Tag Archives: IAPT

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, 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.

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Alliance video: protest against New Savoy Conference of psy-organisations

The Mental Wealth Foundation, supported by The Alliance for Counselling and Psychotherapy, challenge attendees at the 2017 New Savoy Conference.

Why, despite some of the recent rhetoric, are the professional psychological organisations colluding with the Department of Work & Pensions view that being out of work is a pathology requiring treatment? Why support psycho-compulsion by working in environments in which those claiming benefits can be coerced into a distorted form of counselling and psychotherapy? Why support the emergence of State therapy?

OiOiSaveloy from Denis Postle on Vimeo.

Government Attack on Benefits Claimants: A Message from the Alliance

In response to the latest Government attack on benefits claimants with mental health and physical disabilities, the Alliance has written to the press and to the major psy-organisations, who we call upon to take a much more critical stance on these issues. See both letters below.


Letter to the Psy-Organisations

Dear Senior and Representative Colleagues,

The Alliance for Counselling and Psychotherapy is part of the Mental Wealth Alliance that has been engaging with most of the addressees of this e-mail. We have asked that you distance yourself from the DWP in an unmistakeable way and take up a much more combative and critical stance in relation to what is happening to ‘welfare’.

We assume that you are aware of the latest DWP issue referred to by the Daily Mirror and many other media outlets. If not: Tory ministers have rewritten the law to deny increased disability benefit payments to more than 150,000 people

The response we get is that your organisations are doing all that can be done and that there is no difference between your position and that of the Mental Wealth Alliance.

It is time to put your money where your mouth is and start to exert pressure on the DWP to operate in a more equitable, consistent and honest manner.

We believe that your various memberships are expecting this, and we urge you not to follow what is effectively, a collusive path. True, by muting protest you retain your access to the seats of power. But, in these circumstances, this is simply not the proper attitude to maintain.

Below, please find the letter sent by the Alliance for Counselling and Psychotherapy to the Daily Mirror and other newspapers. Will you take similar or analogous actions?

Yours sincerely,

Paul Atkinson and Professor Andrew Samuels (for the Alliance for Counselling and Psychotherapy)


Letter to National News Media

The Alliance for Counselling and Psychotherapy is a nationally recognised interest group of mental health professionals from diverse clinical and academic backgrounds. We were appalled to learn that last Friday, February 24th, without consultation or warning, the Government launched yet another vicious attack on the psychological, as well as financial resources of benefit claimants with mental health and physical disabilities (Tory ministers have rewritten the law to deny increased disability benefit payments to more than 150,000 people Daily Mirror, 24 Feb).

Emergency legislation has over-ridden the rulings of two tribunals that the Department for Work and Pensions (DWP) should expand the reach of Personal Independence Payments (PIP). At stake is mobility support for over 140,000 people who suffer “overwhelming psychological distress” when travelling alone, and more than 1,000 people who need help to take medication and monitor a health condition. The courts ruled both categories of support needed to be included in the PIP assessment of people’s needs. The DWP itself admits this will include for example those who have a learning disability, diabetes, epilepsy, anxiety or dementia.

In September 2016, Theresa May and her DWP ministers promised there would be no more welfare cuts on top of the string of draconian measures agreed last year as the final contribution of Cameron and Osborne’s campaign to punish those who cannot work. It seems her promise was another lie. With delicious irony, Disabilities Minister Penny Mordaunt said this latest move would “make sure we are giving support to those who need it most”. Meanwhile on Marr this Sunday, Tory party chairman Patrick McGloughlin responded to criticism of the emergency legislation by stating “as far as supporting disabled people in this country is concerned, we do very proudly”.

This is a government determined, come hell or high water, to strip welfare provision to the absolute bone, an ideological commitment it justifies in terms of the fiscal necessity of austerity savings and the therapeutic magic for all benefit claimants of getting themselves into work. As mental health professionals, we find it tragic and painful to be living through a period in which the social contract between the advantaged and the disadvantaged is under full-frontal attack.

More particularly, we find it shameful that our own professional bodies – psychotherapists, counsellors, psychologists and psychiatrists – continue to participate in the abuse of human rights and of their own ethical codes through their involvement in the psycho-compulsion of benefits complainants through the DWP’s workfare and Work and Health policies.

We call on the government to reverse its policies of welfare cuts as a minimum step to honouring Theresa May’s promises for a fairer deal for those struggling to cope to maintain any decent conditions of life. And we call upon our fellow ‘psy’ professionals to now insist on a withdrawal of all involvement in supporting the psychological coercion and punishment by the DWP of the most disadvantaged members of our society.

Yours sincerely,

Paul Atkinson and Professor Andrew Samuels (for the Alliance for Counselling and Psychotherapy)

 

Nothing about us without us? Are you bonkers?

In May this year, I joined members of the Mental Health Resistance Network at an event at the Old Vic. It was a panel debate on the state of mental health provision in the UK, one of their Voices Off events linked to the production of Harold Pinter’s The Caretaker. The original panel was Luciana Berger MP, Shadow Minister for Mental Health; Paul Farmer, CEO of Mind; and Simon Wessely President of the Royal College of Psychiatrists. MHRN members protested that there were no service user speakers, and eventually Peter Beresford and Alice Evans were invited onto the panel.

Inspired by the desperate lack of service user voices, mental health activists rapidly got together a zine to distribute at the meeting – a passionate collection of first-hand experiences of living on the sharp end of mental health disability in the UK. Jay Watts of the Alliance contributed a cartoon strip. I promised a short piece but couldn’t finish it for the deadline. Here it is – my belated contribution.

Read the full zine here


What’s wrong with people wanting to talk in public about other people’s mental health without including them in the conversation?

We psychotherapists definitely like to talk about our clients in the third person, though we don’t usually do it when they might be in the room. We do it behind their backs.

We like to exchange anecdotes about how difficult so and so is; about the terribly interesting unconscious meaning of what so and so said; about the clever little interpretation we were ‘able to offer’; about how narcissistic, borderline, dissociated, manic, aggressive, negative or just plain bonkers… so and so is.

So and so is not usually there when we speak about them, which is a good thing. If they were, we wouldn’t feel quite so free to show off how clever we are to our colleagues, or our students, or our partners and friends. We might feel a little inhibited, just a little caught out. A little wanting in ethical authenticity.

For the Mad Old Vic panel, the rationale for talking about, not talking with, is surely that three of the panel members have professional authority in the field.

A senior psychiatrist, the CEO of Mind, and the shadow Minister for Mental Health surely have something intelligent and authoritative to say about people who suffer psychologically. Could it be they have their own psychic pain somewhere tucked away inside them? Better not to ask. We are here to talk about people with mental health problems, not to talk about our own problems.

If you ask me, an awful lot of people are scared shitless by madness. Like they are terrified of poverty. Poverty and mental illness – handmaidens of hell. What they have in common is their contagion. You know, if you get too close the lurgy spreads from you to me. We psychotherapists are scared of this. We fend it off with the technologies of our trade, our magic words like ‘countertransference’ and ‘projection’ – spells we cast to keep the horrors at bay. They make it clear that it’s your problem not ours.

Sitting up there on their panel’s rostrum, I am hoping our trio of professional experts will be able to make a few basic facts clear.

First, that there has been a growing epidemic of mental ill-health in the UK from the 1980’s onward, as evidenced by the massive increase in anti-depressant prescriptions and the need for a huge expansion of primary care psychological therapies to millions of citizens. Thank goodness for pharmaceutics and CBT.

Second, that there is no connection between increasing mental ill-health and the introduction of neoliberal economic and social policies by Mrs Thatcher and Ronald Reagan, under the sway of ideologues like Hayek and Friedman. Atomising communities, destroying social housing, breaking the trade unions, deskilling labour, generating massive inequalities of wealth and income, increasing poverty, undermining social welfare provision, consistently cutting the mental health budget, creating a precariat of low pay, part-time, zero hour employment; overseeing a staggering increase in household debt, manufacturing a global financial crisis, following it up with austerity policies aimed at the least well-off, waging imperialist wars in the Middle East – all of this has no bearing on the mental health of the nation. It is NOT true that it is our society that’s sick.

In fact, third, psychological pain and distress is located in the individual. A good proportion of it is probably genetic and/or the embedded dysfunctionality of troubled families. A lot of it is negative thinking, laced with self-pity and dependence on a welfare culture. People need to strive more, skive less. With a judiciously administered balance of encouragement, nudge, threat, bribery and coercion most people will recover their capacity to join in our happy society.

Finally, we need to trust our psy experts up there on the podium, give them more money and more power. Let them get to work on this contagious epidemic of loneliness, depression, fear and anxiety. Trust the technologies of diagnosis, treatment and cure that are so successfully defining and dealing with the epidemic, offering each suffering individual recovery into happiness, optimism and the chance of being part of our hard-working family. Stop putting money into the welfare state, stop putting money into old fashioned care and treatment. Focus on building the innovative, practical recovery strategies that are quick, easy and cheap.

I suppose when we come down to it, talking with people is not very easy, and not very conclusive. All too often it turns out that, like you, people are really very complex and confusing human beings. Before long, talking with people at any depth over a decent period of time undoes your sense that you may know something more about being a successful person than they do. In fact, talking to people soon leads you to realise that you don’t really know very much at all, once you’ve been taken outside your comfort zone. Soon you are flying by the seat of your pants in that intersubjective realm that is so human and yet so disturbing. Most of us, quite rightly, get busy trying to establish anchors, to impose narratives of meanings that are familiar enough to our poor old egos and their ‘entitlements’.

Otherwise, this is exactly how the contagion gets going. Whose pain, love, fear and loss am I feeling? Yours or mine? When we begin to experience our differences, who is right, who is wrong? Why is it so bloody hard to be me and let you be you? What am I frightened of? Like the testimonials to lived experience in the zine, people move us and not necessarily into worlds we want to visit.

This is not the kind of experience that facilitates handy diagnosis, treatment regimes and evidence-based efficacy.

In an age when a tide of depression and anxiety is overwhelming us, when the loud and increasingly disingenuous promises of more resources for mental health services are outdone only by the savagery of regular service cuts, and when the rhetoric of a revolutionary expansion of psychological therapies is being swamped by mushrooming waiting lists, shorter courses of treatment and undertrained and underpaid workers – surely the very last thing we need are the voices of service users and survivors muddying the waters.

If we are not very careful, the conclusion that neoliberal society itself is a mental health disability afflicting all our citizens will be difficult to disguise.

Paul Atkinson

Andrew Samuels on Jobcentre Therapy and the Psy-Organisations

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


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

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

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

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

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

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

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

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

Andrew Samuels

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


Note 1

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

Jobcentre Therapy: MWF exchange letters with the big Psy-Organisations

Following the Mental Wealth Foundation’s (MWF) letter to the five large psy-professions organisations, challenging their statement on jobcentre therapy and psycho-coercion, the organisations responded (see that response at the end of this blog).

The MWF replied on 12 April 2016, raising further issues and proposing a meeting for further dialogue. At the time of writing, this and other requests to meet face-to-face have gone unacknowledged.  Please read on for the full MWF reply…


From:

Mental Wealth Foundation

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

To:

British Association for Behavioural and Cognitive Psychotherapies; British Association for Counselling and Psychotherapy; British Psychoanalytic Council; British Psychological Society; United Kingdom Council for Psychotherapy

Professional bodies scrutinise Government therapists in job centres plans

Thank you for your response of 24 March 2016. We would like to reiterate our invitation to a dialogue around these issues. We are a unique alliance of 17 diverse organisations, representing clients, therapists, campaigners and academics with a unique breadth and depth of perspective. We would very much like to share this wealth of experience and expertise with you; and to understand your position better. We think your members would expect you to meet with us, given the very diverse range of organisations that have united in order to communicate with you.

We appreciate your assurances that you oppose as unethical any coercion or sanctioning connected with psychological therapy’s contribution to the government’s workfare programmes. We also welcome your statement that “[you] do not believe the role of therapists should be to get people back to work”, and that the therapeutic value of employment is conditional both on individual circumstance and the nature of any particular employment and its environment.

At the same time, we are aware that as members of the New Savoy Partnership four of your organisations have welcomed recent workfare proposals, have initiated collaboration between DoH and DWP on Health and Work pilots, and have invited Lord Freud as Minister of Welfare Reform to open a number of your recent annual conferences. Your ‘Joint Pledge on Welfare’  states:

“We welcome the opportunity the Work Programme provides to support more people with mental health conditions into appropriate and sustainable employment.  Specifically, we will develop our expertise to help people with mental health conditions find, enter and remain in employment.” (emphasis added)

We cannot see how your position differs in any significant aspect from that of the DWP and you seem to have allowed yourselves to be drawn into becoming active partners in the government’s workfare policies. We believe – and we know many of your members agree – that the “psy” professions are being let down by our professional bodies going along with government aims and schemes, instead of using their professional knowledge together with service user experience to influence the proper provision of therapeutic services in more appropriate settings, for the benefit of clients and the profession. Clearly your views do in fact differ significantly from ours. Isn’t this something better explored at a meeting?

Over recent months, dozens of adverts for DWP financed mental health advisor and employment coach posts have invited applications from people accredited by you, including as we have already pointed out, those in Therapy Today. These job descriptions are explicit that the role is to get people off benefits and into work. Our concern remains that no action has been taken to inform or protect your members or their clients about involvement in work of this nature which breaches ethical practice.

The top-down nature of policymaking causes alienation and distrust of government workfare policies with a reliance on expert think-tank research, “evidence-based” reports, and a reluctance to engage in any real collaboration with either service users or practitioners.   We are offering you an opportunity to do something different. We believe it is within your role and responsibility, as national professional bodies representing psychological therapies, counselling and psychotherapy in the UK, to hold open an independent arena of public debate on issues of national policy.

We believe your collusion with the government is now threatening to undermine the ethical integrity of the “psy” professions among service user/survivors and professionals. A year ago, our joint letter to the Guardian signed by 440 psychologists, psychotherapists and counsellors raised the alarm about the probability of mandatory psychological therapy coming into being through the co-location of IAPT workers in Job Centres. A year on, the development of Health and Work projects under the DWP’s workfare banner is promoting more, not less fear, demoralisation, and distrust among the members of the organisations the MWF umbrella represents.

As survivors and witnesses of the impact of these developments, we are compelled to act against welfare to work policies and associated government-sanctioned psychological coercion which harms service users and professionals alike. You didn’t reply to our call to cease engagement with the Government Joint Work and Health Unit, and to hold a national event where all stakeholders views can be heard. We would like our campaign to include open debate with the professional bodies whose interests must surely include upholding the ethical values of psychological practice, for the sake of all.

We look forward to your response to our offer.

 


Appendix

Letter from psy-organisations to MWF, dated 24th March 2016:

Dear members of the Mental Wealth Foundation,

Thank you for your letter,

It might be useful if we started by clarifying a number of points that we have made repeatedly to the Department for Work and Pensions. We do not believe that anyone should be coerced into therapy and would denounce any coercion or sanctioning in relation to ‘job centre therapy’. As a result of ethical concerns raised last summer around coercion and sanctioning in relation to ‘job centre therapy’ we, as professional psychological therapy organisations, immediately contacted the Department for Work and Pensions. We were also acutely aware of, and remain acutely aware of, the wider context of sanctions and cuts.

Work is not always good for people’s mental health and wellbeing and we too recognize that poor quality, stressful and insecure employment can be detrimental and profoundly damaging. We also do not believe that employment should be viewed as a universally beneficial health outcome. At the same time, however, good employment can help people, by adding security and purpose to people’s lives, thus enhancing their mental well being. There should indeed not be a ‘one size fits all’ approach and we do not support a policy of work as cure.

We share the view that clients should have their current needs, perspective and autonomy respected but we also make it clear that we do not believe the role of therapists should be to get people back to work. Instead, we believe that the role of the therapist should always be to work with clients to help them resolve their mental health issues. We also do not believe people should receive psychological therapy in an environment where they feel uncomfortable and we do not believe client’s privacy should be compromised.

It is nevertheless important to recognise that access to psychological therapy remains restricted and people are suffering needlessly because of this. It is also the case that rates of mental health problems among people who are unemployed remain unacceptably high. There are likely to be a multitude of reasons for this, from loss of sense of purpose, to the stresses of the sanctions regime – and we wish to see all of these factors tackled. Improving voluntary access to psychological therapy for jobcentre clients is therefore a policy which deserves proper consideration and as organisations which represent psychological therapists, we recognise that the provision of appropriate, voluntary, therapy can play a role in alleviating distress.

The DWP has repeatedly told us that there will be no coercion involved or sanctioning of clients who do not wish to enter psychological therapy. It has also said that clients will have
a choice of where they can access their therapy. We have also secured a promise of a thorough evaluation of their planned small-scale co-location feasibility trial, which should provide a clear indication of whether people’s health and wellbeing is genuinely being improved in both the short and the long term. We suggest it is prudent to review these evaluations before prejudging a project that could provide genuine help to jobcentre clients who experience issues with their mental health.

We also note that your letter conflates different projects. Our organisations are concerned with the provision of therapy to jobcentre clients. We are mindful that other projects have
been initiated in regard to the co-location of work coaches in GPs surgeries, and that other organisations have engaged in scrutiny of these projects. We do not believe we are the most appropriate organisations to comment on those proposals, given they do not involve therapeutic coaches or psychological therapy – which is why our joint response made no mention of those plans.

We would also ask you to note that any past job adverts for positions outside of our organisations should in no way be regarded as the official opinion of any of our organisations individually or collectively.

Yours sincerely,

The British Association for Behavioural and Cognitive Psychotherapies
The British Association for Counselling and Psychotherapy
The British Psychoanalytic Council
The British Psychological Society
The UK Council for Psychotherapy

‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’. Conference Report – Part Three

In the final part of our report from the conference, Jay Watts and Nicola Saunders share their reflections on the day.


Jay Watts

I’ve slightly volunteered myself to write something about the ‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’ conference because it was, I think, the most exciting event I have been to in a twenty-year history as a mental health professional. Why?

First of all, thinking and planing the conference was a real collaboration, led by Paul Atkinson and Roy Bard. Some of us were lucky enough to hear reports back as they ventured off to territories unknown to find a space that would capture the ethos of the event – a place embedded in the community and activism, as Wade Hall turned out to be. I remember an email from Paul after one such trip, telling me of his delight at finding a local pub to use for small groups called ‘The Winnicott’, so named as the publican had done the one year introduction course to group analysis in the 1970s and been inspired! Here, the kind of embedding of therapy ideas in the community we really need!

“professionals lagging hopelessly behind”

When I arrived on the day, I was greeted with a hug by the marvellous Paula Peters, the kind of touching relations the day, I believe, fostered between those on the front line of disability activism, and us professionals lagging hopelessly behind. Hopelessly? Well, certainly not after the mutual feeding, planned actions, and passion of the day. The opening speeches by Paula, Denise, and Paul were inspiring – as others have written about. But perhaps the banter and respect between the three was as important as a model of what collaborative work might look like.

At 11:00, Rob Stearn and I set off to run our workshop on ‘psychocompulsion’ with about thirty survivors, professionals, and the undefinable. This was both an honour, and a bit of a blow as it meant missing out on other workshops being run at the same time. One of our group – Liz Hughes – has written beautifully about the themes of our conversations so I won’t repeat this. But let me add that I was most taken by the emotional honesty of our grouping, many of whom were suffering that very day with insistent forms and letters from the DWP who just won’t let go of the persecution.

One of the main feedbacks of the day was how nice it was to have a warm lunch ready, so we could talk together and not splinter off to find local amendments. Steaming plate of soup in hand, we settled in to share stories, greet new friends, make new connections. It was especially nice to meet in person many of the twitter activists – we who have shared so many passions, disappointments and hope whilst missing the embodied experience of one another.

“There is a moment in all this, a moment we are in, a moment of potential profound change in how we work together, and the social power we can thus wield”

Afternoon now, I found myself in Roy Bard’s workshop on ‘Mental Wealth’, after the now normal flurry of wondering how I could be in four separate workshops at one time. Roy proposed a new consortium of organisations – survivor, professional, academic, activist – to fight together to challenge the current organisational structures that exist, so deeply in the pocket of the establishment, desperate for crumbs of prestige and funding at the cost of a true ethics. As a group, we held vastly different ideas of what was going wrong, what needs to be done. But out of our dialogue, a tapestry began to be sewn of what the next stage of our activism might look like. And lo and behold, even in the weeks since the conference, the new ‘Mental Wealth’ consortium has bought together very diverse organisations in our first action – a statement to the professional organisations piercing through the ‘reassurance’ of a recent professionals’ press statement saying any link between therapy, job centres and benefits will be ethical.

There is a moment in all this, a moment we are in, a moment of potential profound change in how we work together, and the social power we can thus wield. The conference inspired me most, I believe, because it was one of the first spaces I have been in where the personal, professional and political were taken equally seriously with survivors, professionals and activists present in equal numbers as equals. As someone who has been under psychiatric services in my day, been on disability, but got to get out, this is the only way of being that makes sense to me, that brings it all together.

“We felt mobilised, emboldened, fierce”

After this nourishment, it was with hearts lifted that we reconnected as a larger group for workshop feedbacks, final comments and questions. We felt mobilised, emboldened, fierce. But dotted in amongst this spirit were comments reminding us again and again of the lost lives, anguished realities, and impossible-to-bear poverties the welfare state has inflicted upon us. These comments bought tears to me eyes.

As the formal parts of the day closed – to make way for dance, poetry and music – all of us professionals – I feel – were left with both a renewed horror in what our theories have been used to legitimise, and a profound sense that this event gave us a glimmer that something different was, is, possible. That a different way of being together, supporting each other, fighting for each other is not only conceivable, but the only ethical way to go forward as individuals, professionals and friends.

In solidarity – Jay.


Nicola Saunders

I was late after getting lost but fortunately bumped into Andy, a colleague from the Free Psychotherapy Network, and others talking about how good the opening speakers were, whilst walking to the Winnicott pub for the psy-compulsion workshop – I joined them. We were a mix of survivors, service users, students, psychotherapy trainees and psy professionals. The workshop began with an introduction from Jay and Rob from Boycott Workfare.

After a short silence the group discussion was started by a person who had been forced to stop work because of ill health.   After being told they couldn’t work again and coming to terms with the impact of that on their life, they were told they were ‘fit to work’ at a medical assessment. Looking for work and not being employed because of their illness, they had met Rob and joined Boycott Workfare and the campaign to inform and influence charities from joining workfare.

“The person sitting next to me spoke about not wanting this to be like other meetings where ‘we just talk’.”

A ‘mental health advocate’ had travelled from outside London, spoke next, wanting to be at the conference but frustrated at finding themselves on the waiting list, decided to take the risk after speaking to Paul and ‘came anyway’. Much of their job is now supporting people to engage with the benefits system in order that they receive the benefits they are entitled to. They were very pleased to be there and be with people who want to do something about what is happening.

The person sitting next to me spoke about their not wanting this to be like the other meetings they have been to where ‘we just talk’. Following a discussion on how do psy-professionals engage with other professionals who take up jobs in job centres, they suggested we ask to speak on their training courses and explain to them what happens to the people they see when they do these jobs.

After lunch I went to the Mental Wealth workshop where there was a wide and diverse range of views and critiques of neo-liberalism. It felt to me at times that that there was such a wide a range of views being expressed, that it might prove too difficult to find a consensus, and a big enough campaigning umbrella for all to come together under. I wondered if it might have been helpful for the Mental Wealth and Direct Action workshops to have come together at this point!

Gradually though the campaign to save mental health day services in Liverpool was spoken about. Service users, social workers and academics coming together to defend day support from local authority cuts – and winning. Local defend council housing campaigns were mentioned – 1 in 4 people living on the street have a mental health problem (St Mungo’s: 2016). There was a suggestion for a way of collecting details of the many campaign groups in order that learning and resources can be shared.   And on the Monday after the conference the beginning of the writing of the joint public statement on psychocompulsion under the Mental Wealth umbrella began. I’m sure all in the workshop would have approved.

Nicola

Go back to part one and part two of our report.