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Feb 5 11 2:06 PM

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I saw a report ( http://uk.news.yahoo.com/5/20110202/tuk ... dbed5.html ) that our new coalition government is in favour of more counselling and less drugging for mental health. Good.

But I have sent two responses, and I wonder what others here think of the policy and of my responses, and what more might be worth saying by whom to whom.

One response, about the policy, went to my MP:

Your government’s decision to use more counselling and fewer drugs for mental health is good news both for the NHS budget and for our people's mental health.

However, you could do more good, more quickly if in addition you made more-abundant use of the thousands of already trained, qualified and available counsellors in Britain .

The necessary additional policy change is to guide the GP practices and groups of practices that will from April be the budget allocators that they need not be restricted by NICE’s guidance to use only “evidence-based treatments”, which in practice usually means hiring only counsellors trained in Cognitive Behavioural Therapy (CBT). NICE’s approach is normal in the field of drug therapy; but counselling, in contrast to pharmaceutics, is an art not a science. The NICE concept of measurable scientific evidence verified by “gold standard” randomised double-blind trials is fundamentally flawed when applied to the mental health-giving benefits of counselling. The DoH may be aware of research indicating that many modalities of counselling (CBT, Person-Centred, Integrative, etc) are of approximately equal mental health-restoring value.

What can usefully be measured is lasting outcomes of real benefit to individuals and concern to government, such as people moving off benefits and into work, and reduced sick leave for those in work, rather than narrow and over-precisely defined mental health presentations such as x% reduction of depression or y% lessening of stress in ‘patients’. Those outcomes are after all only, at best, intermediate objectives.

How about using the counsellors available in Britain now to progress your primary objectives, without restriction at least for the next five years as to what modality of counselling they practise, and letting experience of how well they meet those objectives be your guide as to how best to train and use counsellors later on?


The other, about the report, I sent to Sky:

I was glad to see a Sky News report that the government wants more counselling and less drug treatment for mental health.

But when will the ghost of the "knight in shining armour rescuing the damsel in distress" be laid to rest?

The report shows (on the Internet) an attractive blonde lying on a soft leather surface, anxiously looking at a man wearing a suit whose face is invisible (off-screen), and who is sitting over her and using a pen and paper.

The impression on the surfer's eye, I suggest, is that a counsellor is hidden (surely, not since the death of Freud?), male (though about 4/5 of counsellors are women), remote, powerful, and formal – when actually, counselling is a warm-hearted eye-to-eye relationship in which the counsellor wears ordinary clothes, is mostly listening, and where a pen and paper never appears unless in the
client’s hand for self-expression.
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#1 [url]

Feb 6 11 9:45 AM

Re: Government "talking therapies" policy

@ Sai - I think it's great that you have taken the time to respond to these issues. We need more people to actually DO something. You'll perhaps have noticed my 'avatar' - people not being apathetic is a big deal for me.

What's not great is that almost no-one has even read your post yet. Let alone responded. This is one of the things about the value of people replying to posts, even if it's only to say thanks. It highlights the fact that someone is out there doing something, giving something (a shit) about sharing, changing the world for the better, one little step at a time - even though it may seem almost futile. It's not. It helps. It matters.

Rant over. Thanks for caring, acting.

Paul x

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#2 [url]

Feb 6 11 6:36 PM

Re: Government "talking therapies" policy

Hi Sai and Paul,
Sai - just read your post with the two letters - one to your MP and one to Sky. All I can say is thank you for writing what I and I'm positive hundreds of other counsellors feel. It has inspired me to drop a line to my MP again - I've done this before (actually, I went to see him too but this was a few years ago now so it will be worth my re-visiting him again!). Sometimes it can feel like we don't make any impact but I feel its worth trying. I'm not brilliant with words but I will compose something over the next few days. Your points in the letter to your MP are so well made - how can they not take notice!!.I also love your point about the outdated and inccorrect steriotype of a counsellor in your response to Sky.
with thanks, Carol

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#3 [url]

Feb 7 11 12:59 PM

Re: Government "talking therapies" policy

Hi Sai, all,

I go with letters to MP's etc, and have tried doing my bit with the open letter to BACP, and letters to MP's. I am very disheartened by the responses that come back, and try my best to remain non-apathetic.

Might I draw a similarity with events in BAPCA and what for me seems possible apathy towards engaging in doing anything? Some (including me) have said that reviewing the constitution in light of the awfulness of past events seems valid, yet few seem to offer any willingness to engage in such, and in particular to actually get something organised and moving.

I notice Sai's comment on the BAPCA thread I started here, and Paul opening a new thread.

I guess my sense is that BAPCA (however inadvertently or not) has taken the organisational role of representing the PCA to others. Are the PCA community happy with this representation? I feel it should at least be querying what is happening and why. At the heart of it is the huge question of what might be considered a valid part of the PCA.

Maybe BAPCA should offer no representation and instead serve as an information gathering/sharing network to enable individuals to consider their own positions and representations. I guess the problem is that in some forums (gvmt meetings etc), it is organisational reps and not individuals that get invited.

Warmly
Mark

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#4 [url]

Feb 24 11 11:58 PM

Re: Government "talking therapies" policy

Hello all here on this discussion.
I am writing with a heavy heart as although it seems regulation may be disappearing the medicalisation of distress certainly isn't. I have been working for MIND over the last year and we had some cause for celebration in the winter as it seemed our local NHS mental health buddies were including talking therapies ie counselling in their IAPT budget and Mind won part of the bid. Now the small print is revealed and counselling is not what is on offer. I was told by the chief exec that what we are contracted to do isn't 'conventional counselling'. We lose our confidential group supervision and have line management supervision every week, all cases are to be discussed, and after every client session clients have to complete PHQ9 and GAD7 questionnaires.. if they refuse then 'therapy' ends. In order to renew my contract I have to agree to implement this and not only that, I have to be interviewed for the post and give a presentation on IAPT. I found this out today with my prescribed hours,job description and interview time all written out officially. I was left despairing that a place with 'Mind Body and Soul' emblazoned across its building thought this approach to clients is justifiable. I now face redundancy or swallow the pill. I suspect that what I will do is offer my presentation on IAPT and if they still want me as an employee afterwards then at least I won't have compromised my position and I will just have to deal with the rest the best I can. What saddens me is that colleagues (albeit manager and chief exec) both know fully well how strongly I feel about this yet they seem to want to humiliate me by asking me to offer a presentation.. All I could say to them was 'but why are you doing this?' Presently I feel the answer is that they want 'company' people and clearly I am not one of them.
So beware this expansion of therapy. It will be compromised, there is no place for any thing that doesn't fit a medical model framework.
If any one has any recent references to hand that are published that argue against the use of PHQ9 etc as part of a therapeutic interchange I would appreciate it. All the google references I find are pro and I am left feeling slightly mad, although today I was fortunate enough to have seen Brian Thorne and he reassured me that I am not.

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#5 [url]

Feb 25 11 1:53 AM

Re: Government "talking therapies" policy

Hi. Supposed to be in bed for an early start but this is a nightmare that you describe. You are not mad, but the system surely is. Supposed to be improving access to psychological therapies but using screeners designed by drug companies! This conflict of interest is at the heart of the matter. I'm no expert but there is a whole underground of support to tap into. Some of the most useful excursions I have made into this territory (making sense of the madness, finding good links and networks) began here: http://bit.ly/iaptsanity

Perhaps we can talk further - and I hope others join this critical discussion. There are some sound people on this forum (although they don't always drop by often enough for my liking).

Paul x

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#6 [url]

Feb 25 11 9:39 AM

Re: Government "talking therapies" policy

Thank you Paul.. at times like this a swift response means a lot. I am composing a letter and trying to take the heat out of it as I realise the more angry I feel the more I push others I wish to affect away.. at the moment thats a hard process as I feel deeply affected by this and need to move to a place of strength and peace in order to express myself effectively. I appreciate the link and will let you know what happens. In the meantime I need to put myself in the way of some snowdrops and I also came across the 24 hr streaming of the concert for George Harrison recorded in 2002 so have Ravi Shankar calming my soul at the moment..

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#7 [url]

Feb 25 11 11:00 AM

Re: Government "talking therapies" policy

I feel one of the most difficult aspects of your predicament is the extent to which the agency has 'bought into' all of this. I have worked in the voluntary and community sector for around 30 years and it used to be the case - in my experience at least - that managers would 'play the game' to meet funders' requirements whilst providing counsellors with much more support, trust and freedom to practice. For me, the situation you describe would be untenable - but then I've never put myself in a position of economic dependence on my counselling/therapy work. MIND used to be a radical, system-critical, client-centred/user-led organisation 'back in the day'. I remember back in the early '90s I gave up a number of Christmas days to voluntarily open up my local day centre so MIND users had somewhere to go. It was only comparatively recently when I saw the role they played in the HPC saga that I woke up to how much times had changed. I think they used to be where I would say Soteria are now

I hear you taking some time to look after yourself and gather your thoughts, which comes as a relief to me. It's George Harrison's birthday today I believe. I met him in the 80's at Bhaktivedanta Manor - the beautiful property he donated to the Hare Krishna movement. He seemed like a very humble, spiritual guy. I also got to see Ravi Shankar perform when I was living in Delhi. I'm glad you mentioned this stream, definitely going to check it out. I listen to quite a bit of traditional indian music when I'm most stressed (and regularly drop by here http://onurlar.blogspot.com/ to pick up new gems for my collection).

Paul x

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#8 [url]

Feb 26 11 11:23 AM

Re: Government "talking therapies" policy

Absolutely right there re MIND.. I think they think they may be playing a 'long game' but they certainly have been aggressive local bidders and seem to agree to anything in order to gain a bid. I have some idea of what to say now, especially as there was an interesting letter in therapy today this month re the stats IAPT are producing (excluding 91% of 'patients' data) One possible plus is we end up with more sessions per client. Love the story about George and hope you found the concert stream.. I had to watch the entire thing and I found a fantastic woodland full of snowdrops also. By for now x

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#9 [url]

Feb 26 11 11:40 AM

Re: Government "talking therapies" policy

Be interested to see that article - is it online (do members get access to digital copies?)

I'm wondering if I'm being a bit harsh with MIND. Maybe its just that I feel there is a need for the kind of organisation that MIND used to be - in Bradford, if not nationally. I know they have made difficult, pragmatic decisions over the years - strategically, operationally, sustainability-wise (diversification of funding streams) etc. And it's not as if they are contractually tied to embodying the person-centred approach as we might understand it.

I caught some of the stream - but have one of my sons making an all-too-infrequent visit this weekend so am channeling most of my attention into him (although I'm now off to host a meeting of our local group - which is, thankfully, directly across the road from where I live). Thanks for the 'heads up'.

Happy to continue the dialogue at your leisure - many of this issues are not going to go away, however you decide to deal with your immediate situation

Paul x

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#10 [url]

Mar 2 11 8:15 PM

Re: Government "talking therapies" policy

C hayes, I can feel the despair in your voice, and your grief at the curse that has fallen on you.

And frankly, I am more sad than surprised that an organisation which has so wholeheratedly embraced the concept of "mental illness" should have sold out comprensively to the problem-centred not person-centred 'power from the expert downwards' mindset. (Does this have implications for observing truths about BACP and BAPCA???????)

As for IAPT, my MP's response peddles all the expectable lines, but within it is also a fairly clear indication that GPs don't actually have to do what NICE tells them to, if they genuinely believe something else is better in their own clinical judgement. GPs and local primary care or NHS trusts being the decision-takers except for "severe and enduring mental health conditions".

The inference is that if person-centred counselling could actually be seen to be effective, GPs could use it much more than they do, without having to get national NICE permission first.

But who is doing the necessary research?

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#13 [url]

Mar 30 11 8:49 PM

Re: Government "talking therapies" policy

Thank you Christine. That was a landmark research report and I did read and appreciate it at the time, and I gladly re-read it this monthg at your suggestion.

Alas, its message doesn't seem to have got through to NICE.

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#14 [url]

Apr 12 11 2:56 PM

Re: Government "talking therapies" policy

Hi All

Sorry I am an irregular poster, life intrudes sometimes.

The great sadness about getting through to NICE and SIGN (the Scottish body for guidelines) - is that they don't make much effort to listen. I was active, alongside a number of people in Scotland to get the SIGN guideline to recognise person-centred counselling as a worthwhile treatment for depression. The committee, as far as I can see were very much drawn from "medicalisers" who appear to have been systematically trained to ignore what is clear and obvious before them. it makes me very pleased that we don't have a requirement for a psychology degree for counsellors in this country as the belief in working with cognitions and behaviour to the exclusion of all else (even though CBT practitioners don't themselves seem to think that this is what they are doing) seems to be so prevalent. Their attitude to research was to throw out anything that didn't meet their very narrow criteria, especially where that included real-world situations, such as dismissing data that included anxiety alongside depression as if they were not linked in any way. There are people like Robert and Beth, in the article highlighted, keen to do and report on research that makes the point effectively but we are very poor cousins in research funds and in numbers of practitioner committment to research. When the evaluation committee is so heavily loaded against us, we are left feeling powerless and angry. I have worked hard at stating our case as powerfully as I can but it will keep taking a lot of effort for the tide to turn. In Scotland, Isobel Gibson has been doing an amazing job on behalf of PCT Scotland in turning up at meetings with relevant organisations across Scotland to ensure that our voice is heard and that we also get to listen to the views of others. BACP are also now stepping up and providing lobbying advice as we have elections soon. It's good to hear of others doing the same. All we need now is some listening ... anyone know how to teach that?

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#15 [url]

Apr 28 11 12:46 PM

Re: Government "talking therapies" policy

Hi all, first, great work Sai - my own involvement in regulation battle has really sharpened up my sense that we most 'do something' when it comes to politics but also reminded me how soul-destroyingly energy-sapping it can be because you will be not-heard, ignored to death and, if you get too mouthy, demonised, undermined, probably pathologised (oppositional defiance disorder anyone?) and caught in all sorts of political/psychological games. However, the lesson from the fight with HPC is don't give up but do search out comrades and like-minds for support and solidarity.

Am fascinated and saddened - though not surprised - by your post, C Hayes. I won't say too much about MIND because I have little direct experience but in the regulation debate they played a curious role, with their central/national pro-regulation stance seemingly at odds with some of their own on-the-ground local practice with regards accountability etc. Their claims to the 'client voice' seem to me not entirely watertight either. Anyway, the getting-into-bed with IAPT is a bad development, I feel. Now the huge threat to non-medicalised and non-technicalised working (in which I include - dare I say it here! - some sectors of psychoanalysis and other non-PCA approaches) represented by the HPC has been for now knocked back, it seems to me the kind of cultural dominace over therapy that IAPT is starting to have could be the lurking danger we need to challenge.

I think there are many (starting to) feel that way and don't be surprised if this evolves into a campaign of sorts. Some exposure of the dehumanising method/ide-ology and poor practices of the IAPT system could be a good place to start. Not to mention a bit more critical discussion in Therapy Today etc. So if you have a view or even better some inside experience, get writing! (And stay in touch please)

Btw It doesn't take too much rooting around here http://www.clinpsy.org.uk/forum/viewforum.php?f=27 to find some pretty startling discussions among IAPT workers about their clients/supervision (lack of)/workload/practices...

Last, Paul where do those presentations on IAPT etc. come from that you linked to?

Andy

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#16 [url]

Apr 28 11 4:21 PM

Re: Government "talking therapies" policy

@Andy R

[quote]Last, Paul where do those presentations on IAPT etc. come from that you linked to?

As far as I know, Catherine Clarke is behind a lot of that stuff I linked to (mostly via the Neuroleptic Awareness site, although some of her stuff is also posted on YouTube).

http://www.psychological-wellbeing.co.uk/?About_Me

Paul x

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#18 [url]

May 6 11 10:50 AM

Re: Government "talking therapies" policy

Brilliant stuff as ever from DP. Am inspired to spread this link around as widely as possible. Cheers, Andy

Paul x

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