Enforced therapy - part of the problem NOT part of the solution

I did something today that I have never done before – I went on a demonstration.  Since becoming a psychotherapist I seem to have found more of a political ideology, so when I heard about a protest against the DWP rolling out its scheme to integrate mental health therapy services within Job Centres, including that psychological support might be enforced for those unemployed people deemed to have mental health problems, and that they were piloting it on my doorstep, I felt compelled to attend.  

You might ask is why I feel so strongly about this issue, especially since many people might find that a dollop of psychological support would help them manage the emotional impact of struggling to find work in this current economic climate.  So let me get one thing straight – it’s not that I am against psychological support for people in need, far from it. But what really gets my goat is the possibility that it will be an enforced part of a person’s benefit assessment process, and that those who deign to say no to this ‘treatment’ might run the risk of having their benefits cut. The Guardian today (26/6/15) reported that the DWP do not want to do this, but there is still a high level of concern that this is exactly what will happen.  Most, if not all of the psychology, counselling and psychotherapy bodies have published statements expressing concern about this (see UKCP, BACP, BPS, BABCP and BPC), as have service user groups, but I want to share some of my personal thoughts on this important issue.

When I was at the demonstration, people had strong feelings towards those who work offering psychological treatment within this Job Centre.  I can empathise with the viewpoint of my fellow demonstrators, but I can't help but wonder whether these Job Centre staff members really understand what they have signed up to do.  If I hadn't learnt about the impact of trauma as part of my own psychotherapy training, I doubt I would have as clear a sense of how misinformed the idea is either.

Many of my clients have experienced severe trauma in their past – domestic violence, rape or sexual abuse, severe physical punishment in their childhoods, being sent to boarding school at a very young age, war, terrorism, racism, homophobia, bullying, witnessed horrific scenes of violence or trauma, perhaps having to leave their native country because of it, to name but a few examples.  Many of my clients also fit the criteria of the people the Job Centre scheme is designed to work with – people who have not worked for a considerable amount of time, often due in part to their mental health problems. I would wonder if there is no coincidence here, since I believe that people struggling to get to a physical or psychological place where they can look for work often live under the shadow of past or present trauma.

In her seminal book ‘Trauma and Recovery’ Judith Herman states that “no intervention that takes power away from the survivor can possibly foster her recovery” (p. 133).  And this is exactly what the DWP will be doing if they decide to force people to have CBT (or indeed any psychological treatment) in order to be eligible for the benefits they absolutely rely on to survive. They will be taking power away from them on every level.

And I have a further concern – that forcing a person into therapy, even a short number of sessions of CBT, will do harm in the future too.  If, at some point, that person decides to seek counselling or psychotherapy, but their experience of enforced therapy was unhelpful, they will be likely to have a lot of misgivings about re-entering therapy of any form, fearing perhaps that all counselling/therapy works like that.  That person will possibly feel that it was their fault this initial therapeutic help didn’t work, rather than it being a fault of the system.  And that's perhaps because feeling responsible is something people who have lived through trauma tend to do, as it is a way to feel some level of control about something that has felt utterly out of control.

Forcing people into therapy, no matter how well-meaninged this might be, doesn’t work. And it might just cause real harm. 

Reference: Herman, J.L. (1992). Trauma and Recovery: From Domestic Abuse to Political Terror. USA: Pandora books

New beginnings...

Spring is definitely in the air, and I am feeling a sense of anticipation and excitement as spring flowers begin to bloom and nature begins to wake up after a winter sleep. But I have other another reason to feel anticipation and excitement - I am about to start a new phase of my work as a psychotherapist. 

I am increasing the hours available for psychotherapy work, enabling me to work with more clients.  As a result, I have been looking for new rooms to work from, visiting different psychotherapy rooms in and around the centre of London, hoping to find the one that feels 'just right' for me and my work.  It struck me that there are several similarities between this process and the process of starting therapy - and I would like to share them with you.

Excitement mixed with anxiety (or is it dread?) - when we start something new such as therapy (either working as a therapist, or embarking on our own therapy), there is often a mixture of excitement and anxiety.  We can see a successful image of ourselves in our mind's eye, but at the same time we might have a nagging anxiety - "will it work out as I want it to?"  Of course, none of us have a crystal ball, so we can never be 100% sure new ventures will be a success.  But our past can act as a form of crystal ball in reverse -  our previous experiences can give us clues about what new ventures will be like.  Will they be exciting, coupled with a sense of 'can do' about our ability and chance of success, or will they be squashed by negative self-talk:  "It's bound not to work, after all, what have I ever done that is any good?"  Therapy is a wonderful opportunity to get to understand what has held us back in the past, whilst at the same time, building a new relationship - a relationship that can enable us to create new possibilities. 

Can I afford it? - In this day and age, with the financial insecurities life can throw at us, it is vital to carefully think about whether the financial outlay a commitment such as weekly (or more frequent) psychotherapy (or room hire) is affordable, manageable and a good investment.  Some people view psychotherapy as an "expensive luxury", with the money being better spent on a holiday or nice clothes.  But unlike a holiday or nice clothes, psychotherapy can enable us to make permanent changes in our outlook, relationships with others, and perhaps most importantly, our relationship with ourselves. Put it like that, can you afford NOT to begin psychotherapy?

How will I be greeted? - Finding a new venue to work from has meant a lot of travelling around London, as well as meeting the person due to show me the venue.  Since most of these people are new to me,  I want to make a good impression, especially if the person showing me around is the room's owner.  But given a not-so-hot sense of direction, in combination with the need to visit unfamiliar parts of London, I often find myself a little bit lost (as well as hot and bothered!) and end up arriving later than I hoped.  At such times I wonder how I will be greeted - with warmth and understanding, or with carefully concealed irritation and frustration.  

Starting therapy can bring up similar feelings of anxiety about how the therapist will greet us. Such anxieties can be compounded if, like me, you have struggled to find the venue. As a therapist and past therapy client myself, I understand how anxiety provoking that first step of making an initial appointment can feel, and how that anxiety might make anyone flounder - even people with a fantastic sense of direction! As a true believer of 'treat others as you would like to be treated yourself', I aim to offer warmth and understanding to every person who has the courage to ask for help via psychotherapy.   

First impressions really count! - As I visit different places I have become aware of the importance of first impressions. What does the environment feel like as I  walk through the door and move round the building? Does it feel comfortable? Do I feel at ease? There is plenty of research to show that we have a gut sense of whether something works for us or not, but we might struggle to listen to these feelings, tending to be swayed by logic, rationale and our own expectations or desires: for example, "I want this place/job to work, so I am going to try it, even though my heart is saying no".  Therapy is no different.  

We tend to know pretty much straight away if someone feels like a person we feel comfortable with, and want to get to know, and the same is true for psychotherapists.  So even if the photo looks like someone we feel we could really get on with, and it all seems to have gone well when we speak on the phone, if, when we meet, it doesn't feel right, then it's important to listen to this feeling.  However, being in the heat of the moment, I sometimes found myself agreeing to something, even when a big part of me is saying "NO!" This is one reason why I do an assessment over two (or more) sessions, so that both the prospective client and I can have some time to reflect on what it felt like to be in the room together, rather than rush into a commitment that perhaps, in hindsight, doesn't feel right.

Is there a shared ethos/belief system? - I have come to realise that choosing a venue from which to practice involves gaining a sense of the ethos of the place I am viewing.  Does it feel like a place where I can say hi to someone over the metaphorical/literal water-cooler and feel confident that there might be common ground about how we feel about the world (for instance), even if we work in completely different fields of work? 

At first sight, this might not feel that relevant to the world of therapy.  However, as I made my way through my own therapy journey, and then on into training to become a psychotherapist, I realised that there are as many different modalities of therapy as there are countries in the world (now I come to think of it, there are probably far less countries in the world than therapy modalities!).  When I first made my tentative steps into starting therapy I had no idea that there were different schools of therapy (such as CBT, psychodynamic, person-centred, and so on), let alone that there were different forms of psychoanalytic psychotherapy.  Although every therapy I have had has made a positive difference to me, some have made more difference than others.  And some have only been positive because they have made me realise what type of therapy I do not want to have, and what type of therapist I do not want to be!

As someone who really wants to change, you might not feel that bothered about how your therapist works, so long as the therapy itself works. But having a basic sense of the theory behind it can be a very helpful and help us avoid wasting time and money engaging in a treatment that just doesn't match our sense of how problems arise.   Worse, if we tend to 'hoover up' responsibility for something that doesn't work, we might get stuck in a therapy that isn't right for us, thinking that it is our fault it is not working. We might also then be put off trying a different type of therapy that better suits our situation.   

In brief, attachment theory places our earliest relationships at the heart of any predisposition to develop emotional (and some related physical) difficulties in later life.  The relationships between us and our carers in the first few years of a child's life help shape our brain as it develops - for good or ill.  As an attachment-based psychotherapist I see the relationship between client and therapist as the scene for the repair to the damage that happened so long ago.  Because this often happens before the child has a good vocabulary to describe their distress, putting words to the hurt can be difficult.  In therapy, the therapist and client carefully piece together the roots of the client's distress, via words, shared feelings or understanding relationship patterns that seem to repeat across the client's life.  If you would like to read more on this, take at look at my website www.helencordery.com, or the Bowlby Centre website (where I trained).   

And the outcome to my quest?  Well, after all my work to find a new from which to work, I have now decided to use rooms at Counselling King's Cross, and I will be working there on a Wednesday lunchtime from 4th March 2015.  If you fancy joining me for your own journey into attachment-based psychoanalytic psychotherapy with me, why not get in touch? I would love to hear from you!