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.

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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)

Soundings #2: Nobody heard him, the dead man, but still, he lay moaning…

Friday June 26, 2015 

There is a meeting today at 1.30pm at the Streatham Memorial Gardens. I shall be there early. The meeting will gather together a group of people, perhaps 100, maybe more judging from the Facebook page, who will then march up the road, not far, to the Streatham Job Centre. It is a mark of our varying dissatisfactions with the Government’s idea to put CBT therapists in Job Centres in a supposed attempt to get people ‘off the dole and back to work’.  

What a beautiful day for a protest, the roses are blooming and the birds are singing. I barely have time to look at the statue with its inscription To Our Glorious Dead and the list of names inscribed below – it’s 1.15pm and already there are 12 people standing in the shade of the trees, and two are holding up a banner which the other ten are photographing. The gist of the banner is this: ‘CBT practitioners: are you a professional or a collaborator?’ 

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I set to work introducing myself and asking people why they have bothered to come today. 

“It’s a human right to be able to refuse medical treatment. To not be made to be part of an experiment. It’s written in the UN Declaration of Human Rights.”  

“I’m just gutted. Council Houses, Brixton Arches, rent increases, everything.” 

“I want to support people facing cuts to their allowances. I have friends with distress who are scared by the way things work.” 

“It seems a really bad idea to combine a disciplinary system with social care.” 

The next person turns out to be a national spokesperson for the Green Party:

“the Government is crossing a line – it’s written in their Manifesto, their intention is clear. Don’t believe them when they say there’s no coercion, it’s written in their Manifesto.” 

And others:

“Its an inappropriate setting – it is not a place to speak freely, which it should be for any therapy”. 

 “It’s wrong to make a mental health service part of a sanction system.” 

“To cut public spending, they are hitting the most vulnerable.” 

“It’s clearly wrong.” 

“Mental Health isn’t something you can flick a switch and fix”.

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“The problem, in my opinion, is that we live in a system which makes us ill – unemployment, poverty. Actually I’m doing therapy, CBT, over there [points just over the main road which is throbbing with traffic fighting its way into the narrowing Streatham High Road]. The services become part of the problem. They mean well, the people who work there, but it’s done in a way that, well you are made to feel uncooperative if you turn it down. And the political, social situation is not up for discussion – these are the things we really need to talk about if we are going to get better.”  

“The problem with CBT is that it makes you the problem, and tries to change your attitude.” 

“Debt. Struggling with debt leads to suicide.” 

“I’m horrified, instead of funding mental health services in clinical settings, I had to wait six months for CBT – why not fund it more in places where people actually go to talk about their health?” 

“My girlfriend is terrified, and has taken on the language of officialdom. She says that she is a ‘shirker’! She is terrified of psychiatrists, of the ways of the medical system. She feels like a terrible burden on everybody. She has been invited to go to job centres, I go with her, but she panics in waiting rooms, and she panics when she sees the security guards – it freaks her out. She was on DLA, and they said ‘would you like to work?’, and she said ‘Yes, I would like to work!’ and they said ‘we will help you to go to work’. So we went there together, I held her hand, she wanted to work, but her expectations were really unrealistic.” 

“Its funny, they speak of parity don’t they, of parity between mental health and physical health. So, if you break your leg and can’t work, will they send you to the job centre to fix it?” 

“It’s about dignity. My partner has worked, she has paid her National Insurance, she has contributed, but now she has taken on their vocabulary, she calls herself a burden…” 

“Treatment should be voluntary. If the Job Centre should suggest that people go to the Doctor, well, are they qualified to tell people to go to the doctor? If I was working in a Job Centre I would be very uncomfortable raising it with people, because you have to be very diplomatic when you suggest to someone that they might need counselling. Even when your friend says so, you might feel offended! I mean, you have a personal relation with your job centre advisor when you are unemployed, you don’t want them prying into your personal life, do you? You have to be careful if you speak to someone about their mental health, it could be negligent to raise the question, it is a bit like the oppression we associate with Russia. When I was unemployed you had to sit in an open plan office every day for two weeks, and look for work. There were people who lectured you about looking for work. There were a lot of vulnerable there then. Imagine if you had to raise the question of mental health with someone who is clearly in distress and struggling. It could be negligent, are the people in the job centre qualified?” 

“How dare they take food away from someone, it’s against Human Rights.” 

“It is a symptom of our civilisation’s discontent, and therefore, worth punctuating. It might not be necessary, never mind possible, to remove it.” 

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By this time there were about 60 people gathered in the Memorial Gardens, some holding placards and banners and others taking photos. I asked one man what he planned to do with his photos. It turned out he was a freelance photographer commissioned by the South London Press to cover the demo.  

Two women picked up the sticks to the Alliance for Counselling and Psychotherapy banner. They were sisters, and they had another sister with a learning difficulty. They told me that they were ‘watching’ and ‘listening’ to what was happening in the country with the politics, and she said, we have noticed that ‘they go for the weakest first’.  

Now we start slowly to muster together and walk across the road. A bloke rolled down his lorry’s window and shouted, “Get outta the fucking road, go get a fucking job”.  

While we edge ourselves in amongst the traffic and saunter up the main lanes of the road, I recognise someone who used to run a psychotherapy service in one of the big London hospitals. “I used to be head of psychotherapy” he said, “and I would have been raising hell against a move like this made by the management”. Who’s the head of therapy now? I asked. “A CBT guy”, he replied with a rye smile. And is he raising hell against this new policy? A derisive laugh was all that I could hear of the reply amongst the roar of the traffic and the shouts of the London drivers, who only wanted to move fast and not think about us.  


The paradox had not escaped her, so how had it escaped our civil servants and government ministers?


Someone next to me said that she was concerned about therapy being put next to the Job Centre function because “it puts fear into people’s minds,” then added, “which is not desirable.”

“It is the very thing isn’t it, fear,” she went on. “This is what CBT people try to resolve, isn’t it? Yet the people who might need it most would be the ones most vulnerable to exactly this kind of fear.” The paradox had not escaped her, so how had it escaped our civil servants and government ministers, one wonders?  

People with a microphone are raising our spirits with their strong voices. There is a discreet police presence up the hill, and down the hill, and the security guards in the building are checking people’s ‘tickets’ before letting any one in. Too late! An advance guard has snuck into the building and is creeping up the stairs as we listen to the man with the mic doing his best to rouse the rabble. A few people take it in turns to move the crowd through the mic, and then a cheer goes up, and everyone moves to the other side of the street and looks up at the top floor of the building. A large red banner is unfurling in the wind with the words ‘Back To Work Therapy Is No Therapy At All’. It is now 2.30pm. 

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Someone with the microphone is haranguing Ian Duncan Smith and talking about the suicides of people who have lost their benefit, and I remember Stevie Smith’s (no relation) wonderful poem ‘Not Waving, but Drowning’: Nobody heard him, the dead man, but still he lay moaning

Nobody heard him? We can hear him because he is not yet fully dead, only half dead, still moaning. Threatened and pushed out of the symbolic order, off the benefits, deprived of a means to live with his dignity, turned into an object, treated as any old piece of rubbish, but not yet dead. Not yet.  

In April 1953 Stevie Smith wrote her poem Not Waving but Drowning. On 1 July 1953 she self-harmed in the office and her doctor decreed that she is not emotionally stable enough to go back to work. She was retired with a small pension, and dedicated her life to writing and looking after her ailing aunt. In 1957, the publication of her collection under the heading Not Waving but Drowning established her firmly as a major poet worldwide and opens a new life for her of poetry readings and broadcasts. She soon becomes a cult poet and is sought after by the likes of John Betjeman, Philip Larkin and Sylvia Plath.  

Should we, perhaps, rather put poetry into Job Centres, and save the CBT for somewhere more fitting?


Nobody heard him, the dead man, 

But still he lay moaning: 

I was much further out than you thought 

And not waving but drowning. 

 

Poor chap, he always loved larking 

And now he’s dead 

It must have been too cold for him his heart gave way, 

They said. 

 

Oh, no no no, it was too cold always 

(Still the dead one lay moaning) 

I was much too far out all my life 

And not waving but drowning.

 

Stevie Smith

Alliance Newsletter – June 2015

Dear colleagues,

We have decided to circulate a brief newsletter following-up on the issues raised in our recent Open Letter to the Guardian, which has been shared over 6500 times, along with other related developments in the psy field.

• Psychological therapy located in Jobcentres

Following our Guardian letter, a group of therapist, psychologist, disability and social security benefits campaigners met in May to discuss working together to protest at the prospect of coercive therapy and mental health treatment being located in Jobcentres.

The meeting supported the Mental Health Resistance Network’s open letter on the issue, as well as the protest at Streatham Jobcentre Plus on Friday 26th June. Please take a look at the Open Letter and circulate it among interested colleagues. Join us on the 26th if you can. Also see the MHRN Facebook page for newsreel coverage of campaigning around DWP policies and mental health.

There has been considerable media and professional response to the growing thrust by the Government to link social security benefits, mental health and IAPT style psychological therapies within the toxic context of Jobcentres, WCA’s and benefits sanctions. See, for example, this excellent piece by Lynne Friedli and Robert Stearn. Professional bodies are beginning to publicly address the ethical issues raised by “get to work” therapy – e.g. BACP, BPS.

The Alliance is building a resource and news update section on its website on this issue, and will circulate links when it is available. Meanwhile, please contact us with any developments, ideas and relevant resources from your networks: info@allianceforcandp.org

March Against Austerity

The Alliance is joining the People’s Assembly march against austerity in London this Saturday – 20th June – under its new banner. Join us at 12 noon outside Jo Malone, 24 Royal Exchange Building, at Bank.

Big Issue(s) Conference organised by Psychotherapy and Counselling for Social Responsibility – 26th September

This PCSR conference is intended as an opportunity for practitioners to express their concerns about the current direction of counselling and psychotherapy, and discuss plans for action. Take a look at the programme for the conference and its booking form here.

Best wishes,

The Alliance

Nailed: Tory lie on suicide rates and austerity

Dear friends and colleagues,

The question of mental health under the previous government’s austerity policies has taken a vital new twist. Please find a new press open letter touching on this in Monday’s Guardian, here:

http://www.theguardian.com/politics/2015/may/03/us-and-british-health-specialists-support-the-nhs

In the accompanying newspaper report, we read that,

…A [Conservative] party source added: “Every suicide is a tragedy, but the latest available data shows that the rate is now the same as in 2003 and has been relatively stable during successive governments in the intervening period.”

The following rebuttal appears in today’s “i” newspaper (not available online):

SUICIDAL POLICY

Having announced their £12 billion of welfare cuts nearly two years ago, any responsible government would have long since devised clear plans for implementing them (6 May). The Conservatives are also being equally disingenuous about the impact of their austerity policies on Britain’s suicide rate, having recently publicly denied that there has been any spike in the data. This denial flies in the face of all the empirical evidence. Extensive international epidemiological evidence shows a clear and consistent causal link between austerity policies and suicide rates. With the Conservatives returned to office and these cuts imposed, Britain’s suicide rate would soar to previously unheard-of levels.

Dr Richard House – Chartered Psychologist, Stroud; Alliance for Counselling and Psychotherapy

Could you please circulate this far and wide to all your contacts ASAP, and ask them all to do the same… That way, we can maximise the extent to which voters know about this scandalous issue before voting today.

Thanks once again for your much-valued support of our initiatives on this crucial issue.

STOP PRESS: Important news re: deaths linked to ESA. Please share:

http://www.disabilitynewsservice.com/election-2015-greens-demand-ids-apology-for-misleading-voters-on-benefit-deaths/

http://www.disabilitynewsservice.com/dwp-told-to-publish-esa-deaths-report-after-two-year-delay/

‘Like an Open Sky’ documentary

Like an Open Sky – a beautiful documentary by Marian Otero – is a fantastic testimony to children struggling with mental and social difficulties, and the adults who try to understand them.


film

Film maker Mariana Otero wanted to make a documentary about madness, and spent a long time visiting institutions looking for a place to film in. She wanted to find an institution which treated children as subjects, not as objects. Eventually she found one – Le Courtil, on the border of France and Belgium. The film focuses on a small group in one part of the institute. However, the institution is in fact very much larger – it was set up 30 years ago, and has enjoyed a steady growth and welcomes many children who come to it, even, from France. This makes the institution rather popular with the Belgium government, as they see that their investment in the work acts as an ‘export’!

The director spent about a year at the institution before she even strapped on her camera, and you can see how this has helped both staff and children to be at ease in front of the camera. It is clear that some of the children really welcome her and make use of her as part of their experience at the institution. In fact, this becomes the subject of one of the staff meetings that we watch, which discusses the way that one of the children (Alyson) makes use of the gaze of the camera to ‘not fall down in front of’.

Mariana follows the children into the music workshops, the ‘pretend’ workshop, she watches as they cook in the kitchen, or dig and plant in the garden, she accompanies them on a trip to the shops, and into the intimacy of their rooms, and she also follows the staff into their staff rooms and meetings and listens to them animatedly discussing their work via their theoretical ideas. On a night shift, the film-maker asks a worker to explain the difference between neurosis and psychosis, and as the mini-lecture unfolds, you hear him explain the way that the staff work and why they are careful not to make demands on these children.

The film is by turns funny, touching, fascinating and inspiring.

You can read more about the film here, buy a DVD here, read the book of interviews arising from the making of the film here, and watch the trailer here. Details of a community cinema screening on 14 March  in London SE27 are here and on Facebook here.

PCSR & Alliance September Conference Announcement

THE  BIG  ISSUE(S) – Addressing the Crisis in Psychotherapy and Counselling


An invitation from Psychotherapists and Counsellors for Social Responsibility and the Alliance for Counselling and Psychotherapy to a day conference at Resource for London, Holloway Road, London N7.

Saturday 26th September 2015 – 10am to 5pm. Donation: £10 in advance, £20 on the door.

This event is intended as an opportunity for practitioners to express their concerns about the current direction of counselling and psychotherapy, and to discuss plans for action. If you care about the future of counselling and psychotherapy, please come!

More details and booking form here

The Alliance for Counselling & Psychotherapy

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