and how practitioners might respond see: http://www.therapytoday.net/article/show/4899/should-counsellors-work-with-workfare/ and http://www.therapytoday.net/article/show/4968/counsellors-helping-the-unemployed/

About the authors

Andy Rogers trained at the University of East Anglia in the late 1990s and has worked in and written about the therapy field ever since. He now coordinates a counselling service in a large college of further and higher education and is an active participant in the Alliance for Counselling & Psychotherapy.

Paul Atkinson is a Jungian psychotherapist in private practice in London. Political activism has flushed him out of his consulting room over the last few years, nicely timed to coincide with his state pension and the arrival of grandchildren. He is a member of the Alliance for Counselling & Psychotherapy, and has been centrally involved in setting up the Free Psychotherapy Network.