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BLOGPOST – 2024

COUNSELLORS AND PSYCHOTHERAPISTS – PROFESSIONALS OR MAGICIANS?

Whenever we contact a professional we usually have a fair idea about what we are likely to get. Doctors doctor, teachers teach, priests preach, and so on. They, and all the other professionals know what they are supposed to do and the public knows what to expect. This is because every profession, every trade, every calling, has its own accepted area of expertise. Lawyers know the law; surveyors know buildings; bankers know finance. They and all the other professional experts know what they are supposed to know. Equally importantly they know what they don’t know. Furthermore, the established professions all require new entrants to be properly trained and to have reached a basic minimum standard before they can start practicing. Can counsellors and psychotherapists say the same? Are they all properly trained, educated, and qualified? Do their customers know what to expect from them.

It seems to me that if practitioners in the psychological therapies, (the so-called ‘talking therapies’), want to be respected as genuine professionals then that respect has to be earned. To begin with they have to be able to answer a very simple question – “what exactly is psychotherapy and/or counselling”? Or, put another way, what is it that counsellors and psychotherapists actually do? What should the public expect of them?

The sad fact is that there is no general agreement within the psychotherapeutic world about what the answers to these apparently simple questions should be. All of the mainstream professions have their core bodies of disciplinary knowledge – their ‘trade secrets’. In the case of the psychological therapies there is no such knowledge base. The problem is that the talking therapies have emerged from a number of discontinuous and conflicting theoretical backgrounds. This means that there is little chance of establishing any professional common ground between the various types of psychological therapists. Therefore, it is unlikely, at least as matters stand right now, that counsellors and psychotherapists could ever agree on a common purpose. They certainly cannot agree on what their trainees should, or should not, be taught. Neither can they agree about what their practitioners should, or should not, be doing. Instead controversy rages, argument abounds, and doctrinal disputes are bitterly fought over.  

The story of this on-going, in-house, therapeutic civil war is threaded throughout the history of psychotherapy and counselling. The battle goes on today – no armistice is in sight! The psychological therapies have long been crudely divided into three generic types or ‘Schools’. These distinctions largely remain in place today. This is the root cause of all the rivalries. Firstly there is the Psychodynamic School with its claim that it is our unconscious or instinctual reactions to our developmental experiences that make us what we are. Then there is the Humanistic School with its claim that it is how we deal with our ‘here-and-now’ interpersonal and intrapersonal interactions that define us. Finally there is the Cognitive-Behavioural School with its claim that our personalities depend on our ingrained ways of thinking and behaving. Unfortunately, the adherents of any one of these Schools profoundly reject the arguments of the other two. Equally unfortunately, adherents of each School’s many subdivisions just as passionately reject the stances of their rival subdivisions.

For me, a hard-core scientist, the way to resolve these differences is obvious. Let’s subject all the therapies to some rigorous testing and see what works and what doesn’t. Let’s find some evidence. That is what scientists do! The first obstacle is of course that a significant proportion of counselling’s and psychotherapy’s self-styled ‘professionals’ reject to very notion of scientific enquiry. They claim that therapy is an art and not a science and therefore neither the process nor its outcomes can be, or even should be, codified or measured.  So, it seems to me that for those sorts of practitioners, if science is ruled out, it is difficult to see what else they can offer their patients apart from the ineffable. In effect, they are asking their clients to suspend their rational beings and accept instead the power of the unknowable; the indefinable. In other words, they are required to believe in magic. Professional skills are degraded in to hocus pocus.  Is the core purpose of counselling and psychotherapy simply to say “abracadabra”? Is that the therapists’ real trade secret?

Actually, as far as the better-educated therapists are concerned, their claim to professional status is based on a much sounder footing. The good news is that properly trained, properly scientific, psychotherapy researchers have produced some good quality evidence. Generally speaking they have found that the mainstream therapies actually work and do so more or less equally. Further research is starting to suggest that there may indeed be some common, or overarching, curative factors permeating most of psychotherapy’s divisions and sub-divisions. This might mean that eventually we could develop a general body of commonly agreed basic disciplinary knowledge that would allow counsellors and psychotherapists to start to call themselves true professionals. Of course that would mean that each therapeutic School’s defenders to give up some of their entrenched positions. However, that is a story for another day. You can find out much more about this issue in my book ‘What is Counselling & Psychotherapy’ – there is a link on my website or you can order it from Amazon. 

Finally, please note that in this Blog I began by talking about ‘properly trained, educated, and qualified professionals’. The really scary fact is that anybody, qualified or not, trained or not, can claim to be a counsellor or psychotherapist. The even scarier fact is that some of talking therapy’s main professional bodies continue to admit as members, people whose qualification levels are very questionable. I’ll be discussing that sad state of affairs in my next Blog. I shall be examining the poor quality of therapist training in the UK and revealing how the unqualified charlatans and the underqualified ‘professionals’ deceive their customers.

My book ‘What is Counselling & Psychotherapy’ – follow this link

http://www.amazon.co.uk/What-Counselling-Psychotherapy-Practice-Series/dp/1844453618

BLOG POST – SUMMER 2022

CBT – IS IT FOR YOU?

Cognitive Behaviour Therapy – CBT – has been very much the ‘flavour of the month’ in the NHS for some time now. These days, NHS patients with mild to moderate psychological problems are usually referred to a CBT service. This is particularly so in cases of depression or of one of the anxiety conditions. There are two simple reasons why this is so. Firstly, CBT appears to be as effective, (or not), as most of the other types of psychotherapy. Secondly, (and this is the biggie), it is cheap! CBT is cheap to deliver and its practitioners are cheap to train. So, it looks like a win-win situation all round. Well it does until we look a bit closer.

Before we more closely examine CBT let me make one thing very clear. In no way am I against CBT. In the right circumstances it is a very useful type of psychotherapy. It’s a method I very often use with my own patients – but only when it is appropriate. What I am very much against is the over-reliance that today’s NHS puts on to CBT. I am also appalled by the very low levels of training that the NHS requires of its CBT practitioners, especially of its Low Intensity grade of CBT therapists. Now, let’s get back to our closer look at this NHS ‘wonder-therapy’. Is it really so wonderful?

The first point to note is that CBT is only one of the very many types of treatment that properly trained psychotherapists can offer their patients. Obviously no individual practitioner can be an expert in all of these therapies and that is why, like any other profession, psychotherapy has its specialists and consultants. So, if psychotherapists have a wide range of therapies available, (including CBT), why should most NHS patients be directed towards CBT? Clearly patients should be referred for the most suitable type of psychotherapy for their needs, not just CBT for no better reason than it is the cheapest. After all, you wouldn’t expect GPs to prescribe aspirin for everybody simply because it only costs the NHS a few pence to provide. So is CBT a wonder-therapy for all NHS patients or is it really just a wonder-boost for the NHS bean counters.   

The second point to take into account is the way in which the NHS trains its CBT therapists. Most of them are graded as ‘Low Intensity Practitioners’. Sad to say, novice Low Intensity therapists do not need to have had any prior experience in mental health work and their training only takes 45 days. Of course, a few of this new breed of low grade therapists, together with a few of the far fewer, (albeit better trained), ‘High Intensity Practitioners’ might, on a personal basis, have acquired additional therapeutic skills from elsewhere. However, the NHS prefers its CBT practitioners to limit themselves to only delivering CBT. They rarely get a chance to use any other skills that they might happen to have. Sadly, most NHS CBT therapists, particularly the Low Level CBT Practitioners couldn’t do so anyway – their training is far too limited.  

Thirdly we need to further scrutinize CBT’s actual effectiveness. Clearly, if as is claimed, that CBT is as effective as the other psychotherapies, then do any of its alleged other weaknesses matter. Well yes they do. To begin with, just because a particular therapy apparently works for a particular patient that does not mean that it is the best therapy for that client. After all, an extraction would certainly cure your toothache and do so very cheaply too. However, most dental patients would prefer more modern, more complex treatments even if they cost more. Next, the question of long-term relief versus a short-term quick fix needs to be examined. Many mental health issues, many psychological disorders are of a chronic nature. This means that patients have a life-long, or at or least a very long-term, vulnerability to mental health problems. Without good management these patients are prone to relapse.  As CBT is often a short-term fix then it is always possible that one of the more medium / longer term therapies might be more effective in such cases and therefore the true ‘treatment of choice’.

Like many other more extensively trained practitioners, I can, (and do), vary my treatment styles, not just between patients but also within individual treatment programs. In other words I can bring a professional flexibility to my work. Practitioners who only offer one type of psychotherapy, whether that is CBT or anything else, are simply not providing anything like the comprehensive service that today’s complex-needs clients require. Put bluntly, they are failing their clients.

In sum what I am saying is that CBT is an excellent form of psychotherapy but only at the right time and in the right pace. However, it is not the super cure-all that the NHS would have us believe. In my next blog I’ll tell you more about how CBT works. I’ll even let you into a secret. For many patients, using a professional CBT therapist is not always necessary – DIY can be pretty effective too. Next time I’ll tell you how.  

BLOG POST – SPRING 2022

DANGER – ‘THERAPISTS AT WORK!’

For lots of people, feelings and sentiments are messy, embarrassing, and best avoided. When emotions are running high then it’s usually easier to send for the ‘ologists’ than to deal with the sufferers at first hand. That’s why the general public relies on therapists to mop up all that emotional ‘goo’. As a result, modern day counsellors and psychotherapists are all too often used as society’s emotional refuse collectors.

It’s bad enough that society thinks that these modern day, therapeutic ‘Fairy Godmothers’ can magic away unwanted psychological pain. What’s even worse is that all too many counsellors and psychotherapists actually believe it too. For example, whenever there is a particularly tragic event, a murder in a school say, or perhaps a terrorist attack, the news services all solemnly announce that counsellors are in attendance. Now any properly trained psychologist or psychotherapist knows that not only is such an immediate on-site presence irrelevant, but that it can actually be harmful. The problem is that all too few therapists are properly trained. So in they go, ‘saving the world’, smugly blissful in their ignorance. There are other appropriate psychological interventions that do help in the immediate aftermath of emergency situations. These include psychotherapeutic ‘First Aid’ and psychological trauma triage. Unfortunately, very few counsellors and psychotherapists have even heard of these techniques much less ever learned how to use them. 

However, this is not the only area in which the ill-trained majority of the Talking Therapy World’s practitioners rush in where angels fear to tread. That’s because to them, counselling and psychotherapy are always ‘good things’. Therefore, the therapy trade’s practitioners, with their allegedly non-judgemental, multi-cultural, ethos, must be generally beneficial to their customers, (or so they claim). So, whatever the problem, there go the therapists bringing their own special brand of succour to the emotionally wounded, (or so they think). As ever, the road to hell, including psychotherapy’s own version of hell, is paved with good intentions.

However, what most therapists don’t realise is that far from being socially neutral, judgementally neutral, and value-free, the practice of counselling and psychotherapy over the last 50 years or so has actually been an affirmation of a specific socio-political attitude that is still prevalent amongst an intellectually liberal elite in western society. This is the self-centric, self-actualising, way of being that underpins a ‘me, me, me’ view of the self and the world that has been prevalent amongst the ‘right-on’ generation from the 50s onwards. Counselling’s great guru, Carl Rogers certainly has such a lot to answer for.

This ‘me first’ generation, the so-called ‘baby boomers’, found it intellectually convenient to invent a way of ordering society, (and supposedly curing its emotional ‘ailments’), that fitted in with their own belief systems, (or prejudices). They also invented their own Orwellian ‘Newspeak’, (Political Correctness), to supress any alternative viewpoints. So, in this allegedly freer modern society, it seems that only approved of ideas are permissible. Alternative viewpoints should not even be listened to. Far from being intellectual libertarians, today’s super-sensitive right-thinkers happily no-platform the opposition in order to save their own delicate beings from being offended.

So, you don’t think all us super-empathetic, super caring, therapists can be bigoted like that? We can’t be biased or dogmatic? Just go along to any group of counsellors or psychotherapists talking about their work. You will see what I call ‘the noddies’. They will all be nodding approvingly at any statement that fits in with their group-think and looking uncomfortable should any renegades question any of their core beliefs. The fact is that all too many of practitioners in the talking therapies are dangerously undereducated. Most of their training consists of being inculcated with a lot of professional ‘does and don’ts’. Unfortunately, therapist education is mostly normative. It is very rarely formative. Critical thinking is not encouraged. How could it be? After all, most of their instructors don’t even begin to understand the concept of academic criticality and they recoil at even the idea of scientific methodology. How could they? They too are the products of inadequate training.

Is there a way out of this intellectual backwater, at least as far as the talking therapies are concerned? Well yes, but first the psychotherapeutic professions must go through the same healing process that they encourage in their customers. Firstly, deal with denial. Admit that all too many practitioners are currently inadequate for the task. Secondly, determine what is wrong. In my view the core problem is the sheer educational inadequacy of therapist training and therapist trainers. Put bluntly, in the purist sense of the word, all too many of them are educationally defective and intellectually undeveloped. Thirdly, make some serious changes. Doing that, I believe, means establishing some new and upgraded professional standards. These should include establishing a minimum educational requirement of BSc, (not BA), level training for counsellors and an MSc, (not MA), level training for psychotherapists. There should also be a recognised post-qualification licensing procedure.

Of course, my proposals for upgrading counselling and psychotherapy’s professional standards are all ‘pie in the sky’ at present. So what can Joe and Jill Public do about finding a properly trained and qualified therapist? How can they find somebody who actually knows what they are doing? I’ll tell you all about that in my Spring Blog.

BLOG POST – AUTUMN 2021

DEPRESSION – CAUSES AND CURES:

Depression is not the same as feeling downhearted or sad. We all get seriously fed up or feel in a really down mood from time to time. That’s not depression; that’s life. However, sometimes those low moods won’t go away and we don’t bounce back. If those low moods start to seriously affect our lives, to cause us to behave noticeably differently, to interfere with our usual day-to-day functioning, then that’s when psychologists start to consider that we might be suffering from clinically significant depression.

Depression is a very common psychological disorder. Probably about one in four of the UK population develop worrying levels of depression at some time or other in their lives. It’s very likely that about one in ten of the people sitting in your local GP’s waiting room today are taking anti-depressants. There are very few people who have not either been depressed themselves or who do not have a family member or a close friend who has been so afflicted. However, depression is all too often a ‘secret illness’ and its sufferers don’t like to let other people know about their condition. That’s because, even today, mental ill-health still carries a social stigma. So what causes depression and what should sufferers do about it?

Depression in its clinical sense usually arises when life’s problems overwhelm us. What these problems are, and how they affect us will vary from person to person. They don’t have to be huge, ‘blockbuster’ worries. A lot of little things, occurring over a long time can be just as depressing as some serious, one-off, blows to our way of being. Some theorists wonder if depression has a genetic component. Put simply, some people think that’s just how you are made. Other theorists wonder if depression has a nurturing component. In other words, are you feeling low because, in your experience, life is pretty naff.

Lots of different psychotherapeutic theorists have lots of different, (and competing views), about the causes of depression.  They also have lots of views about the best ways to treat depression. However, most practitioners would agree that the core component of depression is Anhedonia. This is an emotional state in which the sufferer generally loses interest in life, has little motivation, feels the future is hopeless, and is usually unable to experience pleasure. Such a person is generally emotionally flat. Nevertheless, whatever, the cause, people with depression need help. So, what can be done for them? What can they expect from the mental health professionals? 

In the UK the generally accepted approach to depression is to deliver treatment in a number of steps.

Step 1 – mild depression – is generally best treated by doing nothing. Left alone, most mildly depressed patients spontaneously recover within six months. In these sorts of cases therapists must be careful not to ‘over-therapise’ because doing so might well make things worse. However, basic-level supportive counselling can sometimes help with the healing process. It can also be the case that elementary CBT might prove useful to such sufferers. This usually involves something easy like providing patients with some basic information about their condition and teaching them some simple steps that they can take to help themselves.  

Step 2 – mild to moderate depression – this is usually more actively treated. Doctors will usually prescribe an antidepressant and psychotherapists normally offer more detailed and more intensive psychotherapeutic  interventions and CBT treatments. For most people a treatment plan that combines pills, talking, and self-management skills training is generally  the most productive way forward.

Step 3 – severe depression – requires a more intensive approach, both from the medics and the therapists. A referral to a psychiatrist or the local Community Mental Health Team  is usually indicated. At this stage, adopting a more powerful medication regime might be necessary. Again, psychotherapy is an important part of the overall treatment plan, even in cases serious enough to require hospitalisation.     

So there you have it, depression is common, it can be crippling but it does not have to rule your life. If it strikes, don’t suffer in silence – get help – it works.

BLOG POST – Summer 2021

COVID AND MENTAL HEALTH: 2020 – Spring at last – a season of hope. Great news about the vaccines but it’s not all over yet – far from it. However, recovery will take time, not least in the nation’s mental health. The UK has been, and still is, experiencing psychological trauma at levels unseen except in time of war. However, its not 1940 anymore, so stiff upper lips, keeping calm and carrying on, and ‘Britain can take it’, are no longer in fashion. People need help with all the ways that this national disaster has  impacted on their mental well-being. had. Reaching out for help is a sign of strength, not weakness. It shows maturity, common sense, a concern for others, and the courage to work through your problems.   

How can you start help? Well first of all help yourself. How are you getting on? Why not do a self-check? Have a look back at how you have changed over teh last 18 months or so. Are you sadder, more stressed, less able to cope? Have any pre-existing problems got any worse? If you are concerned then first of all try and make some positive changes. Exercise more, eat healthily, and above all talk to somebody about what’s worrying you. Anybody will do. A close relative or partner, a family friend, a neighbour, anyone who will listen. Of course, you can always contact a therapist. If you are particularly worried then you really should get professional help. All this advice goes for people you know too. If they seem troubled then it’s a simple job to jut start talking to them.

Remember: Professional help is only a phone call away. Have a good 2021 everybody!

BLOG POST – Autumn 2020

UPGRADING THERAPIST TRAINING:

People depend on all sorts of professionals; doctors, solicitors, architects, nurses, teachers, dentists, accountants, and so on. The essential core of the public’s relationship with any type of professional advisor has to be trust. People need to be sure that these specialists know what they are doing. They certainly don’t expect them to be incompetent or to cause harm. This means that the underlying assumption, no matter what the area of expertise, is that professionals are properly trained and qualified. Usually this means that professional-level service providers have undergone a recognised program of higher education. High-level professionals normally have graduate and postgraduate level qualifications in their chosen fields. Even many of the intermediate-level professions, such as paramedics, police officers, journalists, etc. are rapidly moving towards becoming graduate-level occupations.

In all of the professions that I have mentioned so far, and in the many, many, others that I could have included, professional training is usually a two-stage process. Very often, but not always, these two stages are undertaken in parallel. One stage requires the trainees to study for an appropriate academic degree. The other stage involves these novice professionals in completing a program of supervised, ‘on the job’, practical training. Finally, when a trainee has met the relevant regulatory body’s requirements, then some sort of entry-level professional status is conferred. However, this is not the end of the training process. These days, training is often a life-long process. Many practitioners are required to keep themselves up to date by engaging in professional development training throughout their careers. Any practitioners who fail to keep themselves up to date risk being sanctioned or even disbarred. In addition, those who wish to advance their professional status will take further formal training, usually at postgraduate level or beyond.

If these standards apply to all the other professions, why should professional counsellors and psychotherapists be any different. Shouldn’t they too be qualified to the same high standards? After all, allowing someone to play around with your psyche, to tinker with your very sense of ‘being’, is pretty heavy stuff. These psychological ‘mind mechanics’ really had better know what they are doing. Sadly, expectation that the public have that counsellors and psychotherapists are trained to the same standards and educational levels as the other professions is far from being met. All too many therapists have little more than an A-level equivalent Professional Diploma, and a significant number do not even have that. 

I say that it’s time that the counselling and psychotherapy profession upped its game. It’s what the public deserve; it’s what our profession needs if it wants the respect of the other high-level callings. In order to achieve this, it is essential that our current training programs are revised and significantly upgraded to ensure that all counsellors and psychotherapists have reached a proper professional level. The improved training programs should include a comprehensive overview of the theory and the practice of counselling and psychotherapy. In addition, trainees should be required to demonstrate an ability to engage in reflective and critical thinking, to show that they have an understanding of research and research methodology, and to exhibit a sound grasp of ethics. They also need to acquire the consulting room skills that will enable them to be effective with their clients.

How could all this be achieved? The essential first step is to do away with what I call ‘Schoolism’. I use this phrase to describe the various single models or ‘Schools’ of therapy offered by many of today’s practitioners. The Schoolists mostly believe that their chosen type of therapy is the answer to everything, a sort of universal ‘cure-all’. What rubbish! Would you go to a doctor who only ever prescribed one type of medicine no matter what was wrong with you? Of course not! Therefore, I would argue that trainee counsellors and psychotherapists should be taught about all the main models, (Schools), of therapy and shown how to integrate and deliver them, in part or in whole, according to the needs of each individual patient.

The next essential step is to require all therapists to obtain an honours degree, (or its equivalent), as an essential entry-level qualification. If gaining such a degree were an obligatory first professional step, then it would be reasonable to expect that a newly qualified practitioner’s eventual entry into any therapy’s Specialisms or Advanced Practice areas would require postgraduate education. Of course, in parallel with any of these taught elements in their professional education, trainees would also have to undergo practical, hands-on, training in related client work under the supervision of suitably qualified and experienced practice teachers. 

The third and final essential step will be setting up mandatory post-qualification professional development programs. For the newly qualified this would entail working under the supervision of a professional mentor for a certain period of time. For the more experienced this would involve keeping up to date by attending approved further training programs.

Obviously, by arguing for such a fundamental upgrading of therapist training I will probably be accused of wanting a radical, root and branch, shake-up of the counselling and psychotherapy profession, its practitioners, its trainers, and its therapist education policies. Well of course I do. I want today’s counsellors and psychotherapists to be trained to do their jobs properly – doesn’t everybody?

BLOG POST – Summer 2020

UPGRADING THERAPIST TRAINING

People depend on all sorts of professionals; doctors, solicitors, architects, nurses, teachers, dentists, accountants, and so on. The essential core of the public’s relationship with any type of professional advisor has to be trust. People need to be sure that these specialists know what they are doing. They certainly don’t expect them to be incompetent or to cause harm. This means that the underlying assumption, no matter what the area of expertise, is that professionals are properly trained and qualified. Usually this means that professional-level service providers have undergone a recognised program of higher education. High-level professionals normally have graduate and postgraduate level qualifications in their chosen fields. Even many of the intermediate-level professions, such as paramedics, police officers, journalists, etc. are rapidly moving towards becoming graduate-level occupations.

In all of the professions that I have mentioned so far, and in the many, many, others that I could have included, professional training is usually a two-stage process. Very often, but not always, these two stages are undertaken in parallel. One stage requires the trainees to study for an appropriate academic degree. The other stage involves these novice professionals in completing a program of supervised, ‘on the job’, practical training. Finally, when a trainee has met the relevant regulatory body’s requirements, then some sort of entry-level professional status is conferred. However, this is not the end of the training process. These days, training is often a life-long process. Many practitioners are required to keep themselves up to date by engaging in professional development training throughout their careers. Any practitioners who fail to keep themselves up to date risk being sanctioned or even disbarred. In addition, those who wish to advance their professional status will take further formal training, usually at postgraduate level or beyond.

If these standards apply to all the other professions, why should professional counsellors and psychotherapists be any different. Shouldn’t they too be qualified to the same high standards? After all, allowing someone to play around with your psyche, to tinker with your very sense of ‘being’, is pretty heavy stuff. These psychological ‘mind mechanics’ really had better know what they are doing. Sadly, expectation that the public have that counsellors and psychotherapists are trained to the same standards and educational levels as the other professions is far from being met. All too many therapists have little more than an A-level equivalent Professional Diploma, and a significant number do not even have that. 

I say that it’s time that the counselling and psychotherapy profession upped its game. It’s what the public deserve; it’s what our profession needs if it wants the respect of the other high-level callings. In order to achieve this, it is essential that our current training programs are revised and significantly upgraded to ensure that all counsellors and psychotherapists have reached a proper professional level. The improved training programs should include a comprehensive overview of the theory and the practice of counselling and psychotherapy. In addition, trainees should be required to demonstrate an ability to engage in reflective and critical thinking, to show that they have an understanding of research and research methodology, and to exhibit a sound grasp of ethics. They also need to acquire the consulting room skills that will enable them to be effective with their clients.

How could all this be achieved? The essential first step is to do away with what I call ‘Schoolism’. I use this phrase to describe the various single models or ‘Schools’ of therapy offered by many of today’s practitioners. The Schoolists mostly believe that their chosen type of therapy is the answer to everything, a sort of universal ‘cure-all’. What rubbish! Would you go to a doctor who only ever prescribed one type of medicine no matter what was wrong with you? Of course not! Therefore, I would argue that trainee counsellors and psychotherapists should be taught about all the main models, (Schools), of therapy and shown how to integrate and deliver them, in part or in whole, according to the needs of each individual patient.

The next essential step is to require all therapists to obtain an honours degree, (or its equivalent), as an essential entry-level qualification. If gaining such a degree were an obligatory first professional step, then it would be reasonable to expect that a newly qualified practitioner’s eventual entry into any therapy’s Specialisms or Advanced Practice areas would require postgraduate education. Of course, in parallel with any of these taught elements in their professional education, trainees would also have to undergo practical, hands-on, training in related client work under the supervision of suitably qualified and experienced practice teachers. 

The third and final essential step will be setting up mandatory post-qualification professional development programs. For the newly qualified this would entail working under the supervision of a professional mentor for a certain period of time. For the more experienced this would involve keeping up to date by attending approved further training programs.

Obviously, by arguing for such a fundamental upgrading of therapist training I will probably be accused of wanting a radical, root and branch, shake-up of the counselling and psychotherapy profession, its practitioners, its trainers, and its therapist education policies. Well of course I do. I want today’s counsellors and psychotherapists to be trained to do their jobs properly – doesn’t everybody?

BLOG POST – Spring 2020

MINDFULNESS – ANOTHER ‘FLAVOUR OF THE MONTH’?

Nowadays, you are a therapeutic nobody if you are not into ‘Mindfulness’. It is psychotherapy’s latest ‘miracle cure’. However, before you get too carried away, don’t forget that just like any other human enterprise, psychotherapy too is subject to the whims of fashion. Up until recently Cognitive Behavioural Therapy was the flavour of the month – now it’s so ‘last year’. These days, Mindfulness is the latest ‘must have’ therapy. Didn’t you know?  Are you ‘behind the curve’? Has Mindfulness passed you by? Don’t worry – in a year or two, therapy’s Fashionistas will all be into something else. You can catch up then.    

Actually, Mindfulness is not really the bang-up-to-date modern psychological cure-all that its supporters think it is. Like most new ‘wonder therapies’. Mindfulness is only the latest twist on some very old ideas. The fact is that ‘Mindfulness’ is only a new name for some long-established, common-sense, psychotherapeutic techniques, ones that suit some patients and not others. I’ve been using them for years but nobody told me I was being super-trendy.

So, what is Mindfulness? From a psychotherapeutic point of view, it is about encouraging patients to learn how to become very aware of themselves in the present moment whilst at the same time calmly acknowledging and accepting their feelings, thoughts, and bodily sensations. In other words, it is about acquiring the skills necessary to be able to become at ease with all that a patient is experiencing in the immediate here-and-now. Its roots lie in the meditative traditions of ancient eastern religions. There’s nothing in mindfulness that yoga enthusiasts or Buddhism devotees wouldn’t recognise. It’s certainly not new.

Basically, Mindfulness is simply about learning how to become at ease with yourself, about how to become relaxed. There is of course nothing revolutionary about using relaxation as a therapeutic tool. Lots of psychological therapists routinely use Relaxation Therapy, (RT), as a means of treating patients with certain types of anxiety disorders. RT helps patients to learn how to calmly focus on the immediate and then to constructively face their fears. In other words, RT and Mindfulness are simply different sides of the same coin.

In my own practice I use RT because it works, not because it is trendy. Unlike Mindfulness, RT is not based on any spurious ancient, or new-age, belief systems. I’m a scientist and I use scientific principles. The science of RT is based on the biological fact that humans have two major nervous systems. One is the conscious system, That’s the one that we use to think with and to experience emotions and fears. The other is the autonomic system. That’s the one that controls our bodies, (heart rate, breathing, sweating, and other assorted physiological functions). The important biological fact is that these two systems interact with each other. Any ups or downs in one system’s activity levels will cause corresponding movements in the other system. The trick is finding out how to purposely control both nervous systems.

When we feel directly or indirectly threatened we get anxious. These threats can be real or imagined. They can be high intensity and sudden, (a car crash for example); they can be low intensity and long term, (bullying for instance). No matter what sort of a threat it is, when it impacts on us, both the conscious and the autonomic nervous systems rev up and prepare us to deal with it. This is the well-known ‘flight or fight’ response. So, when we become excessively anxious, then clearly these two nervous systems have gone into overdrive. People who suffer from clinically significant levels of anxiety are in a permanent state of heightened conscious and autonomic systems activity. Therefore, when they hit an additional worrying or frightening situation, (real or imagined), their already revved up nervous systems quickly become overloaded. This means that the first key task for the psychotherapist is to help chronically anxious patients to generally reduce their background anxiety levels. The second key task is to help them to learn how to reduce the anxiety engendered by specific real or imagined threats and so not further overburden an already hyper-active system. I have often found that Relaxation Therapy is a very useful way of achieving these two tasks.

Relaxation Therapy is not difficult to apply. It is simply a method of progressively relaxing the body. Initially patients do this under the direction of the therapist. Eventually they learn how to purposefully relax under their own directions. As the body gradually relaxes so too does the mind. Anxieties decrease and panics attenuate – problem solved! On the surface, the methods used to introduce RT to patients might seem similar to those used in hypnotherapy. However, RT is most emphatically not hypnosis. Hypnosis is about a patient temporally surrendering control to the therapist. In direct contrast, the core purpose of purpose of RT is to enable patients to take better control of their own minds, of their own selves. Patients use RT in order to become calmly aware of what’s going on around them; what’s going on in themselves and in the true nature of their own beings. Put simply, they use RT to get their lives into balance in the present and to place tomorrow’s worries where they belong – in the future. The trendies call this Mindfulness. I call it evidence-based psychotherapy.  

BLOG POST – Winter 2020

DEPRESSION                                            

It’s cold, dreary, and freezing – welcome to winter, UK style!  Sometimes, when we are struggling through these, the most depressing months of the year, it can be hard to find an upside to life. It’s no wonder that so many of us occasionally feel a bit low, a bit depressed. However, for most of us, most of the time, feeling a bit low is just a perfectly normal reaction to life’s downsides. Things go wrong and we get fed up, sad even. That’s all there is to it. That’s life! However, when our gloomy reactions to life’s adversities are excessive, (whatever the season), when they interfere with our lives, when they don’t have an obvious cause, when they are long-lasting, then that’s when depression becomes ‘a matter of clinical concern’.

Mental health professionals recognise a number of different types of depression and classify them according to severity, frequency, and how long the symptoms have lasted. However, carrying out a detailed diagnostic evaluation of depression is an exacting and time-consuming job. Busy GPs cannot afford to be so finicky – they just don’t have the time. In the UK most GPs diagnose depression using the National Institute for Health and Care Excellence, (NICE), Guidelines. However, some diagnosticians prefer to use the World Health Organisation’s mental health check list. These two diagnostic protocols are very similar to each other, easy to use, take only moments, and are reasonably accurate, (at least to begin with). GPs who use the Nice Guidelines check their patients on a yes/no basis against the following criteria.      

Key Symptoms:

Persistent sadness or low mood

Marked loss of interests or pleasure

Associated Symptoms:

Fatigue or loss of energy or slowing of movements

Disturbed sleep (decreased or increased compared to usual)

Decreased or increased appetite and/or weight

Poor concentration or indecisiveness

Feelings of worthlessness or excessive or inappropriate guilt

Suicidal thoughts or acts

The rough rule of thumb is that the more positives scored on the Associated Symptoms list, the more the patient is depressed. In the UK’s National Health Service, depression is usually graded mild, moderate and severe. Treatment is usually offered on a stepped basis depending on how the patient’s needs evolve.  

            Step 1             No action, (most depressives recover within 6 months, treated or not)

            Step 2             Medication and low-intensity psychological therapy, (basic CBT)

            Step 3             Medication and high-intensity psychological therapy (advanced CBT)

            Step 4             Hospitalisation and multi-professional in-patient care

Of course there are many mental health professionals who disagree with the NHS approach to treating depression. They would argue that depression is a much more complex condition than the NICE protocols suggest and therefore the treatments required are equally more complex. Nevertheless, if pushed, many of these dissenting professionals would probably accept that the NHS stepped-care system gives some relief to some people – at least on a short-term basis. However they would also claim that treatments based on medication and/or CBT often only serve to alleviate the symptoms of depression; that they don’t properly address the causes of depression.    

My own approach to depression is multi-faceted from the onset. Being what is known as a ‘Pluralistic’ or an ‘Integrative’ practitioner, I don’t allow myself to be limited to any given treatment model for depression or to exclusively subscribe to any given causative theory. I prefer to tailor each individual’s treatment plan to suit that person’s needs. So, for any particular client I’ll use whichever approach, (or package of approaches), that seem likely to be the most helpful. Not only that, but I will change my treatment plans if my patient’s needs change. Flexibility is the name of the game.

If a do-nothing, time-is-the-great-healer, approach, (NICE – Step 1) seems to be the right one then OK. However the patient’s progress over the next few months needs to be properly monitored. It’s not just ‘file and forget’. There is still a lot that therapist can do and should do to help. For example, carefully applied positive psychological reinforcements will at least encourage recovery and in many cases will help to speed it up. In all cases patients should be helped to review their lifestyles and to make suitable adjustments.

Traditionally, psychotherapists and GPs have been at the opposite ends of the prescribing spectrum. Supposedly, GPs irresponsibly ‘handed out pills like Smarties’ and psychotherapists were far too ‘holier than thou’ to ever consider medication. Fortunately, these outdated, competing, professional orthodoxies have largely disappeared. Modern psychotherapists and doctors collaborate. I often refer patients who present with depression to their GPs. That’s because it is not unusual for patients to need the ‘chemical lift’ that medication can provide before they can even begin therapy. Not only that, but therapists must always remember that all sorts of medical problems, (a defective thyroid for example), can cause depression-like symptoms in people. It is always good practice to get prospective clients medically checked first.     

In many cases my treatment model for depression includes medication and psychotherapy together. Have a look at the information leaflets supplied with any anti-depressant medication – they all say ‘use pills and talk’.  It’s also a good idea if both the doctors and psychotherapists are prepared to adopt a ‘suck-it-and-see’ approach. After all, different pills work, (or not), for different people and that‘s equally true for the wide variety of psychotherapeutic approaches that claim to have a positive impact on depression.. My advice to any patient is to shop around and find the treatment package that suits you and to stay away from any medic or ‘ologist’ who has a ‘one-size-fits-all’ attitude.

So, in sum what I am saying about depression is this. It’s OK, it’s normal to feel low or sad, (generally dispirited), when the circumstances demand it. What is not OK is for those feelings to disrupt your life. So, when your life is getting a bit out of hand, when your life no longer has an upside, get some help – that’s what psychotherapists are for.