Tag Archives: NHS

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.

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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.

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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.

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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.

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.

MWF Letter To Therapy Organisations – Jobcentre Therapy & Psychocompulsion


Mental Wealth Foundation (MWF) is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.


21 March 2016

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; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; Critical Mental Health Nurses’ 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 centresplans

We write in response to your joint public statement of 7 March 2016 outlining the outcome of your meetings with the Government’s new Joint Health and Work Unit and your scrutiny of the Government’s plans to place therapists in job centres [1].

There is no indication that any consultation has taken place with members of your organisations with knowledge of these matters nor with service users, clients and their representative organisations. This lack of consultation and opportunity for wider reflection has contributed to your organisations departing from your own ethical structures and frameworks, and being seen as agents of harmful government policy [2]. It is by now generally accepted that the consequences of the DWP and government policy in this area are far reaching for physically and mentally disabled people on social security benefits. Inexplicably your organisations’ scrutiny of government plans has failed to recognise this.

“It is wrong for therapy organisations to buy into the unthinking praise for ‘work’…”

The joining of Government Health and Work Departments is not helpful, and current DWP policy intended to reduce the socio-economic causes of mental illness to the one simple fact of unemployment is clinically and intellectually ridiculous. The resulting policy promoting work as cure, which your organisations are now supporting, is offensive and dangerous. It is wrong for therapy organisations to buy into the unthinking praise for ‘work’ that often forms part of the rhetoric of governments.

While for some clients improving employment prospects may be an objective, for many others this is not the case and may be profoundly damaging. Indeed, for some people, their mental health problems may have begun because of work e.g. through experiences of bullying in the workplace. This one size fits all approach is simplistic. Premature return to work can result in loss of confidence and relapses affecting future ability to get back to work. This can also lead to prolonged periods without benefits and no income [3].

You state that plans must be aimed at improving mental health and wellbeing rather than as a means of getting people back to work. These are not the aims and objectives being expressed by the people who are implementing the programme right now, involving targeting ‘hard to help’ clients who are likely to be people with enduring physical or mental health difficulties. For example in the Islington pilot project Councillor Richard Watts has stated, “We think there is much more that health services can do to promote the idea of employment for people with health conditions.” In the Islington CCG Commissioners’ report in November calling for employment services in GP surgeries to reach ‘hard to help’ claimants, they state that, “to improve the system we need to…maximise the contribution of all local services to boost employment, making it a priority for health, housing, social care and training. We need to open up how we talk to people about employment, including asking healthcare professionals to have conversations about work with patients, as part of their recovery. We need to give professionals the information and tools to help them to do this.” [4]. For all clients, establishing a trusting relationship is the first priority, involving respecting their current needs, perspectives and autonomy.

“We fail to share your reassurance from the government that these punitive measures will not be pursued against clients”

Jobs advertised on the BACP website in November 2015 have the explicit aim of getting clients back to work and engaging with employment services e.g. “your role will include: producing tailored health action plans for each client, focusing on improving their health and moving them closer to work…generate health and wellbeing referrals to ensure continued engagement with employment advisers” [5]. Similarly G4S advertise jobs for BABCP accredited CBT practitioners with job roles including: “Targeted on the level, number and effectiveness of interventions in re-engaging Customers and Customer progression into work” [6].

We respectfully submit that information about these jobs was known to all of your organisations when you issued your joint statement. This inconsistency is seriously misleading.

We are glad that you oppose conditionality, coercion and sanctions. Clearly such punitive measures have no place in the therapeutic relationship. We fail to share your reassurance from the government that these measures will not be pursued against clients. DWP have repeatedly claimed that sanctions are a last resort and only happen in a tiny minority of cases. The reality is that millions of people have been sanctioned. In the twelve months to September 2015 alone, over 350,000 ESA and JSA claimants were sanctioned [7]. In the Employment Support Allowance Work Related Activity Group the majority of sanctions were of people who have been placed in the group specifically because they are experiencing mental health issues and research shows that benefit sanctions on people with mental health problems has increased by 600% [8].

“therapy may not be explicitly linked to conditions/sanctions but will feel so for many of its prospective clients”

It is not possible to consider this issue without considering the context of sanctions, cuts and persecution which is endemic in the current system. You fail to acknowledge that attending this proposed therapy may not be explicitly linked to conditions/sanctions but will feel so for many of its prospective clients who are on benefits. There is a structural power imbalance between job centre employees and those on benefits. With their income under threat, those on benefits will be especially susceptible to cues, suggestibility and positive reinforcement when attending job centres. Many on benefits have experienced oppressive power relations for much of their lives. Saying no in relation to an apparent free choice in this context is hugely difficult, especially when saying no has uncertain consequences [9] .

Attempts to coerce people into work are detrimental not only to their health but to their safety and, in many cases, present a risk to life. The extreme fear and distress caused by the current welfare reforms, including changes in disability benefits and the new Work Capability Assessments, is widely reported including instances that have led to suicide [10]. Therapy alongside this coercive system breaches the ethical principle of non-maleficence.

You state that there must be choice as to location of therapy. There is a clear danger in putting DWP representatives into GP surgeries, community centres and food banks that are seen as safe havens for people on low incomes and benefits. The presence of DWP compromises this. DWP/Maximus workers in the GP surgery, with access to medical records, will serve as a deterrent to people visiting their family doctor. The model currently in use in Islington allows Remploy/Maximus workers to access and write into GP records; this jeopardises any commitment to client privacy and confidentiality [11].

The choice of method of therapy is an illusion and therapists of all modalities are subject to the stresses of an unjust target driven culture [12]. We are concerned that under-qualified and inexperienced staff, such as job centre coaches, will be in a position to make referrals to Health and Work programs. This is exacerbated by the fact that referrals are likely to be to IAPT workers, many of whom themselves lack in-depth training and experience of severe mental health issues. Inappropriate referrals are increasingly likely in a target-driven culture.

“We call on you to cease your engagement with the Government Joint Work and Health Unit and instead hold a national stakeholder event”

We are not reassured that the feasibility trials planned by the government will contribute to knowledge and understanding and are not reassured by your echoing what government is saying. Instead you and government must listen to the voices of survivors who describe the reality of government plans on their lives and are fighting for services with a vision of humanity beyond work [13].

It is clear from your public statement that you have failed to critically examine and scrutinise the ongoing activities of the Government Joint Work and Health Unit. We call on you to cease your engagement with this unit and instead hold a national stakeholder event which is guaranteed to involve the participation of representative organisations for service users and therapists with direct knowledge of the area, as well as professional bodies like yours. There should be no government involvement in such an event. From it, a representative group can be selected that will adequately represent the views of service users and therapists to the appropriate government departments as well as to the opposition.

References

  1. http://www.bacp.co.uk/media/index.php?newsId=3906
  2. https://www.opendemocracy.net/ournhs/dr-lynne-friedli-robert-stern/why-we-re-opposed-to-jobs-on-prescription
  3. https://www.morningstaronline.co.uk/a-a3e3-Joblessness-branded-a-mental-illness#.VuKWT4SFDzI
  4. http://www.islingtonccg.nhs.uk/Downloads/CCG/BoardPapers/20151111/4.3%20Health%20and%20Employment%20Programme.pdf
  5. ‘Mental Health Advisor – Job Details’ Retrieved from http://www.bacp.co.uk/jobs/jobs.php November 21st, 2015. Available at: https://www.dropbox.com/s/a6p9mod1jb08dne/Mental%20Health%20Advisor%20-%20Job%20Details.docx?dl=0
  6. http://careers.g4s.com/jobs/Cognitive-Behavioural-Therapist_58526/6 crisis
  7. https://www.gov.uk/government/statistics/jobseekers-allowance-and-employment-and-support-allowance-sanctions-decisions-made-to-september-2015
  8. http://www.independent.co.uk/news/uk/politics/benefit-sanctions-against-people-with-mental-health-problems-up-by-600-per-cent-a6731971.html
  9. For a fuller discussion of these issues, see http://mh.bmj.com/content/41/1/40.full
  10. http://jech.bmj.com/content/early/2015/10/26/jech-2015-206209.full
  11. Para 4.3: http://democracy.islington.gov.uk/documents/s6740/Health%20and%20work%20-%20HWB%20update%20Jan%202016%20final.pdf; http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/gps-told-to-inform-patients-dwp-will-obtain-their-fit-note-records/20030820.article. See also http://files-eu.clickdimensions.com/hscicgovuk-amnje/files/emed3dpnlettertogppracticesv1.0.pdf?_cldee=Y29yYWwuam9uZXNAbmhzLm5ldA%3d%3d&urlid=0
  12. http://www.theguardian.com/healthcare-network/2016/feb/17/were-not-surprised-half-our-psychologist-colleagues-are-depressed
  13. http://recoveryinthebin.org/2016/03/10/welfare-reforms-and-mental-health-resisting-sanctions-assessments-and-psychological-coercion-by-denise-mckenna-mental-health-resistance-network-mhrn/

The Ethical Dilemmas of Back-To-Work Therapy

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

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


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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But what does Izzy think as a therapist?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


References

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

About the authors

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

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

PCSR & Alliance September Conference Announcement

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


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

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

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

More details and booking form here