TodayTherapy

For counselling and psychotherapy professionals September 2016, Volume 27, Issue 7
Therapy TodayTherapy
Today
September 2016, Volume 27, Issue 7
Idealised love
and the therapist
Assisted suicide – the
dilemmas for counsellors
The self as a soap opera
Cover FINAL TTSep16.indd 1 01/09/2016 09:29

September 2016, Volume 27, Issue 7
Contents
Features
8. Transference love
and harm
Dawn Devereux explores
the phenomenon of adverse
idealising transference.
14. Connoisseurs of
counselling
Phil Hills calls on the
counselling professions to
stand up for their efficacy
and values.
18. Attachment theory
and post-cult recovery
Alexandra Stein and Mary
Russell describe the impact
of growing up in a cult.
22. Relational ethics
and Ethical Framework
Els van Ooijen explains how
a relational approach can help
untangle ethical dilemmas.
26. All the world’s a soap
Geraldine Marsh delves
into issues of identity and
self and what makes us
who we are.
Cover illustration by
Scott Jessop
Regulars
3. Editorial
4. News
6. Your views
30. Dilemmas
33. Letters
38. Reviews
42. BACP Strategy
44. BACP News
45. Professional standards
47. BACP Research
48. BACP Public affairs
48. Professional conduct
49. Classified
50. Mini ads
52. Recruitment
54. CPD
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Contents FINAL TTSep16.indd 2 01/09/2016 09:30

Editorial
Someone to
watch out
for them
This month’s issue is the first to be
produced under the aegis of our new
publisher, Think.
Think has a very strong reputation
as a specialist publisher of membership
journals, with several award-winning
publications to its name. From this
issue, it has overall responsibility for
the editorial, design, production, print
and distribution of Therapy Today; the
advertising remains with BACP. You’ll
not notice any great changes for the next
four issues but BACP is already working
intensively with Think on a complete
redesign and relaunch for February 2017.
Rest assured, we won’t be changing
what you tell us you love about Therapy
Today – its professionalism, its evidencebased
and accessible articles, its relevance
to frontline practice and practitioners
across all sectors and client groups.
But we will be freshening it up with
new content and different presentations.
This month the cover article is about
the troubling issue of adverse idealising
transference (AIT) – when clients fall
in love with an idealised image of their
therapist. The author, Dawn Devereux,
draws on data from the Clinic for
Boundaries Studies (CfBS) helpline
casebook. The CfBS emerged from
Witness, formerly POPAN, which used to
be the only source of support for clients
who believed they had been abused,
physically, sexually or emotionally, by
their therapist. Their campaigns, together
with some high-profile court cases,
helped bring about the tighter regulation
of the counselling and psychotherapy
professions, and BACP’s own Register.
Sadly, CfBS has recently suspended
its helpline, hopefully only temporarily.
Along with BACP’s ‘Ask Kathleen’ service,
it has been a vital source of independent
support and information for clients of
counsellors and psychotherapists, and
particularly those in the private sector,
without recourse to the NHS complaints
systems. The article’s description of
how clients have become caught in the
web of AIT, more often through their
therapists’ lack of skill or naivety, rather
than evil intent, reminds us why they
may need a guide to help them distinguish
between a difficult experience in therapy
and deliberate or accidental abuse.
Catherine Jackson
Editor
Contribute
We welcome readers’ letters,
original articles, feedback
and suggestions for features.
Please email therapytoday@
thinkpublishing.co.uk
Twitter
Follow Therapy Today on
Twitter @BACP
‘ Workplace
counselling services
have been chipped
away for years...
I see the trend
towards wellbeing
as yet another step
in this process’
Marcus Elliott
(page 6)
‘ When I work with
a client, the words
they say comprise
less than half of what
they are actually
telling me... I don’t
think a smartphone
app can replace that
physical closeness’
Hilda Burke (page 33)
‘ In a conflict between
the divine and the
BACP Ethical
Framework, it’s
hard to see how the
framework can win’
William Johnston
(page 31)
September 2016/Therapy Today 3
Editorial FINAL TTSep16.indd 3 01/09/2016 09:31

News
Cheaper therapy may help more clients
The NHS could treat more
people with depression
in primary care by using a
cheaper alternative to CBT,
according to a new trial
of behavioural activation
(BA) therapy.
BA focuses on helping
people with depression
change the way they act,
rather than the way they
think, and learn to manage
their mood by engaging in
positive activities.
The multi-centre
randomised controlled
COBRA trial aimed to
compare the effectiveness
of BA with CBT. Participants
were recruited from primary
care and psychological
services in three NHS
mental health trusts, in
Devon, Durham and Leeds.
Of the 440 participants,
219 were given CBT and
221 received BA. The groups
were followedup and assessed
at six, 12 and 18 months.
The researchers found
no difference between the
groups at follow-up: a year
after the start of treatment,
around two-thirds of the
participants in both groups
reported at least a 50 per
cent reduction in depressive
symptoms. Participants in
both groups also reported
similar numbers of days
without depression and
anxiety diagnoses, and were
equally likely to experience
remission. In line with similar
trials, drop-out rates were
around 20 per cent and
approximately a third of
participants in both groups
did not attend the minimum
number of therapy sessions.
However, delivering the
BA therapy cost around
20 per cent less than CBT,
because it could be delivered
by more junior staff with
less training, the researchers
say. Typically, in the UK,
a CBT therapist earns
£31,383 to £41,373 and a BA
therapist £21,909 to £28,462,
making BA much cheaper
to deliver. On average, CBT
costs £1,235 per participant,
while BA costs £975 per head.
‘Our finding is the most
robust evidence yet that
BA is just as effective as
CBT, meaning an effective
workforce could be trained
much more easily and cheaply
without any compromise
on the high level of quality.
This is an exciting prospect
for reducing waiting times
and improving access to
high-quality depression
therapy worldwide,’ said
Professor David Richards,
NIHR Senior Investigator
at the University of Exeter
Medical School, who led
the study.
A research team at the
University of Exeter is
now recruiting participants
for a study to evaluate the
effectiveness of online BA.
http://tinyurl.com/zvt7g2c
Most people know what’s good for their mental health
© MONKEYBUSINESSIMAGES/ISTOCK/THINKSTOCK
Most people know what
helps improve their mental
wellbeing, according to a
new report from the NatCen
British Social Attitudes survey.
The report was
commissioned by Public
Health England (PHE) and
is based on survey data from
2,140 face-to-face interviews
and 1,812 self-completion
questionnaires.
Nine out of 10 people
know what good mental
wellbeing is, and nearly three
quarters (72%) say they know
what to do to improve their
mental wellbeing, the survey
found. Spending time with
friends and family, going for
a walk or getting fresh air,
and getting more sleep
were the activities people
most commonly said helped
them feel more positive.
The two factors that people
said had the biggest impact
on their mental wellbeing
were relationships with family
and friends (mentioned by
54% as one of the top three
factors) and their job or worklife
balance (cited by 42%).
Most people said they felt
that the factors that affected
their mental wellbeing were in
their control. But people living
in deprived areas or who had
a mental health problem were
more likely to feel these issues
were out of their control.
The survey also found
that stigma continues to
be a problem for people
with mental health problems,
particularly within the family
sphere: only 36 per cent of
people said they wouldn’t
mind if someone with
depression were to marry into
their family, and less than 20
per cent would let someone
with depression provide
childcare for the family.
Prejudice against people with
a diagnosis of severe mental
illness, such as schizophrenia,
was even higher: 71 per cent
of survey respondents said
they would be willing to
live next door to someone
with depression, but only 45
per cent would want to have
someone with schizophrenia
as their nextdoor neighbour.
Professor Kevin Fenton,
Director of Health and
Wellbeing at PHE, said
the findings reinforced the
importance to mental health
of relationships, job, worklife
balance, finances and
involvement in decisionmaking.
‘We encourage our
local and national partners
to address these issues in
their strategies to improve
the public’s mental health
and wellbeing.’
http://tinyurl.com/zcz3ku6
4 Therapy Today/September 2016
News FINAL TTSep16.indd 4 01/09/2016 09:32

© MEDIOIMAGES/PHOTODISC/THINKSTOCK
Citizens Advice debt warning
Nearly three quarters of
people in debt seeking help
from Citizens Advice services
say money worries are
affecting their mental health.
Citizens Advice offers debt
advice to more than 350,000
people a year. In a new report,
A Debt Effect?, which looks
specifically at debt and social
mobility, Citizens Advice says
that debt issues often cause
other problems in people’s
lives, such as emotional and
mental distress, creating a
vicious cycle.
People with high levels
of debt are 24 per cent more
likely to experience poor
mental health, but people
with poor mental health
are also more vulnerable
to getting into debt and less
able to escape from the debt
trap, the report shows. Being
in arrears can affect people’s
living standards and expose
them to aggressive forms
of debt collection, such as
bailiffs knocking on the door,
which can cause anxiety and
stress and lead to mental
health problems. The report
cites one woman who sought
help from Citizens Advice
because her husband had run
up large debts after becoming
seriously depressed following
a bereavement. Another
woman came to them for
help with severe anxiety
after getting letters from
bailiffs demanding repayment
for a parking fine debt.
According to the report,
more than half of people with
a debt issue (54%) also have a
problem in at least one other
area, such as employment
or housing. Resolving these
other problems in people’s
lives can help their mental
health, Citizens Advice says
– four in five people who
get advice on issues affecting
their lives say they feel
less stressed, depressed
or anxious. Citizens Advice
has achieved good results
from placing volunteers
in GP surgeries, where
they offer patients advice on
social issues ‘on prescription’.
Citizens Advice is calling
on the new Government to
ensure tackling unmanageable
personal debt is at the heart
of its social policy strategy.
http://tinyurl.com/hk6m2nh
Primary care staff hide rising stress levels
Primary healthcare staff
are working under damaging
levels of stress, but many are
hiding their mental distress
and so making their situation
worse, according to the
mental health charity Mind.
In its survey of over 1,000
GPs and other primary care
practitioners, 88 per cent
said they found their working
life stressful; 43 per cent
said stress at work had led to
them resigning or considering
resigning from their job;
21 per cent said it had led
to mental health problems,
and 17 per cent said they
were taking medication to
treat it. Eight per cent said
they had considered suicide
because of workplace stress.
The survey also found
that stress had a significant
impact on their physical
health: 83 per cent said it
was affecting their sleep,
and 54 per cent reported
direct physical health effects.
One in six said they had called
in sick to avoid going to work.
Fear of disclosing their
stress levels is adding to
the stress, Mind says. One
in three (31%) said that they
didn’t want to tell anyone
about their stress levels in
case they were seen as less
capable than colleagues.
Two in five (22%) worried
that it would count against
them in their career.
Paul Farmer, Chief
Executive of Mind, said:
‘It needs to be ok for primary
care staff to talk about their
mental health needs. Like
anyone else, they need and
deserve support.’
http://tinyurl.com/zo65tpw
Older people
and therapy
Talking therapies have a key
role in preventing depression
in older people, a new report
from the Mental Health
Foundation says. The report,
Mental Health and Prevention:
taking local action for better
mental health, says the NHS
should create local service
pathways to make it easier
for older people to access
CBT and psychotherapy.
Other recommended
measures include mental
health first aid training for
home helps and other care
staff in the community, brief
interventions for older people
with physical health problems
who have depression, and arts
and peer support programmes
for people with dementia.
http://tinyurl.com/h5thrrp
Workplace
counselling
Just 27 per cent of employers
provide access to counselling
services and 19 per cent
to an employee assistance
programme, the Chartered
Institute of Personnel and
Development (CIPD) says.
Yet in the same survey,
nearly half (42%) of the
employees reported having
mental health problems in
the past year.
In the survey, 74 per cent
of employees also said their
mental health was good/very
good, and only five per cent
said it was poor.
Public and voluntary
sector organisations
were better at supporting
employees with mental health
problems, the survey showed.
http://tinyurl.com/jrfy6rc
September 2016/Therapy Today 5
News FINAL TTSep16.indd 5 01/09/2016 09:32

Your views
Harnessing
the power of
opposing forces
Emmy van Deurzen
explains the powerful
appeal of working with
relationship breakdown
Life, even at the best of times, is a
continuous balancing act between a
positive and negative pole of existence.
The better we get at facing up to the
dark side of life, the more intense our
experience of the lighter aspects of
living will be.
Many couples learn to constrict
themselves with each other, for fear
of offending. They suppress their hope
and longing for a deep connection.
They give up on themselves and each
other and become cynical about love.
They slowly but surely drift away from
honest exchanges and end up avoiding
and losing the other, whom, actually,
they love.
As an existential therapist I aim to
firmly grasp the nettle of the paradoxes
and tensions in human relationships and
put them into perspective. Existential
therapists do not recoil from people’s
conflicts, but encourage partners who
are struggling with their relationship
to become more aware of the unspoken
ambiguity between them. They throw
light on the clashes in values and purpose
that divide people and help them find
a joint commitment to a project they
can share. Where partners have become
frightened to address their differences
and have gone into hiding, existential
relationship therapists will deliberately
bring out all that thwarted passion to
harness it again. They will delve for
deeply held convictions and strongly
felt sentiments, going beyond strains
and pressures towards both partners’
heart-felt aspirations. They work with
partners in front of each other to help
them recover respect for the other.
An existential relationship therapist
enables partners to start speaking their
6 Therapy Today/September 2016
own truth before they begin to speak
to each other in a real way once again.
They do not aim for sweet harmony,
but for fairness and directness. They
know that any good story is based
on an artful interaction between the
tensions of success and failure, fortune
and misfortune, happiness and misery,
or even of good and evil. And so it is
in good relationships as well. Strong
relationships have weathered some
fierce storms. They do not consist
of a long sequence of easy days where
partners enjoy the blue skies of love
and happiness without interruption.
Good relationships are created, slowly
but surely. They require us to address
the differences and difficulties between
our partner and ourselves on a daily basis.
Nature functions by differentiation.
Electricity is generated when a positive
charge flows to a negatively charged
particle. Life events expose us to constant
trials and tribulations that test our ability
to become vital. We need to know how
to make each other and ourselves safe,
as well as find the courage to face
these difficult explorations together.
The feeling of love is generated when
we discover that we care as much for the
other’s wellbeing as for our own and that
the same is true the other way around.
By allowing partners to re-engage
with both sides of the equation of
their relationship – both love and
fear, kindness and hate – there is a fair
chance that the core of the relationship
is allowed an opportunity to breathe
again, allowing the understanding and
love between partners to be rekindled.
Emmy van Deurzen is a philosopher,
counselling psychologist and existential
psychotherapist, and founder/principal
of the New School of Psychotherapy and
Counselling. She will be giving a keynote
presentation at the BACP Private Practice
conference ‘Relationships: why do we
bother?’on Saturday 25 September.
For details and to book online, or for the
live webcast, visit www.bacp.co.uk/events
Wellbeing and
workplace woes
Marcus Elliott says warnings
about the ‘wellbeing agenda’
are far from exaggerated
I would like to respond to the letter
from Rick Hughes, ‘What’s good
about wellbeing’, in the June issue
of Therapy Today, and his suggestion
that BACP Chair Andrew Reeves was
taking a ‘naïve and simplistic view’
in his warnings about the threat to
counselling from the ‘wellbeing agenda’
in the previous month’s issue.
In my experience, workplace
counselling services have been chipped
away for years, but especially in the
past five years or so, leaving them
barely recognisable. I see the trend
towards wellbeing as yet another step
in this process.
I worked for eight years as a
telephone counsellor in the counselling
department of an employee assistance
programme. When I first joined the
company it had a strong reputation in
the field, dating back to the early 1980s.
While I was there the service was sold
to a major outsourcing company, which
wanted to make the employee assistance
programme part of its wider health
and wellbeing sector. This integration
involved sweeping changes, without
discussion, to the counselling provision
and how the service was delivered.
The counselling department retained
its name but the changes were designed
to bring the service more in line with
the company’s wellbeing programme,
which, I believe, eroded fundamental
principles of counselling practice.
More obvious changes included a
reduction in the amount of call time
available to counsellor and client, from
up to 50 minutes per call to 30 minutes,
so counsellors could take more calls.
A new booking system was introduced,
to maximise the counsellor’s availability
to take calls, but this undermined our
autonomy in managing our approach
and response to calls. It also stripped
away important support and containing
Your views FINAL TTSep16.indd 6 01/09/2016 09:34

structures for the counsellor by
effectively removing access to ad hoc
supervision, which had previously been
available if the counsellor required it
after a difficult or complicated call.
The management used a wellbeing
rationale to justify the changes, but it
was obvious to counsellors that they
were purely motivated by business
and financial needs, rather than clinical
need. The result was a diluted service in
which it became more and more difficult
to engage with the client and to connect
in any deep or meaningful way. Moreover,
the changes were unsustainable because
so many counsellors experienced
increased sickness and absence or
decided to leave. I resigned in 2014 with
burn-out, a great deal of which was caused
by the conflict and stress of feeling I was
working in conditions that no longer
enabled safe and ethical practice.
A year after I left, the service was
closed and the counselling provision
sold off to another employee assistance
programme. The remaining counsellors
were offered voluntary redundancy
and new counsellors were recruited
at a wage around a third less than we
were paid when I first joined the original
company. My understanding is that
this reflects an industry-wide reduction
in counsellor wages, which I feel is a
further diminishing of the profession.
I feel my experience well and truly
highlights the threat that counselling
faces from the ‘wellbeing agenda’. I would
go further and say that changes made to
counselling services under the wellbeing
umbrella are unethical because they are
not in the best interests of the counsellor
or the client, and ultimately undermine
good practice. Andrew Reeves is
absolutely right to be giving warnings
about the very real dangers this poses
to counselling, and its delivery, as we
currently know it.
Marcus Elliott MBACP (Accred) is a
psychodynamic counsellor. He has recently
relocated to the west coast of Ireland
Together we
must stand
Jonathan Hoban explores
the subsconscious
transference in June’s
EU Referendum vote
As many of us continue to struggle to
come to terms with the outcome of the
EU Referendum and the widespread
feeling of uncertainty it provokes, as a
nation we are forced to reflect: why does
our country appear to be dividing rather
than coming together, as it should in a
time of crisis?
As our stream of political leaders
continue to engage in what I consider
to be irresponsible game-playing,
our country’s psychological wellbeing
suffers as a direct result. Throughout
the UK, many of us have witnessed an
acute rise in levels of anger, confusion,
frustration, disappointment, anxiousness
and destructive behaviour in our
communities, following the vote to
leave the EU. Psychologically speaking,
these emotions indicate a significantly
increased stress response to recent
events, accompanied by a feeling of grief.
The lack of clear guidance from our
leaders leaves us, and our fellow citizens
of other European countries, at a loss,
creating fear and instability. These leaders
are, to me, behaving very much like
parental figures who abuse their power
by neglectfully placing their children in
harm’s way, and in consequence destroy
trust and safety within the relationship.
It seems as if it is now left to us, the
collective citizens of this country, to make
a difference as to how we move forward.
Simplistic thinking usually instigates
a simplistic response, whereby a person
or situation becomes either positive or
negative, good or bad, clever or stupid,
wrong or right. This type of thinking
and behaviour fails to allow for a middle
ground of thinking or negotiation.
We were asked to make a ‘leave’ or
‘remain’ decision – a perfect example
of simplistic options that inevitably
produced a simplistic response.
But why did the vote go this way?
My own analysis is that, when the
British coal mining and manufacturing
industries were demolished in the
1970s and 1980s, it created significant
financial pressure on the communities
dependent on them for jobs and security,
who experienced considerable poverty,
uncertainty, powerlessness and fear.
Many have never fully recovered. As a
consequence, scaremongering from the
‘Leave’ campaigners and media hype
about immigration exacerbated their
fears that their jobs, housing and public
services more generally were going to
be even further threatened in the future.
These communities are invisible to most
of us living in more prosperous parts,
as they have remained neglected by the
Government and the media for decades.
The EU referendum provided a
platform and a voice for these sidelined
communities and they responded.
The motivation to vote when you feel
desperate is far greater than if you are
living comfortably. The irony of this
whole situation is that a subconscious
transference has taken place, whereby
the whole country is now experiencing
the uncertainty, powerlessness and
financial insecurity that these neglected
communities have felt for years.
The bigger question now is how
do we come together as a country and
look to the future of the UK as a whole,
and not as a group of divided entities.
Jonathan Hoban is an integrative
psychotherapist in private practice in the
City of London. www.creativecounselling
london.com
September 2016/Therapy Today 7
Your views FINAL TTSep16.indd 7 01/09/2016 09:34

Transference
Dawn Devereux
explores the powerful
phenomenon of idealising
transference and the
harm it can do to clients
Illustration by Scott Jessop
The cliché that people fall in love with
their therapist is well established in the
popular imagination and often treated
with some amusement. In reality,
what some clients are experiencing
is a potentially harmful side effect of
psychotherapy and one that should be
taken far more seriously by the profession.
When a client falls in love with a
therapist it is likely to be ‘transference’:
the predisposition we all have to transfer
onto people in the present experiences
and related emotions and unmet
longings associated with people from
our past. In the initial stages of therapy,
such transferences are usually idealising,
because clients tend to project onto
their therapists the qualities they
longed for from their early carers,
and so experience them in a particularly
positive way. This can help establish the
therapy and the initial intensity usually
fades once the ‘honeymoon’ period
of the therapy is over. However, for a
small but significant number of people,
the experience is very different: the
idealisation intensifies rather than fades,
and the client becomes increasingly
consumed with and dependent on
thoughts about the therapist. This can
be immensely disruptive to the client
and to their family, and can lead to
adverse consequences, as the client’s
autonomy and capacity to think
rationally are typically compromised.
‘I was like a rabbit caught within blinding
headlights. I was uneasy, but in a childlike
way also excited by being so special to a
person such as him. I was very confused,
experiencing feelings that I had not felt
before. I can only describe it as like being
caught up in an emotional earthquake.’ 1
This article is based on the accounts
of people who have had this experience
of adverse idealising transference
(AIT) and who have contacted the
Clinic for Boundaries Studies (CfBS),
an organisation that helps people who
feel they have been harmed by their
experience of psychotherapy or other
professional relationships. Several
hundred people contact the CfBS each
year, and a substantial number report
lasting harm as a result of AIT. The
phenomenon is often discussed within
the discourse on erotic transference
but my emphasis is on the idealising
rather than the erotic aspect; not all
clients experience erotic feelings and,
even when they do, these feelings are
almost always infantile and sensual rather
than adult and sexual. What is desired
is not man but mother.2 This is also why
any consequent sexual contact with the
therapist is likely to be experienced as
confusing and exploitative.
The CfBS working definition of AIT
is ‘a transference reaction that impacts
on a person, so that over a sustained
period their ability to function in
their usual way is adversely impaired’.
The effects can last over a long period
of time, as evidenced by the large number
of people who contact the CfBS about
an idealising transference that began
decades ago and is still unresolved. It is
also evidenced by the many accounts of
transference harm that can be found on
the internet (see www.mentalhelp.net)
and in the client literature.3 Members
of the public who have experienced
this believe that therapists are not
sufficiently knowledgeable about the
phenomenon, or are unaware that their
actions can both cause and exacerbate
the problem. Yet the professional
literature does not appear to associate
idealising transferences with serious
and lasting harm, which is why I want
to share what CfBS has learnt about AIT.
Transference
love and harm
8 Therapy Today/September 2016
Transference FINAL TTSep16.indd 8 01/09/2016 09:41

September 2016/Therapy Today 9
Transference FINAL TTSep16.indd 9 01/09/2016 09:41

Transference
The propensity to develop intense
feelings for a therapist has been
known about since the earliest days
of psychoanalysis and Anna O’s famous
obsession with Freud’s colleague, Breuer.
Freud4 used the analogy of a chemist
handling highly explosive materials
to describe the potentially catastrophic
consequences when such feelings
develop. Freud’s focus, however, was
on the therapist’s experience of the
phenomenon, rather than on the adverse
effects on the client. He emphasised the
erotic aspect, and believed that tenacious
manifestations of the transference were
a resistance to treatment and an attempt
to seek cure through a new relationship.
For this reason, he was clear that such
transferences should be analysed and
not reciprocated.
This view was further developed by
Klein and her followers, who proposed
that destructive and aggressive feelings
are also present and should be
interpreted, particularly in relation to
envy and difficulties in tolerating the
independent existence of the analyst. 5
From the 1970s, following Kohut’s
emphasis on the idealising rather
than erotic aspect of the transference,6
a more positive conceptualisation
of the phenomenon began to emerge.
Kohut focused on the facilitative
aspects of the transference and
insisted that it should not be interpreted
but left to take its course until firmly
established. This view was controversial
and attracted criticism, particularly from
contemporary Kleinians. In subsequent
years some therapists went further,
suggesting that erotic desire in therapy
should be facilitated.7 Our experience
is that this encourages AIT to develop.
Client accounts and insightful blogs on
the internet vividly describe the harm
that can result. A particularly extreme
example of a toxic mix of cult-like
idealisation and sexualisation in group
therapy has recently been described by
the mental health blogger Phil Dore.8
Although the literature greatly
underplays the role of the therapist in
AIT, it is important to state that there is
a type of AIT that develops independent
of the therapist, and quickly becomes
very negative. This is known variously as
malign, malignant, regressive or psychotic
transference, and was elaborated in
particular by Little,9 and more recently
by Hedges. 10 It refers to a situation in
which people with no history of psychosis
become regressed and develop intense,
delusional ideas about the therapist’s
actions in the therapy. Hedges believes
that this is likely to happen just as a
successful therapeutic alliance is forming,
because the person’s fear overcomes
their desire for connection. 10
Effects of AIT
People who contact the CfBS about
an experience of AIT emphasise in
particular their feeling that they are
disempowered. They often compare
the experience to that of a powerful
mood-enhancing drug, a religious
experience or an addiction. They
often use words such as hypnotic,
enchanting, magical and sublime,
and describe striking imaginary
scenarios to illustrate the primacy
of the therapist’s position in their life.
For example, one person described
being haunted by the image of a lifeboat
with only one space, because she knew
she would give it to her therapist and
not her much-loved children.
Although people often describe the
transference as making them feel ‘alive’,
they also describe profound confusion,
distress and shame. Retrospective
accounts also often describe feeling
in thrall to the therapist and considerable
disruption to social and family life, as
the person’s interest in other previously
important relationships diminishes.
‘I cannot over-emphasize the devastating
effect all this had on my husband and
children. I think they could not recognise the
person they had known – a family-orientated
wife and mother. It was as if an alien had
invaded my being and I was speaking and
behaving in ways that were just not me.
It is difficult after these years to understand
the intensity of my feelings for him and the
total subjugation of my will to his.’ 1
Some of the most common feelings
and beliefs that clients describe when
AIT is developing are:
• believing that a ‘real’ relationship
with the therapist would result in
deep contentment
• feeling that other aspects of life are
diminishing in importance, including
relationships with friends, a partner
or children
• feeling that the problems that brought
the person into therapy in the first place
are no longer important
• feeling panic or depression at the
thought of the therapy ending.
‘My feelings for Marion intensified.
During the 166 and a half hours a week
when I was not with her, I thought about
her constantly. The rest of my life was
dwarfed into insignificance… “Relationship”
was no longer an adequate word to describe
what bound us together. In my mind,
I was transported into another world
where I existed in a state of rhapsodic
communication with Marion. We did
nothing, we said nothing, we just were.’ 11
A transference of this kind clearly affects
a person’s judgment and interferes with
‘She said she would always be there for me,
and when I questioned “how” she hugged
me... and said, “Trust me.” This didn’t help.
I needed to know how and this irritated her’
10 Therapy Today/September 2016
Transference FINAL TTSep16.indd 10 01/09/2016 09:41

their autonomy, leaving them vulnerable
to sexual, emotional and financial
exploitation. It also masks the problems
that brought the person into therapy, and
so masquerades as a cure. A client may
spend thousands of pounds on therapy,
only to discover that their presenting
problems have not been addressed.
‘A magic trick had been performed on me:
in just a few hours of sitting alone in a room
with Paul, a large part of my mind had
effectively been taken over, leaving me
with little left to expend on my work,
social life and other parts of normal life.’ 12
Therapist characteristics and AIT
From our discussions with clients
seeking our help, we have noted
particular therapist characteristics that
appear to be associated with AIT. These
characteristics sit along a continuum
but fall broadly into five overlapping
categories. They begin, at the most
severe end, with the psychopath
who becomes a therapist. This is the
‘unscrupulous therapist’ described
in the Foster report, 13 who sets out to
use transference to create dependency
and then intentionally exploits the
client for emotional, financial or sexual
advantage, for years or even decades.
Clients of such therapists often describe
being drawn into cold, humiliating sexual
activity, and/or financial and emotional
exploitation, where they are coerced
into making self-defeating choices.
These therapists frequently exploit
their knowledge of the client’s
developmental vulnerabilities in order
to exert maximum power and control.
Then there are the opportunist
therapists, who may not set out to
exploit the transference but cannot
resist doing so when it emerges. They
reap the emotional, financial and/or
sexual rewards, and often convince
themselves that the client’s feelings
are ‘real’ and that sexual exploitation
is ‘an affair’. They typically have poor
professional boundaries, operate from
a narcissistic position and often have
relationship problems themselves, so
the client becomes a source of comfort
and validation. Clients of therapists in
this category frequently describe getting
into role-reversal situations with them.
The third category comprises
therapists who offer love in the belief
that they can compensate for their
client’s history of poor parenting.
Clients often respond with appreciation
and idealisation, which encourages
the therapist to continue practising
in this way. If the client is predisposed
to developing AIT, they are likely to find
it difficult to tolerate the constraints of
a time-limited love relationship. If they
then act out their frustration, it is not
uncommon for therapists to feel justified
in terminating the therapy, without
being aware of the part they have played.
Some therapists in this category do not
set out to offer love but respond to the
client’s demand that they prove that
they care and find themselves breaching
boundaries if the client’s demands then
escalate and cannot be satisfied.
‘When I met Karen I was struck by her
warmth and confidence. She said she was
an expert on my condition, that my life
would change. I felt elated, as if I’d been
blessed and chosen. We had a special bond,
she looked out for me like nobody had done
before… She said she would always be there
for me, and when I questioned “how” she
hugged me, fixed her eyes on mine and said,
“Trust me.” This didn’t help. I needed to
know how and this irritated her. I began
to be silent during sessions and Karen said
I was trying to sabotage the therapy and
didn’t want to get better. She told me that
her other clients improved because they
trusted her. At the next session, when I
saw her previous client leave, I experienced
a sudden, visceral feeling of rage. I was
drenched in fizzing emotion and couldn’t
think. I went into the room, picked up a
glass and smashed it. I held it to my throat…
That was the last time I saw Karen.’ 14
The fourth group of therapists refuses
to engage with the transference. They
may do little or nothing to encourage
the idealisation; when it emerges they
ignore it, or treat it in a pejorative or
disapproving manner. These therapists
may feel incompetent, irritated or
ashamed that this situation has arisen,
and this produces shame and confusion
in the client. The client then conceals
the idealising feelings and they flourish
in silence, until the adverse aspect
becomes apparent because the feelings
can no longer be hidden. Sometimes
clients of these therapists simply leave
the therapy and then find it impossible
to resolve the transference.
The fifth and final category, at the
far end of the continuum, is therapists
who act appropriately but find that
the client is predisposed to developing
a regressive transference. This is likely
to become apparent just when the
therapist feels the therapy is going well,
and it frequently involves delusional
ideas about the therapist’s actions and
intentions. It may be impossible for the
therapist to resolve the situation because
the client’s beliefs are so tenacious.
Therapists in this group may find
themselves the subject of a complaint,
because the client truly believes they
have acted inappropriately. 10 This may
also happen because the therapist cannot
deal with the strain and ends the therapy
without the agreed notice period.
‘Therapists often act in ways that escalate
the problem. This includes disclosing their
own feelings of attraction for the client,
assuring the client that the feelings will pass’
September 2016/Therapy Today 11
Transference FINAL TTSep16.indd 11 01/09/2016 09:42

Transference
Therapist actions that
contribute to AIT
• Encouraging contact from the
client between sessions.
• Revealing real feelings for the client.
• Discussing details of the therapist’s
privatel life, and in particular
unsatisfactory aspects.
• Making it clear that the client is
being treated in a different way to
other clients.
• Self-enhancing disclosures.
• Disclosures that imply a unique
‘soulmate’ type relationship between
client and therapist.
• Offering real love and care and
becoming over involved in the
practicalities of the client’s life.
• Discourse that hints, often in a
very subtle way, at a future ‘real’
relationship with the therapist.
• Refusing to discuss the transference
in an appropriate manner.
Non-therapist factors in AIT
Clearly there will also be factors that
contribute to AIT but are outside the
therapist’s control. These include the
client’s early developmental experience.
Kohut6 theorised that the necessary
conditions arise if a mother is unable
to attune to the particular needs of her
baby, and the baby is unable to internalise
the mother. Little9 similarly associated
the phenomenon with the infant’s poor
experience of mothering. Blum 15 made
particular mention of children who have
experienced sexualised parenting, and
Hedges 10 proposed that the absence of
nurturing in infancy leaves some people
with an insatiable desire for the mother
they never had. This accords with the
experience of people who contact the
CfBS, who usually describe experiences
of inadequate parenting, rather than
overt abuse. Since not all people who
have had inadequate parenting are
predisposed to AIT, it seems likely
that constitutional factors such as
genetic makeup and the neurobiology
of the brain also play a part.
The therapeutic setting may also
contribute to AIT. Low lighting, a calm
comfortable room, prolonged eye contact
and finding themselves the focus of
another’s intense interest may be a unique
experience for the client and may be
unconsciously associated with a promise
of love and nurture. Because the ‘love’
is one way, it tends to mimic a maternal
relationship rather than a mutual
romantic relationship, which makes
the experience all the more unique.
Gender is also a factor: AIT affects
female clients more than male clients,
and appears to occur more frequently
between male therapists and female
clients, although we at CfBS know of
instances where the client and therapist
are both female. When the client is male,
the therapist involved is usually also male.
We have occasionally come across AIT
with male clients and female therapists,
but the therapist has always been much
older than the client. We have never
come across AIT between an older male
client and a younger female therapist,
although this gender/age combination
is perhaps also uncommon.
What helps to reduce the risk of AIT?
Risk of harm could be reduced if
therapists routinely assessed their
clients’ vulnerability to AIT, especially
the more regressive forms of AIT, at
the beginning of the therapy. We have
noticed that the following three traits are
strongly associated with regressive AITs:
• the client has a history of dependent/
idealised relationships, especially with
health professionals
• they are primarily seeking care,
not insight into their problems
• they hold unrealistic views about
what therapy can provide.
We have worked successfully with
clients who have a history of dependent/
idealised relationships but do not have
the other two traits. Where all three traits
are present, our experience is that the
client will be so strongly predisposed to
regressive AIT that serious consideration
should be given as to the appropriateness
of one-to-one therapy. Consideration
should also be given to the gender of the
therapist. While the literature suggests
that intense transferences are not gender
specific, we have found that clients are
often predisposed to develop AIT with
therapists of a specific gender, and that
they want to see a therapist of that gender.
The risk of AIT can also be reduced
by responding appropriately when
clients bring up transference concerns,
as AIT is much more likely to occur
if the first indications are ignored.
‘Finding themselves the focus of another’s
intense interest may be a unique experience
for the client and may be unconsciously
associated with a promise of love and nurture’
12 Therapy Today/September 2016
Transference FINAL TTSep16.indd 12 01/09/2016 09:42

How to reduce the risk
of AIT
• Inform clients about the
phenomenon at the beginning of
the therapy.
• Carry out regular reviews in which
the potential for AIT is monitored.
• Maintain consistent professional
boundaries and refrain from
personal disclosures that could
encourage idealisation.
• Refrain from making the client
feel special.
• Be clear that the relationship
can only ever be professional.
• If the potential for AIT becomes
apparent, discuss it with the client
in order to work out the best way
of tackling it.
• Take it to supervision and seek
external consultation if it persists.
• Take responsibility for any actions
that contributed to the idealisation.
• Refrain from acting defensively
by blame, rejection and sudden rigid
boundaries, or terminating the therapy
without the agreed notice period.
Most clients tell us that they attempted
to discuss their concerns at an early stage
in the therapy, but did not get a helpful
response. Instead of being alerted to
the potential for harm, therapists often
act in ways that escalate the problem.
This includes disclosing their own feelings
of attraction for the client, assuring the
client that the feelings will pass and
asserting that the feelings really are
a reflection of the therapist’s qualities.
Crucially, we have observed that
therapists whose clients develop AIT
are unlikely to discuss transference,
and are dismissive or hostile when
clients suggest it. Clients also describe
therapists becoming irritated, defensive
and rejecting in response to discussion
about the adverse effects on the client’s
life (see the box, left, for how the risk
of AIT may be reduced).
Informed consent and AIT
Clients who develop AIT tell us they
wish they had been warned about the
possibility before the therapy began.
They often point out that a drug with
the same adverse potential would only be
prescribed with informed consent. Most
feel that, if they had been informed of the
risk beforehand, the experience would
have been less confusing and traumatic.
This is discussed in some published
client accounts of adverse experiences
of therapy. For example, Simpson 12
writes that she would have considered
descriptions of idealising transference
to be ‘far fetched’ if anyone had tried
to warn her about it, but states: ‘If I
had been warned, and decided to ignore
the warning, I think I would have felt
less cheated.’ Other therapy ex-clients,
writing on the internet, describe feeling
‘furious’ and ‘tricked’ because they were
not warned about this (www.mentalhelp.
net). Many describe how they tried to
research the phenomenon but felt
frustrated by the absence of information.
Informed consent has not been
embraced by the counselling and
psychotherapy profession. 16 This is
perhaps because there has been almost
no discussion of the risk of harm from
transference. There may also be a fear that
clients will be discouraged from engaging
in psychotherapy or made anxious by
raising the issue. These are, however,
all factors that other healthcare workers
negotiate successfully. For example,
it would be unethical for a surgeon to
recommend an operation without first
discussing the potential adverse effects.
In our experience, AIT interferes with
clients’ capacity for rational thought,
making them vulnerable to both
dependency and exploitation. As such,
AIT is a potentially serious side effect of
psychotherapy. The absence of discussion
in the professional literature about this
type of harm is concerning because there
is much a therapist can do to discourage
an idealising transference from
becoming adverse. If therapists don’t
know about it, however, there is a clear
risk that they may unwittingly encourage
it. What we hear from people who have
developed AIT is that therapists should
have a greater awareness of what might
encourage it, and that clients should
be informed about the risk before
they embark on psychotherapy.
With thanks to the clients of the Clinic
for Boundaries Studies who have given
permission for their experience to be used.
Dawn Devereux was Director of Public
Support at the Clinic for Boundaries
Studies and is currently on sabbatical.
She has a special interest in helping to
resolve problematic situations in therapy.
Email dawn.devereux@ntlworld.com
References
1. Matheson M. Broken boundaries.
London: Witness; 2008.
2. Stoller RJ. Perversion: the erotic
form of hatred. London: Karnac; 1975.
3. Bates Y. Shouldn’t I be feeling
better by now? Client views of therapy.
London: Palgrave Macmillan; 2006.
4. Freud S. Observations on
transference love. London: Penguin
Books; 1915.
5. Kernberg OF. Further
contributions to the treatment
of narcissistic personalities.
International Journal of
Psychoanalysis 1974; 55: 215–240.
6. Kohut H. The analysis of the
self. London: The University of
Chicago Press; 1971.
7. Mann D. Erotic transference
and countertransference: clinical
practice in psychotherapy. London:
Routledge; 1999.
8. Dore P. The strange family of
Derek Gale. [Blog.] Unsafe Spaces
2016; 2 March. http://unsafespaces.
com/2016/02/03/the-strange-familyof-derek-gale
(accessed 1 March,
2016).
9. Little M. The delusional
transference (transference
psychosis). International Journal
of Psychoanalysis 1958; 38: 134–138.
10. Hedges L. In search of the lost
mother of infancy. New York:
Jason Aronson; 1994.
11. Alexander R. Folie à deux.
London: Free Association Books
Ltd; 1995.
12. Simpson N. Untwining the
transference. In: Bates Y. Shouldn’t
I be feeling better by now? London:
Palgrave Macmillan; 2006.
13. Foster J. Enquiry into the
practice and effects of scientology.
London: Her Majesty’s Stationery
Office; 1971.
14. Nash P. Two years of hell.
New York: Survivors’ Forum; 2002.
15. Blum HB. The concept of the
eroticized transference. Journal
of the American Association 1973;
21: 61–76.
16. Nutt D, Sharp M. Uncritical
positive regard? Issues in the efficacy
and safety of psychotherapy. Journal
of Psychopharmacology 2008; 22: 3–6.
September 2016/Therapy Today 13
Transference FINAL TTSep16.indd 13 01/09/2016 09:42

Research
Connoisseurs
of counselling
Phil Hills calls on the counselling community to come together to
create an alternative to the stranglehold of evidence-based practice
In May this year I was invited to present
a paper at the 10th Keele Counselling
Qualitative Research Conference,
along with other former MSc students.
My first thought was: ‘What’s the
point? Why bother? It won’t make any
difference anyway.’ My own negativity
came as something of a shock to me:
as a student I had been deeply committed
to the importance of personal learning
and of the counselling community
learning from one another. How had
this idealistic learner with a passion
for education and research turned
into one so cynical and disengaged?
After much thought I decided that,
rather than present my research at
the conference, I would instead tell
the story of my journey from engaged
learner to disempowered consumer.
The story would not just be mine,
however; it would illustrate something
more general – the widening gulf
between those who create knowledge
in counselling and those who apply it.
It would speak from the experience of
one who fell on the wrong side of the
gulf, and suggest a way in which the
two sides of that gulf might be brought
back together. This article is based on
the story I told at the conference, with
an optimistic twist by way of a postscript.
The story begins with a 31-year-old,
white, heterosexual, middle-class man
– me – undertaking qualitative research
into his own identity. I wanted to
examine the privileges my identity
confers on me, and how I often fail
to acknowledge or engage with them.
Wanting this research to be meaningful
and potentially transformative, I
eschewed traditional methodologies
(which I feared would leave my privilege
unchallenged) and instead opted to
undertake a series of dialogues with
others, and to trust that the
14 Therapy Today/September 2016
methodology, criteria and writing style
would emerge in these dialogues. I sought,
in Buber’s terms,1 genuine meeting with
my participants, with as few technical
research tool impediments in between
us as possible.
So what emerged through these
moments of meeting? One of the main
threads that runs through my study is
the way in which, after each discussion,
I would try in various ways to understand
what had occurred and then share this
attempt at understanding. And each time
I shared my understanding, I would be
told in response: ‘You’re trying to make
this too clean, Phil – too final. You’re
trying to encompass it and impose an
overall structure to it, which just doesn’t
exist.’ And, further, I was told that
this desire to tell a clear story, or even
just my desire to understand at all, was
symptomatic of a privilege that seeks to
whitewash and deny difference. I was
invited instead to sit with the messy
discord, to hear the many voices rather
than understand them, and to allow the
project to outgrow me.
This was very difficult for me to
hear: my background is in education
and philosophy, where clarity and
explanation are king. But ultimately
I decided, in dialogue, that the moral
and political imperative of our meetings
called on me to include all of our voices,
those of all the participants in the
dialogues, often without comment,
instead of a rigorous analysis, exhaustive
literature review and all-encompassing,
clear explanation.
The work was hugely worthwhile
for me (and I hope for my participants)
and I don’t regret it. My learning was
moral, emotional and political in nature,
centring on what it means to be defined
by others, and how unethical it can be
to resist and deny this. But the upshot
of going off piste in my research was that
I got a worse mark than I would have liked.
This was the right mark, but it left me
feeling excluded from academia – from
one of the seats of knowledge creation.
It left me feeling that this kind of lived,
personal, relational knowledge doesn’t
really count as knowledge in counselling.
Now, this was my choice – I chose to
write in a way that I knew risked getting
a poor mark. But the feeling of being
excluded from the creation of knowledge
set me in mind of other instances of
alienation, and I realised that it’s a
bit of a theme in my professional life.
For example, being a member of
BACP is, for me, an experience of having
a distant, paternalistic instructor tell
me what not to do and demanding that
I pay for the privilege. I feel I have no
voice in the body that represents me,
and that it only represents the bland,
quiet, profitable aspects of me.
Similarly, in my previous life as a
primary school teacher, I was encouraged
to undertake a piece of action research
as part of an MA for which I was
studying. My colleagues and I used
this opportunity to raise our awareness
of our interactions with the young
children in our care and to learn from
them – to learn how to learn from the
children. This was a fundamentally
trusting, human and relational piece
of work, which evolved in a community
of learners and paid great dividends,
opening up new avenues of practical,
situated knowledge. But this knowledge
not only failed to spread beyond us;
it was soon overturned and negated
by official forms of knowledge – by
initiatives backed up by extremely
dubious but extremely evidence-based
research. We were effectively told: ‘Your
learning is local, specific and not really
proper knowledge at all. Our large scale
Research FINAL TTSep16.indd 14 01/09/2016 09:44

‘I was told that this
desire to tell a clear
story… was symptomatic
of a privilege that seeks
to whitewash and deny
difference. I was invited
instead to sit with the
messy discord, to hear
the many voices rather
than understand them’
studies are more important – they are
more true.’ In the years that followed,
I found myself becoming more and more
isolated from the sources of knowledge
creation in education, and, at the same
time (because I was having to apply
this evidence-based knowledge to my
teaching), more and more isolated from
the children in front of me. Eventually,
the gap became too large and, reluctantly,
I left.
Who creates the knowledge?
So far so personal. Does this story
really tell us anything important about
the state of knowledge creation in the
counselling professions? I believe it
does, and that, while we may never end
up as voiceless as teachers are currently,
we are heading, unthinkingly, in that
direction. To make this argument I’d
like to turn to a bigger question: how
is knowledge created in counselling
– who gets to say what counts and
what doesn’t?
To borrow a term from Foucault,2
there are many different discourses
through which knowledge is controlled
and power is exercised in counselling.
For example, there is the discourse of
personal engagement and development.
This discourse holds that we learn best
through direct experience with ourselves
and with others, and that textbooks
and studies provide only a secondary
source of knowledge. In other words,
it places the core of knowledge creation
in counselling within the relationship
between client and counsellor. As a
recent trainee, this kind of relationshipcentred
discourse dominated much of my
learning, and I found it both liberating
and challenging. Although I could
support my learning with theories and
grand men from the past, they were only
ever on the periphery because at the core
was the client, sitting across from me,
unknowable in advance. Fundamental
to this discourse is the supervisor, who
modulates and moderates the learning
of the counsellor, but does so through
the relationship, rather than through
an imposition of external hierarchical
standards or criteria.
Outside the bubble of university,
however, I found myself coming up
against another discourse that was
defining my professional life: evidencebased
practice (EBP). The discourse of
EBP holds that the only real knowledge is
that which is gained through randomised
controlled trials (RCTs): objective
studies conducted in unusual situations
by neutral outsiders. It holds that proper
knowledge is objective, measurable,
and visible only to outsiders, and
that anything that is not objective
or measurable is not knowledge.
It is hard to think of a discourse more
at odds with the relationship-centred
discourse of the counselling literature
and training, and I believe this discourse
is alienating us from the core of our
profession – our clients. So how has
it gained its power? We can see EBP
at work through both practical and
cultural means.
Much of EBP’s power comes from the
role it has in providing or withholding
gainful employment. If you hope to
work for the NHS – far and away the
largest employer in the UK – there’s
a very good chance that you will have
to accept the medical model of illness,
and drop those elements of your
personal beliefs that conflict with this.
You will have to accept, for example,
that you cannot learn from the patient,
and that your practice is defined by the
research of others – others who measure
a relationship as a series of inputs and
outputs. You will have to accept that
September 2016/Therapy Today 15
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Research
your clients are essentially lacking, and
that you will fill in their gaps, primarily
by operating a manual. If you don’t
(or at least if you don’t pretend to),
you won’t get work. And if you don’t
get work, you’re not a counsellor.
It is not just those seeking a job who
have to make compromises, however.
New trainees coming into the profession
will want to be taught the knowledge and
skills that give them the best chance of
succeeding financially in the counselling
professions – why wouldn’t they? But
this means there is a growing pressure
on training institutions to tailor their
training to this new agenda. What’s the
point of teaching counsellors to learn
from their clients if this is a skill unlikely
to be required by the employer?
It doesn’t stop at training institutions:
there is a broader cultural story to tell
here about the way that EBP fits into
the current political context. Ever since
the Blair governments, and perhaps
before, this country has seen a systematic
stripping away of ideology and morality
from political discourse. This depoliticisation
and de-moralising of public
debate has left a vacuum into which the
evidence-based practitioners and their
allies, the economists, have stepped.
No more are public services judged by
their pursuit of the greater good, or by
their ethical rightness. No, measurable
economic impact is now the sole bottom
line in almost all public debate, and so,
increasingly, the knowledge that counts
is knowledge that is measurable and
has economic impacts. One need only
consider the way that Richard Layard’s
influential Depression Report3 was
taken up by the Government to see
this in action in the counselling world.
Across all of the public sector,
knowledge of a more practical, local
kind does not count, because it cannot
be measured, generalised and proven to
have an economic impact. It is through
this cultural shift that EBP has gained
much of its authority, as we have come
to expect that knowledge comes from
above, not below. It is fine to carry on
exploring local, lived knowledge in
supervision, we are told, but if you
want to be engaged in creating real
knowledge (knowledge that has an
impact; knowledge that gets heard,
funded and publicised), then it must
be of the measurable, external sort.
This is a particularly pernicious state
of affairs in counselling, where so much
of what we do is about remaining open
to and meeting the Other as they are,
not as we conceive of them. The best
of teaching, counselling and research
16 Therapy Today/September 2016
is about a disciplined openness, in
which we learn in relationship and
from the relationship, not just about
the relationship. But if you’re practising
EBP, you cannot be open to the client –
they are not in the evidence.
Is there another way?
Where these two discourses –
relationship-centred local knowledge
and EBP – collide, we as counsellors
can often feel powerless to resist the
authority and power of EBP. We just
don’t have the words. Even if we did,
we are too scared of making ourselves
unemployable to say them. Culturally
and practically, we are sleep-walking
into a world in which our lived, relational
knowledge will have less and less status
and impact. Is there another way?
I want to suggest a different approach
to knowledge that may help us to find the
words, and the solidarity, to stand up for
our situated, practical, lived knowledge.
This is the discourse of ‘connoisseurship’
– a term drawn from the work of
American educationalist Eliot Eisner.
Eisner’s term ‘connoisseur’ comes
from the world of art. 4,5 Within the
art world, Eisner found that, although
there was no overall authority dictating
standards, there were nevertheless
clear criteria and standards that were
constantly being negotiated, developed
and refined between artists, critics and
audiences. And, further, he found that
these criteria provided enough structure
for artists to practise well and to improve
their practice.
Within the world of art Eisner found
explicit, quasi-objective criteria such
as technical skill and draughtsmanship
(much as we find in EBP), alongside
criteria relating to established canons
of practice and theory (much as we’d
find in the ‘schools’ or ‘tribes’ approach
to counselling), alongside amorphous
but no less important criteria such as,
for example, emotional impact and
moral worth. What was important,
Eisner noted, was that none of these
sets of criteria – none of these discourses
– trumped the others. To judge their
relative importance required what
Eisner called ‘connoisseurship’ – a
felt sense honed over years of direct,
lived experience and dialogue within
a community of practitioners and
researchers. Such judgments could only
be made by a community that was able
to refer back to the reason and purpose
that brought them all together – to create
great art.
Writing in the 60s in the US, Eisner
hoped to import the discourse of art
connoisseurship into education. He
loathed the way curricula that sought
to control every aspect of a child’s
experience in school were being imposed
on teachers from the outside. But he also
distrusted the woolliness of unreflective
teachers who went along with their
particular group’s tradition because
‘it’s what we do’. Education, as he saw it,
was a messy human process, with aspects
of culture and morality and subjective
taste, as well as aspects of efficacy and
science and objective research. Without
a situated language of connoisseurship
that took seriously all aspects of the
art/science of education, teachers
would be powerless to engage with and
resist the curricula being imposed on
them. Too often, Eisner found, teachers
remained passive and fatalistic in the
face of external agendas, or channelled
their energy into in-fighting and tribal
disagreement. Without a common
language of connoisseurship growing
from a core of shared beliefs and
purpose, and exercised through constant
engagement, their lived, situated
understanding would disappear.
How does this help us in counselling?
The best of counselling, like the best
of teaching, is messy and human. It is
moral action as well as technical process;
relational art as well as measurable
science. Sometimes these different
aspects of our profession will come
into conflict, and how they are to be
balanced is not a question that can
easily be answered. In the current
climate, decisions about these kinds
of conflict are all too often taken out
of our hands and decided by those who
push the EBP agenda. Unopposed, they
make their decisions on the basis of RCT
evidence and economic impact. What
Eisner’s experiences in education and
art highlight is that we, as a community,
are capable of making important
contributions to such decisions, but
that, in order to do this, we must come
together and speak a common language
grounded in our shared purposes.
Eisner’s notion of the connoisseur
gives us confidence to join in the debate
as equal members. For example, it was
only when I re-read some of Eisner’s
essays that I felt confident enough to
stand up for my research against the
mark it received – to say: ‘The lived
experience of my research was more
important than the mark scheme.’
But confidence alone is not enough.
In the face of the practical and cultural
weight of EBP’s dominance, we need to
organise ourselves so that we can act
Research FINAL TTSep16.indd 16 01/09/2016 09:45

‘I also feel there is no
community of shared
purpose through which I
can raise my voice against
evidence-based practice.
Instead I feel I am part
of a splintered profession
that is more concerned
with internal suspicion
than external action’
together. Thinking back to my reluctant
decision to leave the teaching profession,
what was missing then was a genuine
community of engaged, passionate
professionals speaking the same
language as me. Without this solidarity
and clarity of purpose, I felt isolated
and disempowered and unable to act.
As a counsellor now, I also feel there is
no community of shared purpose through
which I can raise my voice against EBP.
Instead I feel I am part of a splintered
profession that is more concerned with
internal suspicion than external action.
Would you, as an NHS commissioner,
choose to fund those who oppose
aspects of EBP when they can’t even
tell you clearly and coherently what
they suggest to replace it?
How do we create a community in
which we can come together to stand
up for our profession and our lived,
relational knowledge? We won’t find
this community by looking above for
someone to give it to us – it’s not in the
nature of large institutions like the NHS
to encourage change from the ground up.
And nor can we look to the professional
associations that represent us – these
bodies are so broad and inclusive that
they lack the sense of direction and
purpose that a community requires.
No, rather than looking up, we need
to look to each other: to stand up for –
and to – one another. I’m not talking
about a support group or a Facebook
page where we can all badmouth
the NHS and EBP; I’m talking about
something much harder and more
risky – genuine engagement – opening
ourselves up to change through deep
and thorough discussions about what
we are doing as a profession and why.
Moreover, not only do we have to
talk to each other in ways that might
expose and leave us vulnerable; we have
to look outwards too. The echo chamber
of our particular tribe is not a place of
connoisseurship, but nor is it helpful to
jealously keep our profession secretive
and protected. It is only by opening up,
riskily, to those who are not like us –
including the evidence-based
practitioners – that we will learn
anything at all. We might be changed
by this, and change is always difficult,
but it is only in this way that we will be
able to come together as a community of
connoisseurs – agreeing and disagreeing,
but doing so in the same language.
Postscript
The day after I presented a version
of this article at the Keele conference,
I attended a keynote presentation by
BACP’s Chair Andrew Reeves, fully
expecting to find it as I have experienced
BACP – bland, safe and irrelevant. My
expectations were, wonderfully, unmet.
When I wrote this paper I would never
have dreamed of submitting it to
Therapy Today, but what I heard from
Andrew changed my mind. What I heard
was someone willing to confront some
of our worst aspects as a profession –
tribalism, limited ambition, learned
helplessness – in order that we might
remake ourselves as a community of
engaged practitioner-researchers. By
tackling our limitations, he suggested,
we could come together as a community
with a shared purpose and direction,
unapologetically advocating for our
own forms of knowledge creation.
This presentation, and what I’ve
read since, has left me feeling that we
stand at something of a crossroads as a
profession. We are under unprecedented
pressure to conform to the EBP model
and accept definition from above,
but we also have an unprecedented
opportunity to take back control of
our profession – to define it from the
bottom up. While we should not look
above us to be given a community, we
may at least find some shelter under the
umbrella of an organisation like BACP,
which seems now to be taking a more
coherent and solid stand and arguing
that we need collectively to define
our own reason for being and our
own standards of knowledge before
others do it for us.
Under this umbrella, and with this
shared sense of direction and purpose,
perhaps we can begin to talk to one
another properly, as connoisseurs
of counselling.
Phil Hills is a recently qualified counsellor
and sporadic blogger (philhills.wordpress.
com). He currently divides his time between
counselling in a hospice in Staffordshire
and co-developing a service providing
counselling and supervision to schoolteachers
(see www.teachingwithheart.co.uk).
References
1. Schlipp PA, Friedman SF (eds). The philosophy
of Martin Buber. Chicago, IL: Open Court
Publishing; 1967.
2. Foucault M. The archaeology of knowledge
and the discourse on language. New York, NY:
Pantheon Books; 1972.
3. Centre for Economic Performance’s Mental
Health Policy Group. The depression report: a
new deal for depression and anxiety disorders.
London: London School of Economics; 2006.
4. Eisner EW. The art of educational evaluation:
a personal view. London: Falmer Press; 1985.
5. Eisner EW. Reimagining schools. New York,
NY: Routledge; 2005.
September 2016/Therapy Today 17
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Cults
Amid the current heightened concern
about religious extremism and the ways
people are enlisted and trapped into
extremist groups, we need to remember
this is not a new phenomenon: cults
of various kinds have been in existence
for many years. Many adults today were
born and/or grew up in such groups.
It is their perspective that this article
addresses, and specifically the effects
of cultic methods of control on their
subsequent relationships.
There is a body of literature on
the general topic of working with cult
survivors, including articles in Therapy
Today.1 , 2 Here we extend this to include
the particular experience of someone
who grew up in a cult. This personal
viewpoint is provided by co-author
Mary Russell, and is written in italics.
There are various definitions of
cults. We use one grounded in the
work of psychiatrist Robert Jay Lifton3
and Hannah Arendt:4
‘A cultic system is formed and
controlled by a charismatic authoritarian
leader or leadership body. It is a rigidly
bounded, steeply hierarchical, isolating
social system, supported and represented
by a total, exclusive ideology. The
leader sets in motion processes of
coercive persuasion (also known as
“brainwashing”), designed to isolate
and control followers.’5
These groups come in a variety of
forms, including, but not limited to,
spiritual, political, commercial or
ostensibly therapeutic. Regardless
of size and type of belief system, cultic
groups all involve some form of undue
psychological control or influence.
Although such groups vary in their
beliefs and the extent of this control, we
would argue that there is a commonality
in the way their members are controlled
and in some of the issues encountered by
those who grow up in such environments.
These commonalities include tight
control of personal relationships,
separation from the outside world and
lack of autonomy in decision-making.
Attachment perspective
‘When I was eight, in 1954, I was left
alone in the house every day for three
weeks because I was not well enough to
attend school. I remember the associated
boredom and loneliness and also a sense
of abandonment... There were a number
of factors in this neglect: my mother was
working, economic conditions were harsh,
and child-rearing views less thought through
than at present. However, it was also cult
related in that, as in many groups, the care
of children was given a low priority.’
It is predictable that in cults any special
attachment to one’s own children –
indeed, any attachment other than
that to the leader – is frowned upon:
such attachments interfere with the
primary allegiance to the leader or group.
This may then lead to neglect and other
attachment problems in these families.5
Understanding this is vital for
therapists working with people who
have grown up in cults, or ‘high demand’
groups (often known as secondgeneration
members). An attachment
analysis can help us understand both
the emotional and cognitive mechanisms
and the effects of these isolating and
highly controlling environments.
Attachment theory states that an
evolutionary adaptation fundamental
to humans is the drive to seek proximity
to a safe other (initially as infants to
caregivers) in order to gain protection
from threat, thus improving chances
of survival. A child seeks its parent when
ill, tired, frightened or in any other way
under threat. The parent then functions
as a safe haven – a source of protection
and comfort. But, once comforted,
the child eventually wishes to explore
its world again, and now the parent
functions as a secure base from which
the child ventures out and to which they
can return when protection and comfort
is again needed. Secure attachment is the
optimal form of attachment, and is open,
flexible and responsive. Similar dynamics
occur in adults in their relationships with
spouses, partners or very close friends.
But attachment relationships do not
always function well. In particular, when
the caregiver is not only the source of
potential comfort but is also the source
of threat, a relationship of disorganised
attachment results. Seeking comfort
from the source of fear is a failing
strategy: it not only brings the individual
closer to the source of fear, it also fails
to produce comfort, thus impeding
the cycle of renewed exploration.
Disorganised attachment has
both emotional and cognitive effects.
Emotionally it can lead to disorganised
or trauma bonding – a powerful,
entangled bond – with the caregiver.
Cognitively it can lead to dissociation
in response to an unbearable situation
of ‘fright without solution’.6
Stein’s research5 indicates that the
closed, fearful world within a cult is
designed to promote a relationship of
disorganised attachment to the leader
or group: a combination of terror and
‘love’ that is used to emotionally trap
and cognitively disable followers. All such
groups arouse fear by employing a variety
of threats – dangers in the outside world,
predictions of apocalyptic events, harsh
criticism or the threat of exclusion. Fear
can also be aroused through emotional
and physical means, such as guilt,
exhaustion and physical punishment.
According to Bowlby: ‘Most people
think of fear as running away from
something. But there is another side to it.
We run TO someone, usually a person.’7
The cult leader makes sure he or she,
and the group, is the only attachment,
and thus the only source of relief from
Attachment theory
and post-cult recovery
Attachment theory provides a key to understanding the emotional damage
from growing up in a cult, explain Alexandra Stein and Mary Russell
Illustration by Scott Jessop
18 Therapy Today/September 2016
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September 2016/Therapy Today 19
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Cults
this fear. Like the infant, cult members
develop a disorganised, potentially
harmful attachment behaviour.
The disorganised attachment of
followers then affects their parenting
and other close relationships. In fact,
in cults the leader deliberately mediates
and controls the relationships of followers
with their children. Disorganised
attachment also characterises the
relationship of the leader to their
own children, as in Mary Russell’s case.
Many studies state that cult leaders fit
the profile of narcissistic personality
disorder, or of psychopaths/sociopaths.
‘My father had an unusual career. For
about 40 years he led a small, far left
political group. Growing up in London,
this was an important part of my
environment as a child and young person.
I left this group when I was 22 on the
grounds that I didn’t understand it and
wanted to lead my own life... There was
control and coercion, and ‘comrades’
were expected to put ‘the party’ before
everything else, including family and
friends. My father played the leading
role, and abused some party members,
both physically and sexually, although
this was not clear to me until later.
‘In my case I was lucky to go to an
ordinary school and to have a mother
who was not fully involved in the group...
‘What I did not realise was that this
group could be classified as a “cult” and
that growing up in a “cult” is likely to
have various psychological consequences,
in addition to its effects on the family
context, on which therapists often focus.
‘In my case it was many years before
I realised that, even though I had
disconnected myself from this group, I had
never had a conversation with anyone who
had chosen to leave. However, I did have a
role as a family member, which I acted out by
making occasional appearances at memorial
meetings that were held to honour my father.
Having started to think about cults, I was
interested in why I had done this and also
rather ashamed... I eventually became
aware of the particular “bubble” in which
I had been living in relation to the now
former cult. The way in which I remained
enmeshed was through loyalty to my father.’
Two things stand out here. First is that
if, after leaving, the former member
does not get to discuss and analyse
their cultic experience as such, they
can remain confused and disoriented
in relation to the group, even many
years after leaving. Second, the ongoing
loyalty to the group or leader (and in this
case Russell’s own father as leader) is a
continuation of the trauma/disorganised
bond created in the isolating context of
the cult. Until a clear, coherent narrative
is developed, this loyalty remains a
coercive and confusing influence.
‘For me, realising some of the psychological
consequences took several stages. In the
first place there was initial therapeutic
work in my 40s, which was very helpful
but failed to address the cult issue directly.
‘The second stage was in my 60s,
reading articles by Gillie Jenkinson,8 where
she pointed out that cults could be political,
which for me was a lightbulb moment.
Jenkinson also used the term “high demand
groups”, with which I could identify at
a point where I was not ready to take on
the term “cult”. I contacted her, and my
work on clarifying this proceeded from
there. At that stage the psycho-educational
component of our work – that is, learning
the specifics of how cults operate and control
their members – was particularly important
in helping me to understand the coercive
and highly controlled nature of the group
in which I grew up.’
This psycho-educational work is
particularly important for adults who
spent their childhoods within cults,
‘Seeking comfort from the source of fear
is a failing strategy: it not only brings the
individual closer to the source of fear, it also
fails to produce comfort, thus impeding the
cycle of renewed exploration’
who can then begin to develop a coherent
narrative that reflects the reality of
their early experience, rather than the
dogmatic and ‘fictional’ narrative of life
in the group described by the leader.
‘Later it was helpful to work with other exmembers
from different groups, particularly
in understanding how much groups with
very different beliefs and philosophies have
in common.
‘In the third stage, I have met and talked
to “survivors” from “my” particular far left
group about how they had come to join and
leave this group. The process of applying an
understanding of the methods and structures
generally used by cults to the particular
group I grew up in has taken place over the
last three years, and included some personal
therapy. One of the most difficult aspects
of this was grieving my loss of respect for
my father, and also fear that being disloyal
would have terrible consequences.
‘Given the disorganised bond to the
leader – who was also my father in my
case – letting go of “respect” for or worship
of the leader can feel extremely frightening.
Such fear has been instilled over many
years. The bond of terror and “love” –
as in relationships of controlling domestic
violence, or Stockholm syndrome – can be
a difficult one to navigate, and all the more
so when the perpetrator is one’s father.
And in the case of one’s father there may be
an imperative to untangle the good moments,
to not dismiss the relationship entirely.
‘In terms of abuse, my father was,
occasionally, violent towards me, as were
and are many other parents towards their
children. However, it becomes even more
difficult to think about such abuse and
name it accurately when an individual’s
grandiosity is manifested by a leadership
position in a group.’
This again reflects the core disorganising
dynamic of terror and ‘love’ within cults:
the grandiosity or charismatic element
20 Therapy Today/September 2016
Cults FINAL TTSep16.indd 20 01/09/2016 09:47

muddies the ability of the child to
understand the abuse they have suffered.
‘Speaking to ex-members of the group my
father led, several of them note the ways
in which they were abused, and at the same
time ways in which my father occasionally
showed caring or appreciation, which
they have clearly remembered for the last
30 years (as I also expereinced). In other
words, there was a combination of fear
and being appreciated, which helped
secure their membership of the group.
‘Similarly, my memories of my father’s
kindness and warmth towards me, as well
as respect and loyalty for him, have made
it particularly difficult for me to think
about what happened in that group. More
general awareness of this phenomenon
would be useful for therapists working
with adults who grew up in cults.’
This potent combination, the
characteristic push/pull of fear and
‘love’ (which Judith Herman describes
as ‘the capricious granting of small
indulgences’9 within an overall
environment of control and terror),
cements the trauma/disorganised bond
between leader and follower, and here
also between father and child.
‘Being in this group as a child did give
me something; unfortunately, it was not
what I needed. I believed our group was
extremely important, that therefore I also
had significance. Although as children we
were neglected and our needs not taken into
account, at the same time my brother and
I experienced a status, because our father
was the group leader. This type of specialness
went with feeling quite disconnected from
the world outside the group and a belief
that we had a magic key that might
unlock everything.’
This sense of an elite status is, in fact,
common to all cult members and serves
References
1. Jenkinson G. Working with cult
survivors. Therapy Today 2013;
24(4): 18–22.
2. Dubrow-Marshall L. In: Jenkinson
G. Working with cult survivors.
Therapy Today 2013; 24(4): 18–22.
to isolate them from the outside world.
It also provides an unrealistic ideal
standard of behaviour – a standard
that can be used as the basis for harsh
criticism or punishment when the
child (or indeed adult) inevitably fails
to live up to it. This is part of the cult’s
system of maintaining a level of chronic
fear, which prevents a sense of inner
security and autonomy and feeds
into the disorganised dynamic.
After the cult
If the client has broken away from the
cult as a young adult, this may happen
as part of a necessary teenage/adult
rebellion. For many leavers, the damage
from the experience need not extend
throughout their adult life. A person’s
attachment status is malleable over time;
subsequent ‘good enough’ relationships
can help a person to develop a more
secure attachment style later in life.
‘I left the organisation after a short period
and never strongly identified with it. I
followed my mother in trying to ignore
my father and the group by disconnecting
from those experiences. In other words,
some of those experiences were put in
the ‘too difficult box’, largely because of
fear and my loyalty to my father. I was
fortunate, for various reasons, in being
able, with difficulty, to develop earned,
secure attachments in most areas of my
life as an adult. However, particularly
as a young adult, this disconnection had a
cost in other areas, including social isolation
and a high anxiety level.’
The untangling of various life
experiences and relationships is very
important for ex-members, and even
more so for those who grew up in cults.
While the cult experience must not be
ignored, the client should not dismiss
the time they spent in the negative realm
of the cult. Good things have happened
3. Lifton RJ. Thought reform
and the psychology of totalism:
a study of ‘brainwashing’ in China.
Chapel Hill, NC: UNC Press; 1989.
4. Arendt H. The origins of
totalitarianism. Orlando, FL:
Houghton Mifflin Harcourt; 1973.
5. Stein A. Terror, love and
brainwashing: attachment in
cults and totalitarian systems.
Routledge; forthcoming.
6. Hesse E, Main M. Disorganized
infant, child, and adult attachment:
collapse in behavioral and
attentional strategies. Journal
of the American Psychoanalytic
Association 2000; 48(4): 1097–1127.
within that framework. People in the
closed cultic world have found (often
secret) ways to show love and affection.
Skills and knowledge they may have
acquired in the group are real assets
that they can now claim. It is vital for
the client to sift out these elements,
own them and not feel they are obliged
to credit the cult leader for them. In fact,
it can be important for ex-members to
acknowledge their own resilience and
resistance and that of others in having
found or created these positive elements
within a traumatic environment.
Conclusion
If the therapist knows that a client has
grown up in a closed cult, they can offer
psycho-education about the isolating,
engulfing and fear-arousing control
mechanisms used within such groups,
and their effect on attachment relations.
What is important is not to focus
on the relationships within the family
without also addressing the context
of the highly controlling, closed group
around it. This context has clear
implications for the parents – whether
they are the leader or followers who
have ceded to the leader or group their
autonomous relationship to their child,
with all its damaging consequences.
Alexandra Stein is a social psychologist
and Associate Lecturer at Birkbeck and
at the Mary Ward Centre, London. Her
book, Terror, Love and Brainwashing:
attachment in cults and totalitarian
systems, will be published in December
by Routledge. www.alexandrastein.com
Mary Russell is a senior accredited
counsellor working integratively in
private practice in Richmond, London.
Her specialisms include trauma and work
with people who have been in cults or high
demand groups. www.maryruss.co.uk;
bluewater@maryruss.co.uk
7. Hesse E, Main M. Frightened,
threatening, and dissociative
parental behavior in low-risk
samples: description, discussion,
and interpretations. Development
and Psychopathology 2006; 18(2):
309–343.
8. Jenkinson G. Rebuilding the
jigsaw. Thresholds 2011; 4: 4–7.
9. Herman JL. Trauma and recovery.
Philadelphia, PA: Basic Books; 1997.
September 2016/Therapy Today 21
Cults FINAL TTSep16.indd 21 01/09/2016 09:47

Ethics
Relational ethics and
the Ethical Framework
Els van Ooijen explains relational ethics and how they can guide good practice
when counsellors are faced with difficult ethical decisions
In their book Ethical Maturity in the
Helping Professions, Michael Carroll
and Elisabeth Shaw comment: 1
‘Relationship becomes the foundation
of what we mean by ethics.’ A common
understanding of ethics in the
counselling and psychotherapy
professions is that it is a code for
resolving dilemmas. However, ethics
is not confined to ‘difficult’ situations;
as Carroll and Shaw’s deceptively
simple comment makes clear, whatever
we do in our everyday practice impacts
on others. Even with the new BACP
Ethical Framework,2 it is not sufficient
to simply check what the code says; we
still have to interpret how the principles
and rules apply in each particular case.
It is generally accepted that a good
therapeutic relationship is crucial
for therapy to be helpful, which may
be why a ‘relational turn’ is evident
right across theoretical orientations. 3,4
A relational turn has also occurred
within ethics, and in this article I will
situate the BACP Ethical Framework
within a relational ethic5 that is
compatible with both rule-based
and principle-based approaches.
The emergence of relational ethics
is generally seen as prompted by the
work of Carol Gilligan.6 Her research
showed that, faced with an abstract
ethical dilemma, women usually
required more information about the
context, relationships and feelings of
the people concerned before making
a decision, whereas men on the whole
did not. Gilligan stressed that, despite
this apparent difference, gender does
not determine moral perspective, and
titled her book In a Different Voice,
rather than In a Woman’s Voice. Her
research was widely reported but
(with a few exceptions) has not had
much impact on the therapeutic world. 1,7
22 Therapy Today/September 2016
A relational ethical stance places
relationship, primarily that between
practitioner and client, at the heart
of practice and decision-making, and
values a deep, empathic engagement
with other people’s feelings and
emotions. It includes an ethic of care,8
which is congruent with the duty of care
therapists have for clients, and implies
a commitment to ‘excellence, expertise
and best practice’.9 Noddings recognises
that a relational stance can be demanding
and that practitioners may not only
experience joy and satisfaction, but
also run the risk of hurt and guilt. 10
She therefore emphasises that a caring
relationship applies also to practitioners’
internal world, as a relational and caring
ethic is not synonymous with sacrifice
but includes the importance of caring
for ourselves to avoid getting burnt out.
Gerhardt helpfully points out that our
‘inner life and outer life are connected’
as ‘we are emotional creatures and
[we] bring our emotional responses
to our politics and economics as well
as to our more personal relationships’. 11
Relational ethics in practice
Relational ethics offer a shift in
perspective and emphasis as, instead
of rules or principles, they place the
client–therapist relationship at the
centre. This subtly differs from the
BACP Ethical Framework’s commitment
to ‘put clients first’, and is less about
what we ‘do’ than what we ‘are’.
Relational ethics are like a tree, 12
where the roots symbolise subjectivity,
deep connection, love, compassion,
physical experience and wisdom, and
the branches objectivity, rationality,
logic and adherence to principles or
rules. To flourish, a tree needs healthy
roots to absorb nutrients and branches
that capture sunlight, with the life force
streaming in both directions within
the trunk. The trunk is like a ‘relational,
intersubjective space’ where ‘roots’
and ‘branches’ can have a dialogue.
A relational ethical stance, therefore,
implies openness, and a willingness to
listen and suspend judgment, in order
to forge understanding and connection.
Ethical decision-making
Difficult ethical issues and dilemmas
should be discussed in supervision,
where therapists can benefit from
the supervisor’s support, different
perspective and expertise. 13 Here I
present an updated version of my own
three-step model of ethical decisionmaking
to more fully encompass a
relational and caring ethic.9
Step 1
Ask, ‘What is the issue, whose issue is it4
and what are the relevant relationships?’
Step 2
Establish the relational space. How do
we explore the issue? How is everyone
feeling and thinking? Facilitate a dialogue
between all points of view (whether real,
imagined or in role-play).
Step 3
Decide what is the most desirable
action, considering the principles set
out in the BACP Ethical Framework.
Once a potential decision has been
identified, check from all viewpoints
and ensure that it accords with the
law and the BACP Ethical Framework.
Brendan, John and Suzie
Brendan, a married man with two
teenage sons, is seeing Suzie, a recently
qualified counsellor, because of
depression; he feels unfulfilled in his
work and in his relationship with his
Relational ethics FINAL TTSep16.indd 22 01/09/2016 09:50

wife. Suzie tells John, her supervisor,
that during their most recent session
Brendan told her he is tempted to
accept a new job involving travel and
long periods abroad. He reported feeling
excited for the first time in ages, as the
job is challenging and well paid. Towards
the end of the session he suddenly
became angry with Suzie and accused
her of trying to make him change his mind.
Suzie asks John for help, as she feels
strongly that Brendan should not accept
the job. She says she regards it as her
ethical duty to help him see that the job
is likely to distance him from his family,
and harm not only him but also his sons.
Step 1
The relationships here are between
1) the counsellor, Suzie, and John, her
supervisor; 2) Brendan, the client, and
Suzie, his counsellor, and 3) Brendan
and his family. The issues include, first,
a rupture in the therapeutic relationship
between Suzie and Brendan, and, second,
whether or not Suzie should seek to
influence Brendan in his job decision.
Step 2
John first helps Suzie to express and
explore what is going on for her. He
expresses his experience of her as a
warm and sensitive practitioner and
wonders about her strong feelings
about Brendan’s decision, and whether it
perhaps triggered anything for her. Suzie
tells him that her father had an affair
and left the family when she was 16, just
before her GCSEs. Suzie says, ‘I took my
exams, but didn’t do as well as predicted.
I went off the rails after that; it’s taken
me years to sort myself out and rebuild
my relationship with my father. I’d hate
the same thing to happen to those boys.’
Suzie asks John whether he thinks that
Brendan had somehow picked this up.
‘A relational ethical stance
places the relationship
between practitioner and
client at the heart of practice
and decision-making and
values a deep, empathic
engagement with other
people’s feelings’
‘That is quite possible, especially as that
is what you think,’ says John, ‘but I also
wonder whether he might have projected
onto you what he is unconsciously
feeling about himself?’ They reflect
on the issue and Suzie realises that,
although she has discussed her feelings
about her father in her personal therapy,
she has unfinished business to take to
her next therapy session. John validates
her decision by saying that working
through stuff often feels like a spiralling
down so you are working through the
same issue, but at a deeper level.
Step 3
John asks Suzie how she sees her work
with Brendan now. Suzie answers that
she had got confused because of her
feelings around her father and that
she now feels that any decision about
the job should be up to Brendan.
She says that she will explore with
Brendan how he experienced their
previous session to allow him to express
any negative feelings he might have
about her and the situation he is in.
Comment
If (as in the above example) it becomes
clear that a decision is for the client to
make, rather than the counsellor, it is the
counsellor’s task to facilitate the client’s
exploration in a way that honours their
autonomy (a key ethical principle), yet
helps them to see all aspects of the issue
clearly. There is a parallel here between
the client–counsellor relationship and
the counsellor–supervisor relationship.
In the same way that Suzie realises that
her task involves helping Brendan make
his decision without imposing her view
on him, John’s relational way of working
helps Suzie to come to her own decision
about how to work with Brendan.
The decisions in the above example are
in line with the BACP Ethical Framework.
Principles that stand out are the way in
which John fosters Suzie’s ‘self-respect’,
enabling her to do the same with her
client, and ‘autonomy’, in that John
facilitates Suzie’s realisation that
the decision about the job should be
Brendan’s, and that she should help
him explore all aspects of the situation
and trust him to make a decision that
is right for him and his family.
Frank, Hugh, Alice and Lisa
Frank, a counsellor in private practice,
is having group supervision with two
colleagues, facilitated by Alice. Frank
tells the group about Hugh, a newish
client in his early 30s. Hugh finds it
hard to relax in the sessions. He sits
on the edge of his seat and talks nonstop.
Some weeks previously Hugh
disclosed that he is having problems
in his relationship with his partner,
Lisa; they are having frequent rows,
and recently he got angry and pushed
her, causing her to fall onto the bed.
She was unhurt, but Hugh felt ashamed.
Frank taught him anger-management
skills, which appeared to be helping.
Just before coming to supervision,
however, Frank received a voicemail
from Lisa, who said that Hugh had been
very angry and had pushed her again.
September 2016/Therapy Today 23
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Ethics
References
1. Carroll M, Shaw E. Ethical
maturity in the helping professions:
making difficult life and work
decisions. London: Jessica Kingsley
Publishers; 2012.
2. Ethical framework for the
counselling professions. Lutterworth:
British Association for Counselling
and Psychotherapy; 2016.
3. Safran JD. The relational turn,
the therapeutic alliance, and
psychotherapy research: strange
bedfellows or postmodern marriage?
Contemporary Psychoanalysis 2003;
39: 449–475.
4. Faris A, van Ooijen E. Integrative
counselling and psychotherapy: a
relational approach. London: Sage
Publications; 2013.
5. van Ooijen E. Ethics in day-to-day
practice. Therapy Today 2016; 26(6):
24–35.
6. Gilligan C. In a different voice.
Cambridge, Mass: Harvard
University Press; 1982.
Lisa said she wasn’t hurt, but wanted
to come and see Frank to tell him her
side of the story. Frank says that the
supervision session is timely, as he
does not know what to do and has
not yet returned Lisa’s call.
Step 1
The group identifies several parts
to the issue: should Frank answer the
call or ignore it? Should he agree to
see Lisa? And what, if anything, should
he say to Hugh? They name the relevant
relationships as between Frank and
Hugh; between Hugh and Lisa, and
potentially between Frank and Lisa
and/or Hugh and Lisa as a couple. They
agree that, for Frank, his relationship
with Hugh is the most important,
but that the situation needs careful
reflection, as whatever he decides to
do is likely to affect the therapeutic
relationship and Hugh’s wellbeing.
Step 2
Alice invites the group to engage in a
role-play dialogue where Frank will be
himself and the other group members
will take the roles of Hugh and Lisa.
First Alice asks ‘Lisa’ to say what she
is thinking and feeling.
Lisa: Well, Hugh has been seeing his
counsellor for weeks now, but I don’t
know what he talks about. He’s still
anxious and gets so angry. I just want
his counsellor to know what this is
like for me; it’s not really fair that he
only hears Hugh’s side of things, is it?
Frank: I’m Hugh’s counsellor, so I’m
trying to help him deal with his anxiety
and control his anger, which will also
be good for you. But if Hugh felt that
I would be reporting back to you, that
might inhibit him and my ability to
24 Therapy Today/September 2016
help him. Confidentiality is important
in the therapeutic relationship.
Lisa: Yeah, but wouldn’t it be better
if I came as well? Because you only
get his point of view! How can you help
him if you don’t get my side of things?
Frank: Well, I’m trying to help Hugh
with his personal problems, rather than
with his relationship. I mean, that would
be couples counselling, which might
also be a good thing to do at some point.
Hugh: Yeah, I just feel that it’s really
important that I can say what I think
without having you there, Lisa. Maybe
couples counselling would be an idea
at some point, but I get so exasperated
with you. I need space – time to think,
but you keep interrupting me, and
(turns to Frank) when Lisa keeps asking
questions it drives me crazy, especially
when she goes on about ‘How long is
this going to take?’
Frank: Hugh, perhaps we can spend
some time considering how this is for
Lisa? Obviously it’s for you to decide
how much you want to tell her about
our work together, but maybe we could
think about what you could say to relieve
her anxiety, without feeling that that’s
intrusive or damages our relationship?
Hugh: Yeah, that would be helpful. I get
anxious and go blank and then feel like
lashing out. I haven’t so far; I’m not a
violent man, but I get exasperated and
just want space, so yeah, that would be
helpful if you could help me with that.
Alice: Hugh, how do you feel about the
fact that Lisa phoned your counsellor?
Did you know that she was going to
do that?
Hugh: I didn’t and I’m angry. (To Lisa)
You had no business to do that. (To
Alice) I find it really intrusive, she’s
encroached on something that she
shouldn’t have.
Frank: That’s also something we can
work on, that you need your own space.
Hugh: Do you think that there’s
something the matter with me that
I need my own space? For me that’s
fundamental, that’s who I am.
Frank: Absolutely, but I think it would
be helpful to think about how you could
talk with Lisa so that you maintain that
integrity but she feels less anxious
and frustrated.
Alice: Lisa, what do you think about this?
Lisa: Yes, that would be helpful. It’s just
that I don’t get any answers and I want to
know what’s going on. I don’t like being
talked about to a complete stranger.
It’s made me feel out of control. I don’t
know what is being said about me. So if
you could talk a bit more and help me
understand, yeah, that would be helpful.
Alice: Frank, I’m aware that you had
this call from Lisa just before you came
today. Presumably you need to decide
whether to ring Lisa back or whether
to mention this to Hugh? Are you any
nearer to having a sense of the best
action to take here?
Frank: This has certainly helped me
see that my relationship with Hugh
is primary, but maybe I should return
Lisa’s call and explain things to her.
That would also show her that I’m a
reasonable person that she can trust
not to jump to conclusions about her,
Relational ethics FINAL TTSep16.indd 24 01/09/2016 09:50

7. Gabriel L and Casemore R
(eds). Relational ethics in practice:
narratives from counselling and
psychotherapy. London: Routledge;
2009.
8. Slote M. The ethics of care and
empathy. Routledge: London; 2007.
9. van Ooijen E. Clinical supervision
made easy: a creative and relational
approach for the helping professions
(2nd edition). Ross-on-Wye: PCCS
Books; 2013.
10. Noddings N. Caring: a feminine
approach to ethics and moral
education. Oakland, CA: University
of California Press; 1986.
11. Gerhardt S. The selfish society:
how we all forgot to love one
another and made money instead.
London: Simon & Schuster UK; 2011.
12. Bergum V, Dossetor J. Relational
ethics: the full meaning of respect.
Hagerstown, MD: University
Publishing Group; 2005.
13. Bond T. Standards and ethics for
counselling in action (4th edition).
London: Sage; 2015.
that I realise that it’s important that she
and Hugh should talk and that I will help
Hugh to facilitate that.
Hugh: I would be very unhappy if you
did that without discussing it with me
first. I would feel unsafe and betrayed,
and I would be unsure whether I could
trust you. The thing is, if you discuss
it with me first, then I would probably
say, ‘Yeah, ring her back,’ but the idea
that you will have a discussion with
my partner without me having been
consulted, I’m not OK with that.
Frank: Yes, I think that is important.
My position is that I would like to ring
Lisa, but that I should consult you first.
Hugh: It would be good if you could
hang on until the next session before
you ring her back.
Alice: So we are coming to a decision,
Frank, that you will wait until you speak
with Hugh about Lisa’s phonecall, and
that you haven’t phoned her back yet
because of what we talked about, and
how he would feel if you did. Or perhaps,
Hugh, you would prefer to talk with
Lisa yourself?
Hugh: Actually I would. Frank, if you
could help me to have a conversation
with Lisa in a way that she can take on
board, I’d prefer that. But I’m just not
happy about you talking with her without
talking to me first. This is my space.
Frank: OK, let’s do that.
Alice: Let’s have a look then at what
ethical principles we have used here.
The obvious ones seem to be beneficence
and non-maleficence: we want to do
good by you, Hugh, and no harm; we
‘A relational approach to
ethics is about honouring
the therapeutic relationship,
promoting the wellbeing
of the client and working to
high professional standards’
respect your autonomy. Trustworthiness
is also relevant, as contacting Lisa would
not only break confidentiality but would
also undermine the trust you should be
able to have in your counsellor. We have
clearly adhered to the commitment to
put the client first and have also shown
that we respect the client’s privacy and
dignity [points 21 and 27 in the BACP
Ethical Framework].
Comment
This second vignette shows that the
three-step model can be used to create
a dialogue between all those concerned,
and is therefore well suited to group
supervision. In individual supervision
it can be helpful to create a constellation
of, for example, stones, shells or toy
animals to represent the different
people involved and have a dialogue
between them. Helpful questions to
ask include: What is your relationship
with everyone concerned? What is
going on for everyone? What is everyone
feeling, thinking, wanting, imagining
and remembering? Then, when all
have been heard and everyone’s
thoughts, feelings and wishes are clear,
the dialogue can move onto step three
and brainstorm the possible courses of
action. Any potential decisions should
be checked out with all those involved
– this could be done in role-play first
and, if possible, in reality afterwards.
Last, it is important to check that any
decision is in accordance with the law
as well as the BACP Ethical Framework.
A postmodern approach
I have put checking the BACP Ethical
Framework and any legal requirements
in step 3, after the reflection on
everyone’s experience, thoughts
and feelings. This is to ensure that the
therapeutic relationship is central, as
our first concern should be our sense
of relationship and care for the client
and not what the Ethical Framework
says we should do. In practice, a
relational approach to ethics is about
honouring the therapeutic relationship,
promoting the wellbeing of the client
and working to high professional
standards. Any decision that is made
in this way is therefore unlikely to
contradict the Ethical Framework,
although it is important to check.
As to legal requirements, I see it as
part of relational ethics to clarify the
limits to confidentiality in the contract
with the client and to ensure that the
client has a physical copy of it.
Relational ethics could be seen as
leading to moral relativism. Such a
criticism would suggest a modernist
belief in absolute truth. However, I
see a relational ethical approach as
postmodern, as it values the ability
to sit with uncertainty and be mindful
not to jump to conclusions, easy
answers or premature understanding.
These are the abilities of a mature
practitioner; a relational approach to
ethics therefore offers a mature ethic
for a maturing profession.
Els van Ooijen is a relational-integrative
psychotherapist, counsellor and supervisor
in private practice in Bristol, and author
of Clinical Supervision Made Easy
(PCCS Books, 2013).
September 2016/Therapy Today 25
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Debate
My new client, Sophie, is distressed. She
lost her temper at a funeral, in an epic
soap opera fashion. She has surprised
herself and doesn’t recognise her own
actions. She looks at me to ask: ‘Who am
I? I don’t know myself. I am a character
living in some melodramatic soap.’
Yes, it’s true, soap opera characters
do act unpredictably and literally out of
character. Think about the contradictory
behaviour of daughter Nico to mum
Sienna in Hollyoaks, or Elizabeth and
Roy’s surprise affair in The Archers.
Soaps are often issue based and require
their characters to bend and morph
to the demands of their extravagant
plot lines as they explore sibling rivalry,
murder, adultery, bisexuality, abuse,
bereavement. Ultimately, the character’s
gymnastic changeability gets used up,
and they die in a car crash/pub brawl/
drowning (or turn up under the patio).
So what has this got to do with
Sophie’s out-of-character behaviour
at the funeral and her feeling that
she doesn’t recognise herself?
Television, like all media, is a
simulation, a fictional representation
of our lives. You could say we all
introject simulations on a daily basis.
Is it possible, then, that, just like these
soap characters, we morph and bend,
reacting to the situations in which
we find ourselves? That the situation
itself dictates our response, like the
scriptwriter, and we are not driven by
our characteristics, our Self? There are
well known studies, such as the Stamford
Prison experiment,1 in which Phillip
Zimbardo set up two teams of ordinarily
well-behaved college students as either
prisoners or guards in a fictional prison
environment, and observed them over
five days as their behaviour degraded
and conformed to what was expected of
them in their respective roles. How does
it feel to surprise yourself and suddenly
commit acts of control and cruelty on
your fellow students? How much do
one’s environment, family and friends
or a particular situation construct
‘who you are’? Did the funeral construct
Sophie’s out-of-character behaviour?
Who is Self?
Philosopher Julian Baggini is unlikely
to offer much reassurance about your
changeable Self.2 He believes that the
Self is actually the construction and
is a ‘messy, fragmented sequence of
experiences and memories, in a brain
which has no control centre’. Even
with neuroscientific brain mapping,
we cannot point to a part of the brain
and say, ‘There, that’s where all the Self
resides.’ However, Paul Broks, a clinical
neuropsychologist who has worked with
clients with severe brain damage, noted
that many clients still held onto a strong
sense of Self, regardless of which parts
of their brain were affected.3 This raises
the question, ‘Where in the brain is
the Self?’ Or is the Self everywhere
in the brain – or, indeed, in the body,
and experienced through our senses?
Neither of these ideas of Self – the
fragmented, uncentred thing or the
predictable response to situational
factors – are helpful to Sophie, whose
already shaky trust in herself could be
undermined further. After all, Sophie
believes, as many of us do, in a more
coherent Socratic ‘know thyself’ concept.
If situational factors are predictors of
our behaviour, then what about our
personal qualities and attributes?
What is the point of psychoanalysis, or
self-development, if there is no Self to
develop? What is it we are ‘developing’?
Aristotle considered that our actions
define our Self.4 If you play the violin
long enough, you become a violinist.
If you carry out the role of a carer, you
are a carer, and perhaps become caring.
All the world’s
a soap opera
Geraldine Marsh explores what makes us who we are
and whether we are in control of the final script or a
constant work in progress Illustration by Scott Jessop
26 Therapy Today/September 2016
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September 2016/Therapy Today 27
Soaps FINAL TTSep16.indd 27 01/09/2016 09:53

Debate
A person can have a whole host of roles
that perhaps define them – for example,
mother, daughter, barmaid or solicitor
– or, to put it in richer soap operatic
terms, the matriarch (Peggy, EastEnders),
the ne’er do well (Eddie Grundy, The
Archers), the tart with a heart (Bet Lynch,
Coronation Street). But are our characters
created by responses to these roles,
or are we proactively acting them out?
Fate may provide the ‘film sets’, but we
still write the scripts by exercising our
free will, don’t we?
The instinctive Self
Without free will, Zimbardo’s idea of
situational predictability has us sharing
the characteristics of our pet cat, who
only produces a miniscule variation
in her essential responses to, say, food
or a live mouse. Tibbles, bless her, is
mostly predictable, motivated as she
is by self-preservation, territorialism,
dinner and avoiding the Alsation next
door. Perhaps, as an animal ourselves,
we often act instinctively, with fear
being a powerful motivator in our
lives and decisions. Whether it is true
or not, we believe we are exercising
free will and are consciously deciding
how to act. That’s if we have the ability
to lift ourselves out of the instinctual
action, the reactive response. As a
psychodynamic counsellor, I am all too
aware of the unconscious re-action in
acting out a character in a client’s life:
the timid father, authoritative mother
or confiding friend. Reading the script
and throwing it away enables the
client to consciously reflect on what’s
happening for them. Perhaps, then,
it is the process of conscious reflection
itself that enables the Self to develop.
But choosing between the instinctive
or reflective action is hard, and requires
us to exercise our free will and make
a decision. We are glued to our seats
by soap opera suspense as a character
fights with a gritty dilemma. Think
Mercedes from Hollyoaks, poised with
a gun; Rhona from Emmerdale, fighting
her attraction to Pierce, or Shoona in
The Archers, agonising between coming
clean to the police or destroying her own
and her husband’s reputations. Think my
client Sophie, who made a decision to act
in a sympathetic, dignified manner at the
funeral but found the angry younger part
of herself that she intended to suppress
coming out shouting over the buffet
at the wake at the Duck and Feather.
How often do we make decisions about
how we will behave, yet find a part of us
still holds on to the ‘losing’ argument?
The decision has to tip one way or
the other, but that doesn’t mean all of
our Self is happy with the way we decide
it should tip. Doesn’t this then indicate
that we are more unpredictable than
we think? The kinds of decisions clients
bring to counselling are often really
difficult ones. Of course they are; if
they were easy, they would decide,
move on and never present themselves
in counselling. But often making difficult
decisions means the part that ‘loses’
doesn’t feel good about the overall
decision. However that doesn’t mean
it’s the wrong decision – just that it’s
a difficult decision.
There is a saying that the branches
of a tree do not fight among themselves.
Yet we human beings clearly can be
conflicted within ourselves and engage
in a right old tussle – branch, twig and
leaf. So how can Sophie, like the tree,
stop fighting with her own branches?
How can she feel more integrated and
accepting of this unpredictable Self?
Given that it is instinctive to fear the
disintegration of Self, how can the
idea of such a contradictory Self ever
feel acceptable? American poet Walt
Whitman expresses this idea as: ‘I am
‘Yet the process of incorporating and
embracing all of ourself can be painful
and require that we accept aspects that we
don’t want to acknowledge, characteristics
of ourself we don’t like’
large, I contain multitudes.’5 There
would be something more celebratory
about encompassing this largeness of
our Self. Yet the process of incorporating
and embracing all of ourself can be painful
and require that we accept aspects
that we don’t want to acknowledge,
characteristics of ourself we don’t like.
And if we do indeed truly know ourself,
how can we can ever surprise ourself?
The Self as a verb
Given this exhausting process of
decision-making, perhaps the Self is
less of a noun and more of a verb. Every
time we stop the automatic, reflexive
reaction and exert our free will to choose
an action, we are ‘Selfing’ – constantly in
a state of creating our Self. Neuroscience
confirms that our brains can continue
to create new neural pathways, new
connections, new associations
throughout our lives (even while
other pathways and connections die).
In other words, we are in the process
of constantly learning, changing
and creating our Selves through our
actions, on a daily basis. This scientific
confirmation of our capacity to change
has been articulated for centuries in
other ways. For example, Buddhists
believe we are the sum of our bodily
experiences, thoughts and feelings, and
emphasise the fluidity of this, and that
this is how we progress through life: our
conscious actions create our Self. Sophie,
for example, would have understood the
anger she felt if she had been her 16-yearold
Self, but she can’t as the person she
is now, 15 years later. Indeed, would you
recognise who you were at 16 years old?
The older you would certainly not wear
that jumper, or date that boy from No 34.
And as for that haircut!
So, in the hope of getting a snapshot of
who Sophie is now, she talks about herself,
her mother, her stepfather, her teachers.
28 Therapy Today/September 2016
Soaps FINAL TTSep16.indd 28 01/09/2016 09:53

Some sentences are echoes of the
family and friends she has introjected,
others an indication of the media she
has introjected: her musical tastes
and fashion dislikes, comments on
Twitter and posts on Facebook, favourite
programmes, celebrities and the vloggers
and bloggers she follows – hyper-real
simulations that have become part of
her. Finally, she talks about that younger,
angrier Self, there at the funeral, at
odds with her current Self. She wants
to believe she’s safe, so talking feels
precarious, as repressed feelings are
unearthed, revealing more ‘multitudes’
of herself to her Self. Will this process
culminate in ‘I feel better now’, or
‘I feel worse and don’t trust myself’?
Will the paradox that is the Self find
a storyline that is all-embracing and,
despite occasional aberrations,
ultimately unifying?
The impermanent Self
Or is there a sub-plot here: that it is
not about judgment of the outcome
but the process of Sophie’s raised
consciousness in and of itself?
Hegel would have it that we are all
on a journey of consciousness raising
that ultimately changes the way the
world expresses itself. 6 Maybe he would
have viewed the different modalities of
counselling in terms of other disciplines,
such as science, medicine, physics or
philosophy, which have to encompass
differing or competing ideas yet have
their own places, allowing for the
‘progressive unfolding of truth’ over
time. Hegel would say that a person
becomes happy when they see that
their individuality is illusory, that the
experience of having a body is merely
a temporary agreement with ‘thinghood’.
I’m not sure most of us could tolerate the
idea of our important Self being no more
than a temporary arrangement. What’s a
soap without its central character?
These definitions, ‘fragmentary bunch of
desires’ or ‘unimportant individual cogs
in a giant history wheel’ might do little
for our clients’ subjective happiness.
And if we did take Hegel’s definition
that the process of raising consciousness
is the be-all and end-all, perhaps within
every counselling relationship, there is
a potential gap between what we think
the outcome is (the client ‘feels better’,
for example), and what is actually
happening (for example, consciousness
raising in and of itself, creating
active ‘Selfing’). As overall levels
of consciousness are raised on an
individual level, there will be a change
in the phenomenology of the client’s life,
which then finds expression in families,
culture, communities and societies.
Looking at the whole effect, Hegel would
say that each age enjoys a staging post of
consciousness articulated in its culture,
arts, poetry, law and science. Presuming
both my client and I are merely part
of this very slow advancement of
consciousness, then our occasional
uncharacteristic actions of Self are
of such a small consequence that they
will have no bearing on this inexorable
progress to greater consciousness.
In the meantime, the microwork
continues as we attend to and nurture
that unique and capricious thing called
Self – an animal Self, a fragmentary,
contradictory and multitudinous
Self; who knows, given enough eons
to develop, perhaps an ideal future
Self into which we could evolve,
some kind of self-determining sage,
who acts consciously without effort 24/7
(and no doubt lives in a bamboo home
that is decorated in natural hessian
and olive, with a juicer and yoga mat).
Even in this fictitious future I somehow
think we would still enjoy settling
down Buddha-like on the sofa with
‘If situational factors are predictors of our
behaviour, then what about our personal
qualities and attributes? What is the point
of psychoanalysis, or self-development,
if there is no Self to develop?’
Tibbles, switching on the television and
en-lightening up the mood with a soap.
We need to see the expression of modes
of behaviour we cannot own. We desire
that cathartic experience. Knowing
that when Elektra, the repressed prim
schoolteacher, tumbles out of character
and gives love-rat Dan, the father of
her child, a ‘shiner’, or Suzie hesitates,
then jabs the accelerator pedal, sending
the school bus ploughing into the triplewedding
venue of Bob/Sally/Vic/Sue/
Pete/Sandra, perhaps we instinctively
understand the balancing act between
reacting unpredictably or predictably.
Soaps reveal us to ourselves, and perhaps
have a place in a ‘Selfing’ process.
They show us that we can depart
from the script written for us and start
improvising. What kind of Selfing would
I or my client choose to undertake next?
How do I want my storyline to read?
So, do you want to know what
happened to Sophie next? Cue music,
roll credits: Da-Da-Da-da-da-da-da-didummmmmmm…
Geraldine Marsh is a counsellor in private
practice in south east London. Her research
interests include meditation, hypnotherapy
and writing. www.blackheathcounselling.com
References
1. Haney C, Banks C, Zimbardo P. Interpersonal
dynamics in a simulated prison. International
Journal of Criminology and Penology 1973; 1:
69–97.
2. Baggini J. The ego trick. London: Granta
Books; 2012.
3. Broks P. Into the silent land: travels in
neuropsychology. New York: Atlantic Books; 2003.
4. Aristotle. The Nicomachean ethics. London:
Penguin Books; 2004
5. Whitman W. Song of myself. In: Murphy F (ed).
Walt Whitman: the complete poems. London:
Penguin Classics; 1977.
6. Hegel GWF. The phenomenology of spirit.
(Translated by AV Miller.) Oxford: Oxford
University Press; 1977.
September 2016/Therapy Today 29
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Dilemmas
Mental capacity
and assisted dying
This month’s
dilemma
Be clear about the
role’s limitations
Lesley Ludlow
Senior accredited counsellor and
supervisor, Croydon
Constance’s role as a counsellor is to
help Wilfred explore and understand
his feelings around his diagnosis. It’s
unclear what he means when he asks
Constance to help him to ‘formulate
a plan’ to end his life and communicate
his wishes to his family. In terms of
practical plans, what Wilfred is asking
of her falls outside her remit, and in this
instance it’s important that she maintains
the boundaries and framework of her
role. However, it’s also important that
Wilfred has a space where he can explore
his emotional response to the diagnosis
and his fears of his future, without
worrying about hurting his family.
With that thought in mind, Constance
would need to give serious consideration
to her own beliefs about assisted suicide
and whether she would be able to work
with Wilfred. The BACP Ethical Framework
states (point 10): ‘… the practitioner’s
30 Therapy Today/September 2016
Constance, a counsellor in primary
care, is working with Wilfred, a
78-year-old man with a history of
depression and suicidal ideation.
He is presenting for therapy with
anxiety, having recently been
diagnosed with Alzheimer’s disease.
Wilfred is fearful about his future
quality of life, in particular losing his
sense of identity and autonomy, and is
struggling to manage unpleasant side
effects from medication to stabilise
the disease, including loss of appetite,
headaches, fatigue and insomnia.
While he still has the capacity to
make what he considers to be a rational
decision, Wilfred wants Constance to
help him formulate a plan to travel to
Switzerland to end his life, and support
personal and relational moral qualities
are of the utmost importance.’ She
would need to consider whether her
beliefs would interfere with and present
a hindrance to the work and her ability
to relate therapeutically to Wilfred.
Wilfred does state that he wishes
to advise his family of his plans, so in
terms of his safety it would appear that
he doesn’t plan to try to take his life on
his own. If Constance decides to work
with Wilfred, it would be important
for her to use supervision to explore
these issues fully and to work within
the Ethical Framework in terms of the
limits of confidentiality. She will need
to be clear with Wilfred about her role
as a counsellor and, while respecting
his wishes, advise him of the policies,
‘She will need to be clear
with Wilfred about her
role as a counsellor and,
while respecting his wishes,
advise him of the policies,
procedures and ethical
code that govern her role’
him in communicating his wishes
to his wife and family. Constance
believes that life is a gift from God
and that assisted suicide is wrong,
whatever the circumstance. She also
experiences Wilfred as confused
at times and questions whether he
has the mental capacity to make an
informed decision. Wilfred insists
that Constance doesn’t disclose
any of this to his GP, family or other
health or social care professionals.
What should Constance do?
Please note that opinions expressed
in these responses are those of the
writers alone and do not necessarily
reflect those of the column editor
or the editor of Therapy Today, or
BACP policy.
procedures and ethical code that govern
her role, and that she would be unable
to respect his wishes should he tell her
he is planning to take his life on his own.
This is so that he fully understands the
boundaries but doesn’t feel shut down
and unable to express his feelings.
Wilfred, by the very nature of his
condition, may be confused. However,
his mental capacity to make the decision
will need to be gauged by his GP, and
by Dignitas should he progress to that
stage. The most important aspect for
Wilfred is that he is provided with a
space to explore his difficult feelings.
The right to choose
Claire Thomas
Person-centred therapist
A first response might be for Constance
to ask if Wilfred has told his GP about
the side effects of the medication.
If not, she might suggest he makes
an appointment to discuss them.
As she is working in a primary care
setting, Constance would have explained
and contracted with Wilfred at the outset
Dilemmas FINAL TTSep16.indd 30 01/09/2016 09:55

ILLUSTRATION BY LARA HARWOOD
the limits to confidentiality and that,
if she felt there was a heightened risk of
harm, she might need to inform his GP,
and then also perhaps the community
mental health or crisis team. Supervision
would have an important role here as a
place to explore risk and the capacity for
this to be contained within the primary
care setting. Constance would need to
carefully and sensitively explore with
Wilfred his insistence that she does not
disclose any information to his GP or to
other health or social care professionals.
She may also need to revisit with him
the agreed boundaries of confidentiality,
perhaps frequently.
The dilemma suggests that Constance
is concerned about Wilfred’s capacity
to exercise his rights and freedom to
choose to end his life. The Mental
Capacity Act 2015 states that a person
must be assumed to have capacity, unless
it’s established that they lack it, and that
all possible steps should be taken to
support a person to make an informed
choice. It also states that a person has
the right to make an ‘unwise’ choice.
Constance will need to seek support
from her supervisor for her work with
Wilfred, as she seems to be finding it
difficult to step into Wilfred’s frame of
reference and experience empathy and
unconditional positive regard for him.
Supervision might also support
Constance to separate her personal
beliefs about assisted suicide from her
judgment about Wilfred’s capacity to
choose to end his life. As a personcentred
counsellor, my understanding
of the actualising tendency would
support me in being alongside Wilfred,
as it would underpin my trust that,
provided the relational conditions are
present, he will make the best choices
for himself. This could potentially
include the choice to end his life.
Part of the primary
care team
Katharine Cossham
MBACP (Accred) person-centred
counsellor in a variety of settings
As a counsellor in primary care,
Constance will have to abide by the
policies and procedures of her employer
and should have already explained to
Wilfred, at the point of contracting,
her obligation to inform her primary
care colleagues if she is concerned
about the risk of suicide.
Given that she is working in a primary
care setting, Constance will also be
mindful of her role as one of a team.
Wilfred will also be under the care
of a GP, possibly in the same building.
Concerns about Wilfred’s mental
capacity are another reason to consider
enlisting the support of a GP, as are
the side effects from his medication.
If the possibility of GP involvement
has been made clear at the outset of
their relationship, as above, Constance
can explain to Wilfred why she is unable
to offer him the assurance that she
will keep all this information to herself.
If not, she is in the difficult position
of having to explain this part way into
their work. Either way, she is not able
to behave as she might do if she were
working independently, when she would
have the BACP Ethical Framework but
no organisational policies to guide her.
Aside from the issue of whether she
can keep his confidence, Constance
could still explore with Wilfred his
feelings around wanting to go to
Switzerland to end his life, and help
him talk through ways to tell his friends
and family, as he has requested. Also,
regardless of the various factors at
play here, would a therapist anyway
help a client to formulate a suicide plan?
Surely our job is to facilitate our client’s
decision-making but not to cross over
into the realm of personal assistant.
We also have the factor of his
Alzheimer’s to consider, which in itself
would be challenging to work with. For
example, this might make it necessary
to recontract each session, and regularly
review previous work – or, in contrast,
it might mean Constance keeps the focus
of sessions on the present experience.
Finally, we have Constance’s belief
that suicide is wrong. We can only
speculate how this may or may not
influence her practice, and whether
she is able to put this belief to one side
and discover what her client’s feelings
are. Given her job, I would hope and
expect that the latter is the case.
Belief and the
Ethical Framework
William Johnston
Person-centred counsellor working
in private practice
In a conflict between the divine and
the BACP Ethical Framework, it’s hard
to see how the framework can win.
If Constance truly believes that it is
sinful for Wilfred to take his own life,
to the point of risking his immortal
soul, and, furthermore, that in failing
to prevent him she risks her own soul,
there surely can be no choice other than
to do everything in her power to prevent
him, including ignoring all his wishes
and speaking with his family and GP.
She must also, in that case, give up any
idea of being a counsellor, at least in the
September 2016/Therapy Today 31
Dilemmas FINAL TTSep16.indd 31 01/09/2016 09:55

Dilemmas
sense that most other counsellors might
view that role. This is the problem when
belief tips over into dogma.
My personal sense is that suicide
is probably unhelpful as a solution to
life’s ills. It’s equally clear to me that
what I believe to be true for myself – or
even what I believe to be true universally
– is only my belief. I don’t actually know
that I’m right. Furthermore, I have never
found myself in the situation of hurting
so much that ending my life seems like
the better option. Accordingly, I have
always made it clear to clients that,
while I might see a limit to confidentiality
if they are at risk of harming others,
it’s doubtful that I would break their
confidentiality in order to prevent them
from harming themselves – certainly not
without their permission. As I understand
things, Dignitas do in any case provide
counselling before they will consent to
assist their clients in killing themselves.
By the same token, it seems to me that
I would be willing to explore a client’s
intentions and beliefs, regardless of
what these entailed, and however much
I might wish – privately or openly –
that they do not follow this route.
Constance’s additional concern is
that Wilfred is not mentally fit enough
to make this decision. Surely the
whole point here is that his increasing
bewilderment is the very reason for
his wanting to end his life? The word
that seems to scream right through
this dilemma is autonomy. It is precisely
losing control over his own life that
seems most to frighten Wilfred. At the
very least he needs to maintain a sense
of autonomy in his counselling sessions.
October’s
dilemma
32 Therapy Today/September 2016
Constance might well be able to help
him by acting as a trusted repository
of his thoughts and ideas. And ultimately
it might just be too late for him to make
such decisions, and Constance’s role
might well to be to support his distress,
as family and authorities steal his
autonomy from him regardless.
Conflict between
role and values
Brian Charlesworth
MBACP (Snr Accred), MBPsS CPsychol
Sometimes the very reasons we choose
to be a therapist in the first place –
such as the willingness to help those
in crisis, our sensitivity to distress and
suffering, and being alert to existential
issues in others and ourselves – brings
its challenges. All these factors can
bring us to a place of conflict between the
professional demands of the role and our
individual moral values. In this case, I see
a potentially challenging way ahead for
Constance, but one with several options.
Constance could choose to explain
clearly to Wilfred her role in the primary
care setting, including the limits this
places on her to respect his wishes about
confidentiality. In effect, organisational
protocols could help guide her choice
of intervention, what to contribute
and when, and help define her role
as a therapist in this setting.
Another possible option might be for
Constance to share with Wilfred what
she herself would do in his position,
Miguel promotes his private practice
online. To manage potential boundary
breaches and risks to confidentiality,
he explains when contracting that
he won’t knowingly follow or accept
a ‘friend request’ from current or
former clients on social media.
Andrea has been coming to
Miguel for therapy following a painful
relationship break-up and wants help
to stop self-harming. She sometimes
arrives late and texts Miguel to ask if
he can see her later or earlier than the
agreed time. She also has a pattern of
saying little and then becoming very
emotional at the end of the sessions.
Miguel has struggled sometimes to
contain her, and has allowed sessions
to overrun.
In their sixth session, Miguel tells
Andrea he has noticed the difficulty
she experiences around beginnings
and endings and makes a link to her
‘Losing control over his
own life... seems most to
frighten Wilfred. At the very
least he needs to maintain
a sense of autonomy in his
counselling sessions’
if she thought this might benefit the
therapeutic process. Making personal
disclosures of this type is a contentious
issue. Some practitioners avoid them;
others might consider it appropriate
in this situation. Doing so might show
Wilfred that Constance is alongside
him, as a fellow human being. The
therapist’s intention in sharing such a
disclosure is the key factor here: would
self-disclosure assist the therapeutic
process, and Wilfred’s process of change?
A further option (building on the first)
might be for Constance to stay with
Wilfred’s distress while he navigates
this decision, and help him face this
challenge by offering a safe space to
work it out. This sounds simple in
words, but could be a major challenge
for any therapist and self-care will be
a paramount concern when engaging
in such a demanding process. We have
to take care of ourselves: we are the best
resource we have, and we have a moral
obligation to do so. We must also include
the option of possible onward referral
if Constance feels that this specific
event is pushing her to the limits of her
competence. This would constitute an
ethical responsibility in itself and would
again demand courage and honesty.
painful feelings following her recent
break-up. Andrea responds angrily to
his comparison and does not show up
the following week. When she fails to
respond to a couple of texts enquiring
how she is and asking her to contact
him, he conducts an online search
and discovers her public profile on
a social media site, where she has
criticised Miguel by name for ‘making
me feel worse’. Andrea turns up for
her next session, saying she’s ‘fine’,
that she forgot the previous session,
and that her phone has not been
working. What should Miguel do?
Please email your responses (500 words
maximum) to John Daniel at dilemmas@
thinkpublishing.co.uk by 23 September.
The editor reserves the right to cut and
edit contributions. Readers are welcome
to send in suggestions for dilemmas
to be considered for publication, but
they will not be answered personally.
Dilemmas FINAL TTSep16.indd 32 01/09/2016 09:56

Letters
The courage to
walk alongside us
I am writing this to the author who
wrote in the April issue of Therapy
Today about her journey with a survivor
and courageous client, who lives daily
with the little known about condition,
dissociative identity disorder (DID).
What courage you both have – to
simply trust the process, because it
can work; a therapist can walk alongside
a survivor, even if they feel at times they
are out of their depth. This was the most
heart-warming piece of writing I have
read about a process that truly meets the
needs of a client who has been abandoned
throughout her life, time and time again.
You as therapist sought attunement with
her, to bear witness to her ongoing pain,
to empathise and affirm, to encourage,
seek to care and progress on the long,
sometimes arduous path with her.
Chronic trauma in childhood is a way
of life and a way of learning. It enables
people to become incredibly creative
therapists. For survivors, it defines
the way that our brains organise and
understand information. You just
need to come alongside us and learn
too. Our recovery may be a slow, hard
process, because trauma, by its very
nature, is disintegrative, disengaging
and disempowering. Hear us; we don’t
always talk your language, but we
do talk, learn, play, hear and we are
amazingly resilient people.
Working with DID means working
with people whose boundaries as
children were regularly invaded through
active acts of abuse. We grew up not
knowing what it was like to be respected,
loved, to have choices, to be heard,
or to have a separate sense of self in a
relationship. Trust within a therapeutic
relationship aids our learning too, so
maintaining healthy and boundaried
relationships is paramount to us.
As survivors we are so often hardwired
both to survive and to heal, and we can
make progress. Working with someone
with DID should be an honour, a journey
of learning, a gift that should be received
with gratitude. Please don’t throw us
to the side; you can learn so much from
working with clients with DID, as long
as you build up a healthy relationship
of trust and integrity.
Name and email address supplied
Living with
chronic pain
I can’t say how grateful I am to read Kim
Patel’s article on chronic pain in the June
issue of Therapy Today. Chronic pain is
such an unknown quantity in medical
science that it has sent me and my family
into a downward spiral of emotions for
the past 11 months now.
My daughter (then only 12 years old)
suffered a blow to her face during a
game of rounders at school. She was
in pain immediately after but, despite
several trips to both the GP and the
A&E department at our local children’s
hospital, her pain remained unexplained.
She has suffered ever since – neither
pharmacological nor medical treatments
have helped, but at least she’s receiving
treatment from the pain clinic now.
It has been a horrendous year for the
whole family, as my daughter’s chronic
pain definitely ‘directly assaults’ our
concept of who we are as a family
(from happy, competent, love outdoor
activities to sadness, endless frustration,
feeling incapable, staying at home
and negativity), and especially for
my daughter’s own self-concept.
I agree with Patel when she suggests
that, with medically unexplained
symptoms, including my daughter’s
(initially missed) diagnosis of whiplash,
the pain can only begin to reduce when
the person starts working with the pain
rather than against it. For the first nine
months my daughter hated her pain,
fought against it, grieved for all the
things she had lost because of her
pain (peace of mind; trust in the adults
around her, because they could not fix
‘Trust the process, because
it can work; a therapist can
walk alongside a survivor,
even if they feel at times
they are out of their depth’
her suffering; the ability to play sports;
cognitive functioning – her memory,
concentration and decision-making
skills were all affected so school work
became harder and harder to bear).
But now that she’s finally working
with her pain instead, thanks to a
terrific psychotherapist, her mood
and self-esteem are slowly improving.
It doesn’t mean her pain has reduced
but it does mean her relationship with
the pain has changed, and that’s already
made a difference to her and to us –
we’re no longer filled with fear and
panic but rather full of hope and
acceptance as we all adapt to this new
concept of ourselves as a family living
with and coping with chronic pain.
Jenny Smallwood
Gestalt psychotherapist, EMDR practitioner
and clinical supervisor
Apps no substitute
for face-to-face
I read with great interest Bina Covey’s
article ‘Can software ever replace the
therapist?’ in your June issue. There’s
been a lot of media coverage and attention
given to mental health apps of late. In my
opinion, there’s no substitute for being
in the same room with a therapist.
When I work with a client, the words
they say comprise less than half of what
they are actually telling me. Usually I’ll
get a strong sense of how they’re feeling
before they utter a word, by their body
language, eye contact or lack of it, or their
posture. I don’t think a smartphone app
can replace that physical closeness.
Hilda Burke
Psychotherapist (UKCP and BACP
accredited), life coach and couples counsellor
What’s in a title?
While I wish to respect everyone’s choice
of title, I was taken aback to see that no
fewer than 10 candidates in the BACP
election for governors called themselves
Miss or Mrs. To me, this signals a nonengagement
with or a misunderstanding
of gender equality issues.
September 2016/Therapy Today 33
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Letters
I can, of course, choose not to vote
for them. But it raises a wider issue for
me. All courses are encouraged to cover
equal opportunities in the curriculum.
Does that now not include sexism? Or
is my understanding of discrimination
against women (and of heterosexism)
out of date?
Men do not call themselves Mr
or Master depending on their marital
status. Until they do – or until I hear
another perspective, I remain –
Ms Janet Tolan
FBACP, senior accredited and registered
counsellor/psychotherapist
Invisible loss of
childlessness
I would like to thank the BACP
and Amanda Sives for the article on
‘Mourning involuntary childlessness’
(Therapy Today, May 2016). I very
much identified with her ‘silent band
of women’ who almost had children.
Although I have not given up yet
or finished my journey of trying to
become a mother, I still feel that I have
‘suffered an immense but invisible loss’.
I am approaching 36 and have had
two miscarriages while going through
fertility treatment using donor sperm.
I have found it hard to share with
people about the fertility treatment
and, because both my miscarriages
were before month three, few people
even knew I was pregnant, which made
it even harder to share it with people at
a time when I needed support the most.
When I did confide in some people,
because even fewer people knew about
the fertility treatment, I got similar
responses to those mentioned in the
article: questions about how far gone
I was, or that they had or knew someone
else who had a miscarriage before starting
their family. These responses always make
me feel so lonely and isolated. Not only
do they ignore that I had lost something
that meant so much because it happened
against the odds but also I cannot just
try again, which is what their responses
imply. This just leaves me feeling even
more disconnected from other women
who’ve managed what has so far eluded
34 Therapy Today/September 2016
‘Counselling... afforded
me the opportunity to
share my feelings of grief
in a non-judgmental
environment where I
did not feel the need to
suppress how I really felt’
me. I’ve begun to feel purposeless as a
woman and unable to share this with my
peers due to the invisibility of my losses.
Luckily I was in counselling to discuss
my first miscarriage when the second
happened, which at least afforded me
the opportunity to share my feelings of
grief in a non-judgmental environment
where I did not feel the need to suppress
how I really felt and where I would not
receive responses that would make me
feel worse about myself.
I urge those who are reading this to
consider the next time you see a childless
woman that it might not be by choice;
she too might be suffering invisibly and
mourning a loss that those around her
have not witnessed.
Victoria Coles
MBACP, integrative therapist
Connecting with
our inner voice
I was pleased to read the article
‘Voice, trauma and voicelessness’ by
Tizzie Dennett-Short in the May issue
of Therapy Today. The sounding, singing
voice is wonderful to uncover when
words no longer suffice; indeed, it can
give rise to words, often imaginatively
and poetically.
It can touch subpersonalities, often
with pleasure; it can encourage gentle,
secure-enough movement between
trauma and safety. How wonderful
if more of us felt able to introduce the
creative, sounding voice in our therapy.
I am not a trained singer, although
I love singing and do lots of it, both
‘composed’ and free. I am lucky to
have trained in voice movement therapy
(VMT) – a way of working that invites
people to connect with and explore their
expressive, unique voice. Being a trained
psychotherapist as well helps to offer all
who come to me a secure and contained
environment appropriate to their needs.
In psychotherapy sessions I use VMT
sparingly, at moments that seem right.
Clearly, I use VMT principles much
more fully with people who come
specifically to work with the voice.
There is a handful of VMT-trained
people in the UK and a larger contingent
spread over Europe, Australia, the
US and South Africa. Some are trained
psychotherapists and some are not
(the latter tend to work as choir leaders
and performers). I would like to feel
that more psychotherapists experiencing
VMT might go some way to recovering
our voices, both internally and externally.
Veronica Phillips
Integrative counsellor and voice
movement therapist
Suicide and online
support
I rarely feel inspired to respond to
articles in the journal. In fact, this is the
first time in 26 years, but I feel strongly
moved to get behind Ben Wrigley’s
suggestion for a ‘virtual’ suicide helpline
poster on Google (‘Your views’, Therapy
Today, July 2016), which would appear
automatically whenever anyone googles
methods of committing suicide.
I recognise that these websites’
descriptions of suicide methods and
ranking pain levels may not in themselves
be necessarily all bad, in that the
exploration of the ‘how’ of suicide may
in itself be a deterrent, as it often is when
a client is exploring suicidal thoughts
with a therapist. But it is the expression
of the suicidal ideation that is the point
here; those who go ahead are generally
those who do not talk about it.
A virtual helpline offering the
chance to talk, maybe using BACP’s
‘It’s Good to Talk’ slogan but providing
a free emergency alternative to costly
therapy, would at least offer the
opportunity and may tip the balance.
I would personally be more than
happy to pay an increased or separate
Letters FINAL TTSep16.indd 34 01/09/2016 09:59

fee each year to help to facilitate this
and would gladly offer time and support
to any efforts that are made to achieve
this – not having a clue what that would
entail myself!
Joy Christopher
‘Inner child’ therapist in private
practice, Norfolk
Action for online
suicide prevention
I read Ben Wrigley’s article on ‘Online
suicide prevention’ (‘Your views’,
Therapy Today, July 2016) with interest,
and agree this is an issue we need to
address, as a profession working with
people who are often vulnerable and
who can be at risk of suicide.
I deliver an NHS-funded service to
support individuals and families in the
aftermath of a suicide in Cornwall
and the Isles of Scilly. As a public health
initiative, our service is designed to
reduce the risk of self-harm, depression
and suicide in the bereaved. Very sadly,
I come across a number of deaths where
the deceased has researched methods
of suicide online or been a victim of
cyberbullying prior to their death.
As a member of Support After Suicide
Partnership, a group of organisations
that provide bereavement support
after a death by suicide (under the
umbrella of the National Suicide
Prevention Alliance), I was invited to
attend a parliamentary online suicide
prevention summit at Westminster on
10 May, chaired by Grant Shapps MP.
Also present were representatives of
Google, Twitter and Facebook, and
the meeting was addressed by mental
health campaigners Jonny Benjamin,
Alastair Campbell and Ruth Jones, CEO
of Samaritans. Ruth Jones spoke about
the collaboration between the Samaritans
and Google, and how searches on Google
for suicide methods bring up the helpline
number for the Samaritans and contact
details for the charity Maytree.
Discussion centred on whether there
should be the same internet restrictions
that govern extremism and child
exploitation, or whether the internet
plays a largely positive role in providing
practical help and support when people
are at their most vulnerable. Mental
health service users who attended
spoke about the benefits of obtaining
help and support from online forums.
This is a complex area that requires
improved public policy. A government
report addressing these issues was
recently published, on International
Suicide Prevention Day, 10 September.
Meanwhile, as therapists working
with people who may be at risk, we
need to familiarise ourselves with the
dangers the internet can pose, and our
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Letters FINAL TTSep16.indd 35 05/09/2016 13:05

Letters
risk assessments should routinely
include asking a vulnerable person if
they have researched methods of suicide
on the internet.
Anne Embury
MBACP (Snr Accred)
Therapy should be
available in prisons
I was pleased to see Erene’s letter
in the July edition of Therapy Today
supporting the principle that therapy
should be available to prisoners.
As a probation officer I became aware
of the need and desire for counselling
among my clients, most of whom did
not want to offend and were keen to
understand why they did and how they
could find an alternative way of living.
This led me to psychotherapy training,
with the intention of providing a service
to this social group. A probation colleague
organised a placement for me in a men’s
open prison. I followed it up with a year
as one of a team of volunteer counsellors
in a closed prison, where we met quite
a lot of resistance from the staff, who
considered therapy silly and pointless.
Later I visited a private men’s prison
where the governor appeared to
understand the value of counselling
and had found the money to employ a
team of therapists to work full time in
the prison’s health department. There
was never a shortage of applicants in any
of these establishments and I think I and
other volunteers made a real difference
to the lives of a handful of men.
I believe the most efficacious way to
rehabilitate a prisoner is through therapy
and I have evidence from my work with
this client group. I would stick my neck
out further and say, if the money that
is currently spent on ‘Thinking Skills’
groups in prisons could be redirected to
proper individual therapy, there would
be a real change in reoffending rates.
We know that a high proportion of
prisoners enter prison with mental
health (especially complex trauma)
and substance misuse issues, and many
have never had a reliable and attuned
relationship with anyone. The current
provision to meet these deficits is
36 Therapy Today/September 2016
‘Prisoners need a therapeutic
intervention at relational
depth to address their
attachment problems and
alienation from society’
nowhere at a sufficient level of quality
or quantity to meet the evident need.
Rather than a few individual therapists
bleating on about this, please would
BACP bring all its weight, as a respected
professional body, to bear upon the
Government? The Parliamentary
Justice Committee on Prison Reform
is currently inviting written evidence
on prison reform in the widest possible
terms. This would seem to be a golden
opportunity to speak up for prisoners’
needs and rights. Written submissions
have to be sent in by 30 September 2016.
Julia Miles
Registered MBACP (Accred), Oxford
Why we need
prison counselling
Having read the ‘Prisoners want
counselling’ report (News, Therapy
Today, June 2016) and then the letter
from Erene in July’s letters pages, I was
moved to respond.
I agree that it is ‘a very sad fact that
offenders have a significant lack of access
to long-term psychotherapy in prison’
and I have been involved in trying to
remedy that lack for many years.
I am now in charge of the primary
mental health team at HMP Haverigg,
Cumbria, where Greater Manchester
West NHS Foundation Trust has invested
in the development of counselling and
therapy in the mental health team.
We have a team of one full-time (me)
and two part-time counsellor/therapists,
plus three wellbeing practitioners,
of whom two have qualified, or are in
the process of training, as counsellors
or psychotherapists.
The team provides appropriate oneto-one
therapeutic interventions on a
short, medium and long-term basis, plus
group work, mindfulness and relaxation.
Since 2001, when I obtained a student
training placement in HMP Lewes,
I became aware of both the need and
necessity for therapeutic interventions
within the prison system. There are
prison service psychologists and courses
developed there that attempt to address
offending behaviour; some jails have
IAPT services and others are served
by volunteers who go in regularly and
provide relationship-based counselling.
Since many IAPT services are
dominated by CBT and a referral
pathway limited to anxiety, depression,
OCD and PTSD, many prisoners fall
outside of this remit. Many inmates
present with issues of severe childhood
trauma (particularly sexual abuse
and/or physical abuse) exacerbated
by chronic poly drug use, and often
also carry a diagnosis of personality
disorder. They need a therapeutic
intervention at relational depth to
address their attachment problems
and severe alienation from society.
I do not plough a lone furrow:
there are two national associations, the
International Forensic Psychotherapists’
Association and the Counselling in
Prisons Network, both of which actively
promote listening to damaged people’s
experience of being human.
Lee Partis
Registered MBACP (Snr Accred),
integrative psychotherapist
Welcome discussion
about asexuality
I have just read Joanna Russell’s article
on asexuality in the March 2016 issue
of Therapy Today and I wanted to write
to say how gratifying it was to see it
included in the journal. It was such
a pleasure to read a discussion that
explored the experience of people
from this little touched upon sexual
orientation and not to see it included
within a list of deviant behaviours, which
it so often is. It would be lovely to see
asexuality covered more thoroughly in
future issues of the journal but this article
was an excellent contribution to the
discussion. Thank you for publishing it.
Chez
Letters FINAL TTSep16.indd 36 01/09/2016 09:59

Catholic parish
family support
Having read the replies from therapists
to the dilemma posed by the 13-year-old
Ghanaian Charlie (Dilemmas, Therapy
Today, July 2016), as a psychotherapist
and priest I have a few thoughts that
might widen the approach.
A first thought was that the parents’
view that homosexuality and transgender
are a sin is a misapprehension. For
Catholics, sins occur only when a fully
mature conscience is contradicted by
a deliberate activity, not just a thought
or feeling. Being a homosexual or
transgendered is not a sin in itself.
To help the parents understand this
would be very important and they would
probably need to hear and understand
this from someone with authority in
their church.
Second, thinking about a 13 year old
and the likely dynamics of the family, no
individual therapist, however sensitive
to transgender issues, is likely to help
without the understanding of the parents
and other members of the family. A move
towards a family approach would be
essential if Charlie is not going to become
more isolated, confused and conflicted.
A final thought was that all the
approaches offered ignored the
possibility that the child’s Catholic
identity could be of value and assistance
in the therapy, rather than a misfortune.
Someone like Charlie could well be a
member of one of our parish families,
and their clergy would know that the
diocese in which the parish is based
would have professional resources to
support the child. These services and
individuals would work within current
BACP guidelines.
Therapists who are unfamiliar with
how pastoral care for families in Catholic
parishes is supposed to work might find
it useful to update themselves by reading
Pope Francis’ latest letter on the family,
‘Amoris Laetitia’, (The Joy of Love).
The letter speaks constantly of God’s
unconditional love for us, whoever we are,
and of the skill and sensitivity needed in
pastoral work to help with the fractures
and complexities of modern life.
Immigration in the past 10 years has
meant the proportion of Catholics in the
UK population has risen to well over 10
per cent. They come from a wide variety
of cultural backgrounds but are more
likely than other denominations to have
a strong attachment to their religious
identity. A better understanding of their
faith and culture is part of the change
affecting us all.
Fr Peter Marden
Registered MBACP (Snr Accred)
We welcome your letters. Email the editor
at therapytoday@thinkpublishing.co.uk
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September 2016/Therapy Today 37
Letters FINAL TTSep16.indd 37 01/09/2016 09:59

Reviews
Art and creativity
in psychotherapy
Creativity as co-therapist:
the practitioner’s guide to the art
of psychotherapy
Lisa Ruth Mitchell
Routledge, 2016, 232pp, £19.99
isbn 978-1138852730
Reviewed by Diane Parker
Although written by an
art therapist, this book is
not an instruction manual
on how to use art and artmaking
in the therapeutic
relationship. Rather,
it is an invitation to all
therapists to approach our
work as a creative art form in itself – to
help therapists and clinicians understand
the creative process and how it applies to
our work in relationship with our clients.
Mitchell neatly and succinctly
summarises the message of her book
in the prologue: ‘The very essence of
healing and change stems from the
process of making an artful connection
with our clients, which is as specific
and unique as any work of art’ (pxii).
She then describes and outlines five
key stages of the creative process thus:
1) incubating; 2) initial idea; 3) diving in;
4) flexible commitment; and, finally,
5) flow. Each stage is illustrated with
examples of case material from her
work with clients – therapists, social
workers, teachers and others from the
‘helping professions’, as well as therapy
clients from her art therapy studio in
Sacramento, California.
Most compelling is a practical exercise
involving paper, pens, paints, glue and
scissors – what the author describes as
a ‘creative process assessment’ (p22) –
to help the reader identify at which
stages of the creative process you are
most likely to get stuck, and most likely
to experience flow (and yes, I did try
this, and no, I wasn’t surprised by the
results). Each section also includes
further exercises – or ‘art invitations’
– to explore and practise each stage of
the creative process, further embedding
the learning from related theory and
case material.
38 Therapy Today/September 2016
Although most of these art invitations
are confined to visual art practices, they
could just as easily be applied to other
creative arts practices, such as music,
dance/movement and writing/journaling.
In fact, this focus on the visual arts is
my only criticism – and it’s a small one
– of such a warm, inspiring and engaging
book. In a profession where burn-out
is a very real phenomenon, anything
that encourages therapists and helpers
to play, to get in touch with our own
creativity, and demonstrates the magic
that can happen when we bring this
into our therapeutic relationships is
to be applauded and celebrated.
Diane Parker is a creativity coach and
dance movement psychotherapist and the
editor of BACP’s Coaching Today journal
Young people,
sex and sexuality
Horny and hormonal: young people,
sex and the anxieties of sexuality
Nick Luxmoore
Jessica Kingsley Publishers, 2016,
224pp, £14.99
isbn 978-1785920318
Reviewed by Jeanine Connor
‘I’ve never worked with
a 13-year-old for whom
sex hasn’t been an issue
affecting everything at
some level.’ So writes
Nick Luxmoore in the
introduction to Horny
and Hormonal. Me neither,
but people are often aghast when I say so.
Those people, and anyone who works
with or is the parent of an adolescent,
should read this book.
In chapter 2 Nick talks about the
sexual undercurrent in school
performances, the frissons between
students and the sexual feelings teachers
might experience towards their pupils.
At a time when the media are all over
relationships between young people
and authority figures, this is honest
and brave. Luxmoore argues that to
deny sexuality is to send it underground,
which is potentially more dangerous.
He references psychiatrist Ian Suttie’s
warnings about the reressive effects
of the ‘taboo on tenderness’, alongside
psychologist Morris Nitsun’s argument
that sexuality is an intrinsic part of any
group experience.
Nick is advocating honesty, and
practises what he preaches. This is
evident throughout the book, but most
explicitly in the chapter about sexuality
in the counselling room (Chapter 8),
in which he reiterates the importance
of acknowledging our feelings towards
our young clients and theirs towards
us. He counsels that, if we can enjoy the
erotic transference, we avoid idealisation,
demonisation or acting out.
Luxmoore demonstrates his use
of language when talking with young
people about sex. He uses their
language, four-letter words and all,
but he also uses his own to educate
and inform. He includes a case example
about a sexually active 15 year old who
has taken an overdose. What struck me
was Nick’s process of decision-making
about confidentiality and when to
share (or not) information with his
client’s parents. This illustrates how
such decisions are never cut and dried;
they are grounded in experience,
courage, and a certain professional
mettle, which Luxmoore has in spades.
Nick compares counselling with sex,
stating that new experiences such as
these are nerve-wracking but potentially
transformational (p30). He states also
that how a person relates in therapy
provides clues about how they behave
sexually (p163), and makes links
between adolescent sexuality, infancy
and parenting. These provide insight
into how much relationship/how much
aloneness a young person can tolerate,
which are backed up with helpful
references to theory.
I noticed several gender assumptions,
– girls are portrayed as more likely to
cry and to be body conscious, and that
it is their lot to withstand the advances
of boys, who are more likely to be
sex-obsessed viewers of porn. This
is how it is for most boys and girls in
most schools. The writing is honest,
not stifled by political correctness.
Nick Luxmoore is my column-mate
in the BACP Children & Young People
journal and I was delighted to be invited
to review his latest book. We’ve never
Reviews FINAL TTSep16.indd 38 01/09/2016 10:02

met, but I read avidly everything he
writes, and often with a tinge of envy
that such wise words are assigned to
his name, rather than mine. Nick ‘gets’
young people and his writing is spot on.
Jeanine Connor works as a child and
adolescent psychodynamic psychotherapist
and is also a writer, supervisor and trainer
Coaching and
mentoring
A critical introduction to coaching
and mentoring
David E Gray, Bob Garvey, David A Lane
Sage, 2016, 368pp, £26.99
isbn 978-1446272282
Reviewed by Andy Wilson
If you are interested in
provoking and challenging
questions rather than
solutions, this book
has much to offer. Gray,
Garvey and Lane offer
critical perspectives on
a broad spectrum of topics related to
coaching and mentoring by describing
or partaking in different ‘discourses’
that cover the discipline from its
beginnings to the present.
The book is organised as a textbook.
There are many activities for readers
to do and mini case studies to illustrate
points. However, the emphasis of the
cases seems to be mainly on the business
and organisational context of coaching
and mentoring, with the occasional nod
to, for instance, community mentoring
or sports coaching.
I found the book quite hard going
at first, but my persistence was
rewarded. The book includes some
interesting new perspectives and takes
a refreshingly critical, evaluative but
open stance. In particular, I enjoyed
a section of the last chapter where the
authors have collated speculations about
the future of the disciplines. I found the
idea of ‘obliquity’ (taking a purposefully
indirect route to meeting targets)
particularly intriguing.
This is an academic book that attempts
to embrace the complexity of coaching
and mentoring and, as a result, may not
be of interest to those looking for a
simple introduction. As mentioned,
its illustrations are also mainly in the
business and leadership arena, which
may make it hard going for those without
some background here. If this does
not rule it out for you, I would strongly
recommend making the effort because
reading it will certainly challenge some
of your assumptions and maybe even
change your ideas, which all good
coaching should.
Andy Wilson is a counsellor, coach
and supervisor
Transactional
analysis textbook
Into TA: a comprehensive textbook
on transactional analysis
William F Cornell, Anne de Graaf, Trudi
Newton and Moniek Thunnissen (eds)
Karnac, 2016, 444pp, £50 (hb)
isbn 978-1782202066
Reviewed by Ian Argent
For some years, the entrylevel
or reference texts
available in the world
of transactional analysis
(TA) have offered a limited
choice. The field has been
dominated by one or two
titles. This book brings a refreshing
new approach, with an impressively
wide coverage.
Into TA is divided into two sections.
The first comprises 10 chapters covering
all the expected TA concepts, from ego
states and transactions to games, scripts
etc. These chapters are alive with short
examples from different contexts and
fields of application of TA, which is a
useful development. Traditional selfreflection
exercises aren’t used here;
instead, the application of TA theory
to practice is presented ‘out there in
the world’.
The book’s second section comprises
a further four chapters that take the
reader into the subject at greater depth.
The ‘four fields’ of TA are each explored:
psychotherapy, counselling, management
and organisational development, and
learning and personal development.
Bringing together these wider TA
applications in one volume gives this
book a great breadth of view. I was
particularly engaged by the chapter on
‘Learning’, written with characteristic
liveliness by (among others) Barrow
and Newton.
The international editors have
achieved a truly global feel in this
book. The most impressive aspect of the
book, however, is its very contemporary
approach. Current trends and recent
evidence, both from within and outside
the TA world, are used to great effect.
The result is a book that places TA
practice firmly in the 21st century.
Into TA will be of benefit to beginners
and experienced readers alike. Although
it’s a heavy hardback and the print is
rather small, giving the book a slightly
dense feel, it is nonetheless a very
comprehensive textbook that is likely
to be drawn upon for years to come.
Ian Argent is a transactional analysis
psychotherapist in private practice
Group-analytic
psychotherapy
From the couch to the circle: groupanalytic
psychotherapy in practice
John R Schlapobersky
Routledge, 2016, 528pp, £36.99
isbn 978-0415672207
Reviewed by Camilla Matthews
This is an encyclopaedic
handbook that will be a
source of reference for
all group psychotherapists,
and a significant teaching
text for trainees. It is a
rich and generous work,
the culmination of John
Schlapobersky’s many years’ experience
of working in this field as a clinician,
teacher and supervisor.
Reading this book is like participating
in a lively and exciting group. It organises
group-analytic thinking in a multilayered
structure where contributions and
arguments are opened up, examined
and stored like nodal points in a splendid
theoretical web. And also like being in
a good group, the experience enriches
September 2016/Therapy Today 39
Reviews FINAL TTSep16.indd 39 01/09/2016 10:03

Reviews
and deepens as each layer is explored
and integrated.
Each chapter contains tables and
diagrams to illustrate Schlapobersky’s
expositions, as well as case vignettes and
commentary. The first section lays the
foundations with the three dimensions of
‘relational, reflective and reparative’, and
then develops ideas about the language
of the group as it moves from monologue
to dialogue and through to discourse.
The middle section divides the groupanalytic
model into the three dimensions
of structure, process and content.
Dynamic administration and group
composition are located in structure
and group-specific factors are recast
as process dynamics and explored in
depth: resonance, reciprocity, valency,
mirroring, amplification and, finally,
condensation. Schlapobersky then
provides therapeutic principles for
working systematically with the narrative
content of people’s stories, interactions
and shared developed symbolism. He
moves deftly between the world outside
the room, the world within the group
and the group within each person.
The final section explores how the
group-analytic model enables change
through the modification and application
of transference, countertransference,
projection and projective identification.
Schlapobersky then moves on to look
at metaphor and play, and closes with
a chapter on location, translation and
interpretation – ‘the heart of the groupanalytic
model’.
This book equips us with a current
and mature clinical discipline that
enables us to find form in both the
spoken word and silence and penetrate
the secrets of inner injury that have
created hurt and isolation. Schlapobersky
notes in his conclusion: ‘Our practice
is charged with paradox. Strangers can
create allies out of aliens, turn anonymity
into security and make common cause
out of seemingly unrelated injury’ (p460).
For Schlapobersky, group analysis is
not a theoretical form of psychotherapy
but a way of being in and of the world.
From the Couch to the Circle is a beautifully
written testimony to the complexity of
group analysis and the simplicity of
strangers meeting.
Camilla Matthews is a group analyst
and supervisor
40 Therapy Today/September 2016
Femininity and
self-harm in Japan
Femininity, self-harm and eating
disorders in Japan: navigating
contradiction in narrative and
visual culture
Gitte Marianne Hansen
Nissan Institute/Routledge Japanese
Studies Series
Routledge, 2016, 210pp, £90 (hb)
isbn 978-1138905306
Reviewed by Michele Head
This book provides an
insight into femininity
in Japanese culture from
a social constructionist
perspective, via analyses
of popular culture. By
analysing gender roles in
a culture that is unfamiliar
(to most Therapy Today readers, at least,
I think it is safe to assume), it allows us
to view gender difference within our own
culture with fresh eyes. In particular,
it highlights the difficulties for women
in Japan as they negotiate contradictory
cultural messages about femininity
and the conflicting requirements of
submissiveness and obedience in the
personal realm and leadership and
strength at work. These diverse roles
are represented in popular culture by
alter egos.
The premise of the second part of
the book is that self-harm and eating
disorders are a symptom of a culture
that, for women, values self-reproach
and strength with regards to adversity/
pain, and slimness and self-restraint
with regards to food. Hansen argues
that self-harm and eating disorders
are a way for Japanese women to
negotiate the impossibility of finding a
path between these conflicting identities.
I was not entirely convinced by the
argument. While a sociological
perspective on eating disorders and selfharm
may be particularly pertinent to
Japan, relevant research is alluded to but
not explored, apart from the correlation
between a rise in self-harm and eating
disorders alongside these contradictory
demands on women in society. Second,
although the book acknowledges that
this is only one sociological viewpoint
alongside many other explanations
for these symptoms, exploration of
intrapsychic and personal experiences
that create symptoms is put to one side.
The book also makes numerous
generalisations that do not tally with
clinical experience, such as ‘young girls
with eating disorders often act too adult’
(p150). Throughout the book there is
also a failure to distinguish between
eating disorders and self-harm as
separate mechanisms; both are simply
seen as acts of self-violence. Both are
interpreted through the lens of gender
only, rather than via multiple meanings.
That said, the chapters on femininity,
with examples usually inaccessible to
non-Japanese readers, are fascinating.
The book engages the reader with the
complicated definitions of femininity,
the demands of society on women,
the impossibility of both accepting
and not accepting designated roles and
the particularities of Japanese society
that render this all the more difficult.
Ultimately, however, in my view, this
is a book for those interested in a social
constructionist view of femininity,
both within Japan and Western societies,
rather than self-harm or eating disorders.
Michele Head is a clinical psychologist
Family tragedy
and dysfunction
The hands of gravity and chance:
a novel
Thomas H Ogden
Karnac, 2016, 300pp, £9.99
isbn 978-1782203575
Reviewed by Eileen Aird
This second novel by
the eminent American
psychoanalyst Thomas
Ogden tells the story of a
dysfunctional family over
four generations. The main
focus is on Erin, Damien
and Catherine, the three
children of Rose, whose husband Brian
was killed in a motorcycle accident when
Catherine was a baby. Rose has never
found it easy to mother her second son,
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Damien, despite an idyllic experience
with Erin. Depressed after Brian’s
death and increasingly unable to cope,
she asks her older sister, Margaret, to
take Damien from her. Margaret agrees,
but on condition that she adopts Damien
and cuts him off from his family of origin.
The arrangement doesn’t work, despite
the care of an idealised Jamaican nanny,
Sybil, who leaves after three years of
looking after Damien, so reinforcing
his sense of abandonment. Margaret
returns him to Rose and embarks on
a psychoanalysis, which offers her
some relief.
As the complex narrative unfolds,
themes of incest, family betrayal and
jealousy, loneliness, illness and blackmail
are added to the physical abuse Damien
suffered from Rose. Counterpointing
this darkness is the love that develops
between Erin and his younger brother
and later between Damien and his sister,
Catherine. The denouement of the novel
brings all three siblings together in a near
tragedy contained by the forces of law
and order. Underlying the family drama
is a discussion of otherness in American
society, and particularly the otherness
of racial difference.
Ogden grapples valiantly with the
immensity of his chosen canvas and
his ambitious desire to map out the
complexity of family dynamics and
the intermingled presence of cruelty
and love, protection, abandonment
and the need to survive. The chronology
of the opening sections, and to a lesser
extent the rest of the novel, moves
between past and present in a way that
recalls the shape of psychoanalysis. This
device is not always successful, leading
as it does to a sense that the narrative
is imposed in a formulaic way rather
than emerging from the development
of the characters. The overarching
themes are those of Shakespearian
tragedy, but the novel’s structure and
style are unfortunately closer to those
of a family saga, albeit a dark one.
Eileen Aird is a psychoanalytic
psychotherapist and supervisor
We welcome new reviewers. If you are
interested in reviewing books, films or
exhibitions, please contact Chris Rose
(Therapy Today Reviews Editor) at
reviews@thinkpublishing.co.uk
What’s the matter with words?
Julian Edge reviews Demolition and
its exploration of the impossibility
of naming and framing bereavement
Any story of bereavement invites
reflection by therapists, especially
those who believe in the power of fiction
to cast light on everyday experience.
The main plotline of Demolition
concerns the bereavement of Davis
(Jake Gyllenhaal), whose wife is killed
in a traffic accident, and his process
in coming to terms with that loss.
We come to realise that the marital
relationship had been under stress.
We wonder if this marriage had
even been partly motivated by
Davis’s opportunity to marry up into
a lucrative position in the business of
his father-in-law, Phil (Chris Cooper).
We watch Davis negotiate an unlikely
relationship with a dope-smoking
older woman (Naomi Watts), who
is struggling to keep her own life
together in a domestic partnership
with her boss, and with her troubled
adolescent son (Judah Lewis).
The storyline is perhaps a little
convoluted, and Davis’s increasing
desire to dismantle and destroy
things – objects, machines, houses –
pushes the metaphor a step too
far, but Gyllenhaal and Watts offer
engrossing performances of loss
and desperation.
However, the scene that hit me
hardest and stayed with me longest was
the harrowing one in which Phil says:
‘When a man loses his wife, he’s called a
widower. When a child loses its parents,
it’s called an orphan. When a parent
loses a child – there is no word for that.
And there shouldn’t be!’ I remember
a dual impact. Emotionally, I felt the
personal threat of ever having to
face up to that situation, along with
a renewed wave of empathy for clients
with whom I have worked who have had
to do so, whether as a result of accident,
illness or self-harm. Cognitively, I
recognised the challenge: How can we
work in the face of that observation –
‘And there shouldn’t be!’?
A fundamental purpose of my
counselling lies in helping clients
find words. Words that will help them
become more aware, for example, of
the emotions that are assaulting them,
of the thoughts that are undermining
them, of the actions that are entrapping
them. If we can shift the ferocious
energy of feel-think-do into the matter
of words, perhaps we stand a better
chance of having our experiences,
instead of allowing our experiences
to have us.
But when the very language refuses,
and we acknowledge its right to do so,
how do we come to live well with an
experience that our whole culture has
shied away from naming? Or can this
very fact itself, perhaps, be helpful
in learning to accept and go beyond
the horror?
Julian Edge is a counsellor with Age UK
Manchester and in private practice
Demolition (2016, 100 min) is directed
by Jean-Marc Vallée, written by Bryan
Sipe, and stars Jake Gyllenhaal, Naomi
Watts, Chris Cooper, and Judah Lewis
September 2016/Therapy Today 41
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Strategy
BACP 2016
membership
survey
Ruth Clowes reports
the headline findings
from BACP’s 2016
membership survey
Earlier this year, BACP
carried out a comprehensive
survey of its members to
find out more about you,
and to understand which of
the Association’s products
and services you most value.
More than 5,600 of you took
part – nearly 14 per cent of our
total membership. Thank you
to those of you who took the
time to offer your feedback,
and congratulations to our
lucky prize draw winners.
The survey will be repeated
annually and, along with our
new strategy that we launched
in April, will inform much of
our work in the coming years
as we look to improve your
membership experience.
Shared values
A vital part of our work is
to set, promote and maintain
standards for the profession
in order to safeguard clients.
It’s clear from our survey
that you share these values
and that public protection
and professional credibility
are top priorities for you too
(see the infographic, right, for
the survey’s headline findings).
These shared values are
vital to our success, and no
doubt also explain why the
vast majority of you plan to
continue your membership
beyond your next renewal
date and would also
recommend the Association
to a fellow counselling
professional who is not
already a member.
Working on your behalf
At BACP we undertake a
wide range of activities
across several departments,
all aimed at raising standards
within the profession and
supporting you and your
clients. Collaborative working
has become increasingly
important to us, and includes
a commitment to working
more closely with the British
Psychoanalytic Council
and the UK Council for
Psychotherapy. We also
regularly advise governments
on matters of policy relating
to mental health, and
undertake and commission
research into counselling
and psychotherapy.
We’ve recognised that
these are the areas of our
work about which you are
least aware. This is something
we’re looking to change,
by improving the way we
share news about our work
with you. Over the next
few months, you’ll notice
development of the home
page of our website – www.
bacp.co.uk – with the addition
of a regularly updated
news area. The counselling
professions are built on a
foundation of honest and
transparent communication,
and it’s these principles that
guide us as we look to further
improve the ways we let you
know about the work we do
on your behalf.
The ethical and the practical
Our Ethical Framework for
the Counselling Professions is
our central guiding document
and you’ve identified this,
as well as our accompanying
suite of Good Practice in
Action resources, as the
most valuable element of
BACP membership. You also
told us that you’d like to see
more Good Practice in Action
resources to support you in
your work. We are continually
adding to these guidelines.
We launched guidance for
working with children and
young people last month and
resources covering spiritual
abuse and private practice
are due for publication later
this year. This last resource
is expected to be particularly
popular, with 85 per cent of
you specifically requesting
more tools and advice to
support you in your career
as a private practitioner.
A shared identity
Our Association was formed
nearly 40 years ago by a group
of volunteers. These founders
were passionate about the
value of counselling and its
potential to support people
and communities to achieve
real change in their lives.
Our survey shows that
17 per cent of you already
volunteer with us in some
capacity, from speaking at
our events across the UK to
acting as spokespeople in the
media. It’s also great to know
that many more of you are
interested in getting involved
in the future. We’re in the
process of reviewing the
way we work with volunteer
members and look forward to
letting you know more about
how you can contribute to
the work of your Association
and help us promote the
value of BACP and the
counselling professions.
Membership experience
You and your clients are at
the heart of everything we do
and supporting you is central
to our philosophy and values.
We work hard to enable you
to access resources to help
you develop and maintain
effective and competent
practice. In line with our
new strategic direction,
and in response to this year’s
membership survey, we’re
looking to further evolve
the services and resources
we offer you, making your
membership more relevant
and better value for money.
We can only achieve our
aims with your support and
honest feedback.
Ruth Clowes is BACP
Deputy Head of Membership
Engagement. ‘From the Chair’
returns next month.
42 Therapy Today/September 2016
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British Association for Counselling & Psychotherapy
Membership Sur ey 2016
14%
How likely are
you to..?
Renew your BACP
membership next year?
Recommend BACP membership
to a colleague or friend?
Mean value on a scale of 0 to 10
The products and
services BACP
members most
value…
Ethical Framework
Good Practice Guidance
of BACP’s total membership took part in the survey in February 2016
8.8
7.6
9.1
8.9
Professional information/key updates
8.5
Mean value on a scale of 0 to 10
The aspects of
our work our
members value
the most:
Setting, promoting and maintaining
standards for the profession
73%
Safeguarding clients through the setting
and maintaining of standards
64%
Providing continuing professional
development opportunities for counsellors
and psychotherapists and other
professionals
42%
Percentage of members who are
aware of this activity and who put it in
their top three most valued activities
How much do you
agree with these
statements..?
I share the values that
BACP has set to safeguard counselling
and psychotherapy clients
8.9
Membership of BACP affords me
professional status & credibility
8.3
BACP is working hard on my behalf
6.4
Mean value on a scale of 0 to 10
Our members
said they’d like
us to provide
more of these…
Practical resources (e.g. templates for
writing contracts, keeping client notes)
91%
BACP Good Practice Guidelines
90%
Access to tools and advice for working
in private practice (e.g. accounting
advice, card payment services)
85%
Percentage of respondents who
said they would or may use
Things we do that our
members are least aware of:
Working collaboratively with
other organisations
43%
Advising UK Governments in order to inform
national and international policy and procedures
concerned with mental wellbeing.
34%
Undertaking and commissioning research to
encourage informed practice
33%
Percentage of members who are unaware of this
aspect of our work
To what extent
has membership
of BACP met
your expectations
over the last
12 months?
Not met
9%
27%
Met
Many others would like to
be involved in our work,
these opportunities were
the most popular:
Contributing to one
of BACP’s journals 20%
Being a member of a
reference or special
interest group
Being a volunteer
for a professional
conduct hearing
61%
Partially met
of members are involved in our
work in a voluntary capacity,
from speaking at events to
acting as media spokespeople
18%
13%
3%
Exceeded
Percentage of respondents who don’t currently
volunteer in this way who expressed an interest
Company limited by guarantee 2175320
Registered in England & Wales.
Registered Charity 298361
BACP pages FINAL TTSep16.indd 43 01/09/2016 10:06

News/Professional standards
BACP 40th Annual General Meeting
Our 2016 Annual General
Meeting (AGM) takes place
on Thursday 24 November
at our offices in Lutterworth,
starting at 2pm. Members are
welcome to attend in person
and we’ll be broadcasting
the meeting live by webcast.
The webcast will also be
available online for up to
30 days after the event.
To book your free place
or to watch the webinar,
please go to www.bacp.co.uk/
about_bacp/agm2016.php.
We’ve undertaken an
in-depth review of our
governance with our
solicitors, both in terms of
modernising our systems of
governance and ensuring that
our processes are compliant
with the latest company law.
Much has changed since our
last review and it is important
that our processes reflect this.
We’ll be putting the proposed
substantive changes to the
Articles of Association and
Standing Orders to members
as Resolutions at the AGM.
The AGM is also an
opportunity for members
to submit a Resolution for
consideration and vote. You
can find further information
about what a Resolution is
and how to propose one on
our website at www.bacp.
co.uk/about_bacp/agm2016.
php. Resolutions must be
submitted by midnight, Friday
2 October. We’ll be sending
more information soon
about how to vote on Board
and Member Resolutions,
either before or at the AGM,
by e-voting, postal or proxy.
Voting for the 2016
Governor election closed on
9 September. The results will
be announced at the AGM.
Changes to accreditation applications
Two new documents
relating to accreditation
have been launched this
month. A revised Counsellor/
Psychotherapist Accreditation
Scheme application pack
was issued on 1 September,
together with a revised
Guide for Applicants, which
explains the requirements
of the scheme in more detail.
Both may be downloaded
free from the Accreditation
section of BACP’s website.
While there are no changes
to the criteria for application,
there is a change to the word
count for the ‘Knowledge
and Understanding’ section
of the application (criterion
8). In response to applicant
demand, this has been
increased from 1,000 to 1,400
words, to give applicants
the chance to explain their
rationale in greater depth.
The increased word count
applies from 1 September
to all applicants currently
writing their applications.
All accreditation schemes
ask applicants to demonstrate
their use of the Ethical
Framework. This applies
to those seeking Accredited
Member status, Senior
Accredited Member status
and to counselling courses
and services seeking
accreditation. The new Ethical
Framework for the Counselling
Professions came into use on
1 July 2016. All applications
for accreditation signed on or
after this date will be assessed
using this framework.
Applications signed before
1 July 2016 will be assessed
using the Ethical Framework
for Good Practice in Counselling
and Psychotherapy, the
framework that was in place
at the time the application
was written. Resubmissions
will be assessed using the
framework that was in
place at the time the initial
application was signed.
After 1 October 2016 all
applications will be assessed
using the Ethical Framework
for the Counselling Professions.
Between now and then we
will consider the individual
circumstances of those
wishing to be assessed under
the old framework. Applicants
will need to support their
applications with a clear
statement as to why use of the
previous Ethical Framework
is appropriate.
Service accreditation
The deadline for the
resubmission of conditions
set for counselling services
accreditation applications
has changed. From 1 October
2016 all services will be
allowed six months to
prepare and resubmit
criteria deferred in their
initial or renewal application.
New applications deferred
before this date will be
allowed up to 1 April 2017
to resubmit. Resubmitted
applications currently
being processed at BACP
are unlikely to be affected.
This change is part of the
process of bringing parity
in deferral dates to all
accreditation schemes and
to accommodate the rapid
pace of change in counselling
services. Services are
reminded that only one
resubmission is permitted.
Applications that are
unsuccessful on resubmission
(initial or renewal) will not
achieve accredited status
but may apply again.
If you have any queries
about the changes, please
email Penny Thomas at
penny.thomas@bacp.co.uk
Pilot CPD
platform
BACP has launched a new
continuing professional
development (CPD)
platform that provides
members with access to
quality online learning from
your own home or workplace.
The new resources
comprise three packages
of video e-learning focusing
on specific topics. The first
package, ‘Getting started in
private practice’, is available
now and guides you through
preparing for, setting up
and marketing your private
practice. Further packages
will follow later this year, on
‘Addiction and bereavement’
and ‘Young people: eating
disorders, LGBT, self-harm’.
Each package includes
around 18 hours of content
and costs £25, including VAT.
You can view the resources
for three months from the
date of purchase or until
the package expiry date,
whichever is the sooner.
For more information,
to view a taster and to buy,
please visit the BACP website
at www.bacp.co.uk/learning/
pilot_platform
44 Therapy Today/September 2016
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Good Practice in Action
CYP conference in London
You can now download
from our website more than
20 Good Practice in Action
(GPiA) resources to support
you in your practice. These
include new resources
for working with children
and young people, ethical
decision-making and working
with suicidal clients.
We’ve more in the pipeline
for the autumn, including
an introductory resource for
working in private practice,
and research overviews for
supervision, mental health,
and equality, diversity and
inclusion (EDI) within the
counselling professions.
New resources for record
keeping and assistance
with ethical decision-making
will follow early next year.
The GPiA publications have
been developed to accompany
the new Ethical Framework
for the Counselling Professions.
They are based on current
research and reviewed by
member-led focus groups
and experts in the field. If
you would like to be involved
in the focus groups or have
expertise to offer the Good
Practice Steering Group that
oversees the development
of the resources, please email
Susan.Dale@bacp.co.uk.
Members can download
these resources free from
www.bacp.co.uk/ethical_
framework/newGPG.php
‘Self and identity: breaking
down barriers to inclusion’ is
the theme of this year’s BACP
Children and Young People’s
conference, on Saturday 12
November 2016 in London.
The conference will explore
children’s identity and sense
of self; John McMullen will
deliver a keynote presentation
on ‘Complex trauma in child
soldiers’, and Raymi Doyle
will lead a workshop on
‘Dissociated self and autism’.
To book, visit bacp.co.uk/
events. To book a place on the
live webcast visit bacp.co.uk/
webinar
Nuisance calls and scams
If you advertise your services
on your own website, an
online directory or social
media, you may be a target
for nuisance calls and scams.
We’ve received complaints
from members who’ve been
targeted by high pressure
sales people and criminal
scams. BACP’s Scams: a guide
for counsellors gives advice on
how to deal with persistent
sales calls and fraud. Search
for ‘scams’ on our website.
Newly accredited
counsellors/
psychotherapists
Tajinder Adnan
Deborah Altrudo
Robin Altwarg
Mary Ames
Karen Anderson
Penny Annesley
Lisa Anson
Michael Appleton
Charlotte Baby
Joe Badham
Holly Bagshaw
Allison Banister
Judi Bauernfreund
Rosaleen Benaim
Tarandip Bhullar
Adele Birbeck
Frances Bish
Johanna Bishop
Francine Blanchet
Dominique Brady
Louise Brock
Joanna Brown
Mateja Brvar
Lisa Bryant-Jones
Jean Burke
Lorraine Bustard
Alison Carling
David Carvalho
Francesca Castronovo
Ruth Cerner
Alice Chance
Bernard Chappell
Peter Chatalos
Ian Clarke
Julie Clayton
Dianne Cockburn
Gail Collingwood
Jill Conway
Victoria Coomber
Allison Corbett
Margery Craig
Odette Crompton
Alva Cudden
Paula Dalton
Diane Dannhauser
Howard Davis
Laura Davis
Charlotte Deeves
Donat Desmond
Lauren Draycott
Jane Dudley
Marie Duffy
Chris Eggleton
Nancy Elliott
Pearl Ellis
Sally Emerson
Catrin Evans
Sue Fleming
Pauline Forster-Fowler
Jacqui Foster
Gareth Fowler
Karen Fraser
Claire Galt
Debbie Gannon
Anupama Garg
Claire Garnett-Jenkins
Josie Geddes
Nicola Gibbs
Zoe Gilbert
Jacqueline Glynn
Debra Goodman
Marja Gray
Bridget Grew
Richard Grimes
Kate Guest
Linda Gwatkin
Deborah Haddow
Karen Hancox
Margaret Harper
Anita Hart
Emma Haslock
Andrea Hawkins
Ailsa Hayter
Anne Head
Adam Hegarty
Shirley Hesketh
Julia Hill
Theresa Hill
Pam Hinds
Rachel Hirsch
Nicola Hobbs
Philippa Hodges
Lucy Hodkinson
Naheed Holmes
Iris Huang
Christine Jackson
Sarah Jackson
Elizabeth James
Hannah Jeffery
Sasha Jenkin
Susan Jennings
Helen John-Eccles
Pamela Johnson
Michael Jones
Olayinka Junaid
Manpreet Kaur
Kamalyn Kaur
David Kelly
Joanna Kent
Saidat Khan
Myira Khan
Sally King
Patricia Knowles
Carmen Langford
Debra Langton
Anthony Larkin
Marie-Therese Laverty
Janet Leighton
Jacqueline Leon
Chris Lewis
Debbie Lockyer
Cindy Lowe
Jennifer Loy
Philomena Lufkin
Margaret Lyon
September 2016/Therapy Today 45
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Professional standards
Elise Marshall
Andrew Martin
Sandra Masters
Julie Maxwell
Daniel McBride
Julie McCrae
Anne McLoughlin
Phyllis McPeake
Lorraine Mdwara-Tindale
Carole Miles
Theresa Mitchell
Laura Muir
Alison Murphy-O’Connor
Agnes Murria
Melanie Musson
Lara Myers
Julie Newberry
Mahroo Niroomand
Caroline Norman
Victoria Norris
Lynne O’Brien
Susan O’Sullivan
Jacquie Owen
Deborah Parker
Ella Parker
Serena Parry
Deborah Peat
Jane Pennington
Debra Pepper
Shelagh Peters
Margaret Peters
Francesco Piro
Christian Ponsford
Lynda Prentice
Jill Punton
Angela Ramsay
Christina Ramsey
Desmond Reid
Angela Risner
Susan Ross
Sabina Rostampour
Laura Ryall
Mandy Ryan
Dhanesh Sakaria
Antonio Sanchez
Heather Sanderson
Alex Sanderson-Shortt
Rebekah Savill
Sian Schofield
Ingrid Christine Schultz
Malcolm Scott
Marion Seibert
Emma Sice
Carole Simpkins
Marina Sinclair
Andy Singleton
Joanne Small
Andria Smith
Vivien Spencer-Grey
Jo-Ann Spilling
Debbie Start
Bernice Sumray
Leyla Swan
Tracey Swinburne
Vincent Tanner
Heather Tatham
Elinor Taylor
Kathleen Taylor
Karen Taylor
Nicolena Theodorou
Kulbinder Thorpe
Rachael Tonge
Jane Tritton
Edward Tuffnell
Catherine Van Wyk
Sean Veitch
Mary Vitoria
Lisa Walford
Alison Walker
Coral Warner
Victoria Warner-Hill
Sandra Wathall
Ruth White
Mary Whiting
Stacey Whittaker
Kevin Wilson-Kirby
Sara Wiltshire
Christine Wood
Ian Woollams
Liane Wynn
Members whose
accreditation has
been reinstated
Jan Bardua
Zohren Mirmohkam
Maria North
Louise Wastlund
Newly senior
accredited counsellors/
psychotherapists
Jacqueline Chivers
Deepika Eyre
Carole Gibson
Jacqueline Hurst
Jan Runham
David Smalley
Simon Stephens
Raili Watkins
Newly senior accredited
supervisors of individuals
Bob Froud
Jane Hancock
James Rance
Nicky Rodgers
Jane Steeples
Dawn Underhill
Members not renewing
their accreditation
Elizabeth Allan
Ann Angier
Gwen Bird
Pauline Brooks
Colin Brown
Ellen Carr
Linda Carrington
Sarah Catchpole
Jocelyn Catty
John Cooper
Anne Coughlan
Shirley Cullup
Clare Davies
Helen Delahunty
Kieran Docherty
Allyson Edmunds
Carol Ervine
Barbara Fisher
Michael Fox
Patricia Foxon
Derek Grant
Jane Gutteridge
Charles Hampton
Peter Hanson
Viva Hart
Christina Holland
Nonie Insall
Jane Insley
Lynne Johanson
Frances Kelly
Alison Lacey
Marion Leslie
Frances Mann
Pamela Margrie
Suzanne Marsh
Polly McDonald
Maureen McGrath
Hilary Minter
Carla Morrell
Ian Morrow
Linda Paton
Linda Pike
Angela Power
Aileen Rainsbury
Rosamund Ramsden
Paul Regan
Christine Renshaw
Judy Robinson
Shirley Rose
Catherine Ross
Susan Sawyer
Thomas Seagraves
Mary Shannon
Valerie Skinner
Francis Smith
Donald Stevenson
Gill Stringer
Anita Sutton
Stephen Taylor
Anita Tedder
Barbara Thomas
Roberta Trayman
Margaret Watters
Norma Weston
Beverley White
Rachael Williams
Susan Wright
Organisations with
new/renewed service
accreditations
• ARC (Access to
Resources & Counselling)
• Coventry University
• Coventry University
College
• De Montfort University
• Holy Trinity Centre
• Kingdom of Abuse
Survivors Project (KASP)
• Leeds Beckett University
• Mind in Barnet
• Mind in Croydon
A full list of current accredited
services is available at www.
bacp.co.uk/accreditation/
Newly accredited
courses
• Network Counselling &
Training Ltd: Diploma in
Counselling (April 2016)
• City College Southampton:
BA (Hons) in Person-
Centred Counselling &
Psychotherapy (May 2016)
• Metanoia Institute:
Diploma in Humanistic
Counselling (June 2016)
• Northern Guild: Diploma
in Psychotherapeutic
Counselling: Children
and Adolescents – evening
delivery (July 2016)
A full list of current accredited
courses is available at www.
bacp.co.uk/accreditation/
All details are correct at the
time of going to print.
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Research
Research enquiry of the month
September’s research enquiry
of the month considered:
‘What is the effectiveness
of counselling for longterm
health conditions?’
We consulted the BACP
scoping review ‘Counselling
and Psychological Therapy
for Children with Longterm
Medical Conditions
(LTCs): a narrative review
of the literature’.1 We also
conducted an electronic
search using Google Scholar
and our internal abstract
database, applying the same
search terms as the scoping
review to search the adult
literature: (‘long-term
conditions’ OR ‘chronic
illness’ OR ‘asthma’ OR
‘diabetes’ OR ‘renal or kidney’
OR ‘multiple sclerosis’)
AND ‘counselling’.
The search produced a
plethora of research articles
exploring the effectiveness
of counselling for a variety of
long-term conditions (LTCs).
Thomas and Smith2
conducted an evaluation of
counselling and rehabilitation
courses for chronic fatigue
syndrome (CFS). A total of
56 participants completed
a range of self-report
questionnaires covering
their illness history,
psychopathology,
psychosocial factors and
health and wellbeing at
baseline (before the
intervention) and
approximately six months
later. Comparative analyses
of these data indicated that
the intervention decreased
perceived levels of fatigue
and disability and resulted
in significant improvements
in ratings of mood, anxiety,
depression and physical
symptoms. The findings
therefore suggest a
counselling intervention for
CFS can result in measurable
improvements in illness status
as well as improvements in
mental health and
psychosocial variables.
Lusignan and colleagues3
explored the impact on
healthcare use when people
with LTCs were referred to
IAPT psychological therapies
services. Routinely collected
primary care, psychological
therapy clinic and hospital
data were extracted for
1,118 patients referred to
psychological therapies
from 20 GP practices and
6,711 controls, matched
for age, gender and practice.
Referrals to psychological
therapies were associated
with better adherence to
antidepressant medicines
and less accident and
emergency (A&E) attendance
by people with LTCs.
If you have any research
queries, or would like to know
more about September’s
enquiry of the month, please
email research@bacp.co.uk
REFERENCES:
1. Brettle A, Paris N. Counselling and
psychological therapy for children
with long-term medical conditions
(LTCs): a narrative review of the
literature. Lutterworth: BACP; 2015.
2. Thomas M, Smith A. An
evaluation of counselling and
rehabilitation courses for Chronic
Fatigue Syndrome. Counselling and
Psychotherapy Research 2007; 7(3):
164–171.
3. Lusignan SD, Chan T, Tejerina
Arreal MC et al. Referral for
psychological therapy of people
with long term conditions improves
adherence to antidepressants and
reduces emergency department
attendance: Controlled before
and after study. Behaviour Research
and Therapy 2013; 51(7): 377–385.
Research Conference 2017 – call for papers
The 23rd BACP Annual
Research Conference will
take place on 19 and 20 May
2017, in Chester, at the Crowne
Plaza Hotel (stc). The theme
of the conference is ‘Research
Next research
surgeries
We provide free monthly
telephone research surgeries
for members with queries
relating to research. Whatever
your query, we’re here to help.
Our next surgeries are on
19 October, 16 November and
14 December, from 2-4pm. To
book your place, please email
stella.nichols@bacp.co.uk
and reflective practice for
the counselling professions’
and our co-host is the
University of Chester.
We are now accepting
abstract submissions for
Applications are invited
for the BACP Outstanding
Research Award.
The award is open to
anyone who has recently
undertaken research
(completed or written up
within the past 36 months).
The winner will be presented
with a specially designed
consideration. The deadline
is Friday 4 November 2016.
For more details about the
conference and how to submit
an abstract, please go to www.
bacp.co.uk/research/events
Applications invited for
Outstanding Research Award
plaque at the BACP Research
Conference in May 2017.
Applications should be
submitted by 27 January
2017. The submission form
and further information on
how to apply can be found
on the BACP website at
www.bacp.co.uk/research/
resources/awards.php
Free client
data storage
BACP members can access
a secure, web-based client
data management system for
free. The platform, COMMIT,
can be used to collect and
store a wide variety of routine
outcome measures, along
with client data and details
of sessions.
The platform is primarily
for practitioners working with
children and young people,
but it can be used to collect
and store measures from
adult clients too. If you are
interested in learning more
about COMMIT, or would
like to access the test site,
please email Charlie Jackson,
BACP Research Officer, at
charlie.jackson@bacp.co.uk
September 2016/Therapy Today 47
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Public affairs/Professional conduct
Westminster health ministers
Prime Minister Theresa May
has reshuffled her team at
the Department of Health.
Jeremy Hunt stays as
Secretary of State for
Health, but his remit has
been expanded to cover
the mental health portfolio.
Minister of State for Health
is Phillip Dunne, MP for
Ludlow. Nicola Blackwood
is Parliamentary Under
Secretary of State for Public
Health and Innovation.
She is responsible for mental
health services, children’s
health and school nursing
and prison health services,
and is ministerial lead for
Public Health England.
Parliamentary Under
Secretary of State for
Community Health and
Care is David Mowat. His
responsibilities include
clinical commissioning
groups, integration of
health and social care and
community health services,
and NHS England. Lord
Prior is Parliamentary
Under Secretary of State for
Health, with responsibility
for specialised commissioning,
reducing clinical variation,
and NHS procurement.
Sanction compliance
Jan Bardua
Reference No: 678116
Essex SS0
BACP was satisfied that
the requirements of the
sanction have been met.
As such, the sanction reported
in the June 2015 edition of
the journal has been lifted.
The case is now closed.
This report is made under
clause 5.2 of the Professional
Conduct Procedure.
Sanction compliance
Alex Fergusson
Reference No: 697681
London N16
BACP was satisfied that
the requirements of the
sanction have been met.
As such, the sanction reported
in the April 2016 edition of
the journal has been lifted.
The case is now closed.
This report is made under
clause 5.2 of the Professional
Conduct Procedure.
Sanction compliance
Stephen Hockett
Reference No: 624046
Essex SS9
BACP was satisfied that
the requirements of the
sanction have been met.
As such, the sanction reported
in the December 2015 edition
of the journal has been lifted.
The case is now closed.
This report is made under
clause 5.2 of the Professional
Conduct Procedure.
Withdrawal of membership
Claire Symons
Reference No: 748120
Cornwall TR20 8DJ
Information was disclosed
to BACP, which was
considered under Article
12.6 of the Memorandum
& Articles of Association.
The nature of the
information raised
questions about the
suitability of Ms Symons’
continuing membership
of this Association.
The Article 12.6 Panel
subsequently made a number
of findings and it decided
to implement Article 12.6 of
the Memorandum & Articles
of Association. Ms Symons
appealed against the decision
and subsequently withdrew
her appeal, which was
considered by the Article
12.6 Appeal Panel. In light of
the Appeal being withdrawn
by Ms Symons, and the
decision of the Article 12.6
Appeal Panel to terminate
the Appeal Proceedings, the
decision of the Article 12.6
Panel, which convened on 28
October 2015, to withdraw Ms
Symons’ membership stands.
Subsequently, Ms Symons’
membership was withdrawn.
Any future re-application
for membership will be
considered under Article 12.3
of the Articles of Association.
Full details of the decision
can be found at http://www.
bacp.co.uk/prof_conduct/
notices/termination.php
BACP Professional
Conduct Hearing
Findings, decision
and sanction
Anthony Martin
Reference No: 544423
Middlesex HA1
The complaint against the
above individual member
was heard under BACP’s
Professional Conduct
Procedure and the
Professional Conduct
Panel considered the
alleged breaches of the
BACP Ethical Framework for
Good Practice in Counselling
and Psychotherapy.
The Panel made a
number of findings and it
was unanimous in its decision
that the findings amounted
to professional misconduct
in that they demonstrated
that the practitioner had
contravened the ethical
and behavioural standards
that should reasonably
be expected of a member/
registrant of this profession.
The Panel found no
evidence of mitigation
and imposed a sanction.
Full details of the decision
can be found at http://www.
bacp.co.uk/prof_conduct/
notices/hearings.php
BACP Professional
Conduct Hearing
Findings, decision
and sanction
Angela O’Connor
Reference No: 553313
Cheshire CH43
The complaint against the
above individual member/
registrant was heard under
BACP’s Professional
Conduct Procedure and
the Professional Conduct
Panel considered the alleged
breaches of the BACP Ethical
Framework for Good Practice in
Counselling and Psychotherapy.
The Panel made a
number of findings and was
unanimous in its decision
that these findings amounted
to professional malpractice
in the provision of inadequate
professional services, in
that the service for which
Ms O’Connor was responsible
fell below the standards that
would reasonably be expected
of a practitioner exercising
reasonable care and skill.
The Panel found some
mitigation and imposed
a sanction.
Full details of the decision
can be found at http://www.
bacp.co.uk/prof_conduct/
notices/hearings.php
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