'The views expressed are the views of the writer, not necessarily those of BACP. Publication does not imply endorsement of the writer's view'

I honestly do believe that psychologically, if GP's and other medical professions, especially the dieticians supply enough information on how the body's digestive track and the body's way of supplying the decisive nutrients into the blood stream, then, this may deter people who are obese to understand how their body's work. And the harm they are doing to themselves by eating fatty and above all sugary things which will inevitably result in type 1 and 2 diabetes and blood pressure.

I am not knocking the profession on their good work, but, looking at it from a psychological view, if you explain to people how the body works, then, they will understand it much better and the damage they are doing to themselves by eating bad foods.

Lastly, are we not complicating what we are telling the obese to eat. Let's go back to children's basics, and explain the Pyramid of good health. The bottom tier (vitamins) - Fruit and Vegetables, Second tier - (carbohydrates) potatoes, rice and brown bread. Third tier (protein) - meat, nut products such as peanuts, raisings etc. And lastly, what to avoid at the top of the tier - processed foods, crisps and sweets, sugary cakes and buns etc.

I am not a dietician, nor do I be tend to be, but, it is absolute common sense to go back to basics as what children are told what and what not to eat, and on how the body works in the anatomy of the abdomen.

I hope this article is useful, and I am sorry that I have not had the time to write much more.

Christopher Anthony Antoniou
Counselling Psychotherapist and Counselling Psychologist

I would like to write in support of Andy Rogers' letter (Therapy, December 2005) regarding statutory regulation.

I have a Diploma in Counselling from Exeter University and my counselling work has been primarily in the area of serious crime and domestic abuse. I was already into my fifties when I changed professions - from producing TV programmes on health issues to becoming a counsellor. I used capital savings to pay for the training, supervision, personal therapy and personal development and for many years worked as a volunteer bereavement and victims' counsellor. With only part of my expenses paid for by the voluntary agencies I started up a small private practice but few clients in the South West are able to afford private counselling.

Working to BACP ethical guidelines I was forced to withdraw from voluntary counselling as I could no longer afford to support the agencies, and they in turn preferred to refer clients to 'other' unspecified counselling services. I suspect this meant GP counsellors who are already working with long waiting lists and short term therapy – seldom appropriate for victims of violent crime.

In 2002/3 I sat on well funded Domestic Violence Forums where the main topic of debate was awareness training. In 2004 I battled with Victim Support over long-term support of victims by volunteers who were untrained in psychological therapies. My ideas for multi agency counselling strategies fell on deaf ears. By 2005 I reluctantly decided to withdraw from counselling for a year while I concentrated on alternative business interests in order to pay the bills.

I have the necessary training and supervision hours, counselling practice and personal development hours if I wished to apply for accreditation. My year's absence from counselling work would I understand prevent me from applying in the near future but most importantly I am resistant to the idea because I know that regulation would not make me 'a better counsellor'. My training was very specific regarding self regulation and ethical practice. Accreditation would make not one iota of difference to that. In fact I believe it could be detrimental.

I believe my life experience and independence help me empathise more with clients not less. While we suffer a frightening level of mental illness in this country the Government remain obsessed with regulation rather than focussing their efforts on improvements to mental health provision that utilises both the state and private sector.

Meanwhile my clients are falling through an ever widening net. With minimal counselling skills Police Family Liaison Officers and Victim Support volunteers are struggling to combine acute response with long term psychological support. NHS counsellors and CPNs are using short term therapy where (in my opinion) it is inappropriate. Meanwhile a few wealthy clients in the inner cities are benefiting from private psychotherapy or well funded trauma services. There has to be a middle way that serves the whole country not just the lucky few.

What we need are independent counselling agencies supported by both State and private sponsorship. What we do not need is a Government imposed regulatory authority that dictates how psychological therapies should be practiced and continues year on year to move the goal posts on criteria.

Carol Jones
Counsellor

I went to boarding school aged 15, a mixed experience 25 years ago. The decision to send my 13 year old daughter to board wasn't taken lightly or quickly and ultimately rested with her, as does the decision to continue going. My mother's life was fundamentally damaged by being sent to boarding school aged 4.

Not every parent who sends their child boarding is 'delegating parenthood' as Nick Duffell suggests. I presume that he's also against nurseries, child minders and working parents. By sending my daughter to board in the countryside she now has access to a life that I can't offer her on an estate in inner city London. (Not all parents of boarders are rich. The forces paid for me to board and my daughter has a full scholarship.) Our relationship is now more loving and appreciative and she has freedoms simply not available to her here, not least to mix with boys and girls of all backgrounds - hers is one of 35 state boarding schools - under the watchful and caring eyes of many adults.

Boarding has been a shattering experience for some children. It's less likely to be damaging now because of legislation and social changes but still, some children, particularly younger ones, will be harmed. Some children will be harmed by their experience in day schools, by their experience of living with two or one or no parents, by their experiences in their privileged or underprivileged neighbourhoods, by experiences of poverty, by life.

It's proper and good that support groups exist for children who have an abusive experience of boarding, but I feel concern at the level of vitriol and blanket accusation used by the organisers of these groups. There is certainly a debate to be had, perhaps most urgently on the unheard voices of children which is the real problem in any case of child abuse. Is there a debate to be had about the level of child abuse in the family vs that at boarding school? I doubt we'll ever know the vehemence and fixed views of those who say they support children abused by boarding seem unable to accept any experience or opinion that doesn't concur with their own.

Clare Slaney

I am writing in response to Penny Gray's interview of Terry Lynch 'Beyond the Medical Model', December 2005.

It was very encouraging and reassuring to know that Mr. Lynch is willing to recognise and challenge the limitations of the medical model. What made it more poignant was the fact that Mr. Lynch has worked as a GP.

Having worked as a Health Visitor and most recently a Therapist in a Child & family Unit I am very familiar with the very strong influence of the medical model and agree that this is often fuelled by pharmaceutical companies who are able to invest huge amounts of money into research and clinical trials.

During my time working as a Therapist in a Child & family Unit, my colleagues and I developed The Alert Programme for children and parents where Attention Deficit Hyperactivity Disorder (ADHD) was an issue. This was a pilot that explored sensory integration issues for the youngsters and parent training for mums and dads. Whilst some of the youngsters were on medication the additional benefits of this intensive programme were clear to see.

Helping the youngsters to 'self-regulate' and recognise when they were 'too high' or 'too low' was key to their day-to-day management. Their parents also found the support from each other a tremendous help and they are now actively seeking to set up a regular support group. Our Consultant Child & Adolescent Psychiatrist was an enthusiastic supporter of the programme, making regular referrals to the team, although our capacity soon outweighed the demand! The group was extremely cost-effective in terms of intervention and outcome. However, the cost for running the group - around £60- (for venue, refreshments, flip chart etc.) was queried by the NHS Foundation Trust! I somewhat doubt if the invoice would have been scrutinised had it been a prescription for medication.

I have long believed in the merits of the social model working in conjunction with a medical model. It is not easy to stand up and be counted as the medical hegemony is very powerful. I would like to thank Terry Lynch for speaking out. It is surely a synthesis of both the medical and social model that is the way forward.

As Mr. Lynch so succinctly points out, if we do not embrace this then our concept of 'selfhood' will diminish and this would be a tragedy for those who believe in the resilience and potential of the human race.

Donna Carlyle
Counsellor, BACP Member

Thank goodness that there is at least one GP out there who recognises that the medical model is not always the answer in helping people with mental health problems (therapy today, Dec 2005). I was uplifted and inspired by the article written by the GP turned psychotherapist, Terry Lynch, who has found that his patients require more than prescribed drugs in order to lift themselves out of the depths of depression or deal with other mental health problems such as bi-polar and schizophrenia.

As a counsellor working with clients who are initially referred for substance misuse problems, I am becoming increasingly frustrated by the limitations of the medical model in helping them cope with their emotional and/or psychological problems. Having previously been prescribed sleeping tablets, anti-depressants, anti-psychotic drugs and other "less harmful" substances by either their GP or a psychiatrist in the past (usually without much of an idea of why they were being prescribed – the label of borderline personality disorder seemed to be the nearest to any sort of diagnosis), many clients feel that their needs are still not being met and more often than not, their health is worse from the terrible side effects of the drugs. If they stop taking the medication, they are told that there is no further help available other than counselling for their drug or drink problem. Other forms of treatment such as cognitive behavioural therapy, psychotherapy, alternative or complementary therapies are not options usually suggested or made available by medical practitioners and many of these clients continue to self medicate with drink or various illicit substances. Labelled as "dual diagnosis" (clients with substance misuse and mental health problems), they usually end up going from one treatment service to another like yoyos with no clear care co-ordination.

Tragically, some people find drastic solutions to their problems and I recently attended the funeral of a client of mine who suffered from bi-polar and been "in and around the system" for years. He believed that the various medications he received made him feel worse and would occasionally stop using them for some respite. Once they were out of his system he began to feel better in himself, he lost weight, stopped sweating and began to feel more confident. The last time I saw him his anxiety had subsided and he was enjoying interacting with other people.

With the help of counselling and complementary therapies, he had stopped drinking heavily. Unfortunately because of his mental illness (bi-polar), this period of "normality" was short-lived and I later heard he had gone back into hospital, started another phase of medication and the cycle started all over again. Two or three months later, he took matters into his own hands and those of us who had contact with him were left wondering whether things could have been different if he had received more specialist care in terms of his mental health needs. The sad thing is that there are so many more people who have had similar experiences of the mental health system i.e. being fobbed off with medication that does not seem to make them feel any better and often makes them feel worse. We need more GP's like Terry Lynch who can think outside the box and beyond the medical model.

Damaris Perry
Counsellor / Health Worker

The letter from Andy Rogers regarding 'Regulation Reality' (December) raised some important points but still left me with a sense of unease. The present laissez faire situation allows for anyone to present themselves to potential clients as a counsellor or therapist irrespective of training undertaken or the general level of competency attained. That must means that vulnerable people can unknowingly find themselves at risk.

Regulation will not provide a complete safeguard but it would present some protection to clients. The alternative is to continue to leave clients who may be a risk to find their own way, unaided through a confusing landscape of services and providers. My personal view is that this is unfair and clients deserve better.

I can understand the preference for self regulation but this will only work if there is universal acceptance of standards and ethics by all who call themselves counsellors and this seems at best unlikely. And self regulation without enforcement is no regulation at all.

Of course statutory regulation would be imperfect. It could however serve to enhance the professional status of the committed counsellor in the eyes of what can sometimes be a sceptical and wary public. By deciding to join in with the process of developing a regulatory framework, we can at least try to influence the outcome and ensure that whatever is adopted is in the interest of both the client and the counsellor rather than the bureaucrat.

There is of course an alternative. We can stand with hand outstretched and order the regulatory waves to stay back. I can understand the possible attraction of that approach for some but I am not sure that it is the right way forward for this age and time – or for the client.

Geoff Boutle

I would like to comment on the articles on eating disorders featured in October 2005 issue of therapy today (Vol 16, No 8).

Whilst I found the authors' comments interesting, I was a little surprised to find that there was no mention of significant research which has been done in this area as reflected in guidelines from the Department of Health (2001) and National Institute for Clinical Excellence (NICE 2004a,b). Whilst it is certainly good to reflect on different approaches and experiential issues, it does seem rather perverse to virtually ignore national recommendations. Anorexia and Bulimia Nervosa are very serious conditions with potentially life threatening consequences and therefore need to be treated by well qualified practitioners with specialist training and certification in areas such as CBT. My own experience is that some practitioners are adopting CBT methods but do not have the specialist training to achieve effective outcomes and may even do harm. I believe that these articles, although stimulating, should have at least mentioned the above issues for reasons of safety, given that your journal may well be read by trainees and members of the public, as well as qualified counsellors and psychotherapists.K R Jones

DoH (2001) Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guideline, London: Department of Health Publications.

NICE (2004a) Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, CG09, January, British Psychological Society and Gaskell.

NICE (2004b) Eating disorders: Anorexia Nervosa, Bulimia Nervosa and related eating disorders (Understanding NICE guidance: a guide for people with eating disorders, their advocates and carers and the public), January, London: National Institute for Health and Clinical Excellence.

Here here! to Lesley Sorrell's letter (November) "A rose by any other name?" I too was at a loss to wonder what had happened to our professional journal when September's therapy today popped through my letterbox.

I pride myself in reading the CPJ from cover to cover most months yet I do not remember there being any debate or mention of the possibility of changing the CPJ to a therapy today magazine complete with crossword! You say in the September editorial that the new name won the vote but who, please tell me, has voted and how? Surely such a fundamental change to the nature of OUR journal deserved at least a balloting of all the members and some kind of prior debate - otherwise it looks like a case of the tail wagging the dog.

Like Lesley, I too would like to know what the rationale was behind this change and how this vote took place.

Lynne Kendall MBACP

I have recently re-read the letters posted in the BACP journal/web-site about 'Reporting on Sanctions'. As the subject of a complaint which was upheld and received major coverage in the October 2003 Journal, I am concerned that your members may have missed the small box in the June 2005 edition announcing that I have complied with the sanction requirement.

Iylana Vanzant in her book 'Yesterday I cried' wrote, "Healing in public is an awesome task that requires you to lovingly point out the defects of others while you are healing your own". My defects were certainly pointed out and I had not been informed about the pending introduction of full reporting of decisions arising out of adjudication.

The classification 'Private and Confidential' that had accompanied every piece of correspondence to me applied only until I was found guilty. This then abruptly changed in what Grainne Griffin called "a trend toward transparency" (August 2004). Her suggestion that such reporting should be viewed as having a "more educative function" leaves open the use and abuse of live material. For instance, the information about me, reported in the Journal, was posted on student notice boards and used for teaching purposes. Students experienced it as a source of fear, namely, "this is what could happen to you if you make a mistake". I wonder if I will ever receive an invitation from a provider of counselling courses to offer a valuable contribution on the 'learning outcomes' of the imposed sanction rather than subjecting students to what can only be described as a 'knee jerk' reaction that leaves us all impoverished?

Organisations and individuals sent me copies of the report underlined in red ink from an unnamed source. Whilst I appreciate that BACP is a regulatory body, I wonder if it has ever considered the need to regulate those within the profession who take it upon themselves to police its adjudications and actively seek further punishment on top of what has already been a bloody chastisement?

I appeal to those in our profession who, as Grainne reported, were "frustrated at not knowing the details behind decisions of adjudication". Please give some thought and consideration to the ordeal of those like myself, who struggled to maintain their practice throughout a lengthy period of investigation, living through the devastation of the complaint being upheld and then undergoing further exposure exacerbated by full reporting in the Journal. Remember that through all this I was expected to continue to practice in order to fulfil the sanction or find my self boxed under "Membership Terminated"! The reported details of any case in the Journal are but a fragment of the whole and need to be viewed in this light. It was from a profound duty of care for myself that I needed to disentangle the many allegations that arose from this kind of reporting from what was actually factually correct.

I can certainly resonate with much of what Marilyn Edmondson put forward in her letter (August 2004) "that the mental anguish involved in tolerating the psychological harm of the increased exposure will be immense". Fitness to practice was a real issue for me during the many months that followed the publication and meeting the sanction. I had to present reports which far outweighed the original criteria for Accreditation. The work involved in 'reflective practice' for some reports amounted to more than 10,000 words. [Ed: no sanction ever dictates a word length. It is a matter for the practitioner concerned to decide.]

My ability to practice competently was only one part of the process to of meeting the sanction. During the two years, I created a 50 foot walking labyrinth which served as a metaphor for attending to the rebuilding of my identity and self-confidence. My persona of being a 'good counsellor' has certainly gone through the refiner's fire. I am now standing on ground within me that is solid, strong and boundaried. I have learned that I cannot bless what I cannot transform and, as gruesome has this process has been, I can resonate with the author Judith Duerk, who writes, "A woman's perception of her own suffering undergoes a profound healing. What had been the source of greatest shame slowly reveals itself to her as the seed of her truest gift, her pearl of greatest price, grown from her gravest flaw". This process helped me uncover my gravest flaw, "the fear of getting it wrong".

So, whilst this letter highlights my grievances over the procedural aspects of having a complaint upheld, I can say that I also have a deep sense of gratitude. Compassion is a gift that I have found in abundance through the experience. Firstly, in the face of so much judgement real or imagined I have fostered a depth for self-compassion and self-forgiveness not known to me before.

Secondly, we cannot always be right and it has been healing for me to discover the pearls of wisdom that lie in getting it wrong. There are always lessons to be learned and this is one that was shape-changing from the core of me. It is hard to see what text book I could have learned it from and I have come to accept that some lessons are only found in the very fabric of the human relationship and living them as consciously as we know how to.

Lastly, I believe that there are some fundamental principles missing in the current Ethical Framework with regard to complaints against members.

Principles such as:

(i) The extent of the 'guilt' should never be amplified beyond what actually happened.

(ii) We counsellors should support one another in improving our standards of practice, not exclude or condemn individuals.

My hope is that this letter will have given the reader some insight into the journey of a member living through a complaint being upheld; that it will continue to stimulate reflection towards best practice; that the membership will continue to openly discuss and dialogue with BACP to foster a climate whereby integrity and respect is central in all our dealings both within the therapeutic relationship and the organisational membership.

Maranú Gascoigne MBACP (Accred)
maranu@btinternet.com

A note in therapy today (Nov p50) tells us that an Association of Independent Practitioners has replaced what was originally the PSMF (Personal, Sexual, Marital and Family) Division. The name was changed later to PRG (Personal Relationship Group) but it is incorrect to state that the name of the Division has been changed many times. It is also incorrect to claim that what has happened now is simply a change of name.

A note in the journal in September (p54) describes the Division as being for 'individual counsellors who are working independently rather than organisationally'. Thus a Division for the many counsellors who work in organisations providing counselling on sexual issues, marital issues or family issues (we could also add bereavement workers) seems to have been abolished.

The current issue of the journal tells us that 'those who work in very specialised areas' who are not sure of their 'professional direction' may like to join. This would seem to exclude those who want to share work experiences and to learn from others in a supportive environment whilst remaining working, often (but not always) as volunteers, in the organisation or agency they have chosen to serve.

The list of Divisions presented to new members of BACP will now include AIP 'which is really the Division for those working independently'.

I am sorry that BACP has taken this step, not simply changing the name of the Division but totally changing its nature and purpose.

Mary Godden
Founding Chair, PSMF Division

I started to read Gertrud Mander's article on counselling the bereaved (Bereavement Talk, therapy today, November 2005) with interest, but by the time I'd finished it I felt rather dismayed.

As a person-centred counsellor working with bereaved people, I felt heartened by her reference to grieving as a natural process which is the consequence of investing emotion and affection in another and her statements that "Everybody's experience of bereavement is different…" and that there are "…as many different individual reactions to bereavement as there are bereaved persons"; such statements together seemed to imply a respect for and valuing of individual experience of bereavement. I was therefore troubled to read statements alongside these and elsewhere in her article, regarding the individual experiencing of particular clients, which I felt were patronising, very judgemental and even contemptuous.

Referring to one former client, for example, she states, "When I first met her she was clearly on the brink of madness…", and later on, "her hysteria and the incomplete mourning for her husband morphed into bottomless self-pity…" (my emphases). In my view, such statements and language, far from saying anything about the client, serve to highlight the counsellor's/writer's own highly judgemental attitudes – a lack of empathy and genuine respect towards her client and her experiencing: in fact, I would say Gertrud clearly objectifies, pathologises and judges the client and her experiencing here!

Later on in the article, referring this time to working with bereaved people generally, she states "Another danger is erosion of sympathy, as the counsellor's sensitivity can become blunted when they are exposed to too many variations of one theme. And when the client's complaints go on for a very long time – as they did for a full year in a case of mine of a client bereaved by her husband's unexpected suicide by hanging. It is very difficult to keep one's interest alive and to remain patient", (all my emphases). I find the language she uses here offensive and again patronising – indeed, I read this passage with a degree of shock followed by anger. To me, her use of the phrase 'variations of one theme' and her reference to her client's communications of her experiencing as complaints, especially in the circumstances of such a traumatising loss, beggar belief – in fact, I had to read this passage more than once to ensure that I'd read it correctly. I'm aware that my reaction here was partly personal in that I myself have been bereaved through sudden suicide, also by hanging – it was therefore as a client as well as a counsellor working with bereaved people that I found this passage shockingly insensitive. (The writer's sensitivity definitely seems to have been blunted here!). It made me wonder who the writer thinks might be reading her articles – some kind of cosy closed-off world of counsellors untouched by such (or similar) traumatising life experiences? For what comes across to me on reading certain passages such as this is a kind of them and us attitude. In this respect, I also found the editorial by-line for the article, with its reference to the pitfalls of counselling the bereaved (my emphasis), similarly objectifying and disrespectful towards bereaved people and what they may be experiencing (as opposed to what some counsellors might experience while working with them); I'm quite happy to risk being pedantic and say that I would have been more comfortable with something like 'the challenges for counsellors working with…' (I'll leave the reader to fill in the blanks!).

Gertrud also seems to think that a year is a long time for what she calls her client's complaints to have persisted. When it comes to my own personal experience of grieving my own loss through suicide I can say now that a year was a mere drop in the ocean – due to many different factors and the specific circumstances of my unique loss. I'm also aware that this can be the case for any bereaved person regardless of the manner of death. (If it feels like a long time to the counsellor, how might it be for the client who's living this experience?)

As regards the need for the counsellor to remain patient; if I ever felt I needed to be patient with a client, then this would be saying something about me, not the client and as such it would be something for me to own and to explore further. In other words, this is the kind of statement which again I feel is saying something about the counsellor rather than the client. Perhaps it's just the unfortunate wording here but it also seems to me that if any counsellor requires to remain patient (which suggest to me that they are waiting for something to occur) they are not really with their client, alongside them in their frame of reference: in other words, it suggests a lack of empathy and the other core conditions, that is a genuine depth of empathy towards their client – empathy as a way of being, not empathic skill and certainly not sympathy.

At times Gertrud also made what I consider to be sweeping unsubstantiated assertions and I want to respond to one of these in particular. She states that, "Commonly the bereaved are helped by their support system of family and friends. But not everybody is able to allow the mourning process to take its natural course towards acceptance". In my experience, many people do not have such support systems. I am aware that even where people do have family and friends around them, many clients don't experience families and friends as supportive other than perhaps initially following the bereavement – the physical presence of family and friends in their lives does not necessarily mean clients have support, or that they are getting or will get the support they need (whether emotional and/or practical support, etc). I would therefore dispute her assertion here. What really bothers me about this passage however is that she seems to infer that if people are not helped by supposedly having this support, it is because they as individuals are not able to allow the mourning process to take its natural course. In other words, the client's difficulties are entirely individualised: her generalisation here seems to ignore or even deny the social, economic and cultural contexts in which an individual lives which may have some, if not significant, bearing on their experience of loss: the social and cultural dimensions of their loss. Gertrud alludes to internal factors which can influence a person's grieving process, such as dynamics particular to their personality, the relationship they had with the dead person, the client's spiritual beliefs if they have any, etc but she makes no mention of external factors which can contribute to a client's difficulties and grieving process. In my experience these commonly include inadequate emotional support: it can understandably be very difficult for grieving relatives to support the client to the degree that s/he needs due to having to cope with their own losses and grieving; clients can also feel very isolated in their grieving due to their experience of others' (friends, colleagues, neighbours, etc) expectations around mourning and grieving, for example that the client should no longer be feeling and acting certain ways after a specific period of time following their bereavement. The theoretical model of grief Freud outlined in Mourning and Melancholia, or at least others' representations of this (my understanding is that he never actually applied this theory to instances of grief following a major bereavement), seems to have helped to create a culture of expectations around grieving and mourning in wider (Western) society which it seems to me, just adds to some bereaved people's difficulties.

Other examples of external factors which can impact on a person's experience of their loss/grieving process include an ongoing lack of practical support (eg with looking after children when a partner/parent has died); the absence, or quality of other relationships in the bereaved person's day-to-day life; poverty precipitated or exacerbated by the bereavement resulting in the client being caught in the poverty trap; the disenfranchisement of the person's grief due to (the significance of) their loss not being acknowledged by others (eg due to prejudice such as homophobia).

It's my experience that there are many different such circumstances and factors which may impact on or further complicate or exacerbate a person's grieving process and which may contribute to their 'stuckness' and as a counsellor it's important for me to be aware of social, cultural and economic realities outwith the counselling space that may be impacting on the individual client and their experiencing of their loss.

It's even more important for me to try to be aware of the possible factors within myself and the therapeutic relationship which may be impacting on my client's process: this includes any need or fear of my own which could undermine my ability to be unconditional and genuinely empathic and open towards my client. Gertrud alludes to one of the possible factors in this respect namely the counsellor's own fears around death. I would suggest that there are many other possible needs, fears, prejudices, etc any counsellor may have which could get in the way and contribute to stuckness in the client's process, and I would include in this a counsellor's expectation that their client should conform to or fit particular models of grief or indeed therapy. I feel it's vital that any counsellor is able to recognise theoretical models as just that in order not to impose their own expectations around these on the client (especially as there seem to be enough expectations regarding grieving outwith the counselling room!)

As regards Freud's and others theoretical models of grief, there's a growing body of research and other literature questioning whether such things as acceptance and letting go (however these may be defined) are a natural or necessary part of grieving for every person or every loss, and my own personal experience and my experience as a counsellor certainly support such questioning; both also support my fundamental belief that true respect for the bereaved individual involves being open to learning from them what is true and important for them in their individual process and in the face of their unique loss.

Mora Maclean

The Article How fair is fair (June? CPJ) and Is BACP lobbying (October, therapy today) made me feel deeply worried and disvalued as a trainee counsellor.

I think BACP as counsellor's professional body has the responsibility to support and protect counsellors as well as the public.

It seems unfair that all the professionals have different scales of payment not only as qualified practitioners but also in some cases throughout their training (in medical training a house officer is getting paid but no where near a consultant).

I wonder why qualified or newly trained counsellors should not be entitled to some sort of payment regulated and implemented by BACP. We need to be recognised and valued as any other professionals and that is not possible without BACP's support.

Nazanin Ghodrati
Second year diploma student

I write in response to letters from Nigel Rickard and Nick Duffel (Dec issue). Although an experienced therapist myself, I write from a personal perspective.

Rickard holds the notion that 'a decision for a child to board is seldom successful if the child itself is not happy with boarding'. The child, in my view, has a right to the truth and this statement neatly sums up the level of denial of what children have the right to expect. Duffel says 'a child belongs in a home'.

The child in me is outraged – 'why did no-one tell me at 9 years old, that a child belongs in a home?' I was the child of my parents' values and had no point of reference upon which to question whether what I wanted was differed from what my parents' best efforts, told them I needed. They had also been 'sent away' and at a much earlier age. Their trauma remains locked deep down because their whole social structure, beliefs and identity would be called into question. Institutional and establishment values would falter and topple and who would be there to pick up the pieces?

Their child is the one who takes care of them. She will not question them because her life depends on their acceptance. Of course she will find a way to fulfil their needs, whatever the cost. She does not feel sad or angry, she doesn't miss her family. She wets her bed but never cries, because there are others worse off than her. There are always others to feel sorry for. She soaks up the belief that she is privileged and can never pay back what she owes. No amount of charitable concern is ever going to satisfy her need to expurgate her guilt. But it does keep her busy and it helps prop up the system, which persists in failing to tell children that if they want to grow up in their own home with their parents and siblings, and there are no dangers in doing this, then they have that right.

It has taken me many years of personal therapy to uncover the truth in myself that I have denied, ridiculed, and projected. My body can feel things now which all my life I've repressed. I am for ever indebted to friends and colleagues, who have held up the mirror and said 'no, that's not normal'. Eventually I had to look in the mirror myself and stop arguing white was black. This particular 'good, clever, responsible' child didn't want to know she was abandoned with her despair.

To return to the rights of the child, I think it is an altogether different experience for the child who's parents are able to be emotionally open about their own feelings and to allow the child full and contained expression of theirs. For families in certain situations, boarding offers a compromise solution. I argue that the extent of that compromise needs to be fully acknowledged and parents need to be given the information on which to base their judgements. The truth about the psychological damage to many, as a result of their boarding experience is fiercely denied in our society and those which have shared values.

Extreme eccentricity, bizarre behaviours, addictions and self-destructive patterns are accommodated in the British upper classes and tolerated by those who feel powerless or do not care. The anti-social behaviours Nigel Rickard refers to are where we chose to point the political finger. Why, because the sickness in the dominant and successful classes is going unchallenged and unmet. Ex-boarders need society's permission to step out from the shadow of shame and to be told that someone understands and help is available. It's time to come clean with the emperor about his fine set of clothes.

How very eco-lush TT seems to have become over the past recent editions. Tales of body/mind splits beings welded back together (I can feel the healing) leave me feeling, ironically, a little torn. Oh, who am I kidding? I always feel 'torn'.

On the one hand it's nice: oh yes, indeed, there is life beyond the therapy room. But also some deep dark feelings of guilt and inadequacy creep into my bones as I remain, my bum planted firmly on chair with clients in same mode, exercising only the muscles of my jaw and conscience. Just when I thought I had escaped the clutches of my (over punitive) internal supervisor – he's back. And yes, definitely a 'he'. And he's wagging a finger at me right now as I type nagging at me to "grab it, go on, seize the moment, take your clients by the hand and dance round the garden; smell those flowers".

Tut, tut. My own invitations to nature have been rather less manifestly successful. Having a therapy room at home which backs onto the garden and has two glass walls has at times been a delight. Clients in the throws of despair stopping mid-sentence to say "ooooh, look, it's a robin" has been an interesting demonstration in moment-to-moment experiencing. Encouraged by early success I hung 'fat balls' outside the patio door to further encourage my feathered "thera-pals". Far better than me, apparently, they had been successful in at least momentarily extricating clients from their internal despair to delight in simple, uncomplicated, barefaced life and survival. (I hear the 'Jungle Book' calling – "look for the bare necessities, the simple bare necessities, forget about your worries and your woes.")

How much better when my feathered delights were joined by squirrels that dangled themselves full length upside down, bellies revealed, from the trellis to get at the food. Unlike the timid birds they were apparently quite oblivious to the curiosity and scrutiny of my clients; in fact, at times I wasn't sure who was scrutinising whom.

The birds and the squirrels were shortly joined by the tiny brown mice – at first feeding on the crumbs that fell off the bird feeder onto the ground, but then they too discovered the nutrition highway of over the trellis, down the trellis, down the wire and into the feeder so that the fat balls were joined by furry balls who sat and munched and blinked and twitched. I was a little more wary of this new addition knowing that some of my clients may react adversely to the beady-eyed rodent variety of wildlife now also peering in through the glass. But no, delight again. I must confess as the variety and quantity of small hairy/feathered critters accumulated and some rather hectic feeding bonanza's dominated my sessions it did occur to me that I really ought to try and drag my clients back to their issues. How ironic that felt, I cannot tell you.

This tale of nature's abundance does not have a happy ending and I guess some of you have already sussed that one. I, too, should have known better (ah, the wonderful aroma of freshly baked hindsight). Encounters with wild things have rarely gone my way. The family's first adventure into pet ownership was a rabbit which my young son decided needed liberating from its cage early one morning. It never made it back although I lost at least a stone over the next few months attempting to put it back: Paula Radcliffe darling, move out of my way I'm coming through. No, instead it terrorised the neighbourhood over a surprisingly large area for the next 12 months: made unscheduled visits to surrounding houses to - a. eat the insulation off any stray electric wires

b. surprise many people by guest appearances in any/all rooms of their houses: notably including one elderly neighbour, dosed up to the eyeballs with drugs after having pneumonia who felt 'much better' until he saw what he thought was his black cat at the bottom of the stairs, only it had long pointy ears. He turned right round and went back to bed, apparently.

c. eat all of their precious flowers (of course)

d. attempt to mate with their cats (this took most people by surprise and the cats weren't that impressed either)

No, no. Nature does not, in my experience, much care for the idea of containment and romantic notions of mine about scoring therapeutic lessons off the back of something so uncontainable were mistaken and ended rather rudely, largely speaking for the mice, but maybe not exclusively so as the story, I rather fear, has not yet culminated.

War ensued as the mice decided to 'come on in' and spread the good feelings to my lounge, hall, bedrooms etc. Christmas was spent in the company of a small hoard of them particularly appreciating the After Eight mints my youngest son had spread liberally over his bedroom floor. Thrown to the wind surprisingly rapidly were any ideas of congruence: clearly mice were cute and adorable outside my patio doors, inside they quickly became dirty and intolerable. I turned from abundant giver of life to The Annihilator (more honestly I passed that task onto willing partner but was doubtless guilty by association).

It's been war since then. This week, I sat in a session with a client who was (attempting) a quiet reflective moment to the unmistakeable sound of a mouse eating something presumably rather important like wiring/floorboards/ insulation in the floorboards above us and, as far as I know, doing a little tap dance to boot. I sat wondering whether it was likely to fall out of the ceiling or, per chance, had a friend who would shortly be making a bee-line for my client's feet. My thoughts drifted on to professional indemnity insurance and whether they had had a claim before from a client who was suing for mouse-induced trauma. Oh, the disgrace of it all. How come this was never mentioned in the textbooks under 'therapeutic environment' (…."the therapist should be aware of the possible encroachment of mice into the client's space....")? And, oh, the torment of 'what to do if mouse makes appearance' mental debate. Should I hit it over the head with my shoe? Hmm, that didn't feel good. Should I look pleased to see it? Hmm, not very unconditional. Or, and this one entertained me for a while, should I pretend not to have seen it at all? Clearly, each of these options were considered with due respect to the particular presentation of the client I was with at this juncture. As you've undoubtedly noticed, it was pretty hard to give my client any real attention at all other than in the fantasy state of 'mouse meets client mode' I had fallen into. I think, however, that this fantasy may have some mileage to consider in supervision as possibly presenting a new way of thinking about my clients. But sorry, I am, once again getting totally distracted.

I try to be encouraging to the little creatures, but they go one step too far. I think my clients also find me fairly 'permissive' but I can't help wondering, if not fretting, about what they would make of all this wonton slaughtering that has gone on behind their backs. The words from Kaye Richards and Jenny Peel's article ("Outdoor Cure" therapy today December 2005) haunt me now: "Clients see clearly the ways in which the existential givens of nature comment explicitly and unequivocally on the existential givens of life". As I free fall into melodramatic interpretations I think 'Oh yes, yes, they will see that, should they step out of line I may either annihilate them or castrate them' (rabbits fate). I shall have cause to consider any dreams they bring to the sessions of seemingly wondrous and giving mothers which switch to nightmares as mother turns to hideous murderous zombie pursuing them down dark corridors. Perhaps they would provide proof of the power of unconscious communication. More likely explanations include my over-active imagination and even more likely my very guilty conscience.

The worst my clients, hopefully, have to fear from me is that they may be pursued by mice but as always, as therapist, I am relentlessly pursued mostly by my own demons.

Suzanne McCall

Reference: Peel, Jenny and Richards, Kaye 2005 "Outdoor Cure". therapy today, Vol 16, No 10

BBC TV, in its programme on Stepfamilies, has sadly, continued the misinformation about counselling. By introducing Susan Hayman as a counsellor the BBC conveyed the impression that counselling is about diagnosing people, telling people what to do and even providing holidays in the countryside. None of this is counselling.

Stepfamilies is, like Channel Four's Supernanny, the teaching of life skills, in order to meet a specific expert-defined problem. It contains good ideas and some inspiration for families at the end of their tether. But it showed an outsider taking the role of expert, telling the family what their problems were, then telling them what to do about them - and that is not counselling.

As a counsellor myself I support people in clarifying for themselves what they feel the problem is and then in deciding for themselves, what they want to do about it. In this way individuals become empowered, become more understanding of themselves and others and able to decide on a solution which fits with who they as unique individuals are. And because they have solved their own problem, they are empowered and better able to face future life problems.

To reframe an old saying: if you give someone a fish you feed him for a day; if you help him to fish for himself you help him to feed himself in the future.

Richard Leah It's official: CBT is taking over the world! Not only has it co-opted the ancient practice of meditation by slapping a new name on it and congratulating itself on such an exciting development – trampling the small, but fundamental, inconsistency of 'not going for change' (p.6, November 2005) under its feet in the relentless march to dominance – but I also see, in my new (horribly named) therapy today that CBT is the answer to panic disorder (p.13), that all children should be offered it (p.14), that it helps children and adolescents develop coping skills (p.15) and that it is the first line treatment for chronic pain (p.22). Other approaches are mentioned only in passing or with thinly veiled contempt as either out of date ("The importance of CBT training", p.26) or ineffective ("Off Site", p.28).

As any first year psychology undergraduate groaning their way through endless statistics classes will tell you, the core ethos of CBT is one of measurement and change, while other therapeutic approaches focus on relationship and experiencing. We should not mistake the sheer quantity of data generated by CBT, meshed with a cultural fascination with quick-fix, goal-oriented achievement, as evidence of its superiority and I question what appears to be an editorial slant in this direction. As a person-centred therapist, I have had countless clients who have come to me after CBT 'treatment' either puzzled or angered by being told not to feel or think the way they are feeling or thinking; no doubt there are an equal number turning up for CBT who are delighted finally to receive exactly that. Different approaches work for different people and it would be devastating for our profession to lose its diversity.

Rather than sit and grumble about this trend, those of us from other approaches must grasp the nettle of research and evaluation. As part of a team trying to raise money for such a project, however, the barriers of funding are hard to overcome. It is possible to argue, I think, that by investing so heavily in CBT, the NHS is actually covertly funding the research to support it while the rest of us must scramble desperately for resources for similar work.

On a positive note, it was good to see that the winner of this year's BACP Research Award was the person-centred school counselling project run by the University of Strathclyde Counselling Unit. In the report, the young people said that the most helpful aspects of the counselling they received were that the counsellors listened attentively, made them feel accepted and 'didn't try to sort [them] out'. Kind of like 'not going for change' then.

Susan McGinnis MBACP

I was astonished to read Jeremy Clarke's critique (November2005) 'Lesbians and Therapists' of Cordelia Galgut's earlier research (May 2005). Not astonished that someone would wish to critique research per se but that it should be so reactionary in tone.

The message from Galgut's research is by no means new; research going back more than 20 years tells a similar story. Simply put, lesbian women value practitioner openness around sexuality, value practitioners' evident comfort with their and their client's sexuality, prefer female practitioners as a minimum but lesbian practitioners as an ideal. This is mainly true, that is, it is a general finding within which not all lesbians in all circumstances will need a lesbian practitioner.

Varying aspects of this have been demonstrated and have contributed to the message over the years. For example the story across a range of service provision in U.K. Psychology (Annesley and Coyle1999), U.K. therapeutic and mental health services generally (MacFarlane1999), health services (Mugglestone1999) lesbian sexual health needs (Sigma report on behalf of the Lesbian and Gay Foundation in Manchester2002), practitioners who have a remit to address sexual difficulties (my own M.A. 2002 ), clients who wish to address sexual difficulties(my current PhD.),U.S. therapeutic experiences with Social workers (Brook 1981) and relational factors which inhibit or enable disclosure of identity (Ort 1987).

MacFarlane's work interestingly also highlights gendered differences between the stated needs of lesbians and gay men, suggesting that lesbians and gay men can have conflicting needs. For example when referring to gender specific services, especially residential or in patient services, lesbians tend to want single sex services where gay men prefer mixed sex services, a minority in each case had a preference or were not concerned in a way that was contrary to their gender.

It is somewhat ironic that Clarke should criticise Galgut for not referring to her own therapeutic experiences, uses her disclosure of sexuality and therapeutic orientation as part of the critique, and finds it appropriate to identify Weinberg with regard to his sex and sexuality, yet not identify himself in any way other than to mention his place of work. To this end I presume Clarke is male, based on my perception of dominant cultural norms and values, I could of course be wrong.

Presumably Galgut took the stance she did because of her orientations yet Clarke fails to notice his world view influencing him. As a politicised client-centred practitioner I use the language of my orientations just as I use English rather than Latin, why would I use concepts from another orientation in preference to my own?

To state that I am lesbian is no more breaching my privacy than knowing that I identify as female, white, am a counsellor and so on. It is simply a fact of my identity as a person. Perhaps Clarke tries to hide this from his clients, but why sexuality and not other elements of identity in that case? For example does he recommend removing wedding rings, hiding books, sitting in an empty room if working from home so as not to demonstrate ones level of affluence and so on?

Finally Clarke provided me with a laugh, albeit rather hollow. To suggest that naming 3 London organisations and citing 'out' private therapists is evidence of plenty of alternative services for lesbians who require openness or that a London based private organisation that requires openness of therapists leads to coming out in an unthinking way, is nonsense. I can suggest he read Vanessa Snowdon Carr's recent work asking Psychologists in Wales about their training, experiences, and service provision for LGB service users; evidently not only is Dafydd the only gay in the village, Offa is the only dyke in Wales.

Or he could try asking lesbians if they feel well served (even in London), instead of presuming.

To continue my policy of transparency (a term in use in client-centred therapy), if my letter reads as being angry, that is because I am.

When will 'listening professionals' finally hear a message that has been repeated, undoubtedly many times and in many more ways than I know of, and actually respond to it other than trying to question the messenger? When will 'listening professionals' look at their own practice, their own reactions, question them and rise to the challenge of meeting the needs of a minority population?

Annesley P., Coyle A. [1999] Lesbian Women's Experiences of Clinical Psychology Services: a Qualitative Analysis in The British Psychological Society Lesbian and Gay Psychology Section Newsletter issue 3. Other studies have been done by these researchers.

Falco K. [1991] 'Psychotherapy with Lesbian Clients, Theory into Practice'. New York: Brunner/ Mazel. (Brook and Ort's work)

McFarlane L. [1999] Diagnosis: Homophobic, The Experiences of Lesbians, Gay Men, and Bisexuals in Mental Health Services. London: P.A.C.E.

Mugglestone J. [1999] Report of the Bolton and Wigan Lesbian Health needs Assessment, 'Are You Sure You Don't Need Contraception?' Bolton Specialist Health Promotion Unit. (N.B. Bolton and Wigan, two places to the North of London, well past Watford Gap).

Snowdon Carr V., seminar at the BPS Joint Lesbian and Psychology Section and HIV Faculty Seminar Day 'What's Different About Sex' London, November 2005.

Henderson L. et al (Sigma Research) (2002) First, Service: Relationships, Sex And Health Among Lesbian And Bisexual Women.

Morrison S.L (2002) No Sex Please! We're Lesbians! A Comparative Enquiry into a Perceived Gap in Psychosexual Literature and Services. M.M.U.

As a tutor delivering counselling courses in adult education, I very much welcome a forum that addresses ethical concerns that might meet students and tutors alike. Adult education has the general aim of providing education available for all, a principle I both admire and support. All institutions, because of funding and funding accountability, are governed by take up, retention and pass rates. Somewhere in this process and service, basic therapeutic and professional principles might not receive the focus and attention they deserve, or not be clearly understood by the management structure delivering such courses. My professional view is that I have a contract with my students in a similar way that I do with my private clients, offering containment as a basic therapeutic/teaching-learning principle. I would find it useful if BAC could produce ethical guidelines for tutors, and discuss the kind of clinical governance that adult education might provide to support tutors and students in this process. The College in which I teach is pro-active in challenging itself and the learning it delivers, so this letter is not a specific reflection of the organization in which I teach, but a general reflection of what might prove useful to counselling trainers and trainees throughout the teaching/learning community.

My students always ask very interesting questions, and I will direct them to your student website, once it's constructed.

Sylvia Merritt

I have read with great interest your article on mind body medicine in the November edition of therapy today.

My background is in Palliative care and now I work as a counsellor in primary care.

I am a great believer in meditation of course it took many years of practice to be able to be still and focus on breathing to bring inner calm. Most of all it required a great deal of patience to achieve the wellbeing and assuredness that I feel in my personal life as well as professional work. Meditation also provides me with a peace and ease which within promotes mindfulness which for me is about being in the present moment, excellent example in therapy today of being invited to eat a raisin mindfully, we all know what one looks like and have an idea what one will taste like, we could probably eat several handfuls in less than 10 minutes and not be aware of taste of texture because we may also be allowed to be distracted by other activities eg read or watching television, chatting on the telephone. We would not have been mindful! How same event been mindful we would probably not eat several handfuls as we would become content with a smaller amount.

How many times have we come across people ourselves with people rushing because they had reason to, however now they don't have to rush but so do so because of habit, being mindful helps bring into awareness of my thoughts and behaviour and reactions, it is certainly a life-enhancing way of living, I agree that before introducing it you need to experience personal meditation, it is such a freeing experience for me, I would describe it like an inner cleansing and peace restoring. I often take advantage of meditation in between seeing clients.

The only sad fact about this is in today's society many people seem to be after a quick fix, meditation and mindfulness develops slowly, however, once mastered it can only develop further during our highs and lows in this journey in life. It can be a positive and highly effective skill to have both as a client or therapist.

Ms Taj Kaur MBACP

I think that those debating the merits or otherwise of boarding schools are often talking about different things.

There is, I think (and hope), a difference between boarding schools as they once were and boarding schools as they are today. I went to a so-called progressive school between 1966 and 1971. Despite its claims to enlightenment, it got caught, as so many institutions do, in the web of its own hype. The sorts of distress that I experienced were very subtle, permitted both by the myths that the school built which dictated that such distress was not possible in such a well-intentioned world, and also by my own denial. It is precisely the fact that I went willingly which then made it so difficult for me to admit that – maybe – it had all been a terrible mistake. My two older brothers had both been to the same school, and both had a really good time. The failure of admitting that I was not having a good time would have been doubly shaming.

I was shocked to re-read letters that I sent to my parents, in which I told them what a good time I was having. I recall that I was usually miserable, and also very lonely. For this reason I too found myself being very suspicious of Chris Papp's description of pyjama-clad children holding mugs of hot chocolate and squealing with delight. I would question what is happening in the silence – in the unheard spaces. I must add that I was also lonely at home. I cannot blame the school for my entire misery; I am sad, however, that no-one picked up on it; or, if they did, they were not prepared to do anything creative or useful on my behalf. Whether I would have responded to such help is, of course, a whole other question. I was probably less afraid of being miserable than I was of embracing the shame of acknowledging how miserable I was.

This notwithstanding, I am sure that boarding schools today are far more conscious of the possibilities of suffering. They would, I hope, be looking precisely for ways of spotting those who are putting up a façade, and would be more competent at doing something about it. In this respect, I would agree with Nigel Richard, since, under these circumstances, an unhappy child is more likely to get support at school than from his/her own family, where the investment in denial is going to be so much greater. I certainly would not romanticise either families or day schools. Maybe the wider question concerns our whole attitude towards children and young adults – but that is a very much wider question altogether.

What is important is that schools never, ever, allow themselves to become self-congratulatory. I think that, so long as any institution has the humility to acknowledge that they will always get it wrong somewhere along the line, then there is a far greater chance of their getting it reasonably right, often enough to make a difference.

Rather like counsellors really.

William Johnston

'All submissions to therapy today will be considered and may be edited at the Editor's discretion. The Editor's decision regarding publication is final'