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

Difference and diversity

Congratulations! I felt I had to write in response to October's edition of CPJ. It has to be the best issue I've read so far, with a comprehensive range of highly relevant views and angles on the theme of difference and diversity. Ironically, for those readers who also receive the UKCP journal, respect for difference has dominated their latest journal too.

As a left-handed, lesbian woman of Jewish background and strong artistic and mystical tendencies, I could identify with many of the issues. Thanks to therapy and other life interventions, I have been able to integrate my particular mix of uniqueness until it no longer defines the limits of my struggles, but still enhances my abilities as a counsellor and psychotherapist. So many of our predjudices are subtle and easily overlooked, yet nonetheless destructive, as Aileen Alleyne's article points out. Part of our role is to be aware of and to challenge our own as well as our client's belief systems and assumptions that diminish each other's humanity.

I would particularly like to mention Chris Jenkin's article on spirituality and how people's spiritual/ paranormal experiences are misconstrued. I co-run a certificate training in counselling skills, (Descriptor - Working with a Spiritual Model). Our training attracts interest precisely for the reasons Jenkins sets out; one of our main aims is to equip counsellors to be aware of and meet the spiritual/psychic experience of their clients. This includes awareness of 'spiritual emergency' (A term coined by Stanislaf and Christina Grof), experiences which often include symptoms defined as mental illness. Thankfully there is beginning to be a glimmer of recognition in some mental health authorities and within our own local authority the consultant who has a keen interest,is nowbeing funded to research this area. People like Grof, Roberto Assagioli and Ken Wilber have tried to address this pathologising of spirituality and the uneasy distinctions between them. Our course reflects another need, the marginalising of counsellors whose spirituality and psychic/intuitive gifts play a central part intheir role as therapists. Sadly, we seem to offer a safe place for many students, who have felt unsafe to voice their experiences on conventional counselling courses and have come to complete their conventional qualifications with one which seems more relevant to them. It seems a sad reflection of our profession in which so many of us, whilst not necessarily subscribing to a religion, are nonetheless inspired and motivated by spiritual values and sensitivities: self-awareness, empathy, tolerance, compassion, love, intuition, vision, faith, desire to offer healing and growth.

Rachael Clyne
Accredited counsellor and psychospiritual psychotherapist

How can CORE generate meaning?

I am writing in response to the article on CORE which appeared in the August edition of CPJ. I work as a counsellor in two practices in Derwentside, seeing 16 clients per week. The PCT recently ran a pilot scheme to assess CORE.

Regarding the article, I have the following comments to make:

Funding: if we are dealing with people who use numbers to justify expenditure, then maybe a system like CORE is necessary in order to secure more resources. We need to speak the language of the natives. The author speaks of the need to 'generate meaning'. There is a worrying undercurrent in this article. The thinking seems to be: we have all this data, now what sense can we make of it? The author seems to have completely lost sight of what should be the prior question, i.e. Why generate the data in the first place?

What if the system is based on a fundamental misunderstanding of the whole human enterprise?

As therapists we have a duty to point out that the most important things in life cannot be reduced to numbers, e.g. What is love? What is health? What is happiness?

'Generating meaning' is a valid description of what some clients value most about counselling: the process of trying to understand their world, both the inner world and the worlds of the people with whom they share their lives. How can this be reduced to numbers? In the course of my training much emphasis was placed on the value of open questions rather than closed! The CORE system consists almost entirely of closed questions. Why not simply ask the client, 'What worked for you?' The answer could be, 'I can understand the difficulties in my marriage better.' It could equally be, 'that relaxation exercise'. I was very concerned to find that the client hardly appears at all in this article! This is the inevitable consequence of placing too much reliance on statistics. And thus paper work increases and human resources dwindle. Ask any teacher, any doctor, any health visitor…

The scenario of counsellors 'meeting to examine the database… and engage in virtual conversations about the data' makes me shudder. Where is the client in all this? Let us by all means meet with colleagues to discuss cases, that would indeed be a great improvement in our service. I would be interested to know how much it has cost the Brighton/ Littlehampton PCT to install and run the CORE system. Audit should include equipment, computers, stationery etc., time spent on admin and training sessions, (wages, hire of room etc.) and time lost from client work as a result of therapists and admin people attending training sessions. Have more people gained access to counselling as a result of Core implementation? Has the quality of the service given increased? How many extra hours of therapy could have been provided if the same funds had been spent on employing more therapists? These statistics would indeed be of interest to us all.

The author states that 'the whole purpose is to seek to improve the service that we offer to our clients'. Have you asked the clients what they would like? I would like to know if the therapists themselves were asked if they wanted to use the CORE system?

As for the therapists, I suggest the question you ask them should be phrased thus: If you were given X thousands of pounds to improve the counselling service in your area, how would you spend it? Such an open question would generate some very interesting and creative ideas. It would also considerably reduce the stress induced by what the author admits has been 'an anxiety-provoking experience.' As a matter of interest, has stress for staff also been reduced to numbers?

Paul Spence

Computer therapy inappropriate for depression

Computer-generated therapy for people suffering with depression? On the whole, I think not. Why? Because depression is more usefully – therapeutically – viewed as a symptom, rather than a disorder in itself. It is more accurately viewed as a response to, an underlying malaise, rather than a stand-alone 'state of being' in its own right.

For example, when a patient is anxious, too much and too often, depression acts as a safety valve or a trip-switch, shutting off the overloaded, overwhelmed experience of anxiety. Similarly with feelings of grief. Thus depression is a response to (eg anxiety or grief) and a withdrawal from relationship with self and/or others.

People suffering from depression are invariably isolated, lonely, withdrawn people who find difficulty in expressing and sharing their underlying feelings of, for example, anxiety, grief and despair. The antidote therefore is expression through relationship with another who both understands and empathises with the sufferer – that is, a warm-blooded feeling human being!

To interact with a computer screen, however patient-friendly, is thus essentially not therapeutic. This medium actually further isolates the patient from a real relationship into a 'virtual' relationship and is collusive with the symptoms of depression, that is, a withdrawal from expressive relationship with another.

Therapy is a human, presumably interactive experience which pharmaceutical companies (via the manufacture of largely palliative anti-depressant drugs) and now, computer programmers, seek to subsume. Interestingly, Clare Pointon's article on computerised counselling programmes (CPJ June 04), illustrated such programmes' heavy reliance upon CBT – the therapy most reliant upon a skills-based approach that also seeks to down-play the relational and human ingredient that much research indicates is the most significant ingredient in therapy.

Our contemporary preoccupation with being all inclusive and thus welcoming of new initiatives, such as computer-generated counselling programmes, sometimes means we are at risk of becoming inexact in clearly defining and describing, in this care, precisely what is meant by the term counselling and what it involves.

John Sivyer
Therapeutic counsellor

Salacious detail

Recent correspondence suggests that all are not happy with the way BACP is handling the reporting of Sanctions reporting. Tony Morris (October CPJ) rightly stressed that BACP should take the lead in moving away from the current tendency to press for vengeance and humiliation so beloved of our tabloids. The report on pages 60-61 of your October issue reads like a report in the News of the World with all the salacious detail it can cram in. This seems to me to be quite unnecessary. All that is needed is the list of articles of the code which were the subject of complaint and the decision and sanctions. As Tony says, if someone has justifiable need to know more detail they can enquire directly to the BACP and be advised privately.

Peter Ball
Counsellor

I am horrified to learn that your organisation has arbitrarily decided to exclude hypno-psychotherapy from your categories of psychotherapy for accreditation purposes, without consulting your membership, in spite of your stated policy of non bias toward individual models. I am no longer an individual member of BACP but as the future of my profession is likely to be affected by your decision-by-committee I am exercising my right to object in the strongest terms.

Hypnosis is an effective and often-used tool in psychotherapy, and only ignorance of its use and application can account for this blatant bias. When my own mother was suffering from depression in the 1960's, and being treated at the Middlesex hospital the very first intervention made by her psychiatrist was to teach her self-induced relaxation. I now know, having studied the ethical use of clinical hypnosis as part of my psychotherapy training, that what she learned was self-hypnosis by another name. Cognitive Behavioural therapists who are moving to the APET model are learning to use hypnotic relaxation for lowering emotional arousal and creative visualisation to facilitate the behavioural aspect of treatment.

I believe most models of psychotherapy can be facilitated by the well judged use of hypnosis or relaxation techniques, and indeed certain interventions can result in a trance state in the client which, if the therapist does not understand it, can be poorly managed to the detriment of the client. More vital, the management of the hypnotic state is a most valuable and I would say necessary part of any counsellor or therapist's training. Without it I have seen clients wandering out of a clinic and into the street without being properly restored to normal awareness, and I have had discussions with St Mary's University in Twickenham around starting a course in the management of abreaction, which can and does occur during osteopathy, sports massage, aromatherapy etc.

Hypnosis is a naturally occurring state, which is only looked on with suspicion because of misunderstanding. Anyone who has ever failed to hear what has been said to them while concentrating on something else, a TV programme perhaps has been hypnotised. Anyone who has later remembered what was said, for example 'would you like a coffee?', can understand post-hypnotic suggestion. In fact direct suggestion plays a very tiny part in hypnopsychotherapy. The most frequent application in my own practice is to lower the emotional arousal which keeps the cortex from working properly. This immediately reduces the black and white thinking that renders many interventions less effective.

Another worrying aspect is that the most effective non-drug treatment for depression makes use of this kind of arousal lowering, and imaginal rehearsal of better ways of being to keep depression-free. Without proper training in the management of trance this can be made much more difficult.

I object most strongly to your decision to divide hypnosis from psychotherapy and reject anything linked with the former without proper consultation or research, and based on misinformation and lack of knowledge.

Angela Plotel

I read with interest Clare Pointon's article in last months CPJ 'Does our training embrace difference and diversity'. From my experience it may have been better to name the article 'Does counselling embrace difference and diversity'. After all counselling does not exist within a vacuum and training, placements the role of the BACP and how we are perceived by society are all vital ingredients.

Let me say that I am white, male 49 years of age, a journalist who recently graduated with a Diploma in Integrative Counselling at a University in the North of England where diversity and difference were core topics. I would like to relate some of my experiences during training and placements and highlight that the lack of integrating diversity and difference is more mainstream than marginal groups of Gays, disabled people, black people etc and has led me to question and examine more fully what I mean by integration.

Being on a course is like living in a bubble at times, where you are taught certain ways of integration and work within an integrationist framework. I am told that 'there is a decline in the belief of purist approaches to understanding' (1) and 'clearly there was a realisation among many that the segregation of the therapies was both unhelpful and unrealistic' (2).

My experience after the 2 year course is very different. Whilst in training I had the Head of Counselling of a well known voluntary organisation tell me that 'Freud was a w***er' and unless I was off a certain psychodynamic philosophy would not be offered a placement. During training my therapist was an experienced Psychoanalyst from a Jungian background who believed in the integration of attachment theory with neuroscience, but was not into Jung and the Transpersonal. On another occasion she told me that 'I don't do 'Clarkson' which was a central teaching tenet of my course.

On one of my placement we had a group supervision session when I was told that 'if integration is about a hammer and chisel then you can stick it up your arse'. At another session a person centred trainee said that because of her background she 'couldn't possible do short term work of only 6 sessions'.

In another group session other students immersed in scholastic and purist attitudes defended passionately the 'truth' of their own school and argued with creative verbal vigour the 'errors' of my way.

On another occasion 2 trainees from a particular 'pure' background complained about the Head of Counselling and how she ran the placements and her philosophical slant which led to an investigation by the BACP. The Head was cleared of any sanctions and faced no naming and shaming in the CPJ although the distress has meant she has not yet returned to work. What does this say about A) the 2 students if anything? B) The course content and values of the teaching staff from the University where they were taught? C) The BACP who recently gave accreditation to the course where the students came from, is this what Pointon means when she says institutionalised 'oppression' and D) what would the public make of it all?

In some ways these varied experiences while, not necessarily pleasant, has accentuated my thinking and feelings of what contributes to an effective therapeutic encounter between the client and myself.

At the moment integration, diversity and difference are buzzwords. In England Trevor Phillips, the Chairman of the Commission for Racial Equality called on Britain to abandon 40 years of multicultural policies. Phillips said 'Multiculturalism suggests separateness. We are in a different world from the 1970's. What we should be talking about is how we reach an integrated society, one in which people are equal under the law, where there are common values - democracy rather than violence, the common currency of the English language, honouring the culture of these Islands, like Shakespeare and Dickens' (Sunday Times May 2nd 2004 pg 15). !

So much so that people from different cultures residing in Britain are being encouraged to show public allegiance to the Crown. 20 years ago educationalists that opposed multiculturalism and tried to insist that English should be used as a first language in school were branded racists and vilified. Is there then one definition of integration, diversity and difference based on the values implicit or is it changeable depending on a particular moment in time in history?

Back in the 1970's when I was a student of sociology we talked in terms of cultural integration and assimilation. Certain communities such as the Irish and the Italians were considered assimilated into British culture as they worked and socialised and accepted the values of this society. Other cultures such as Chinese and Japanese were integrated in that they worked in our society economically but part of them were not assimilated into British society as they maintained many of their own values from their homeland and kept together and avoided mixing outside their community.

From a personal point of view I would like to feel that the therapeutic relationship aims to be assimilation and a 'oneness' between the client and me and that when there is difference and resistance to this then it is more of looking, working and exploring in an integrative way. I would like to feel that I move from the integrative through to the assimilation with clients and back depending on the circumstances. In a counselling context Samuels was also concerned with a 'oneness', not so much by trying to bring everything together with an integrated whole as by recognising that 'diversity has its place within a 'unified' of the field, a cohesive vision of psychotherapy'.

It has made me consider how I deal with difference and diversity within counselling and within society. Does that mean the multicultural policies have failed and that we no longer live with difference and that the new definition of 'integration' is 'oneness' and different to my own thoughts and feelings of 'oneness'. 40 years ago integration meant dealing and accepting diversity and difference but now we are told it is 'oneness'. Now integration is something that resembles the view that difference and diversity doesn't work. Yet it is still called integration. Does it mean that we are moving away from a pluralist and integrative viewpoint towards a form of purism? What then are the implications for counselling, as we do not live in a political, economic or social vacuum? Will integration, as we know it in counselling now be different in 40 years' time and really be a form of pluralism in another cloak? Is not does our training embrace difference and diversity. Fundamentally what is difference and diversity per se.

Lawrie Madden

'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'