People Not Pathology: Humanising Counselling and Psychotherapy – Two Day Conference in Birmingham

People Not Pathology:

Humanising Counselling and Psychotherapy

A Two Day Conference  May 2nd & 3rd 2020  in Birmingham

Save the date …..Save the date …. Save the date …… Save the date

Organised by Psychotherapy and Counselling for Social Responsibility and the Free Psychotherapy Network

 

Psychotherapy and counselling in the UK is alive and well. The demand for therapy and the supply of therapists have been growing steadily for decades.  At the same time, for the last two decades at least the heart and soul of the profession has been under attack from the neoliberal policies of the state and our own professional bodies.

It’s time to take a stand and start to turn the tide. How do we stand together to humanise our profession and play our part in transforming neoliberal narratives about mental health into a vision of society organised around people’s needs?

We want the conference to be as participatory and “bottom up” as possible, prioritising small group discussion in workshops. Some themes:

Conference Day 1: The Problem

Medical model of mental health and its treatment via CBT and psychotropic drugs; individual responsibility and the denial of the politico-social model of MH; colonisation by short-term evidence-based therapy; IAPT; professional bodies as state regulators of therapy, gatekeepers of training and employability; SCoPEd; DWP use of psycho-compulsion; unpaid work by counsellors, psychotherapists, art therapists & group therapists; underpaid, overworked, deskilled gig economy for psy workers.

Conference Day 2: What are we going to do about it?

How do we campaign for the social model of MH; what kinds of collective political action will challenge neoliberal attacks on relational therapy; how do we build alliances with service users and support user-led initiatives; campaigning against unpaid work; boycotting DWP psy work; organising our own bottom-up democratic professional organisations and trainings; working as therapists in communities; respecting and facilitating the psycommons; open-ended relational therapy for everyone, not just the well off.

Contact paulwilliamatkinson@gmail.com

Letter from #MillionsMissing Campaign – May 12th 2018 (ME Awareness Day)

Dear Free Psychotherapy Network,

I was very interested in the article on your website calling on therapists not to collude with harmful back-to-work therapies and pyscho-compulsion.

You may not know, but the model for these therapies have been forced upon a group of patients with a physical disease for decades.  The rooted of the BPS model go back to the PACE trial on people with ME. This trial was part funded by the DWP and set out to prove that instead of the neurological condition described by the WHO it was a combination of deconditioning, fear of activity and false illness beliefs.  The ‘success’ of this trial has long been disputed by patients but is only now coming under scientific scrutiny.

PACE has been used to ‘prove’ that CBT and graded exercise are an effective way to return people to health.  Unfortunately, even trivial exercise such as having a shower has a catastrophic effect on ME sufferers, leaving them bed bound and in pain.  Some never regain the level of functioning they had before treatment.  However, they are told that it their fault for not trying hard enough or not challenging their false illness beliefs.  Parents are accused of perpetuating their child’s illness and there are a high level of accusations of FII against mothers.

The PACE trial has been thoroughly debunked but it’s influence continues and has contributed to the appearance of scientific evidence for IAPT. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3

ME sufferers have been the ‘canary in the coal mine’ for many years, protesting without being heard.  The BPS lobby has been able to stigmatise a whole group of patients as ‘militant activists’ and akin to the animal rights lobby in the level of danger they present to scientists.

However, in the only legal arena that these accusations have been examined they were found to be ‘grossly excessive’.

http://informationrights.decisions.tribunals.gov.uk/DBFiles/Decision/i1854/Queen%20Mary%20University%20of%20London%20EA-2015-0269%20(12-8-16).PDF

This harm has been compounded by the blocking of any research that doesn’t fit the BPS view.  Any protests are met with contempt and the accusation that people with ME are afraid of being seen to have mental health problems.  It is a perfect Catch 22.  If you don’t protest then you are assumed to agree that ME is a mental health issue.  If you do protest then it proves that you have a mental health problem but are in denial.  In reality, sufferers are only asking for effective treatment for their primary biomedical problem.  They welcome counselling to help them accept the limitations that this long term illness has forced upon them.  ME sufferers are in the same position that people with MS were before the discovery of a bio marker when it was considered to be hysterical paralysis.

Things are now changing around the world.  In the USA the NIH has found insufficient evidence for CBT and GET http://www.meassociation.org.uk/2016/08/us-federal-agency-downgrades-its-advice-on-cbt-and-get-occupy-m-e-website-16-august-2016/ The Dutch have recently done the same https://www.meaction.net/2018/03/23/dutch-health-council-downgrades-get-for-me-cfs/

NICE are reviewing the UK guidelines but have refused to remove them until the end of the process, which will take at least 2 years.  In that time many more patients will experience iatrogenic harm.

MEAction are holding a series of demonstrations across the UK on May 12 to draw attention to the #MillionsMissing from their own lives.  We are asking therapists to stand with ME patients in asking NICE to stop GET now, rather than wait for the 2 year period to expire.

I am organising the London MillionsMissing protest and reaching out beyond the ME community to ask for allies.  https://www.facebook.com/millionsmissinglondon2018/

Sincerely,

Denise Spreag

http://www.virology.ws/2015/10/21/trial-by-error-i/

https://www.unrest.film/

http://stonebird.co.uk/new/index.htm

Demo at New Savoy Conference 21st March 2018

The Alliance for Counselling and Psychotherapy has organised a demo at the New Savoy conference again this year. Please circulate the flyer linked here to your networks and come along yourself if you can make it. It’s an early start at South Kensington.



Some context:
• The hierarchy of IAPT and psychological services in the NHS who gather at these conferences continue to offer liberal mouthings about DWP welfare reform policies, WCA and PIP, sanctions, coercion around Work and Health. But they’ve actually taken no real action to boycott DWP/Health collaboration, despite all the developments re judicial reviews, UN condemnations, the recent Parl Committee report, and the UC debacle.
In his intro to the conference, in the programme link above, Jeremy Clarke (NS chair) says:
 “The second issue is the running sore of welfare benefit reform, and its negative impact on mental health, that undermines whatever benefit we make to population wellbeing. Have we reached a consensus now for how we can turn the tide? The BBC’s Mark Easton will find out”
• The overall theme is depression; there are sessions on the crisis in the IAPT workforce, latest staff survey, impact of targets; session on Work and Health Unit; Wessely’s review of human rights and compulsory treatment; session on Employee Assistant Programmes (often run by people like Maximus); familiar faces in the list of speakers.
The scam of IAPT as a service in local communities. IAPT has a massive evidence base, tons of statistics for every CCG in England including “recovery” rates; ethnicity stats; deprivation stats; etc etc No-one really analyses the figures. For IAPT, it seems just collecting the stats is their claim to being evidence based and therefore their claim for funding from the Government. In fact, their stats reveal a shockingly failing provision.
For example, out of over 1,350,000 referrals a year, 85% either never enter any kind of therapy, or never finish a course of treatment, or don’t “move to recovery” (as IAPT jargon has it). In my CCG (Tower Hamlets) only 6.6% of referrals to IAPT “recovered” and among the Bangladeshi community who make up over 30% on TH population only 3% “recovered”. Paul Farmer’s Taskforce target for % of population who “need IAPT therapy” is 15%, rising to 25% by 2021. In TH about 2% of the pop were referred/referred themselves to IAPT, of whom as I say 6.6% “recovered”.
IAPT will be a major part of the propaganda around the NHS reorganisation now in progress, via the STPs and the ACOs they are developing (link here for more info on this). STP management have “the mental health crisis” high on their agenda – certainly their PR agenda – and selling more provision for IAPT services will be a major plank of the campaign. See Hunt on this role for IAPT here.
IAPT is rarely taken to task as a service that is massively failing communities all over England. This is true in the Labour Party as much as anywhere else. This has to stop. It is a propaganda service for neoliberal capitalism and its dissemination of psychological scapegoating and coercion across society.
Hope to see some of you on the 21st,
Paul Atkinson
New Savoy 2018 jpeg

New Savoy 2018.pdf

New Savoy Protest against psycho-compulsion of MH claimants – 15th March 2017

scan9

“We have endured year after year of austerity with cuts to our services and benefits and jobs, whilst the already far too rich are coining it in. Britain is the site of gross and unacceptable levels of inequality, and it keeps getting worse. Nothing that comes from the mouths of this government can be trusted, as they continually say one thing whilst doing the complete opposite. We are faced with crises in every sphere of the services that we need including education, social care, prisons, mental health services, housing, zero hours contracts and the health service. All are being undermined and destroyed whilst the corporate media mainly ignores the hell that has been created for so many, or distracts us with endless propaganda campaigns designed to get us turning in on one another whilst the corporations steal away everything that our grandparents struggled to achieve.”

Roy Bard  MWA zine#2

Details of the protest here

Read the Mental Wealth Alliance zine for the protest here


Mental Wealth Alliance response to the psy professional bodies’ statement on benefit sanctions and mental health 30/11/16

From:

Mental Wealth Alliance[1]

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

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

30th January 2017

MWA response to the psy professional bodies’ statement on benefit sanctions and mental health  30th November 2016

We welcome the call from the psychological therapy bodies for the government to suspend the use of sanctions by the DWP subject to the outcomes of an independent review of its welfare policies and their potential damage to the mental health of benefit claimants. Given the accumulation of evidence over many years of the material and psychological suffering inflicted on benefit claimants by workfare-based conditionality[2], it has been frankly shocking that the professional bodies directly concerned with the mental health of the nation have preferred to welcome and participate in workfare policies rather than publicly and vociferously dissociate themselves.

The timing of the statement is given to be the recent report on sanctions by the National Audit Office. Welcome as its report is, the NAO’s perspective on government policy is primarily monetary, not one of health, ethics and social justice. Its “vision is to help the nation spend wisely”.  The choice of this timing represents realpolitik on the part of the professional bodies no doubt, as perhaps is the intention of the conditional statement: “The sanctions process may be detrimental to people’s mental health and wellbeing”. But surely as psychotherapists and counsellors we can do better to represent the overwhelming evidence of personal suffering on such a scale than point to poor returns on expenditure and an ambivalent proposal that sanctions may be detrimental to people’s mental health.

Sanctions are only one dimension, albeit at the sharp end, of a welfare regime based on the political assertion that people need to be coerced off benefits and “nudged” into work. The psychological pressure of WCA and PIP assessments, job search rules, work programmes on “good employee” behaviours and the regular cuts to welfare benefits generally are part and parcel of the psycho-compulsion of the DWP benefits regime.[3]

We dispute the government’s premise that work is a therapeutic priority for people suffering from mental health difficulties. The marshalling of evidence for this modern-day workhouse mentality lacks both substance and integrity. Work has become the ideological mantra for neoliberal welfare policies.

Obviously where people want to work and where employment possibilities exist that will support and nourish people’s mental health, then encouragement, training and professional support should be available. But why is there no acknowledgement of the hundreds of thousands of claimants with mental health difficulties who cannot work, whether they want to or not?[4] Where is the evidence that people with mental health difficulties are actually benefiting from what is now two decades of workfare conditionality in the UK? Where is the evidence that in our current labour market decent jobs exist that will nourish people’s mental health? And where is the evidence that psychological therapy for benefit claimants with long-term mental health disabilities succeeds in supporting them into decent jobs they want, can survive and maintain?

When the professional bodies say, “an estimated 86-90% of people with mental health conditions that are not in employment want to work”, they are supporting the proposition that getting into work is an overwhelmingly important and efficacious goal for this group of benefit claimants. It is not clear where this figure comes from and what it means.

A similar figure is quoted by The Royal College of Psychiatrists’ report on Mental Health and Work (2013)[5], making use of a Sheffield study by J. Secker and others (2001)[6]. In fact, Secker finds that of their sample of 149 unemployed service users, when asked if they were interested in work of any kind – including voluntary and supported work –  “around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. Only 15 people (10%) had no interest in work”. At the same time, only 25% of respondents saw full-time employment as a long-term goal. 71% said that their preferred vocational assistance would be “help for mental health/keep current service”.[7]

This study does not translate into “86-90% of people with mental health conditions that are not in employment want to work”.[8] What it points to is the complex texture of attitudes, desires and fears around waged work that are the common experience of service users, alongside the harsh realities of the current labour market, the socio-economic environment generally, and the dire state of mental health services of all kinds more particularly.[9]

From our point of view, the professional bodies’ statement is a step in the right direction. It is a step that must now be followed through with active political pressure on the DWP and the Dept of Health to suspend sanctions and set up an independent review of their use, including the damage they inflict on people’s mental health.  Parliament has already called for such a review.[10]

But more than this, the remit of such a review should include all aspects of conditionality in a benefits system that deploy psycho-compulsion through mandatory rules or through the more subtle imposition of behavioural norms which aim to override the claimant’s voice.

We again suggest that the psy professional bodies would benefit by widening their own conversations to include service users and the rank and file of their membership. They would also win more credibility as organisations with ethical and social values independent of the government’s policies of dismantlement of social security and the welfare state if they were willing to make transparent their currently private conversations with DWP.


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

[2] Parliamentary committees, the national press, endless reports from charities, service user organisations, people with disabilities, claimants unions and workfare campaigners have been reporting the physical and psychological damage of ‘welfare reform’ and its tragic outcomes for a decade.

[3] On psycho-compulsion and the benefits system see Friedli and Stearn http://mh.bmj.com/content/41/1/40.full and https://vimeo.com/157125824

[4] In February 2015 over a million people claiming ESA under a MH diagnosis were in either the Support Group or WRAG. Over 70% of new applicants for ESA are found unfit for work

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470545/3307-2015.pdf

[5] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17

[6] Secker, J., Grove, B. & Seebohm, P. (2001) Challenging barriers to employment, training and education for mental health service users. The service users’ perspective. London: Institute for Applied Health & Social Policy, King’s College London.

[7] Ibid, pp. 397-399

[8] Compare a DWP survey of disabled working age benefit claimants in 2013. 56% of 1,349 respondents agreed that they wanted to work. Only 15% agreed that they were currently able to work. Only 23% agreed that having a job would be beneficial for their health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224543/ihr_16_v2.pdf

[9] For example, some of this complexity is flagged by Blank, Harries and Reynolds (2012) The meaning and experience of work in the context of severe and enduring mental health problems: An interpretative phenomenological analysis Work: 47 45(3)    “Stigma, the disclosure of a mental health problem and the symptoms of the mental health problem are frequently described, as well as feelings of hopelessness, seeing recovery as uncertain, and feeling a lack of encouragement from services. Difficulties in accessing occupational health services, having a disjointed work history, lack of work experience, age, lack of motivation and fears about competency, as well as the social benefits system and caring commitments, are also experienced as barriers to accessing employment for people with mental health problems.”

[10] https://www.parliament.uk/business/committees/committees-a-z/commons-select/work-and-pensions-committee/news/benefit-sanctions-report

 

Open letter to therapy’s professional bodies on the psychocompulsion of welfare claimants – from the Mental Wealth Foundation

_______________________________________________________________

 

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

________________________________________________________________

 

Date                21 March 2016

From:

Mental Wealth Foundation

Mental Health Resistance Network

Disabled People Against Cuts

Recovery in the Bin

Boycott Workfare

The Survivors Trust

Alliance for Counselling and Psychotherapy

College of Psychoanalysts

Psychotherapists and Counsellors for Social Responsibility

Psychologists Against Austerity

Critical Mental Health Nurses’ Network

Free Psychotherapy Network

Psychotherapists and Counsellors Union

Social Work Action Network (Mental Health Charter)

National Unemployed Workers Combine

Merseyside County Association of Trades Union Councils

Scottish Unemployed Workers’ Network

 

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

 

 

Professional bodies scrutinise Government therapists in job centresplans

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

  1. http://www.bacp.co.uk/media/index.php?newsId=3906
  1. https://www.opendemocracy.net/ournhs/dr-lynne-friedli-robert-stern/why-we-re-opposed-to-jobs-on-prescription
  1. https://www.morningstaronline.co.uk/a-a3e3-Joblessness-branded-a-mental-illness#.VuKWT4SFDzI
  1. http://www.islingtonccg.nhs.uk/Downloads/CCG/BoardPapers/20151111/4.3%20Health%20and%20Employment%20Programme.pdf

5          ‘Mental Health Advisor – Job Details’ Retrieved from http://www.bacp.co.uk/jobs/jobs.php November 21st, 2015. Available athttps://www.dropbox.com/s/a6p9mod1jb08dne/Mental%20Health%20Advisor%20-%20Job%20Details.docx?dl=0

6          http://careers.g4s.com/jobs/Cognitive-Behavioural-Therapist_58526/6 crisis

  1. https://www.gov.uk/government/statistics/jobseekers-allowance-and-employment-and-support-allowance-sanctions-decisions-made-to-september-2015
  1. http://www.independent.co.uk/news/uk/politics/benefit-sanctions-against-people-with-mental-health-problems-up-by-600-per-cent-a6731971.html
  1. For a fuller discussion of these issues, see http://mh.bmj.com/content/41/1/40.full
  1. http://jech.bmj.com/content/early/2015/10/26/jech-2015-206209.full
  1. Para 4.3 http://democracy.islington.gov.uk/documents/s6740/Health%20and%20work%20-%20HWB%20update%20Jan%202016%20final.pdf

http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/gps-told-to-inform-patients-dwp-will-obtain-their-fit-note-records/20030820.article.

See also http://files-eu.clickdimensions.com/hscicgovuk-amnje/files/emed3dpnlettertogppracticesv1.0.pdf?_cldee=Y29yYWwuam9uZXNAbmhzLm5ldA%3d%3d&urlid=0

  1. http://www.theguardian.com/healthcare-network/2016/feb/17/were-not-surprised-half-our-psychologist-colleagues-are-depressed

 

  1. http://recoveryinthebin.org/2016/03/10/welfare-reforms-and-mental-health-resisting-sanctions-assessments-and-psychological-coercion-by-denise-mckenna-mental-health-resistance-network-mhrn/

Empathy Explores Beyond Limits – Peter Ryan

 

Death is like a cold, dark whirlpool, a wave of suffering, just waiting to wash us away
you who rest in comfort upon the shoreline, how can you know our state? (Hafiz)

I am a passionate about spreading the word, work and wonder of empathy. This passion is born out of years counselling studies and practice experiences. However, it is individuals from various social, economic and cultural backgrounds that have shown me just how far reaching the cosmic dimensions of empathy can be. Empathy penetrates the darkest corners of the human condition and sheds an understanding light of acceptance onto the chaos of existence.

It has a Ninja-like quality of daring at its heart. I named this quality a courageous sensitivity.

The effectiveness of my courageous sensitivity to engage traumatised individuals in the therapeutic process is evidenced in Extending the Empathy Zone Embrace[1].

I believe, the secret to exploring hurtful experiences locked within the inner terrain of human existence is down to one fundamental fact – empathy is a born survivor. It thrives in the unknown, vulnerable, emerging presence, keeping its edge sharp. Instinct is empathy’s whiskers, intuition its resonator. Empathy recognizeswelcomes and treasures the individuality, personhood, identity, spirit or soul of the other human being in all its shared and unique aspects[2]. That is why, when labouring with raw materials from a client’s subterranean world, it is essential external forces of influence, bias and control on a person are equally welcomed for empathic exploration. Not all psychological problems are caused by childhood experiences; not all emotional stress concerns individuals. The influence of history, geography, economics, philosophy and religion on individual responsibility is vastly underestimated[3]. A closed system of relating only condemns people once again to draw in the exhaled breath of oppression found in stuffy, compartmentalised environments. An empathic ecosystem liberates individuals by its refreshing, interconnecting atmosphere. Its breath-taking relationship is designed to blend in with its surroundings, not to be apart from it.

Empathic understanding…always leads directly into the psychic connection itself. Rational understanding is merely an aid to psychology, empathic understanding brings us to psychology itself. (Karl Jaspers)

There is still a lot of misconception about empathy. It’s often mistaken as a fluffy, “female” feeling to be used as a tissue for mopping up tears. Nothing could be more wrong. Empathy is always knowledge-based[4] drawing on both masculine and feminine qualities beating quite capably at its organic heart. Empathy’s unisexual soul is the bedrock of what it means to be a complex human being. And attempts by many high ranking professionals seeking to place a “cognition crown” on empathy’s majestic head are doomed to failure. This top-down approach heavily laden with logic and order will just not do. Parading empathy in ordered logic as the ideal state of mind not only betrays a deep wariness towards human unordered and often irrational feelings and emotions but also demonstrates a poor understanding of empathy’s true power. Viewing empathy through such a lens condemns it to exist in a restricted, incongruent and lifeless enclosure whose walls are fiercely guarded by seemingly superior reason. If this state of affairs continues to gain ground in the counselling realm, it will rip the heart out of empathic engagements. I am reminded of the late Indian history writer and teacher, Abraham Eraly, who said: Everything was efficient and well-ordered in the Indus cities, most remarkably so, but there was little scope for artistic flourishes or individual creativity in this bloodless, precision-engineered society.

 From the first moments of a therapeutic encounter with a client, I let empathy guide our way through the session. Empathy is felt and reasoned simultaneously. It is a quantum experience[5]. As the dynamics of our empathic connection develops and clients stop hugging the shoreline of familiarity then the spirit of adventure into understanding the waves of their suffering can begin. Empathy is the sail that keeps the vessel of healing afloat in the dark whirlpool. Therapy without empathy is not counselling. And counselling without empathy is not therapy. Empathy is not a ‘technique’ of responding to the client, but a way-of-being-in-relation to the client[6].

Empathy is extremely effective in alleviating shame – the underlying emotion of many disturbing feelings and behaviours. As beautifully expressed by five year shame researcher Dr Brené Brown: Shame is highly, highly correlated with addiction, depression, violence, aggression, bullying, suicide, eating disorders (…). Shame is an epidemic in our culture. Empathy is the antidote to shame[7].

In order to be vigilant against the creeping vine of shame and its ability to produce chock-off points, therapeutic engagement requires constant use of body awareness which is the gateway to keeping empathy fresh when dissolving shame. Empathy is not only a born survivor. It is the rescue service available in bringing isolated clients back from the brink of oblivion and into the fold of humanity. It is not for nothing that empathy represents the deepest expression of awe, and understandably is regarded as the most spiritual of human qualities[8].

I believe that finding answers to difficult issues is made easier when clients are fully supported by an empathic therapist who trusts in their capacity to transform. For empathy, in all senses of the word, involves an ongoing, ever-changing process of self-transformation[9]. This confidence in empathy and positive transformation has an evolutionary component embedded in my sense of trust.  For we humans are gifted with possessing the most highly sophisticated powerhouse of abilities on the planet – the nervous system with the most powerful brain known to us. This highly specialised system utilises and arranges interactions between humans and the world around us. It is regulated by the constant flow of information via sensing, instinct, intuition, visceral experiences, images and perception. Being open and non-judgemental to the plethora of ‘subterranean gifts’, generated by new experiences, is vital to keeping our powerhouse in pristine top-notch shape. Consequently, if the nervous system is used to distort or deny perceptions and experiences, and emotions and feelings that those persecutions and experiences could/would evoke, it becomes overstressed and starts failing, and with it the zest for real, authentic life.

For empathy to thrive it must feel the pulse of emotion. Emotion is the engine where the zest for life is created. Emotion is the true touch-stone in successful empathic communication and is the gateway to authentic living. Authenticity is to empathy what water is to life. The bridge linking empathy and authenticity is called unconditional acceptance. Empathy distilled from a non-judgemental openness draws forth the clear, clean waters of authenticity in an endless cycle of rebirth and sparkling purity. Accessing the life force of authenticity is dependent upon maintaining the quality of a non-judgemental presence. Empathy and unconditional acceptance enhance one another in promoting movement towards congruent living.

Thus the first step towards an empathic life and authentic living is to take a stand. That is, take ownership of what we are experiencing and by doing so calibrate our ability to evolve fully into the unfolding moment. In counselling, as in life, limits imposed on experiencing the integral stream of our internal information system keeps human potential locked in a flat-earth landscape.

We don’t always have to express verbally what we are feeling, but, as Carl Rogers phrased it, we must be open to making our feelings available to our awareness. We need to tune in and trust in our private unique frequencies and rhythms. By doing so we allow for a more confident space to bloom in which the fruits for an empathic life and authentic living can be enjoyed.

To be faithful to that which exists nowhere but in yourself — and thus make yourself indispensable.

(Andre Gide)

 

[1] http://uktherapyguide.com/blog/extending-the-empathy-zone-embrace/

[2] http://www.empathictherapy.org/What-Is-Empathic-Therapy-.html

[3] Clarkson P. The therapeutic relationship. London: Whurr publisher Ltd; 2009

[4] Joseph S. and Worsley R. Person-centred psychopathology. United Kingdom: PCCS Books Ltd; 2012

[5] Rifkin J. The empathic civilization. Cambridge: Polity Press;2010

[6] Mearns D. and Thorne B. Person-Centred counselling in action. London: SAGE Publications, London; 2008

[7] https://www.ted.com/talks/brene_brown_listening_to_shame?language=en

[8] Rifkin J. The empathic civilization. Cambridge: Polity Press;2010

[9] Cinramicol A & Ketcham K. The power of empathy. London: Piatkus publications;2000

Going clean, going legal and the personal responsibilities of the ‘productive’ citizen – Lena Theodoropoulou

Francis Alys Don't cross the bridge before you get to the river
Francis Alys Don’t cross the bridge before you get to the river

In theory

The coalition’s government [i] drug strategy for 2010-2015 is a clear, straight-forward document that describes their intentions and plans as well as the changes that actually took place in the UK drug recovery system during the past five years.

The document starts with a statement by the Home Secretary and her commitment to chase those involved in the drug trade; following that, she attempts to make an arbitrary link between drug use, organised crime and the security of UK borders. The inexistent in the real world, as described by the Home Secretary, distinction between drug users and drug traders is no news; the fact that it is mentioned though at the very beginning of the document makes it clear that for its instigators, addressing the connection between offending and drug activity (use or trade) is a priority for the ‘safety of the community’ and their strategy will evolve based on that conviction.

In the main body of the document it is mentioned that amongst the main targets of recovery is for individuals to cease offending, stop harming themselves and their communities and successfully contribute to society. Further on, it is stated that ‘key to successful delivery in a recovery orientated system is that all services are commissioned with best practice outcomes in mind’ that include: a reduction in crime and re-offending, sustained employment, the ability to access and sustain suitable accommodation, improved relationships with family members, partners and friends and the capacity to be an effective and caring parent. At the same time, the government calls the services to provide individualised, person-centred treatment and care plans tailored to the service-users’ needs. This is quite a paradox as, based on the guidelines above, it is obvious that the centre of attention is not the person that actually asks for help but the safety and wellbeing of the people and institutions around them. It is clearly stated that the services won’t be judged (and funded) on the premises of their therapeutic work, but on their ability to produce ‘good citizens’, meaning citizens that have a job, a house, are part of or in the process of forming a nuclear family, are good parents, do not offend etc. It is safe thus to conclude that individualised treatment only refers to the identification and correction of the ‘deviances’ in the service-users’ lives, rather than an effort to accompany them in the discovery of their own aspirations, plans and chosen way of being.

 

In Practice

As a support assistant at a residential detox and rehabilitation centre, I was invited to attend with the residents a group called GOALS, delivered by an external facilitator. The initials stand for ”Gaining Opportunities and Living Skills” and it is designed to teach the participants the ”Ten Keys of Success”. The facilitator introduces it as a course on how to become successful, delivered in a variety of settings, including companies that are interested in strengthening their employees’ motivation.

The GOALS group focuses on encouraging the participants to take responsibility for their own actions, acknowledge the fact that there is always a choice and learn how to leave the past behind them. The booklet of the course includes a variety of decontextualised catchy quotes coming from thinkers, philosophers and celebrities. Positive thinking and anger management become priority areas and the facilitator starts using examples on personal responsibility and the availability of choices. Among others, she uses the example of the UK’s age of criminal responsibility (the age of 10) and states that by that age people are able to tell the difference between right and wrong (and hence take responsibility and pay the consequences of their actions). The following example is about a man claiming that he had no other choice but to steal in order to feed his children. Once more, alternative options are presented to the group including food banks, or even looking for food in the garbage in order to avoid offending. And finally, when it comes to anger, the participants are advised to leave the past behind for their own good and learn how to forget and forgive.

Bit by bit and with one example after another, a value system is created, based on personal responsibility and the identification of legality with justice. It is also interesting that, although the examples used throughout the course didn’t mention directly drug/alcohol dependence, the connotation is obvious: obedience and legality equals a clean and happy life while disobedience and resistance equals social exclusion and relapse; and it is the enforcement of such equations that render the specific recovery model not just invalid but also unethical and dangerous. If there is a shared, universal feeling amongst people that have experienced drug addiction that would be guilt and shame. In addition to that, the route towards treatment is not an easy one. It usually involves lots of pain, disappointments and disillusionment as well as a feeling of defeat. All these conditions put the person that asks for help in a vulnerable, but also a very respectable position; manipulation though is definitely not the way to show respect. The government’s drug strategy pushes towards treatment that steps on peoples’ guilt and anger (in many cases the outcome of personal as well as social suffering) in order to create obedient, functional and productive citizens. Although the basic principles are quite similar in most treatment models, the reasoning behind them is completely different. Violence and offending for example constitute a ‘boundary’ in most treatment models around the world, not because it is ‘not right’ but because it reflects a lifestyle in many cases adopted during the times of addiction and bears negative connotations for the people in recovery. Additionally, linking offending, criminality and eventually drug dependence with resistance to social injustice and any behaviour that goes against the norms is again an effort to manipulate people during a very sensitive period of their life and takes us back to the initial point of this text that the government’s drug strategy is not about supporting the people that ask for help but about creating ‘safe communities’ and forcing social stability. Finally, playing the card of personal responsibility is an attempt to take the weight off the State’s back when it comes to social injustice and exclusion.

The subordination to a substance is the outcome of the original fear of a person to stand against the world with a clear mind; and this fear is not a choice but a result of the marginalisation since an early age of those that fail to fit in the prevailing social narratives and adapt to the rules of institutions. The failure there is not personal but systemic and has its roots in the imposition of social norms in a top-down fashion. The government’s approach to addiction creates a vicious circle that reproduces rules, restrictions and oppressions, even in the intimate and in theory free of all fear space of recovery.

All this is not to say that personal responsibility does not exist and does not play an important role in recovery. It does though alongside social and collective responsibility and does not only apply to the ex/drug users but to everyone else surrounding them, including drug workers, researchers, services, policy makers etc. Drug recovery is not (just) about being able to stay healthy, get a job and have babies. It is also an act of resistance, an escape from a pointless routine and a desire for freedom. Thus, addiction can only be treated in an environment that offers people the freedom to make their own choices, free of social expectations; free of the guilt of failure to reproduce stereotypes.

[i] This text is based on the previous government’s drug strategy, the outcomes of which are by now embedded in the practices of drug services. Although the new conservative government hasn’t yet published its drug strategy for the next five years, it is quite safe to say that they are expected to follow a similar agenda as they are the instigators of the current drug strategy anyway.

FPN regional groups: plans for local networks

We are in the process of organising a number of regional meetings this Autumn to encourage and support the building of a network of local FPN groups in parts of the country a strong interest has been expressed.

At the moment there are meetings in the pipeline in the following areas:

Manchester and the North West

Newcastle and the North east

Cambridge

East Midlands

Brighton/South Coast

We will ist more information about dates and venues as we go along. If you are working in any of these areas and want to take part, or if you would like to set up a meeting in your area, please get in touch. Email Paul Atkinson at paulwilliamatkinson@gmail.com.

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Therapists: how to join the network

If you are a therapist and would like to join the FPN, we ask simply that you share our
commitment  to  providing free or very low fee open-ended therapy to people on low incomes. See the statement on the home page of our website. There are then three steps to joining:

1.   Tell us you are a qualified counsellor or psychotherapist, and are registered with a professional body

2.   Send the following details, which will be posted on our directory of therapists, to Andy Metcalf at andymetcalf62@gmail.com

  • Your style of Work…….ie Psychotherapy/Counselling/Couples Work
  • Your qualification/registration… ie UKCP/BACP etc
  • Your postcode
  • Your contact details … email or phone number or both
  • Any other details you would like to mention

After your details are posted, the conditions of the work with a client who contacts you from the FPN  directory (free or a low fee, frequency, holiday breaks, etc)  are for you and the client to negotiate within the frame of your private practice.

3.   When you feel the time is right,  write a brief profile piece explaining why you have come to join the network and what it means to them. Find examples here.

If you have any other questions please do get in touch with Andy Metcalf.

Thanks

Recovery In The Bin – Letter to Luciana Berger

Please take the time to read and support this letter from a User Led Mental Health Activist Facebook Group campaigning for social justice and equality . Attached are the Recovery In The Bin network’s 18 Key Principles, if you wish to know more.

Dear Luciana Berger – Shadow Minister for Mental Health,

We are writing to you to raise our concerns and priorities for Governmental Mental Health care and provision in the UK. We enclose the first of a number of our “position statements” we intend to send to you.

We are a User Led Mental Health Activist Facebook Group campaigning for Social Justice and Equality in MH care and practice, with a focus on critiquing and challenging mainstream ‘recovery’ ideology. At the time of writing our membership stands at 474 and this is growing by the day.

We believe ‘recovery’ has been colonised by MH services, commissioners and policy makers. We reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation language, techniques and outcomes. Some of us will never feel “Recovered” living under these intolerable and inhumane social pressures.

We believe access to quality housing and disability benefits designed for mental health claimants would give people a stable and secure environment to raise their quality of life and health. This would enable efforts towards going back to study, work IF people choose / aspire to this and allowing people to volunteer indefinitely and claim benefits if this improves their quality of life and MH – recognising how valuable this work is to society.

Our first “position statement” is about the Welfare State and Social Housing, and follows this letter.

We will cover the following issues: –

Work Capability Assessment (WCA)

Benefit Sanctions

Personal Independence Payment (PIP)

Employment

Voluntary Work

CBT in Job Centres

Social Housing & Homelessness

We look forward to hearing from you about the matters we have raised.

Yours Sincerely,

Recovery In The Bin

Copy:

Jeremy Corbyn MP and Leader of Labour Party.

John McDonnell MP and Shadow Chancellor.

Owen Smith MP, Shadow Secretary of State for Work and Pensions.

Mental Health Resistance Network.

Social Workers Action Network (SWAN).

Psychologists Against Austerity.

Critical Mental Health Nursing Network (CMHNN).

Critical Psychiatry Network.

Disabled People Against Cuts (DPAC).

The Peoples Assembly.

Statement on the Welfare State and Social Housing

Work Capability Assessments (WCA)

  • The Work Capability Assessments (WCA) for Employment Support Allowance (ESA) appear to be weighted in favour of those with physical disabilities, and often fails to take into account fluctuating conditions, common to mental distress, such as anxiety and depression.
  • Access to welfare advisors and advocacy workers has been severely reduced due to cuts to funding, services and the legal aid budget.
  • We are aware of a number of deaths related to the “reforms”, including recent reports that a coroner has ruled that the WCA contributed directly to the suicide of a claimant, and that steps need to be taken by the DWP to prevent further such incidents. (The Independent 20.9.2015).
  • We believe the WCA needs to be abolished as a matter of urgency.

Benefit Sanctions

  • Sanctions remove the very means of existence, and as a consequence the related death toll is rising.
  • Those in the ‘Work Related Activity Group’ face huge cuts to their benefits in the near future, even if they manage to avoid being sanctioned.

Personal Independence Payment (PIP)

  • PIP is not MH orientated and self-harm/suicide risk factors have been removed from criteria.
  • MH claimants struggle to obtain the necessary medical evidence because MH services are now short term, and once discharged no specialist reports can be secured.
  • Loss of DLA/PIP to MH claimants who are not in receipt of ESA because they’re doing some part-time work or self-employment will be rendered unable to continue working or plunged into poverty, being under immense pressure to work more hours, which could lead to mental distress and deterioration. 

Employment

  • There are approximately 700,000 vacancies and 2 million (possibly more if you count those who are sanctioned/on Workfare) applying for those 700,000 vacancies, therefore the maths don’t work here.
  • It’s evidenced that Workfare doesn’t work and only provides massive profits to private companies using public funds and plunges more people into sanctions/food banks.
  • MH claimants have been and are being targeted as the ‘low hanging fruit’ (their description) in the full knowledge that MH (and Learning Difficulties) has the lowest employment rates.
  • Temporary and zero contract hours shift work is evidenced as being bad for anyone’s mental (and physical) health, but this looks set to become more common for MH claimants who are at threat of sanction/workfare.

Voluntary Work

  • We often carry out highly valued long term voluntary work within Trusts, University’s and Charities, so chosen voluntary work (with appropriate evidence) needs to be considered as an additional outcome to employment, as for some people that’s the most ‘doable’, maintaining the best ‘stability’.
  • Voluntary work gives a person greater flexibility, and provides less pressure to paid work when s/he is not feeling up to it.
  • MH claimants have had benefit claims stopped/reviewed for doing voluntary work (even when organised by own MH Trust & MH professionals have had to intervene by advocating that it’s part of their treatment).

Cognitive Behavioural Therapy (CBT) in Jobcentres.

  • We believe getting back to work, especially after many years of unemployment, due to MH complexities, is unlikely to be resolved by a “quick fix” such as CBT.
  • Many of these initiatives are being piloted in Labour controlled authorities. For example, in June 2015, Service Users protested outside the Streatham Job Centre, which had been identified as a site for trialling the introduction of CBT inside Job centres.

Social Housing & Homelessness

  • Some Councils/Housing Associations are losing over 90% of their stock, and letting agencies/private landlords don’t want tenants on housing benefit. This is a significant factor with respect to the increasing levels of homelessness that should not be acceptable for any Government.
  • Very vulnerable mentally distressed people are ending up sleeping rough because of refusal to join groups in high support mental health housing, which means they have refused an offer of housing and are deemed voluntarily homeless.

The privatisation of mental health: how good services are turning in favour of the rich

by Elizabeth Cotton, Middlesex University

The Care Quality Commission, the independent regulator of all health and social care services in England, recently produced a sobering report about the crisis in mental health services, with A&E staff attitudes bearing the brunt of criticism about failed care.

However, the Guardian’s recent ClockOff survey found that those working in health are the most stressed in public service – 61% say they are stressed all or most of the time.

Mental health has always been the poor cousin in public services and these reports are not about failures of individual compassion or positive thinking, but the impact of precarious work on all of our states of mind.

Take the psychotherapy profession. A 2015 report about a deterioration in public psychotherapy provision found there had been a 77% increase in complex cases, yet 63% of clients reported that NHS therapy was too short to do any good.

Insecure jobs and the growth of contract and agency labour, unwaged labour, and the retreat into private practice are linked to changes happening in the NHS that have left a fragmented and confused system of healthcare that even the leadership finds difficult to manage.

Rise of the agency

The advent of agencies is nothing new in healthcare but with the massive rise in demand for mental health services, NHS cuts and the waiting lists of between six and 18 months for talking therapies, we are now seeing the creation and expansion of private contractors and employment agencies for therapists. Because of the intense insecurity of agency work and the fear of blacklisting of individual therapists, professionals don’t want to talk about this growth of third parties in mental health and, as a result, not much is known about them.

The growth of contract and agency labour is part of a national campaign to downgrade mental health services. Under the NHS’s Increased Access to Psychological Therapies (IAPT) the main bulk of services are low intensity “well-being” programmes, based on a diluted model of Cognitive Behavioural Therapy. This service is delivered by “psychological well-being practitioners” (PWPs), a formalised and standardised role with intense targets of eight to ten satisfied clients a day. Under this system, if a patient does not pick up the phone for an initial assessment within the allotted 15-minute time period they are referred back to their GP, presumably to wait for a further six months.

Running out of time for mental health?
‘from www.shutterstock.com’

This model of well-being, to be clear, can under no description be considered as therapy. Although most of the people working as well-being practitioners are highly qualified, their job is not to provide a space where patients can actually say what is on their mind. The work is scripted and always leads to one compulsory outcome which is that everyone feels well. Those who offer more support, mainly through giving more time and going off-script, are forced to keep this secret from employers because it breaks their contract of employment, leaving them to carry the full ethical and clinical consequences of their interventions.

To add insult to injury, tucked away in the 2015 budget is the proposal that increased access to psychological therapies should be introduced to 350 job centres in the UK. It’s a psychologisation of poverty, where unemployed people are forced by precarious PWPs to internalise a global economic and social crisis. In this scenario its hard to imagine who needs the most help, the client or the clinician.

A growing percentage of such services are provided by contractors and labour agencies who are literally buying up the growing NHS waiting lists. As with all externalised employment relations, it is not just the contract of employment that gets passed over to third parties, it is also the responsibilities of employers.

Internships and honorary psychotherapists

The most important part of your training as a psychotherapist, along with your own personal therapy, is to carry out clinical work. In order to train as an adult psychotherapist and become an accredited member of a professional body you have to work part-time, usually one to three days a week for between four to eight years.

The problem is that trainees are not paid. There is currently no comprehensive data on how many psychotherapists work unwaged as “honoraries”, but with an estimated 6,000 psychotherapists training every year, a conservative estimate is that 2,000 full-time jobs in mental health are covered by unwaged workers. This includes a substantial percentage of the psychotherapists working for the NHS, the big third sector providers such as Mind and many local mental health charities providing clinical and well-being services in the UK.

Professional bodies are complicit in this system of unwaged work leading to the curious situation that the bodies charged with building a sustainable profession are currently not able to do that. If there is a political cause worth fighting for it is to make the demand for our professional bodies to organise a platform to negotiate wages.

There are some who work full time and do the training on top, but like other areas such as the media and arts, it means this profession is open primarily to people from families affluent enough to support them. This is not to say that rich people make worse therapists, but it does raise important questions about class and power.

Turning to private practice

Then there are the therapists employed directly by the NHS. In most cases the days of “permanent” contracts are over, cuts in funding and increasingly short funding cycles mean many jobs are fixed and short term.

Most NHS services are understaffed, particularly in child and adolescent mental health services leading to an emerging gold rush for private contractors and agencies. The insecurity of NHS workers has profound implications for workplace fear, creating cultures where clinicians are reluctant to raise concerns about patient care. Despite the important debate going on now about raising concerns, in the NHS the reality is that precarious workers are unlikely to speak up for fear of victimisation and job loss.

Many experienced psychotherapists have retreated to private practice, unable and unwilling to navigate a broken system. Many make enough money to live, but only having spent most of their working lives in the NHS with their pensions intact. This generation will retire within the next five to ten years leaving behind a whole generation of self-employed practitioners, who will never earn enough to cover the basics of pensions or sick pay. Private practice does offer massively needed services and a careful assessment and referral can make the difference between life and death, but it increasingly means that services are accessed only by those that can afford it.

The current economic argument for mental health services is based on the unacceptable working conditions of thousands of mental health workers. From psychological well-being practitioners, to psychologists in job centres, to the clinicians employed by Maximus and Atos to carry out welfare assessments, working in mental health poses significant risks to both clients and clinicians. As long as psychotherapists are working quietly and diligently under precarious conditions, the NHS as an employer will never respect the people who work for it. In a context of deteriorating mental health services, the fact that psychotherapists are an unorganised and silenced group of public servants is a matter for both professional and personal ethical concern.

This column looks at the reality of our health and care systems from the perspective of those working to deliver services. Please send us your stories from the frontline.

The Conversation

Elizabeth Cotton is Senior Lecturer at Middlesex University.

This article was originally published on The Conversation.
Read the original article.

Group Analysis Therapy – a therapy for our time?

Much of what we know about groups and the power of group therapy we can ascribe to the pioneering work of W.R Bion and S.H Foulkes, during and after the second world war. With this in mind, is it time again, as we did then, to consider group therapy being a therapy of our time? Today, it is not the threat of totalitarian regime from overseas that drives the distress that people feel but a pervasive culture of distilled fear of the “other” proliferate by today’s political classes which permeates the self and instills such anxiety.

Whether it be: ‘The need for austerity’, ‘The war on terror’, the fear of ‘Mass Migration’ or attacks upon the so called ‘scrounging indigenous benefit claimants’. The results are the same – that anxiety is increased, our sense of wellbeing is eroded, relationships suffer and social cohesion is attacked. The threat may not now be now from the Nazi’s, but an enemy that threatens us regardless.

Whilst this fear of the other is perpetuated, it is an uncomfortable truth that narcissistically driven gain, with its associated personality traits, is often afforded the status of being the highest of personal achievements. Conversely, collective, relational or just groups that promote sharing or creative thinking within non-hierarchical, non-financial orientations are given something far less than the status they deserve.

With this in mind, is it time to think about the group and it’s power to both inspire and hold the most intense feelings once again? But also is it time to challenge the individual to think about their personal entitlements, fears and anxieties over and around the other? Perhaps now, such as then, reconnection to group processes is required.

It was S.H Foulkes who gave the greatest trust to the power of the group to hold the most distressed, and in turn gave us the best understanding of the origins of that distress and the processes that underlie it.

For Foulkes and his acolytes, in the early days of ‘Group Analysis’, often it would be group processes rather than individual that would be relied upon most heavily to manage the most distressed. In those days in the Northfield hospital, it was the trauma of war (what we now know as post traumatic shock disorder) that was being treated and it was the group itself that was the main therapeutic medium for that treatment.

To understand how this medium was and is so therapeutically useful, we have to go further into Foulkes’ theories of the individual and the construction of the self. Whilst Foulkes was a classically trained analyst in the Freudian tradition, he had within his theoretical model of ‘Group Analysis’ a radical concept and departure from the orthodoxy of psychoanalysis. This he called ‘The Matrix’- a symbolic and hypothetical web of unconscious communication and meaning that we are all a part of, that permeates and shapes the person from their earliest moments.

The importance of this concept was that he saw individuals not as individuals per se, but as connected to a much wider net of socio-political and psychological process, whereby the individual was influenced and created by the environment and relationships around them. With this, the individual was seen not to communicate solely for themselves but as a ‘nodal point’ of communication for the wider system that included the personal.

In fact, Foulkes struggled so much with the notion of the individual that he thought that distress and neurosis emanated from its very formation. Or as Foulkes himself put it:

The deepest reason why patients………. can reinforce each other’s normal reactions and wear down and correct each other’s neurotic reactions is that collectively they constitute the very norm from which they deviate.  (S.H Foulkes 1948).

Reading Foulkes, we can begin to understand the need for the group and people’s places within it. As the socio-political influences of the day reinforce the need for greater perverse individualism and narcissistic gain, both the individual and the society at large experience greater levels of neurosis, creating a self fulfilling negative feedback loop that feeds and consumes itself equally. For Foulkes, it was only connecting and remaking contact with those larger social processes that alleviated the personal and social neurosis.

In the therapeutic world, perhaps the harshest of criticisms is, rather cruelly, that of ‘denial’. And it is this Foulkes was charged with. Foulkes’ highly positive schema of the individual within groups, reconnected to the matrix that in their individual state they had deviated from and become distressed, was considered far too utopian for some of this contemporaries and followers. It is true to say that Foulkes had no schema for the anti-group or destructive phenomena that occurs in groups. It was perhaps W.R. Bion who could describe more fully the destructive elements within group life and with it present something of a dichotomy in group thinking.

Bion, in his theory of groups, was able to differentiate when groups were working and when they were not. When processes were creative and when they were stuck. Bion described this as the theory of “Basic Assumption Groups”. Using his theory to think about groups, we are able to differentiate when a group is working – engaged in its primary task of overcoming and understanding neurosis – and when it is not – that is, has become a “basic assumption group”. Bion, essentially an analyst trained in the Kleinian school, was able to identify when anxieties were high and the group had fallen into an unconscious defensive position. In such a position, the group relies heavily from within its number on dependency figures, in the unconscious hope that the individual or pair will rescue it from its neurosis. Differently to Foulkes, it was the personal unconscious stimulated by the presence of the group, and the imponderables therein, that inspired the group to amalgamate into a split position and defend against its primary work task.

While personally I find the theory of groups fascinating and could spend far more time exploring than this piece allows, I want to return to the central point that groups are both able to inspire and hold the a strongest of feelings. I asked the question, ”is group therapy a therapy for our time?” And whilst there is obviously no definitive answer to this question, what is important is that therapy in our time should have a way of reflecting on the type of processes that inspire the kind of anxieties that people suffer with and illustrate that their origins are not always from within. Our therapeutic understandings need to be able to place a person in the socio-political context that permeates the individual, and both give an understanding of what inspires anxieties and make conscious how those anxieties come to reside there in the first place.

In addition to this, therapy needs locate us within our own personal potential to split and inspire in us a greater understanding of what influences our splitting. There resides within us an understandable desire for a charismatic leader(s) to rescue us from our most primitive fears, a desire which drives us to project not just the worst of ourselves, but also the best of ourselves into the other – depleting our own internal resources. It is group analysis and group therapy that can most usefully offer this in my understanding.

Lastly, there is a brief point referred to earlier regarding narcissism. I made the point that in our time often what can be described as serious narcissism and self entitlement is celebrated and defended within our society – the banking crisis and the defence of those that maintain it, whilst scapegoating the poor, being the most obvious of the current examples of this. However, in groups it is my experience that narcissistic processes either within a group’s membership or within the therapist themselves remain unchallenged. Actually, group analysis has a unique unfathomable way of both inspiring a person’s narcissistic traits to be present and challenging them when they do. However, that is another paper altogether. But needless to say, the benefits of challenging the cult of narcissism would have far reaching positive outcomes.

I started with a point that what we know about groups was inspired by the need to treat the sufferers of the worst conflicts the world has known. Today, conflict – whist not as explicit as the wars of the 20th century – is waged in ideology and economics as much as conflict with weapons. As such, I believe the group is required to illustrate the processes that underpin the split positions that allows for such sadism, and at the same time acknowledges that, like then, there are many distressed people traumatised by those same processes. Groups are ideal to support and hold the most serious of traumas.

Michael Caton