Tag Archives: IAPT

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

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


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

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

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

Inconvenient histories

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

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

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

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

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

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

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

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

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

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

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

Maps and missing territories

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Language barriers?

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

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

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

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

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

Tipping point

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

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

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

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

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


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


References

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

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

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

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

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

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

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

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

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

 

*


 

Advertisements

How do we get mental wealth?

In his address to a Labour Party conference fringe event, Paul Atkinson examines the social and political forces at work in our society’s current approach to psychological distress and asks what we need from a new government to support and nourish the nation’s mental wealth.


For whatever reasons – reasons that I think are very important and need to be explored – the emotional and psychological difficulties of living in this society are becoming increasingly visible and alarming: in our families; in our schools and colleges; in our local communities; in the attention drawn to mental ill health by (social) media, charities and celebrities, as well as politicians and social policy makers.

Should we think of this growing attention to mental health and the emotional conditions of contemporary life as a sign of growing awareness of the pain and suffering that has always been with us, hidden away in the private closet of social stigma and shame? Or are we witnessing the symptoms of an increasingly dysfunctional, disturbed and disturbing political and social structure? However we interpret it, I think we can say that there is something very, very wrong. It has either always been wrong, or over the last two to three decades we have been getting something very wrong. Certainly both Tory and Labour governments have been getting something very wrong, and are continuing to get it wrong.

To my way of thinking, there is something very wrong with a political economy which simply carries on, blindly it seems, propagating and prioritising the same fundamentally alienating and corrosive values:

economic growth before all else;

the accumulation of status and worth through money, wealth and conspicuous consumption;

generating and acquiescing in deep inequalities of material wellbeing and of the opportunities to make creative, satisfying lives.

To my libertarian socialist mind, capitalism has always generated toxic side effects in its exploitation of people’s mental wealth – in the service of profit and the accumulation of the few. Neoliberal capitalism – its extractive and kleptocratic offspring – seems to be generating an accelerating pandemic of fear, insecurity and anxiety which is splintering and dividing us as communities and individuals.

So my message to the Labour Party is that we need a government that is prepared to redefine what society is for, who society is for. A government that acknowledges the priority of people’s emotional and spiritual lives, their relationships, their need to give and receive care, support and love from each other. We need a government that is prepared to put our mental wealth before our economic wealth.

Yes mental health services need more money, far more money and human resources. But better funding alone is not the answer.

I am not a mental health service user or survivor of the psychiatric system. I am not poor, black or gay. But let me give you an example from my professional world in which I can claim some small expertise by experience. Let me give an example of how more of the same as far as mental health funding is really not the answer; an example of how what seems like a major step for improving the nation’s mental health is turning out to be as much part of the problem as part of the answer.

In an article in the New York Times in July 2017, titled Englands Mental Health Experiment: No-Cost Talk Therapy, Benedict Carey – US journalistcelebrated as a globally inspiring initiative the UK’s programme of short courses of cognitive behavioural therapy (CBT) in every primary care service in England – the Improving access to Psychological Therapies (IAPT) programme:

‘England is in the midst of a unique national experiment, the worlds most ambitious effort to treat depression, anxiety and other common mental illnesses.’

Colleagues and I on the left of the psychotherapy profession groaned in despair.

In 2008, Richard Layard and David Clark persuaded the Blair government to roll out an ambitious programme of CBT, offering psychological therapy for one million referrals a year through GPs. Layard, an economist specialising in unemployment and welfare to workfare policies, argued that mental ill health was the primary burden on the welfare budget of unemployed people receiving Employment and Support Allowance, and psychological therapy provided by the state would pay for itself by getting people off benefits.

On the face of it, it has been a huge success. Its champions call it the ‘IAPT revolution’. Every CCG in England offers psychological therapy under IAPT. Roughly 1.3 million referrals (some self referrals) were made to IAPT last year. It claims a 45% recovery rate. People in therapy that otherwise would never see therapy.

In reality…

Despite its value to probably many thousands of clients, the reality of NHS psychological therapy is far from the rosy picture Benedict Carey or its champions paint:

At an operational level, IAPT is an assembly line mental health fix.

Of the 1.3 million referrals last year, one third actually finished a course of treatment. In the end, only 12% of all referrals “recover”.

Almost half of these received what is called low-intensity (LI) treatment – something most psychotherapists would not recognise as talking therapy. For example, the most successful LI “therapy” was through non-guided self-help books.

The average number of sessions for all IAPT treatments is nine. A fifth consist of just two sessions. Recovery rates are falling, and the number of patients returning for repeat treatment is growing.

Almost all state funded talking therapy is now CBT, which has replaced virtually all other kinds of psychotherapy previously available free on the NHS.

The gold-standard evidence base for IAPT, based on random control trials, is in fact an avalanche of statistics highly manipulated towards maintaining state funding. Waiting lists are growing. Recovery rates within more deprived areas of England are significantly lower than in wealthier communities.

Meanwhile, according to a recent report by the British Psychological Society, the mental health of IAPT therapists and psychological practitioners is suffering a monumental nose-dive – 50% suffering depression, anxiety and acute work stress.

*

And yet, for the moment at least, there seems to be little recognition at government level that something is amiss – the programme is expanding. IAPT is doing an important political job. As far as I and my fellow campaigners are concerned, that political job looks like this:

First, IAPT has no brief, no money and no time to be thinking about the causes and meaning of the mental health issues it is managing. It deals with symptoms on an individual basis and aims to get people back into their everyday “normal” lives as quickly and cheaply as possible. As far as I can see it has no interest in the social model of mental health or in the influence it might have on getting government to think about the emotional impact of economic and social policy generally.

Second, I think of IAPT as a partner of Big Pharma in the growing mental health/happiness industry. CBT with its tick-box inventories, like the mass consumption of anti-depressants, has grown rapidly since the end of the 1970s. They are both contemporaries of the neoliberal turn. IAPT therapy is essentially courses of positive thinking, encouraging you to take more responsibility for your states of mind and adapting a little more flexibly to the realities of the world you are in – including of course the world’s markets.

Third, like antidepressants and other psychotropic drugs, IAPT is administered from the top down, on the medical model of diagnosis and allocation of treatment by a health professional. While the client hopefully has a say in the content of a talking therapy session, she has little say in who she works with, in what kind of setting, with what kind of frame, for how long and so on. If you want a choice of psychotherapy approaches, if you want a therapeutic relationship that is on-going and open-ended, led by your own sense of need, pain and distress, then it’s private practice at £60 – £90 a session.

Fourth. IAPT is an NHS service, state funded and state led. Its basic brief is to get people back into the flow of a “normal” life as quickly and cheaply as possible. This has always included getting people back to work. From its inception, IAPT has occupied and helped create a space in which the government’s policies on mental health, employment and welfare meet up within the toxic framework of workfare, cutting welfare, maintaining a low wage labour market.

“psy professionals have allowed themselves to be drawn in to a system of psychocoercion”

What we as psy workers have been witnessing, as New Labour’s workfare iniatives have progressively developed into the Tories’ vicious – yes, murderous – attacks on people with mental and physical disabilities and on welfare provision generally, is that psychotherapists, psychologists, occupational therapists and mental health workers have been increasingly drawn in – and have allowed themselves to be drawn in – to a system of psychocoercion of people on welfare benefits, a system which glorifies work as the ultimate goal and obligation of citizenry.

As we know, the experience of many claimants with mental health difficulties is one of being terrorised by benefit cuts (whether in work or not), sanctions, fitness to work assessments, PIP, and now the further cuts of Universal Credit. For many, being driven off benefits is not into work: it is onto the streets, into the food banks, into an early grave through ill health, addiction, self harm and tragically, suicide.

The New Savoy Conference, IAPT bosses’ annual trade conference, welcomed with open arms the Tories’ welfare to work policies and the opportunities they offered for state funded therapy to get involved in “helping” people get off benefits and into work.

When George Osborne announced in his spring budget 2015 that he was co-locating teams of IAPT therapists in Jobcentres, that DWP employment coaches were going to be located in GP surgeries and at one point in food banks, finally some of us psy professionals woke up and realised our own professions were becoming agents of psychological terror. That our professions were allowing themselves to be drawn into the violence that is at the heart of the neoliberal project. We got together in 2015 and formed the campaigning alliance that organised this meeting.

*

So, coming back to the question, what do we want from a radical Labour Party and Labour government to support and nourish the nation’s mental wealth?

Looking at this year’s Labour Manifesto:

Do I think it’s enough to talk about restoring Tory cuts to mental health services, putting more resources into attending to children and young people mental health, reasserting the need for parity of esteem with physical health, and offering a wider choice of therapy options under NICE guidelines?

Do I think it’s enough to restore Tory cuts to ESA, get rid of sanctions, the bedroom tax, WCA and PIP assessments, to talk about support and care for people who cannot work, and the social model of disability – or even Universal Basic Income?

Well, no.

Of course mental health services need more resources. The hypocrisy of every party declaring their distress at the lack of such services while doing bugger all except to cut funding further is shocking. The only way of understanding this is that mental illness is still regarded as a shameful, frightening shadow of our culture which politicians can get away with ignoring and attacking, as they do with welfare claimants.

Yes, we need more safe spaces for people with acute and severe mental health problems. We will continue to need more people with specialist trainings. And yes we need more talking therapy without a doubt.

But, FIRSTLY we need these services as part of a very different understanding of the kind of society and the kind of relationships that promote and support our mental wealth. Most of what gets called mental ill health is facilitated by the social, cultural and emotional conditions people are living in from day to day, and the conditions we have been in most of their lives.

We need housing policies, education and early years policies, transport policies, policies on working conditions, as well as health policies, that give the first priority to how people feel about themselves and their world, not to how they can be managed to maximise GDP.

And SECONDLY, absolutely crucially, if we are going to take seriously the priority of mental over material wealth at all, we need a society in which people feel that they not only have a say in how their world is developed and run; we need a society in which people feel they have THE say, the FIRST and LAST say, day to day, in how their world is organised.

Top down mental health services, administered by psychiatrists, psychologists, therapists, nurses and other professionals disempower and isolate individuals as mental health problems. To as high degree as possible these services need to be designed, managed and developed by service users and survivors. Professional services need to be in service, really in service, not driven by their own managerial ambitions, their profit making, or the fear of hanging on to an impossible job.

“Work remains the absolutely critical structure of social control in these capitalist societies of ours.”

For how long are we going to carry on preaching and believing in the insanity of the capitalist work ethic? That your value as a citizen is dictated by having a job? That it is your obligation to society to be in waged work? Are we absolutely bonkers?

Only 13% of people worldwide actually like going to work, according to a Gallup poll conducted in the States and published in the Washington Post October 10th 2013. According to new research by the London School of Business and Finance, which interviewed 1,000 male and female professionals of different age groups from across the UK, an overwhelming 47% want to change jobs and more than one in five are looking to career hop in the next 12 months. And over 60% of people living in poverty in the UK are in working families.

Forcing people with mental health difficulties into work says it all. Work remains the absolutely critical structure of social control in these capitalist societies of ours. Those who cannot work are to be treated as pariahs. They are the worthless lazy dependent scroungers that everyone can hate and treat with contempt – along with the homeless, the poor, the food bank users and the immigrants.

How appalling do the conditions of work have to become for us to say STOP. Something is very, very wrong. Why on earth can a parent, and especially a mother of young children, not say I don’t want to work, I want to focus on bringing up my kids?

Why is it treated as a utopian fantasy that work should be enjoyable – ‘adult play’, the psychoanalyst Donald Winnicott wanted to call it – that work be defined in all sorts of ways but basically as creative effort?

What the hell is wrong with us?

Yes, let’s have trade union power, workers’ power established at the centre of everyone’s working life. But also let’s get rid of the workerism that’s embedded in traditional left visions of a transformed society. We need so much more than the dignity of labour defining what life is about.

So let me just end on this. No, I don’t think more of the same is at all good enough. Yes, I think Corbyn’s Labour Party is beginning to take seriously the possibility of a world transformed. But there is a long way to go before mental wealth becomes the real standard by which we measure society and our political economy.

UEA Course Closures – An Attack on Values

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

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

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

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

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

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

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

‘Say the right things, when electioneering…’

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

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

‘One day, I am gonna grow wings…’

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

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

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

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

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

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

‘It’s just business…’

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

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

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

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

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

‘Fitter, happier, more productive…’

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

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

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

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

‘We are standing on the edge…’

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

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

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

In a BBC interview, Gormley said,

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

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

(Song lyrics from Radiohead’s OK Computer.)

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

andyrogerscounselling.com

@AndyCounsellor

*


 

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