19 June 2015

On Therapy as Social Control by Phil Dore

This is a post written by Phil Dore and reblogged from unsafespaces.com

I was reading an interesting article in the Medical Humanities journal, about use of psychological therapies to “help” unemployed people find work. The article, rightly in my view, points out that such therapies are on very dubious ethical ground.

There’s a view out there, which I think is utterly erroneous, that therapy and psychiatry can act as a remedy for all sorts of social ills. Give everyone enough CBT and fluoxetine, so the idea goes, and poverty, social inequality, abuse, bad housing etc will simply cease to be a problem. Does it work? Of course it doesn’t.

The article describes some “motivational” statements that were sent out to people on the Work Programme.

Go hard or go home
My only limitations are the ones I set for myself
Failure is the path of least persistence
It's always too soon to quit

Unsurprisingly, those who received this responded with “anger, humiliation and depression” rather than being encouraged to get up and seek work. One can only imagine how such banal rubbish sounded to people who sent out multiple job applications at the height of the Credit Crunch, only to discover that nobody was hiring.

There’s other examples of such “therapy” being offered as a solution to problems in society. News reports have suggested that jihadists may be forced to undergo “deradicalisation” therapies. Although I agree that radical Islamism is a danger, the idea that people will give up their beliefs because a therapist told them to strikes me as naive in the extreme.

We’ve been here before. In the seven years I’ve worked in Child and Adolescent Mental Health Services [insert usual disclaimer here about how views expressed are in a personal capacity and not necessarily those of my employer] I’ve seen the vogue come and go for anger management. Schools, voluntary services, youth offending services and CAMHS were all sending vulnerable, often traumatised kids to anger management, so they can learn how to control their “anger problem”.

I’ve been struck by how many young people benefited from this. Virtually none of them. If they did, it usually wasn’t for a reason to do with the actual model of therapy. Perhaps they developed a good relationship with the worker, and the anger management exercises were simply something to do while they got to know each other.

Part of the problem is how it’s framed as an “anger problem”. Of course, the problem isn’t really anger. Children aren’t sent to anger management because they kept writing indignant letters to their MP. The problem that everyone is concerned about is their behaviour – smashing up bus stops, getting into fights and so on. It’s what they do that gets them sent to anger management, not how they feel.

As for those feelings of anger, those are often rooted in a much wider systemic problem – they live in a bad part of town, they aren’t getting appropriate parental boundaries, in some cases they’re being abused or neglected. To simply say they have an “anger problem” is a reductionist, narrow explanation that ignores wider issues outside of their control. What they often need is nurture, care, compassion and stability, not a finger pointed at them saying that they’re the problem and they need to sort it out.

Mostly importantly, what all these therapies ignore, whether it’s mandatory CBT on the Work Programme, forced deradicalisation or anger management, are the issues of consent and a client-based approach. It ignores a basic and fundamental tenet of therapy – that it’s there to help the client do what they want to do, not what everyone else wants them to do. That’s what makes such therapies not only unethical, but ultimately ineffective.

31 May 2015

The Law in respect of Counselling for Adoption Issues

Update December 2023 this law no longer exists. Adult adoptees and adopters do not need to have counselling with ofsted registered therapists anymore. https://www.bacp.co.uk/news/news-from-bacp/2023/20-december-new-law-change-to-improve-access-to-adult-adoption-related-therapy/

Update April 2023 https://www.communitycare.co.uk/2023/01/10/dfe-proposes-law-change-to-improve-adults-access-to-adoption-counselling/

In 2010 there was a law passed that means that only counsellors registered as an Adoption Support Agency and with Ofsted are able to offer specialist adoption counselling. This is an extract from a relevant page on the Counselling Directory website :

Approved Adoption Counselling

In December 2010, the law changed so that only counsellors and psychotherapists registered as an adoption support agency (ASA) with Ofsted are able to offer specialist adoption services. These amendments to the Adoption and Children's Act of 2002 were designed to ensure that the one in four UK individuals affected by adoption in some way, are provided with support and services from practitioners who hold the proper qualifications and experience. The introduction of this legislation now means that any counsellor working with a client for whom any aspect of adoption is the main focus, must be registered with Ofsted and subject to regular inspections.

It may be that some individuals are seeking counselling for issues they feel may be related to adoption (such as low-self esteem) but where adoption is not the key issue. In cases such as these where the entire counselling experience is not likely to revolve solely around the adoption itself, it is fine to seek help from a professional who is not an Approved Adoption Counsellor.

I am able to work with other issues that may be part of what is going on such as addictions or low self-esteem, but it is illegal for me to take on a client specifically with the purpose of working with the adoption issue itself.

In my experience many counsellors are not aware of this legislation so please do ask anybody that you enquire with whether they are registered specifically with Ofsted and as an adoption support agency. If you would like specific, adoption counselling I would contact your local council Adoption Unit practice manager and ask if they can refer you to anybody suitably registered.

I have happily worked with people affected by adoption issues but there has always been another presenting factor such as gambling, a personality disorder, trauma or relationship problems which has been the cause for seeking counselling.

Amanda Williamson Counselling and Coaching for Couples and Individuals

24 May 2015

How Counselling Can Help With Divorce and Separation

by Amanda Williamson

As a professional counsellor I often see clients with issues around family break ups, affairs, problems with ongoing divorce settlements and conflicts about children. These issues often leave people feeling rejected and very vulnerable. Sometimes these issues can tap into old wounds from childhood.

Divorce and separation involves loss for both parties and is one of the most stressful things we can go through as adults. A huge loss like this is akin to a bereavement and it is normal to experience a range of emotions such as shock, denial, anger, guilt, sadness and depression.

The shock is particularly present for those who did not make the choice to separate and it can leave them feeling bewildered and powerless as well as impacting on self-esteem. Guilt often haunts the person who makes the decision, sometimes for years afterwards, even if the relationship was beyond repair.

Our emotions are there for a reason and we need the opportunity to express them or we can end up stuck with them which can in turn affect our future relationships or sense of happiness. We might not always have the opportunities in our personal lives to explore emotions without other people imposing their agenda. There may be friends and family members who mean well, but we can feel pressured to be feeling and behaving in a way that others expect of us, despite the fact that grieving is a very individual process.

Some people are used to being the “strong” or “responsible” one and do not feel comfortable sharing their difficulties with anybody in their personal lives.

One of the ways which counselling works for many people is that it provides the opportunity to talk about our inner world of emotions. A good therapist will help their client to explore what is lying behind symptoms such as depression, anxiety or anger without imposing judgement or an agenda. In paying attention to and understanding these difficult emotions and how they might be tied up with judgements or beliefs about ourselves we can be in a better place to move on.

There may have been relationship dynamics present in the relationship which continue to play out post separation and divorce. Perhaps one partner is perceived by the other as being controlling or manipulative. Clearly there is a limit to what counselling can do to alter somebody else’s behaviour but it can help people to have clearer boundaries and feel more comfortable in asserting their own needs. If somebody has had a lifetime of shelving their own needs then some coaching in assertiveness can really help them.

Many people are pleasantly surprised at how a different perspective from a trained and experienced counsellor can really help them get on with life in a better place. It is well worth considering, particularly if someone is struggling in the aftermath of a difficult separation.

19 May 2015

When does sexual attraction turn into sexual misconduct? by Phil Doré

This post is reblogged from another site. The original post was deleted due to legal threats sent to the site owner. I had unpublished this post on my site but currently have it live whilst I seek legal advice from a solicitor and the police. Protecting the public comes at a price of receiving ongoing threats and harassment from perpetrators. I feel a duty of care to the public as I have had people contact me separately expressing their concerns...

[PLEASE NOTE THAT IN REBLOGGING THIS PIECE AS A MATTER OF PUBLIC INTEREST I WAS SUBJECTED TO VARIOUS THREATENING EMAILS FROM RAY BOTT-HOLLAND. THIS IS WHAT I SENT IN RESPONSE:

Dear Mr Bott-Holland

I write further to your email correspondence of 6th April 2018 and the many subsequent, unsolicited messages you have sent. I have sought legal advice and, as I suspected, there is no case for me to answer. I request that you cease communicating with me about this matter with immediate effect. If you persist in contacting me unsolicited I will have no option but to report you to the police for harassment.

Amanda Williamson]

"Given that I’ve blogged about serious sexual misconduct cases in counselling and psychotherapy, @sameihuda on Twitter drew my attention to this article in BPS Research Digest. It deals with the tricky topic of when therapists develop a sense of sexual attraction to their clients.

The article refers only to when therapists have sexual feelings, not when this turns into actual sexual acts (fortunately, none of the therapists surveyed in the research cited had done this). I’ll give some thoughts on when this could happen.

Of those surveyed, 90 percent admitted to having felt attracted to a client on at least one occasion. I don’t think that’s particularly shameful. People feel attracted to other people all the time, including to people with whom it would be a seriously bad idea to actually try to take things further. Not just therapy clients; it could be your co-worker, or your best friend’s husband or wife. I’m sure there are far more occasions of it happening and people doing nothing than of times when people act on these thoughts. When this topic is discussed, professionals have a tendency to talk about transference and counter-transference, but for the life of me I can’t see why. It’s such an everyday, ordinary thing that it really doesn’t need any psychoanalytic concepts to explain it.

When this happens, I would hope that therapists would be honest with themselves about this, and in most cases they probably are. This is why psychotherapy training places so much emphasis on the therapist undergoing regular therapy and supervision – so you’re aware of what’s being brought from yourself into the room, and so you can learn to deal with what’s being brought in.

The research offers examples of both good and bad ways to respond.

Effective ways of coping involved the following processes, though not always in order: noting the attraction, which was often accompanied by feelings of anxiety or unease; facing up to the feelings, which often involved managing shame and embarrassment; reflecting on the attraction, including the relevance of the therapist’s own past; processing the feelings, including considering the implications of the situation; and finally formulating a way forward that would be to the client’s benefit.

Harmful ways of coping included: clumsily reinforcing therapeutic boundaries, which often left the client feeling rejected and to premature ending of therapy; taking a moralising or omnipotent stance, including implying that the client had inappropriate feelings; feeling needy (“… it seems inevitable that being single … you imagine those ‘what if’ questions, if we’d met elsewhere …”, said one male, middle-aged therapist); over-identifying with the client (one therapist talked of feelings of “yearning and anguish” after therapy ended; another spoke of being overwhelmed by a client’s pain and extending therapy sessions to cope); and finally responding with over-protective anxiety, including offering support that they didn’t usually offer, including allowing meetings between sessions, touch, hugging and sharing of personal information.

On the issue of clumsily reinforcing boundaries, this might be something to particularly consider if the therapist decides they need to pass the client on to a colleague. As a personal view, they should reflect on whether that actually needs to happen (which it doesn’t in all instances; and if it isn’t then it shouldn’t necessarily be rushed into as a decision). If it does need to happen, then it needs to be done in a careful, sensitive and non-rejecting way, so as not to harm the client.

Let’s move on to the question of when such thoughts and feelings (which, as I’ve said, I think are perfectly normal and not at all shameful), lead to actual actions, which by contrast would be the worst betrayal of a therapeutic relationship one could possibly commit. When does that happen?

I don’t have any research data to hand (if anyone knows of any, feel free to drop it into the comments section below) but anecdotal evidence seems to suggest that serious sexual misconduct doesn’t generally start with a perfectly normal session one week, and then the therapist and client having sex the next. More likely there’ll be other, lesser boundary breaches leading up to it.

The Professional Standards Authority’s Clear sexual boundaries between healthcare professionals and patients: responsibilities of healthcare professionals gives examples of such precursor breaches.

revealing intimate details to a patient during a professional consultation
giving or accepting social invitations
visiting a patient’s home unannounced and without a prior appointment
seeing patients outside of normal practice, for example when other staff are not there, appointments at unusual hours, not following normal patient appointment booking procedures or preferring a certain patient to have the last appointment of the day other than for clinical reasons
clinically unnecessary communications.

These are behaviours that both professionals and clients should keep a careful eye out for.

Now let’s have a look at the personalities of some of the people I’ve written about on this blog. There’s Palace Gate, struck off as a counselling service by the BACP after its director John Clapham was found to have groomed trainee and subordinate counsellors within his firm. The company responded to the allegations in a manner more befitting a cult than clinicians. They still have on their blog a long, rambling, paranoid article full of psychobabble and accusing the complainants of waging a “battle between therapists”.

Or there’s Ray Holland, who was struck off by the UK Council for Psychotherapy for serious sexual misconduct with an “evidently vulnerable client.” The UKCP found that he “threatened [the client] in order to prevent her from reporting the matter” and “spoke with the absence of empathy towards [the client] whom he said he believed was ‘a fantasist’.” After he was struck off, I found that he had rebranded himself and carried on practicing. He cited membership of various impressive-sounding but non-accredited therapy organisations, and renamed himself Ray Bott-Holland.

After I blogged about this, he sent me a legal threat, which I promptly sent viral on Twitter, and I referred RayBot to the answer given in Arkell v Pressdram. I never heard from his lawyer, if he ever had one in the first place.

There’s other cases, and by no means do I post online everything I’ve heard about every case. Some of what I’ve heard has been absolutely horrific. I remember receiving one account from a traumatised client, and not being able to get to sleep that night.

So, does this sound like the behaviour of ordinary professionals who behaved foolishly and got themselves out of their depth? No, it doesn’t. It sounds like the actions of highly dangerous and manipulative predators.

To conclude, I think it’s a normal thing for professionals to feel attracted to a client. However, if you’re a properly-trained, ethical therapist with good boundaries, it really isn’t difficult to not have sex with your clients.

On the other hand, psychotherapy is a profession where people sit in a room and hand over their darkest secrets and fears to another person. That gives the professional an enormous amount of power. With that in mind, one has consider the possibility that psychotherapy may be a very attractive career option to a psychopath."

20 April 2015

If I had the power to regulate counselling…?

A couple of weeks ago I was asked a question by a peer which he posed as follows:

I’d like to ask you about what you see as the best way to regulate counselling, there’s two reasons for this question. The first is that your experience as both a complainant and a practising counsellor gives you a valuable first-hand view of the issues and I’d like to find out more about what you’ve learnt from that.

The second reason for starting this conversation like this is that I’d like to see what happens if I apply the style of open questioning and reflecting that I’ve learnt in my counselling training to a conceptual rather than emotion issue (in this case exploring the concepts around regulation of counselling). Debates in academic philosophy tend to be adversarial in nature, which works well is all the parties concerned are adept philosophers but it ends up excluding everyone else. I’m curious to see what academic philosophy could learn from counselling practice.

The question is: if you had the power to pass a law to regulate counselling and psychotherapy what would it say?

I was very pleased to have this opportunity to reflect upon where I was in terms of my thoughts on regulation and decided to throw together a compilation of my thoughts as they stand right now (for now….the thinking ever evolves…). These were by and large as follows:

Thank you for your message and for giving me the opportunity to consolidate my thoughts on regulation.

This is such a complex issue for me and I would like to share some of that complexity. My thoughts in answering your questions are:

Emotions

First of all, this is an emotional issue for me, since being a complainant was an emotional ordeal. It affected my career, my family life and relationships. I lost the respect of peers at Palace Gate who decided to believe the opposition's narrative (I believe because it was easier for them to believe that, as they had dependency on Palace Gate for income, prestige, familiarity aka "easy life" etc etc). However, it is the emotional impact on me that has driven me to explore the possibilities of regulation and really get stuck into the debate.

I do not believe that it is ever possible to remove emotions from arguments. I am very interested in the research into the purpose of emotions by Antonio Damasio, particularly the role of emotions in decision making.

My "natural" response

This is how I refer to my thoughts pre-Palace Gate. It seemed very obvious that there is a need for regulation because there are baddies out there. Abuse and exploitation exists and I believe that this profession is no exception. In fact. I think that all caring professions attract members of the Karpman Drama Triangle; Rescuers. Rescuers can also be Persecutors and Victims. None of these are helpful to clients and keep them stuck in their unhelpful dynamics, or worse. It just seemed a no-brainer that there should be a level of protection. Drama Triangle types have no business in therapy. This is part of the shadow. This lack of self-awareness coupled with the imbalance of power can be highly damaging. People can pay hundreds of pounds plus to feel worse. I wish we could measure ego fragility as part of the fitness to practice.

Being aware of my own agenda - looking at what the public want

As part of the continual scrutiny of my motives in how I behave/what I believe in I asked the public about their opinion of regulation in the profession. I was genuinely open to people not giving a monkeys or being opposed to it. Maybe it was the way I posed the question but there was an overwhelming agreement that regulation should be in place. Moreover, most people thought that we were already regulated and many expressed shock that we aren't. This was very helpful to me and gave me extra impetus. These are the service users and their needs and opinions are incredibly important to me. More so, in fact, than self-serving professionals who clearly do have an agenda (myself included).

The opposition

I know the arguments against regulation. Quite frankly I think that some of those arguments are silly. I struggle with Brian Thorne's and Andrew Samuels' stances. Thorne says that regulation would be like getting a Sergeant Major to choreograph a ballet. I find that argument silly. The sort of gubbins that politicians come out with. I haven't heard any real reasons why we shouldn't proceed with some kind of regulation. I hear name calling. People calling the BACP "empire builders". Judgmental, assumptive terms (not that I am immune from throwing some out myself, clearly). That we would have to practice under a code of fear. I believe that fear is behind the opposition to regulation. Which leads me onto…

"Freedom is what you do with what's been done to you"

Boundaries are freeing. We can work creatively within a code of ethics. I find this empowering. I like to know where the edge of the cliff is lest I fall off it. I want to see the view but if the knowledge and thought of somebody before me has led to there being a clear path that I can safely follow then I can skip along that path instead of fearfully crawling along. Also, I'm less likely to recklessly run around with gay abandon, so I'm probably not going to slip off the cliff and break my neck. Now, if people want to take that risk then fine, but it is not on to tell somebody you'll lead them safely past the cliff edge, then decide to take them cartwheeling past, and to do so with no safety mechanisms in place. It's other people's lives we are dealing with.

I'm not even sure how useful that analogy is. I will ponder on it further. I suppose that one could argue that an individual may be okay with being dragged to the cliff edge by a therapist. I would argue the next point though.

Therapists as gurus, miracle workers and high-priests/esses

I have had a number of clients tell me that I have saved their life."You have made me a new person". "Without you I'd be dead". Strong words indeed and such a privilege to hear. But I feel a certain level of discomfort around that and I do reiterate to my clients that they do the work, I simply facilitate and provide a safe, professional, boundaried environment. I do believe that these clients could have had the same result with other therapists although am aware that the chemistry between therapist and client is an important factor (and largely outside of my control!). My point is that I think that the "power" we provide is actually quite simple. "Good enough" therapy can be life changing. I'd like to think that my intelligent insights and references to different theories and research findings in neuroscience are life changing too ;-) but really, at the bottom of it all, I think that the real power is in being boundaried, consistent, self-aware and acting with true beneficence.

Regulation - no perfect solution

So we boil down to the question; what would I do if I had the power to regulate? The short answer is, I'm not 100% sure. I have a few questionmarks around the PSA and I struggle with the fact that the NCS has a register with the conflict of interest in having their Chair as the person who founded Chrysalis, who set up the NCS to oversee them. I am rankled that there are therapists who have done a course with no supervised placements who can call themselves "accredited therapists" (via the NCS system) versus the training I had which according to the AR's puts me in exactly the same category as people with a lot less experience. I have anecdotally noticed a sense of entitlement with a few Chrysalis students from comments online, possibly contributed to by the aggressive marketing (eg stating that the diploma qualification leads to earning at least £45 an hour; a claim which formed the basis of an upheld complaint with the ASA). The origins of the NCS being set up by the management of Chrysalis to regulate their own training and students is something I have heard others struggle with too. I think they'd do well to sever the connections and this will be in the interest of their members. I also feel bad for students of Chrysalis who thought that they could become BACP members once qualified but apparently the BACP rules changed part way through the training for some (I don't know this for a fact). I guess this leads to the "Empire Building" accusations but I totally get why the BACP insist that supervised placements are an integral part of training.

I get frustrated by the somewhat infantile name calling against the BACP by therapists who have chosen not to be members of the BACP and those perhaps whose credentials don't match up to the BACP requirements so are unable to join the BACP Accredited Register. I see discussions on LinkedIn between professionals colluding with each other, very much in child ego state with deeply unconstructive criticism; very childish, unfounded rants about the BACP. I'm sure the BACP are not for everyone and, like us all, have their flaws but can't we be reasonable? What are we, as professionals, modelling?

I am ranting, and unashamedly so and hopefully with reason and consideration to facts. I am also aware that I absolutely have my own agenda in this and actually, in the scheme of things, it's quite petty. Given that the opposition to the HCPC route was so vehement, the best way forward is probably via the PSA AR's. And although I struggle with the fact that the NCS can be on par with BACP and UKCP when I believe I see a clear difference (riddled with my own agenda), the point is that they do have a complaints procedure and they are accountable to the PSA. Given that the Chair of the PSA told me he was on good terms with the PSA CEO Harry Cayton I do have some skepticism, but I consider it a healthy dose. The CEO of the NCS I found to be very professional and I really enjoyed the conversation I had with her last year. I was told that their code of conduct was co-written with the director of the Clinic for Boundaries Studies and I really respect that.

Idealism vs realism

I flit between the two. I am Myers-Briggs INFJ type. Integrity, authenticity and by default self-awareness are concepts I strive to prioritise in all my decision making. In an ideal world we wouldn't need regulation. But we do. Realistically, the PSA ARs are the best way forward, in my opinion, based upon what I understand presently.

In Summary

This is work in progress. As I learn more I will adapt. I have taken a back seat on the campaign for regulation of late but intend to pick it up again post election. I have a lot of work ahead of me. As far as I know, everybody else in these shoes has given up. That might happen to me but it hasn't happened yet. If regulation came into force and I ended up losing my work because I am not deemed fit to practice then I would retrain. If I was found to be incompetent as a practitioner then I would change jobs. Regulation trumps my career. So I have no fear.

So I'm being honest and throwing it out there. There are lots of conversations being had in the therapy world between professionals about regulation and this is just one of them. What I would like to add is that through being public with my own experience I have become increasingly aware of extreme abuses of power in therapy, as I have been approached by a number of victims. These stories are often not heard by the people commenting on regulation. In fact, due to the hurdles intrinsic in the complaints processes, the industry's collusion with abuse (by failing to truly acknowledge the existence of it) and the fact that the nature of abuse usually invokes deepest shame in the victim, these people's stories will never see the light of day.

More posts on regulation:

Guest Blogger Patrick Killeen - Accredited Registers vs Protected Titles (July 2015)

Regulation - a client and therapist friendly way forward? (November 2014)

The problems with a voluntary regulatory scheme (Sept 2014)

Spreading the word on AVRs - the Professional Standards Authority responds (Sept 2014)

The Regulation of Counselling and Psychotherapy - What the Public Want (June 2013)

Amanda Williamson Coaching and Counselling Service in Exeter, Devon

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