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Norcross and Lambert have also helpfully summarised what it is about the therapy relationship that is ‘demonstrably effective’: the therapist-client alliance, collaboration, goal consensus, therapist empathy, positive regard and affirmation, and the recording of client progress data. 4
King’s College London is a partner in a large-scale data collection initiative across the higher education sector called SCORE (Student Counselling Outcomes Research and Evaluation), which is supported by both BACP and UKCP and is amassing and publishing outcomes data from several student counselling services. Turner’s professional experience is that outcome measures are a helpful addition to her work and to the higher and further education sector. For her, collecting and pooling outcome data are essential for individual professional development and the development and status of the profession. ‘Large datasets ensure counselling services are fit for purpose. The data can help services strategically align themselves better to student need and practitioners shape their interventions to make them more useful and viable. I think studies like PRaCTICED and ETHOS are a huge opportunity for practitioners to look outside their own clinical practice and maintain our professional development in the way key stakeholders expect us to. These studies offer evidence of our value as a specialist service and that what we are doing is valuable from a more externalised measure.’ For me and, I am guessing, for thousands of other practitioners, reading Yalom’s books provided a beacon of hope during the early years of training, promising that, at some point, all this hard work would pay off in the creation of human connections like no other. It seems that, at the age of (almost) 90, Yalom is still creating those connections. Don’t miss our extraordinary ‘Big interview’ this issue. So, what do these results mean for the counselling profession? Professor Michael Barkham, who led the PRaCTICED trial team at the University of Sheffield, says the levelling off in benefit from the PCET interventions by one-year follow-up suggests that practitioners need to examine how they can adapt their interventions to better equip people to cope in the long term. For Cooper, these findings highlight a need for the person-centred counselling profession – and that means most counsellors raised on Carl Rogers’ theories of personality change and the six ‘necessary and sufficient conditions’ – to re-examine their model of practice. ‘I think there needs to be a rethink around what school counselling looks like. For some clients, it may be of greater value if it delivers more direction, more structure and more skills around developing their [young people’s] coping abilities.’ What is it to step into the other’s world when they have lost their moorings? How can we be with this in our own bodies as counsellors and psychotherapists? Confronted by loss, carers and therapists can experience strong embodied counter/transferential feelings for the person with dementia. Butler is aware of this incorporation too: ‘I think I have lost “you” only to discover that “I” have gone missing as well.’ 17 How does the body of the other summon us to engage? It is the embodied relational engagement that sustains us in the living of everyday life. And, as Jonathan’s words vividly attest, relationships are made up of gesture, voices, spoken, soft, harsh, touch, skin, breath, embrace. As a helping profession, and as human beings, our instinct is to want to do something, which makes Anthea Kilminster’s article on providing culturally sensitive, trauma-informed counselling for displaced people, written before the recent events, seem all the more pertinent. She shares how the Yorkshire-based service, Solace, has supported displaced people from around the world, including Syria and Iraq. The thousands of people fleeing Ukraine will join the estimated 70 million already displaced worldwide, greater than the total population of the UK. A number will make their way to the UK, and counsellors like Anthea will be there to help them adjust.Jacobson agrees that the therapy platforms wouldn’t exist if therapy was easier to access. ‘I have been asked by friends in the past to recommend a therapist and, if it was not appropriate for them to come to a therapist at my clinic, I would do my own search in their geographical region, or for the specific issue that they or their child was needing help with. And what I have found is that it is very hard to sift through the practitioners and to get insight into their reputation. Another challenge was that often neither fees nor availability were displayed. It doesn’t surprise me that people can be easily discouraged in persisting in finding a therapist.’ Neimeyer R, Lee SA. Circumstances of the death and associated risk factors for severity and impairment of COVID-19 grief. Death Studies 2022; 46(1): 34–42. Brooker D. Person-centered dementia care: making services better. London: Jessica Kingsley Publishers; 2007.
She died a week later. The home had told me I could go and see her just for five minutes to say goodbye before she died and I donned all my own PPE – cagoule, waterproof trousers, goggles, dust mask – I didn’t want to use up the PPE at the care home. I think she knew I was in the room, but she was very heavily sedated. I just stood at a distance and spoke to her and said goodbye and came away. I didn’t touch her, I didn’t know if I could do that. And she died the following evening. I was told she wasn’t on her own when she died, which was some comfort. You must provide evidence that you have permission to use any written or visual material from a third party, such as extracts, pictures or diagrams. And the result is widespread anxiety and sadness. But, she stresses, ‘anxiety and sadness are normal reactions to abnormal situations – and we have had an abnormal situation for going on three years now. And the treatment for such sadness is human connection.’ Chatbots are providing ‘therapy’ to thousands of people around the world. Sally Brown learns what artificial intelligence can offer counselling. I Can’t Find Myself communicates all that is unspoken in the lived experience of dementia. It calls for our attention (and intention) in our relational and kinaesthetic engagement with people living with the illness. It is not about what we can do for people living with dementia; it is about how we can be with them.’The second response to I Can’t Find Myself is from Marina Rova, a dance movement psychotherapist based at East London NHS Foundation Trust, who has worked on an NHS continuing care dementia unit. Marina describes her own embodied resonance as a starting point for intersubjective relating: Meantime, the July issue offers rich reading, not least Phil Hills’ and Rachel Lawley’s description of how they, as newly qualified counsellors, set up and are now taking a specialist counselling service into schools to offer support to the teachers. It’s a story of head, heart and sheer business-mindedness that, as they say, has meant they can work to the values and principles that brought them into the profession. As is so often the case, alcohol progresses to harder substances. Drugs are a common part of the gay male scene and it is in this area that the problem most visibly manifests. In the past 20 years, the use of drugs such as cocaine, ecstasy and marijuana has evolved into far more dangerous substances, such as GHB, mephedrone and crystal meth, often in a sexual setting, which has contributed to an unseen public health crisis. The British crime survey 2013/14 showed that 33% of gay men had used illicit drugs in the previous six months, three times the rate of straight men and the highest rate of any group. 4 Over the past 10 years or so, there have been many high-profile cases of successful gay men either overdosing or taking their own lives or killing people while under the influence of drugs. These are extreme cases but not as uncommon as they should be. I know from my own private practice that these issues come up on a regular basis, and responding to them is not always straightforward. But it’s not an issue we can sidestep, given that, since the pandemic, a reported ‘record number’ of six million people have received antidepressant medication, 2 on top of an increase in antidepressant prescribing of 23.3% in 2019/20. 3 Dr Moncrieff argues that therapists have a key role to play in both educating clients about how antidepressants work and supporting those experiencing the effects of withdrawal. As a follow-up, I would highly recommend the comprehensive, easy-to-read guide, ‘Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs: Guidance for psychological therapists’, 4 produced by the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG for PDD) with funding from BACP, to which Dr Moncrieff has contributed.
And if there’s an uncomfortable silence? ‘I’ll explore that with them. I’m interested in why. But I carry some cards with me, and I’ll sometimes bring them out and we’ll just play a game if a young person is feeling particularly anxious or uncomfortable. It’s all part of building the relationship.’ It’s startling to read such a clear description of a phenomenon that is, arguably, besetting much of the Western world right now. We are seeing a greater prevalence of grief in extraordinarily grief-full times, and there is a growing realisation that maybe we need to come up with different ways to support those struggling with their grief, because current resources may not be enough. The knowledge gap seems to start with training. Therapist Josh Hogan says the ‘diversity’ module on his course was mainly focused on race and ethnicity. ‘We were asked to reflect on our differences and how this would affect us in the therapeutic relationship, but there was no specific guidance around working with LGBT clients,’ he says. Allegranti B, Silas J. Embodied signatures: a neurofeminist investigation of kinaesthetic intersubjectivity in capoeira. The Arts in Psychotherapy (forthcoming).
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Allegranti B, Wyatt J. Witnessing loss: a feminist material-discursive account. Qualitative Inquiry 2014; 20(4): 533–543. We are living in a time of grief – we are grieving not just the millions of deaths from COVID-19, but the loss of much that we previously thought we could take for granted. Despite all our medical breakthroughs and technologies, we have discovered we are not in control, and that a tiny virus can evade all our protective barriers and overwhelm us. We are grieving the loss of our assumptive worlds 1 – that is, the beliefs and values that grounded and secured us, that gave us confidence that we could keep ourselves and those we love safe. The root cause of these problems is trauma caused by shame. Many of us learn very early on that not conforming to gender expectations, let alone expressing our sexuality, is met with negativity, shame and sometimes even violence, from families, friends and wider society. For instance, I loved musicals and hated football – something that should not be a big deal but that attracted derision and bullying from those around me at school. When a child is told enough times that they are not OK, eventually they begin to believe and internalise it. And, of course, the stress of living in a prejudiced world as an adult can also take its toll.
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