Around the table with some children yesterday morning....
Poppy Day is approaching, and this prompted a discussion about what poppies mean, and why we wear them each year.
This led on to an explanation of what "war" is, and why it occurs.
A five-year-old girl looked puzzled and simply asked "but why don't they just have a conversation?"
It reminded me of the comment made by Harry Patch, the "Last Living Tommy" who survived until 2009 as one of the oldest veterans of WW1.
Asked what he would say to modern-day politicians who consider armed conflict, he said - "Talk.... Talk now. You will only have to do it later, anyway."
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Infrequent musings and general comments on life, from the perspective of a UK psychotherapist.
Saturday, 5 November 2011
Tuesday, 27 September 2011
The Wisdom of Age
A recent loss within the family has got me thinking about the Circle of Life (hat-tip to Disney) and the Ages of Man (hat-tip to Will Shakespeare).
In my thinking I've been zooming out a bit, and looking more at the long view of life and the numerous stages it contains. In this recent week, a new era has made itself known, where I see mortality creeping up on those around me (and therefore on me too!)
A hotel owner I once met in Austria (in my 20's) was trying to explain to me why he wanted to retire with his wife. It was a lovely turn of phrase - one that wouldn't have been chosen by a native English speaker - but that made it all the more potent:-
"By and by .... you will come to know .... The Age"
This spoke to me of the wisdom that comes with experience. He was assuring me that I would learn what I needed to learn, in time, and that in that sense, my ageing would be like his. As the years go by I appreciate that more and more, and still know that I have far to go, of course.
I hope that 'The Age' will bring wisdom in my life, and in my work.
.
In my thinking I've been zooming out a bit, and looking more at the long view of life and the numerous stages it contains. In this recent week, a new era has made itself known, where I see mortality creeping up on those around me (and therefore on me too!)
A hotel owner I once met in Austria (in my 20's) was trying to explain to me why he wanted to retire with his wife. It was a lovely turn of phrase - one that wouldn't have been chosen by a native English speaker - but that made it all the more potent:-
"By and by .... you will come to know .... The Age"
This spoke to me of the wisdom that comes with experience. He was assuring me that I would learn what I needed to learn, in time, and that in that sense, my ageing would be like his. As the years go by I appreciate that more and more, and still know that I have far to go, of course.
I hope that 'The Age' will bring wisdom in my life, and in my work.
.
Monday, 12 September 2011
Economics, Morals, and The Bystander
I note that UK Prime Minister David Cameron, and his colleague William Hague, were optimistic yesterday about ongoing relations with Russia...
http://www.tinyurl.com/43rlrz7
I heard a few stories too about the approach of the Russian regime that we're familiar with ... torture, murder, and the corrupt dealings of business and government.
Of course, there are many other administrations in the world that show a dubious morality - Japan continues to promote 'scientific' whaling, Canada continues to allow seal culling, and Zimbabwe is just one of the African states where murder and all sorts of other grievous violent acts are taking place daily.
The Russian story got me thinking today in particular because one could almost hear in Cameron and Hague's voice a slight hint of economic desperation. Oil and gas, oil and gas.... the economic climate in the UK is such that Cameron is flirting with China, and basically turning down the volume on any residual issues with Russia. The economic pressure on him to work in the UK's interests are too high.
At a high political level, then, there is discounting at work. Not the kind of discounting one might encounter in therapy, though - out-of-awareness, just-under-the-cognitive-surface discounting. This is a kind of active, purposeful discounting. I fact, I'm reminded of Petruska Clarkson's writing on The Bystander. Are we, as nations, becoming more prepared to take the bystander role with each other (on, for instance, human rights abuses), in order to keep trade moving and support the global economy?
This is the tightest economic era in generations. I worry that more international bystanding will result; more abuses of self (the citizens) and each other (armed conflict, over oil and resources, for instance?) that gets overlooked in favour of economic harmony.
Maybe there's a risk too that we become more bystanderish towards each other, as our own economic safety makes us more prepared to overlook the sufferings of others.
.
http://www.tinyurl.com/43rlrz7
I heard a few stories too about the approach of the Russian regime that we're familiar with ... torture, murder, and the corrupt dealings of business and government.
Of course, there are many other administrations in the world that show a dubious morality - Japan continues to promote 'scientific' whaling, Canada continues to allow seal culling, and Zimbabwe is just one of the African states where murder and all sorts of other grievous violent acts are taking place daily.
The Russian story got me thinking today in particular because one could almost hear in Cameron and Hague's voice a slight hint of economic desperation. Oil and gas, oil and gas.... the economic climate in the UK is such that Cameron is flirting with China, and basically turning down the volume on any residual issues with Russia. The economic pressure on him to work in the UK's interests are too high.
At a high political level, then, there is discounting at work. Not the kind of discounting one might encounter in therapy, though - out-of-awareness, just-under-the-cognitive-surface discounting. This is a kind of active, purposeful discounting. I fact, I'm reminded of Petruska Clarkson's writing on The Bystander. Are we, as nations, becoming more prepared to take the bystander role with each other (on, for instance, human rights abuses), in order to keep trade moving and support the global economy?
This is the tightest economic era in generations. I worry that more international bystanding will result; more abuses of self (the citizens) and each other (armed conflict, over oil and resources, for instance?) that gets overlooked in favour of economic harmony.
Maybe there's a risk too that we become more bystanderish towards each other, as our own economic safety makes us more prepared to overlook the sufferings of others.
.
Saturday, 30 July 2011
Therapy can drive you mad??
UK newspaper The Independent published an article today describing how post-9/11 americans were left worse off after counselling.
http://tinyurl.com/3uauevf
According to the article's author, Guy Adams, a huge number of therapists "flooded in" to New York after the 9/11 attacks, "setting up shop" in various buildings. Adams's underlying suggestion seems to be that these therapists were self-serving profiteers. Some elements of the readership have responded by calling therapists "bloodsuckers" and accusing them of practicing "discredited" modalities.
The academics he's quoting are actually saying something different, in my view. They are saying that a blanket approach to large-scale incidents may have mixed results, because inevitably some people will find themselves talking to a counsellor when they're just not ready to do so.
If you haven't actually asked to talk to someone, and you end up kind-of-having-to, then you may be harmed rather than helped. No big surprise there....
I believe that the therapists who went to NY after 9/11 did so with good intentions; hoping to help in the healing of psychological wounds. Maybe the blanket response wasn't required, but it was uncharted territory for everyone.
Perhaps one of the lessons here is that after a critical incident, we need to attend to the basic survival needs first, and then allow those who are affected in their souls to approach the right people - in their own time, under their own steam.
.
http://tinyurl.com/3uauevf
According to the article's author, Guy Adams, a huge number of therapists "flooded in" to New York after the 9/11 attacks, "setting up shop" in various buildings. Adams's underlying suggestion seems to be that these therapists were self-serving profiteers. Some elements of the readership have responded by calling therapists "bloodsuckers" and accusing them of practicing "discredited" modalities.
The academics he's quoting are actually saying something different, in my view. They are saying that a blanket approach to large-scale incidents may have mixed results, because inevitably some people will find themselves talking to a counsellor when they're just not ready to do so.
If you haven't actually asked to talk to someone, and you end up kind-of-having-to, then you may be harmed rather than helped. No big surprise there....
I believe that the therapists who went to NY after 9/11 did so with good intentions; hoping to help in the healing of psychological wounds. Maybe the blanket response wasn't required, but it was uncharted territory for everyone.
Perhaps one of the lessons here is that after a critical incident, we need to attend to the basic survival needs first, and then allow those who are affected in their souls to approach the right people - in their own time, under their own steam.
.
Tuesday, 26 July 2011
Grief, Loss, and the Meme generation
The death of Amy Winehouse has sparked an understandable flood of tributes from friends, family, and fans. Undoubtedly she was a troubled soul, and I'm not intending to launch into an analysis of all that. Suffice it to say, she lost a battle that is all too common in our world.
I noticed that the tributes started to come in extremely early - mostly via the social networking site Twitter (with Facebook following closely behind). Wife of the former UK Prime Minister, Sarah Brown, was the first to be quoted on the BBC News channel; I couldn't think of any other reason to air her comments, other than perhaps being the first cleb-type to have tweeted in those first few hours. It seemed weird to me.
We have all become used to the more creative demonstrations of grief; the roadside shrine, the photo pinned to a tree, the coloured and pictured headstones. I guess that the 'new' way some people have of expressing their feelings is to tweet it, or add a comment on their Wall.
I'm curious about this, though. Will it lead to an individualized grief that precludes the face-to-face sharing of sadness?
Even more worrying is the thought that, in the future, the importance of tweeting something (for the world to see?) will come to outweigh the authenticity of the sentiment.
.
I noticed that the tributes started to come in extremely early - mostly via the social networking site Twitter (with Facebook following closely behind). Wife of the former UK Prime Minister, Sarah Brown, was the first to be quoted on the BBC News channel; I couldn't think of any other reason to air her comments, other than perhaps being the first cleb-type to have tweeted in those first few hours. It seemed weird to me.
We have all become used to the more creative demonstrations of grief; the roadside shrine, the photo pinned to a tree, the coloured and pictured headstones. I guess that the 'new' way some people have of expressing their feelings is to tweet it, or add a comment on their Wall.
I'm curious about this, though. Will it lead to an individualized grief that precludes the face-to-face sharing of sadness?
Even more worrying is the thought that, in the future, the importance of tweeting something (for the world to see?) will come to outweigh the authenticity of the sentiment.
.
Monday, 18 July 2011
All Human Life is Here.....
Having a quick peek through the news pages today, wondering if anything would grab me enough to make a comment on my blog..... and.....
what strikes me today is the sheer diversity of stuff, maybe so much that I feel a bit wordless!
Newspapers, police, politicians.... heads rolling, scalps being claimed, the guilt-by-association that bleeds ever further, and yet a residual feeling of "it" not quite being resolved yet in our consciousness
The Space Shuttle program ends - and despite it being a huge white elephant, I have a very sad feeling, partly nostalgic and partly about the loss of hope and aspiration. What now will bring us a sense of faith in human potential?
The headline that, in the UK town of Kidderminster, researchers have found that "Patience lasts around 2.5 minutes" before people start huffing and puffing in grumpiness. The 'meme generation' (as I heard it said on the radio this morning), can also be read as the "Me-Me" generation....!
The world needs some therapy-thinking!
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what strikes me today is the sheer diversity of stuff, maybe so much that I feel a bit wordless!
Newspapers, police, politicians.... heads rolling, scalps being claimed, the guilt-by-association that bleeds ever further, and yet a residual feeling of "it" not quite being resolved yet in our consciousness
The Space Shuttle program ends - and despite it being a huge white elephant, I have a very sad feeling, partly nostalgic and partly about the loss of hope and aspiration. What now will bring us a sense of faith in human potential?
The headline that, in the UK town of Kidderminster, researchers have found that "Patience lasts around 2.5 minutes" before people start huffing and puffing in grumpiness. The 'meme generation' (as I heard it said on the radio this morning), can also be read as the "Me-Me" generation....!
The world needs some therapy-thinking!
.
Friday, 8 July 2011
Recession and Mental Health
http://tinyurl.com/4xzdsjv
News today that, in the current recession, mental health of the public is suffering. Not just on the UK, either; this effect seems to be spreading across Europe.
Driving home today, as the news came that British Gas are hitching up their energy prices by a whopping 16-18%, I couldn't help but wonder how many people would be pushed a little closer to the edge by the sudden and marked rise in the cost of living.
I wonder what can be done, in the face of increasing pressure from external factors like this, to support people who feel they are struggling?
.
News today that, in the current recession, mental health of the public is suffering. Not just on the UK, either; this effect seems to be spreading across Europe.
Driving home today, as the news came that British Gas are hitching up their energy prices by a whopping 16-18%, I couldn't help but wonder how many people would be pushed a little closer to the edge by the sudden and marked rise in the cost of living.
I wonder what can be done, in the face of increasing pressure from external factors like this, to support people who feel they are struggling?
.
Tuesday, 5 July 2011
NICE and psychotherapy ... part 3
In this final instalment, I'd like to look at the conclusions drawn by the UKCP/Roehampton report on NICE's apparent attachment to CBT.
As we've already seen, NICE favours the RCT as the 'gold standard' of Evidence. So what's the problem with that? Well firstly, the RCT has been examined and discussed by academics who conclude that it may well NOT be the most useful methodology as far as psychotherapy is concerned. Secondly - although NICE acknowledges that other forms of research method exist - it seems to ignore them! (In TA terms, we might think of this as discounting on an organizational or political level).
So far, the bulk of Evidence that NICE has recognized comes from the CBT community. No surprise, since the methodology is very fitting to a modernist paradigm. But it is a world away from what the UKCP's document describes as "Therapy as dialogue". Other forms of therapy (particularly those which are longer-term, more analytical etc) are ill-suited to these trials - indeed, most practitioners of these modalities would shy away from RCTs (on well-thought-out ethical and theoretical grounds). There has been a sea-change in TA and other therapy communities recently, towards a more relational (and therefore postmodern) ethos. NICE and the RCT aren't geared up for this kind of approach - so inevitably, they stick with what they know.
The result, then, is that NICE has favoured CBT - by virtue of its use of a particular research method - and then blinkered itself to other methodologies and modalities. Politically, NICE's endorsement of a Quick, Cost-Effective and Evidence-Based approach fell right into the hands of a government who wanted to squeeze the welfare/mental health budget.
The economist Layard was looking at the budget and saw CBT as a way of saving money, by reducing the number of mental health welfare claimants. The government jumped onto this bandwagon, and sadly, so did the media - spreading the contamination, confusion, and mystification. As I've mentioned before, the constant use in the media of the catchprase "Psychological treatment such as CBT" is nothing short of product placement.
The public are misinformed about therapy as a whole; we have worked so hard to change this - but now the perception is being further warped, this time with the collaboration of some segments of the therapy community itself.
The NICE-CBT-IAPT collusion is damaging in so many ways - not least in the suggestion that the nation can be made Happier - by (in the words of Oliver James) "spreading a thin layer of CBT across the country".
.
As we've already seen, NICE favours the RCT as the 'gold standard' of Evidence. So what's the problem with that? Well firstly, the RCT has been examined and discussed by academics who conclude that it may well NOT be the most useful methodology as far as psychotherapy is concerned. Secondly - although NICE acknowledges that other forms of research method exist - it seems to ignore them! (In TA terms, we might think of this as discounting on an organizational or political level).
So far, the bulk of Evidence that NICE has recognized comes from the CBT community. No surprise, since the methodology is very fitting to a modernist paradigm. But it is a world away from what the UKCP's document describes as "Therapy as dialogue". Other forms of therapy (particularly those which are longer-term, more analytical etc) are ill-suited to these trials - indeed, most practitioners of these modalities would shy away from RCTs (on well-thought-out ethical and theoretical grounds). There has been a sea-change in TA and other therapy communities recently, towards a more relational (and therefore postmodern) ethos. NICE and the RCT aren't geared up for this kind of approach - so inevitably, they stick with what they know.
The result, then, is that NICE has favoured CBT - by virtue of its use of a particular research method - and then blinkered itself to other methodologies and modalities. Politically, NICE's endorsement of a Quick, Cost-Effective and Evidence-Based approach fell right into the hands of a government who wanted to squeeze the welfare/mental health budget.
The economist Layard was looking at the budget and saw CBT as a way of saving money, by reducing the number of mental health welfare claimants. The government jumped onto this bandwagon, and sadly, so did the media - spreading the contamination, confusion, and mystification. As I've mentioned before, the constant use in the media of the catchprase "Psychological treatment such as CBT" is nothing short of product placement.
The public are misinformed about therapy as a whole; we have worked so hard to change this - but now the perception is being further warped, this time with the collaboration of some segments of the therapy community itself.
The NICE-CBT-IAPT collusion is damaging in so many ways - not least in the suggestion that the nation can be made Happier - by (in the words of Oliver James) "spreading a thin layer of CBT across the country".
.
Wednesday, 29 June 2011
NICE and psychotherapy ... part 2
Okay, back to the "NICE Under Scrutiny" document from UKCP....
The report from Roehampton also looks in some depth at NICE's use of research. In these days of "Evidence-based Practice", the so-called Gold Standard for research is the Randomized Controlled Trial, or RCT.
Now, there has been so much intelligent and scholarly analysis of RCTs, and their drawbacks when applied to psychotherapy, that the debate is now well and truly 'out there'. The fact that NICE continues to hold up RCTs as sacred - the 'only' research that can really be considered 'evidence' is frankly a bit crazy. In TA terms, we might think of this as a contamination. (This suggestion was made some time ago in the TA community - if I can find a reference, I will post it!)
Contamination though it may be, this is a vivid demonstration of how NICE is still steeped in the medical model and the machinery that goes with it. Politically, NICE is colluding with the over-sanctification of medicine and adding to the mystification (see my previous post around Radical Psychiatry). In basic terms, NICE is holding a hammer in its hand and looking at everything like it's a nail. (Hat-tip to Abraham Maslow).
NICE is practically and psychologically bound up with the economics and politics of the day, and unfortunately this translates into an unhealthy attachment to politically useful forms of 'evidence'.
Qualitative research, for instance, is much harder to sell to voters, and even harder to use if one wants to inform policy. But it is still a hugely valid and rich form of research in psychotherapy.
.
The report from Roehampton also looks in some depth at NICE's use of research. In these days of "Evidence-based Practice", the so-called Gold Standard for research is the Randomized Controlled Trial, or RCT.
Now, there has been so much intelligent and scholarly analysis of RCTs, and their drawbacks when applied to psychotherapy, that the debate is now well and truly 'out there'. The fact that NICE continues to hold up RCTs as sacred - the 'only' research that can really be considered 'evidence' is frankly a bit crazy. In TA terms, we might think of this as a contamination. (This suggestion was made some time ago in the TA community - if I can find a reference, I will post it!)
Contamination though it may be, this is a vivid demonstration of how NICE is still steeped in the medical model and the machinery that goes with it. Politically, NICE is colluding with the over-sanctification of medicine and adding to the mystification (see my previous post around Radical Psychiatry). In basic terms, NICE is holding a hammer in its hand and looking at everything like it's a nail. (Hat-tip to Abraham Maslow).
NICE is practically and psychologically bound up with the economics and politics of the day, and unfortunately this translates into an unhealthy attachment to politically useful forms of 'evidence'.
Qualitative research, for instance, is much harder to sell to voters, and even harder to use if one wants to inform policy. But it is still a hugely valid and rich form of research in psychotherapy.
.
Thursday, 23 June 2011
Group Process, and the writing process
Thinking today about group dynamics - the structure and process of groups. I'm particularly interested in this in terms of healthcare services (the "multidisciplinary team".
The 2 or 3 journal articles has now become a small pile, and I can feel, perhaps, an article brewing.....
Although I enjoy writing, it's a bit of a painful process at times, and rather time-consuming. I tend to collect bits of stuff like a jackdaw and then start typing (surrounded by the stuff I've accumulated) until I'm finished. I haven't yet found a way of doing it little-by-little, which would probably be more practical (and less stressful).
.
The 2 or 3 journal articles has now become a small pile, and I can feel, perhaps, an article brewing.....
Although I enjoy writing, it's a bit of a painful process at times, and rather time-consuming. I tend to collect bits of stuff like a jackdaw and then start typing (surrounded by the stuff I've accumulated) until I'm finished. I haven't yet found a way of doing it little-by-little, which would probably be more practical (and less stressful).
.
Tuesday, 21 June 2011
NICE and psychotherapy ... part 1
This is the first of a few posts dedicated the the UKCP's document "Nice Under Scrutiny", published a few days ago. UKCP have commissioned an authoritative academic report into NICE's foray into the world of psychotherapy, and the resulting roll-out of CBT via the IAPT programme.
NICE is an organization steeped in the biomedical model, where a linear pathway is assumed to be the norm - diagnosis, treatment, cure. Symptoms, or pathology, is the major focus of attention; the patient is simply the carrier or presenting 'face' of the pathology that is to be treated.
The debate about the dangers of the biomedical view in mental health is not new... not by a long way. Back in the sixties, the Radical Psychiatry movement was making noises about the oppressive, alienating effects of psychiatric diagnosis. The 'manifesto' of the Radical Psychiatry movement, which was produced in 1969, still feels relevant today, and is worth a read..... http://www.emotional-literacy.com/rpman.htm
Today, as in 1969, the medical establishment (including NICE) are trying to shoehorn the emotional lives of real people into diagnostic boxes. They have picked on depression as seemingly the most prevalent 'condition', and of course Lord Layard has picked on it due to its perceived economic effects. But the obvious truth is that human emotionality cannot be distilled down into such narrow (and some might say arbitrary) criteria. As Irvin Yalom said, the medical model is a "wafer-thin barrier against uncertainty".
This is to say nothing of the interpersonal effects of diagnostic labelling, and the dehumanizing effect of psychiatric treatments upon patients.... see R.D. Laing, for a start! The bottom line is, you can't treat people's distress by trying to use a standardized approach.
I recently heard a tale of IAPT which sent shivers down my spine. A person had been referred to the IAPT service by their GP, due to multiple trauma including a recent bereavement. They were telephoned by an IAPT worker, who tried unsuccessfully to 'treat' her with the manualized CBT-style spiel. The person later told her (face-to-face, psychodynamic) counsellor that they needed to talk about their sadness and loss, not be told to 'make a list of negative thoughts you need to change, and have it ready next time I call you'. What kind of therapy is this?
The use of a treatment protocol is fine, in cases of actual organic illness. But treating, say, a strepto-throat-infection is so very different from treating sadness, fear, loss, anguish, or any other kind of mental or psychic pain. The 'pathology' can't be isolated, so the medical model falls over.
The determination of NICE to push ahead in this way, and the onward rumbling of IAPT, seems to represent an unwillingness to accept that psychotherapy is different.
.
NICE is an organization steeped in the biomedical model, where a linear pathway is assumed to be the norm - diagnosis, treatment, cure. Symptoms, or pathology, is the major focus of attention; the patient is simply the carrier or presenting 'face' of the pathology that is to be treated.
The debate about the dangers of the biomedical view in mental health is not new... not by a long way. Back in the sixties, the Radical Psychiatry movement was making noises about the oppressive, alienating effects of psychiatric diagnosis. The 'manifesto' of the Radical Psychiatry movement, which was produced in 1969, still feels relevant today, and is worth a read..... http://www.emotional-literacy.com/rpman.htm
Today, as in 1969, the medical establishment (including NICE) are trying to shoehorn the emotional lives of real people into diagnostic boxes. They have picked on depression as seemingly the most prevalent 'condition', and of course Lord Layard has picked on it due to its perceived economic effects. But the obvious truth is that human emotionality cannot be distilled down into such narrow (and some might say arbitrary) criteria. As Irvin Yalom said, the medical model is a "wafer-thin barrier against uncertainty".
This is to say nothing of the interpersonal effects of diagnostic labelling, and the dehumanizing effect of psychiatric treatments upon patients.... see R.D. Laing, for a start! The bottom line is, you can't treat people's distress by trying to use a standardized approach.
I recently heard a tale of IAPT which sent shivers down my spine. A person had been referred to the IAPT service by their GP, due to multiple trauma including a recent bereavement. They were telephoned by an IAPT worker, who tried unsuccessfully to 'treat' her with the manualized CBT-style spiel. The person later told her (face-to-face, psychodynamic) counsellor that they needed to talk about their sadness and loss, not be told to 'make a list of negative thoughts you need to change, and have it ready next time I call you'. What kind of therapy is this?
The use of a treatment protocol is fine, in cases of actual organic illness. But treating, say, a strepto-throat-infection is so very different from treating sadness, fear, loss, anguish, or any other kind of mental or psychic pain. The 'pathology' can't be isolated, so the medical model falls over.
The determination of NICE to push ahead in this way, and the onward rumbling of IAPT, seems to represent an unwillingness to accept that psychotherapy is different.
.
Sunday, 19 June 2011
Goodbye to Brian Haw
A brief pause to pay tribute to Brian Haw, veteran anti-war protester who famously camped out in Parliament Square and conducted a 24/7 protest for almost a decade.
Why devote a post to Mr Haw, on a blog about 'therapy thinking'?
In the words of Radical Psychiatry, oppression of people and the mystification of it results in alienation.
Brian Haw's UK was a country where people were alienated from their government. A country alienated from other countries. Why? Because of the decisions to go to war, and oppress nations abroad; decisions shrouded in mystification that generations to come won't understand.
I reckon history will judge Brian Haw to be a hero of peace and free speech. I also consider him a wonderful example of "Speaking Truth To Power".
.
Why devote a post to Mr Haw, on a blog about 'therapy thinking'?
In the words of Radical Psychiatry, oppression of people and the mystification of it results in alienation.
Brian Haw's UK was a country where people were alienated from their government. A country alienated from other countries. Why? Because of the decisions to go to war, and oppress nations abroad; decisions shrouded in mystification that generations to come won't understand.
I reckon history will judge Brian Haw to be a hero of peace and free speech. I also consider him a wonderful example of "Speaking Truth To Power".
.
Thursday, 16 June 2011
NICE, CBT and IAPT finally get a critical review
UKCP (The United Kingdom Council for Psychotherapy) are publishing an academic report that they commissioned some time ago.
I'll be blogging some more about the findings of the report over the next couple of weeks, and exploring some of the important points that are made.
Having given the report a once-over, I am really encouraged that a highly-respected academic team have brought their weight to the issues. Finally, we can begin to debunk some of the mystification, economics and politics behind the NICE/IAPT/CBT set-up.
.
I'll be blogging some more about the findings of the report over the next couple of weeks, and exploring some of the important points that are made.
Having given the report a once-over, I am really encouraged that a highly-respected academic team have brought their weight to the issues. Finally, we can begin to debunk some of the mystification, economics and politics behind the NICE/IAPT/CBT set-up.
.
Tuesday, 14 June 2011
Men's Health Week: 13-19 June 2011
I'm all in favour of "Men's Health Week"...
http://www.menshealthforum.org.uk/21706-mens-health-week-2011
In the psychosexual field, I am always working with men who want or need to talk about their bodies. Commonly, it's getting past the initial hurdles of embarrassment and shame that prove difficult. After that, most guys find a sense of relief and support in being able to open up and talk.
I admit, because of the work I do, I tend to be quite pushy with men I meet, young and old. If they're young, I will usually find an opportunity to talk about examining one's testicles. If they're not-so-young, I will ask about their prostate and encourage them to visit their GP for a "well man" check.
So, my good wishes to Men's Health Week. And let the "meat and two veg" jokes begin. (One way around the embarrassment is humour.....)
.
http://www.menshealthforum.org.uk/21706-mens-health-week-2011
In the psychosexual field, I am always working with men who want or need to talk about their bodies. Commonly, it's getting past the initial hurdles of embarrassment and shame that prove difficult. After that, most guys find a sense of relief and support in being able to open up and talk.
I admit, because of the work I do, I tend to be quite pushy with men I meet, young and old. If they're young, I will usually find an opportunity to talk about examining one's testicles. If they're not-so-young, I will ask about their prostate and encourage them to visit their GP for a "well man" check.
So, my good wishes to Men's Health Week. And let the "meat and two veg" jokes begin. (One way around the embarrassment is humour.....)
.
Tuesday, 7 June 2011
Joe Glenton and "The Choice" (Radio 4)
I listened with interest today to Joe Glenton being interviewed by Michael Buerk.
Former Lance Corporal Joe was an objector to the war in Afghanistan. He also suffered from PTSD symptoms following his deployment, which were inadequately addressed by the military. As a result, he took the decision to go AWOL, and returned to the UK later to face court-martial and a spell in military prison.
Joe explains that his main driver was his ethical objection to the war. It's also plain that the army's response to his PTSD was derisory. This brings to mind the classic military approach - as on the battlefield, they patch 'em up and send 'em out again. Only with psychological wounds, the treatment is much more difficult (emotional) so it's best avoided (or at best, medicated away). But the theory is the same. We don't want emotionally needy (literate) people in the ranks; we don't want politically aware (thinking) people, either. The job is to go and follow orders, and maybe get shot at. So people like Joe find an unwelcoming home in the military.
Classically, the military life can be seen as a massive Parental system. Its heirarchy and ethos greatly favour a non-emotional, closed-off approach to the world, because "it's the job". The recruits (moved into a Child role) are taught to suppress their feelings, and emotions are devalued culturally. If this comes into conflict with the truth of one's core self, then a problem is inevitable. I've also seen problems arising in relationships between forces-people and their non-forces partners, because the emotional toolkit needed to nurture a healthy relationship with that person isn't available.
It seems to me that Joe was (is) a thinking, feeling human being. Looking for a thinking, feeling response from the institution that is the military, small wonder he felt like he was talking a different language. What followed was the sense of disappointment and frustration that comes to us all, when we experience a need that isn't met by an unresponsive 'other'.
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Former Lance Corporal Joe was an objector to the war in Afghanistan. He also suffered from PTSD symptoms following his deployment, which were inadequately addressed by the military. As a result, he took the decision to go AWOL, and returned to the UK later to face court-martial and a spell in military prison.
Joe explains that his main driver was his ethical objection to the war. It's also plain that the army's response to his PTSD was derisory. This brings to mind the classic military approach - as on the battlefield, they patch 'em up and send 'em out again. Only with psychological wounds, the treatment is much more difficult (emotional) so it's best avoided (or at best, medicated away). But the theory is the same. We don't want emotionally needy (literate) people in the ranks; we don't want politically aware (thinking) people, either. The job is to go and follow orders, and maybe get shot at. So people like Joe find an unwelcoming home in the military.
Classically, the military life can be seen as a massive Parental system. Its heirarchy and ethos greatly favour a non-emotional, closed-off approach to the world, because "it's the job". The recruits (moved into a Child role) are taught to suppress their feelings, and emotions are devalued culturally. If this comes into conflict with the truth of one's core self, then a problem is inevitable. I've also seen problems arising in relationships between forces-people and their non-forces partners, because the emotional toolkit needed to nurture a healthy relationship with that person isn't available.
It seems to me that Joe was (is) a thinking, feeling human being. Looking for a thinking, feeling response from the institution that is the military, small wonder he felt like he was talking a different language. What followed was the sense of disappointment and frustration that comes to us all, when we experience a need that isn't met by an unresponsive 'other'.
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Wednesday, 1 June 2011
End-of-life care - a human right
I'm feeling encouraged today to see that GPs in the UK are recognizing the need for good, respectful palliative and end-of-life care.
I have worked in end-of-life care for some time, as part of my wider practice. I have seen that the wishes and desires of people nearing their death must be recognized and attended to, as far as possible. It helps maintain their humanity right to the end, and helps to give their life meaning.
http://tinyurl.com/3nrpeuk
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I have worked in end-of-life care for some time, as part of my wider practice. I have seen that the wishes and desires of people nearing their death must be recognized and attended to, as far as possible. It helps maintain their humanity right to the end, and helps to give their life meaning.
http://tinyurl.com/3nrpeuk
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Monday, 30 May 2011
I'm featured in the Spring Edition of "Kidaround"
... Kidaround is a magazine produced for Essex parents. I am happy to have been featured in their "wellbeing" section. In a short piece, I say a little about working with couples who are also parents.
http://www.kidaround.biz/wellbeing.htm
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http://www.kidaround.biz/wellbeing.htm
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Sunday, 29 May 2011
A 'new' form of therapy
In Scotland, mental health patients are being offered a new kind of therapy.... fishing.
I love this idea! I strongly believe that re-connecting with nature is a great way of nurturing ourselves and maintaining a good mental balance.
http://www.tinyurl.com/4y6gcye
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I love this idea! I strongly believe that re-connecting with nature is a great way of nurturing ourselves and maintaining a good mental balance.
http://www.tinyurl.com/4y6gcye
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Monday, 23 May 2011
Superinjunctions - is privacy possible in the digital age?
Amid all the hoo-ha about superinjunctions here in the UK, I am quietly cheering at the twitterers and other social media who have 'outed' Ryan Giggs et al.
It seems to me that these legal instruments are only used by those with enough money to afford them. The rest of us, sadly, have to protect our reputations the old-fashioned way..... by, well, trying to be good people, and when we aren't, admitting to it.
Those who find themselves in the media spotlight are now subject to scrutiny like never before. Things can slip out of control so quickly, too - it almost seems like one's privacy can be entirely lost in 24hours. And of course, since Google and others have a policy of caching pages, the history sticks around for quite some time.
I remember a colleague some time ago talking about the value of shame - the idea that shame can actually be a positive thing, because it at least helps to prevent us from engaging in anti-social or criminal acts.
Clearly, though, shame is a tough feeling to endure - hence some of the huge sums spent by some in obtaining these injunctions. All to defend against shame.
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It seems to me that these legal instruments are only used by those with enough money to afford them. The rest of us, sadly, have to protect our reputations the old-fashioned way..... by, well, trying to be good people, and when we aren't, admitting to it.
Those who find themselves in the media spotlight are now subject to scrutiny like never before. Things can slip out of control so quickly, too - it almost seems like one's privacy can be entirely lost in 24hours. And of course, since Google and others have a policy of caching pages, the history sticks around for quite some time.
I remember a colleague some time ago talking about the value of shame - the idea that shame can actually be a positive thing, because it at least helps to prevent us from engaging in anti-social or criminal acts.
Clearly, though, shame is a tough feeling to endure - hence some of the huge sums spent by some in obtaining these injunctions. All to defend against shame.
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Wednesday, 18 May 2011
Stephen Hawking tells Google 'philosophy is dead'
Cosmologist Stephen Hawking recently advised us that if we have faith in a God, or believe in heaven, then we are using a "fairy tale" to defend us from our "fear of the dark".
Now he's declared that philosophy is dead. Apparently, the world of science has advanced so much, it's left the art of philosophy behind. “Most of us don't worry about these questions most of the time. But almost all of us must sometimes wonder: Why are we here? Where do we come from? Traditionally, these are questions for philosophy, but philosophy is dead,” he said. “Philosophers have not kept up with modern developments in science. Particularly physics.”
My worry is this - if philosophy is dead, who's going to protect the scientists from their own narcissism?
Philosophy and its related disciplines offer an essential counterbalance to the modernist paradigm, which assumes that we can (and should) know everything - and that science has all the answers. I'm not at all convinced it does.
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Now he's declared that philosophy is dead. Apparently, the world of science has advanced so much, it's left the art of philosophy behind. “Most of us don't worry about these questions most of the time. But almost all of us must sometimes wonder: Why are we here? Where do we come from? Traditionally, these are questions for philosophy, but philosophy is dead,” he said. “Philosophers have not kept up with modern developments in science. Particularly physics.”
My worry is this - if philosophy is dead, who's going to protect the scientists from their own narcissism?
Philosophy and its related disciplines offer an essential counterbalance to the modernist paradigm, which assumes that we can (and should) know everything - and that science has all the answers. I'm not at all convinced it does.
.
Wednesday, 4 May 2011
Osama Bin Laden is killed - but will the nightmares go away?
The killing of Osama Bin Laden has been met with some triumphal and patriotic celebrations in the US, which I admit I find a bit bemusing. Here in the UK, some writers are commenting on this reaction, asking "what happened to being magnanimous in your successes?".
An area of interest for me over the years, especially since 9/11, is the way our politicians have encouraged us to think about terrorists, enemies, and the threat posed by them. The "Power of Nightmares" documentary produced by the BBC explained eloquently how, when politicians claim they can protect us against terror/invasion/the bogeyman, it shores up their authority over us. We, the frightened children, are made to feel protected by the powerful, aggressive leaders (Bush & Blair in particular)... whose narcissistic supply is also boosted as part of the deal.
Now that the big bogeyman Osama is dead, what will become of this symbiosis? You'll notice that we still have enemies to fear and fight (these days they are called 'insurgents' or something similar), but they have much less potency as a threat to us on home soil.
So how, in the post-9/11, post-Bin-Laden world, will our politicians shore up their authority? It will be interesting to see what unfolds...
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An area of interest for me over the years, especially since 9/11, is the way our politicians have encouraged us to think about terrorists, enemies, and the threat posed by them. The "Power of Nightmares" documentary produced by the BBC explained eloquently how, when politicians claim they can protect us against terror/invasion/the bogeyman, it shores up their authority over us. We, the frightened children, are made to feel protected by the powerful, aggressive leaders (Bush & Blair in particular)... whose narcissistic supply is also boosted as part of the deal.
Now that the big bogeyman Osama is dead, what will become of this symbiosis? You'll notice that we still have enemies to fear and fight (these days they are called 'insurgents' or something similar), but they have much less potency as a threat to us on home soil.
So how, in the post-9/11, post-Bin-Laden world, will our politicians shore up their authority? It will be interesting to see what unfolds...
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Thursday, 7 April 2011
Call yourself a counsellor?? The "Brass Plaque" argument
One of the major historical strands in the debate about regulation of psychotherapy and counselling in the UK has been the so-called "Brass Plaque". This refers to the notion that (at present) anyone can set themselves up as a counsellor or psychotherapist, simply by having a nice-looking shiny name-plate outside an office. Put simply, if you call yourself a counsellor, you can be one - even without relevant qualifications or training.
Regulation (supposedly) offers the public protection against charlatans and bad therapists, qualified or not - and part of the package entailed the legal protection of the titles "counsellor" and "psychotherapist".
I must admit, I never really bought this argument. I have always had some faith in Joe Public, and believed that he/she would be able to tell who's who. But I am beginning to reconsider. Those people wishing to name themselves (without, perhaps, the necessary credentials) have increasingly complex ways of covering this up. We're now living in a world of flash(y) websites and bold claims, nice pictures and all-too-positive 'testimonials'. If a website has a high Google ranking, it's often mistakenly assumed that the company must be 'reputable'. In truth, these rankings are more about e-marketing than good service or clinical expertise. Maybe it's getting easier to fool Joe Public.
I stumbled into a website recently of someone reasonably local to me, who doesn't seem to be qualified in counselling (they have been trained in an associated field, you might say). But there is no evidence of BACP/UKCP membership (or of any other professional bodies), and no information about their qualifications. Some interesting claims were made, when I looked further....
(Counselling is) "... literally repeating what the client says each time..."
(On couple work) "your conflicts ..." ".. will become a thing of the past!"
Some of the material, like the first example above, shows a gross misunderstanding (and misrepresentation) of the counselling process.
The second example shows how a bold claim can be incredibly misleading. I have never been in the business of telling couples that ANY of their conflict will disappear entirely an this way - it's unrealistic.
Now I've (nearly) stopped seething, I am more sympathetic to the idea that our titles should be protected, and those using them falsely should be stopped.
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Regulation (supposedly) offers the public protection against charlatans and bad therapists, qualified or not - and part of the package entailed the legal protection of the titles "counsellor" and "psychotherapist".
I must admit, I never really bought this argument. I have always had some faith in Joe Public, and believed that he/she would be able to tell who's who. But I am beginning to reconsider. Those people wishing to name themselves (without, perhaps, the necessary credentials) have increasingly complex ways of covering this up. We're now living in a world of flash(y) websites and bold claims, nice pictures and all-too-positive 'testimonials'. If a website has a high Google ranking, it's often mistakenly assumed that the company must be 'reputable'. In truth, these rankings are more about e-marketing than good service or clinical expertise. Maybe it's getting easier to fool Joe Public.
I stumbled into a website recently of someone reasonably local to me, who doesn't seem to be qualified in counselling (they have been trained in an associated field, you might say). But there is no evidence of BACP/UKCP membership (or of any other professional bodies), and no information about their qualifications. Some interesting claims were made, when I looked further....
(Counselling is) "... literally repeating what the client says each time..."
(On couple work) "your conflicts ..." ".. will become a thing of the past!"
Some of the material, like the first example above, shows a gross misunderstanding (and misrepresentation) of the counselling process.
The second example shows how a bold claim can be incredibly misleading. I have never been in the business of telling couples that ANY of their conflict will disappear entirely an this way - it's unrealistic.
Now I've (nearly) stopped seething, I am more sympathetic to the idea that our titles should be protected, and those using them falsely should be stopped.
.
Thursday, 31 March 2011
"No Health Without Mental Health" ... or, "no debate without product placement"
I recently received an invite to a conference around mental health , entitled (something like) 'the implementation of the mental heath strategy'. The invite makes particular reference to the "No health without mental health", the UK government's mental health strategy.
It also goes on to say that "Central to these plans is to improve access to psychological therapies such as Cognitive Behavioural Therapy (CBT)..."
Sadly, this is another example of how the wide range of therapies is being artificially distilled down according to its 'evidence base' (or perhaps its percieved cost-benefit to the state?).
On TV and radio, as well as from political sources, the covert advertising of CBT over other therapies is still going on. Try the examples below, and see what effect you notice.....
"Soft drinks like Coca-Cola (Coke)"
"Fast food chains such as Burger King"
"Popular phrases, for example 'evidence-based'..."
In much of the debate around mental health and IAPT, it seems you never hear the phrase "talking therapies" without the adjunct "such as Cognitive Behavioural Therapy".
How about calling this by its name? Product Placement.
Fortunately the UKCP is still asking for a wider view, claiming that the current approach denies patients a fair choice.
http://www.ukcp.org.uk/ukcps_reaction_to_no_health_without_mental_health.html .
It also goes on to say that "Central to these plans is to improve access to psychological therapies such as Cognitive Behavioural Therapy (CBT)..."
Sadly, this is another example of how the wide range of therapies is being artificially distilled down according to its 'evidence base' (or perhaps its percieved cost-benefit to the state?).
On TV and radio, as well as from political sources, the covert advertising of CBT over other therapies is still going on. Try the examples below, and see what effect you notice.....
"Soft drinks like Coca-Cola (Coke)"
"Fast food chains such as Burger King"
"Popular phrases, for example 'evidence-based'..."
In much of the debate around mental health and IAPT, it seems you never hear the phrase "talking therapies" without the adjunct "such as Cognitive Behavioural Therapy".
How about calling this by its name? Product Placement.
Fortunately the UKCP is still asking for a wider view, claiming that the current approach denies patients a fair choice.
http://www.ukcp.org.uk/ukcps_reaction_to_no_health_without_mental_health.html .
Wednesday, 16 March 2011
Victor Frankl
A nice quote from the author who told us so much about the resilience of the human spirit:
“When we are no longer able to change a situation - we are challenged to change ourselves."
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“When we are no longer able to change a situation - we are challenged to change ourselves."
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Monday, 28 February 2011
"Excellence"...... it's ... umm... well, it's good.
Have you noticed how many organizations, government agencies, and managers these days are referring to "Excellence"?
In the healthcare and psychotherapy worlds, we are already familiar (perhaps too much so) with NICE (the National Institute for Clinical Excellence) and The Council for Healthcare Regulatory Excellence (CHRE).
A couple of thoughts.... firstly, I tend to flinch these days simply because "Excellence" seems to be bandied around now like just another bit of management-speak. Ducks in a row, blue sky thinking, etc.
Also, I frown a little at the hyperbole of it - like, what happened to "Awesome"?? It's mostly used now by people who haven't really experienced anything truly awe-some. The guy who told me that making a credit card balance transfer recently was 'awesome' clearly hasn't stood at the top of a mountain or met someone who lives with a terminal illness.
I think I'm most bothered about the notion of "Excellence" because it seems to suggest that good enough isn't good enough, and that anything short of Clinical Excellence is poor practice.
BACP have a policy/procedure document that is known as the 'gold book' .... I can't help wondering, what happens next - the platinum one...????
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In the healthcare and psychotherapy worlds, we are already familiar (perhaps too much so) with NICE (the National Institute for Clinical Excellence) and The Council for Healthcare Regulatory Excellence (CHRE).
A couple of thoughts.... firstly, I tend to flinch these days simply because "Excellence" seems to be bandied around now like just another bit of management-speak. Ducks in a row, blue sky thinking, etc.
Also, I frown a little at the hyperbole of it - like, what happened to "Awesome"?? It's mostly used now by people who haven't really experienced anything truly awe-some. The guy who told me that making a credit card balance transfer recently was 'awesome' clearly hasn't stood at the top of a mountain or met someone who lives with a terminal illness.
I think I'm most bothered about the notion of "Excellence" because it seems to suggest that good enough isn't good enough, and that anything short of Clinical Excellence is poor practice.
BACP have a policy/procedure document that is known as the 'gold book' .... I can't help wondering, what happens next - the platinum one...????
.
Sunday, 16 January 2011
Big on Bonuses, Short on Humility
Bob Diamond, the CEO of Barclays Bank, recently said in Parliament that he feels we should stop blaming the bankers for our financial crisis. He suggests that we have persecuted them enough, and the public needs to move on.
This is a switch on Karpman's Drama Triangle, from Persecutor to Victim. (The taxpayers have, and continue to do, the Rescuing) ... In order to avoid having to make any apology, or gesture, he simply points the finger back and says "you're persecuting me!"
The true position of those bankers like Diamond is, of course, the Persecutor. In bleeding society dry of its funds, they aren't considering whether their needs are sustainable - or moral. Instead, they continue to "Take It", with the grandiose sense of entitlement that is one of the hallmarks of narcissism.
I will feel much more positive towards bankers when I observe some change in the champagne-charlie-casino-royale largesse, and a more sustainable, socially responsible ethos emerges.
I won't hold my breath....
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This is a switch on Karpman's Drama Triangle, from Persecutor to Victim. (The taxpayers have, and continue to do, the Rescuing) ... In order to avoid having to make any apology, or gesture, he simply points the finger back and says "you're persecuting me!"
The true position of those bankers like Diamond is, of course, the Persecutor. In bleeding society dry of its funds, they aren't considering whether their needs are sustainable - or moral. Instead, they continue to "Take It", with the grandiose sense of entitlement that is one of the hallmarks of narcissism.
I will feel much more positive towards bankers when I observe some change in the champagne-charlie-casino-royale largesse, and a more sustainable, socially responsible ethos emerges.
I won't hold my breath....
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