April 17, 2014

When it’s not good to talk: Adverse effects of psychological therapies

Yesterday I commented on a UKCP misconduct hearing in which a client was left “crying daily and not sleeping” following a therapy exercise which involved being held. The therapist involved was found to have committed misconduct (though wasn’t sanctioned).

This caused me to ponder a question: can psychological therapies be described as having side effects? By this I don’t necessarily mean misconduct cases of the kind I’ve highlighted regularly on this blog. Can therapists who are not regarded as committing some form of unethical practice inadvertently and unintentionally cause harm?

It’s an under-researched area, though this discussion thread mentions quite a few papers on the topic. Trauma therapies are one particular field that springs to mind. There’s been a strong vogue for “psychological debriefings” following major disasters. Aid agencies, entirely well-meaningly, have flown out teams of workers to offer the disaster victims a one-off session of talking therapy, in the belief that this will aid processing the psychological trauma, and reduce the risk of full-blown PTSD. Given how widespread this is, it’s striking how little evidence there is for its effectiveness. Indeed some researchers have suggested that it can actually deepen rather than process the trauma, making PTSD more likely rather than less.

Perhaps part of the problem is the assumption, widespread in our society, that “it’s good to talk”. Something bad has happened, we must talk about it. For a quick musical interlude, this assumption was caustically satirised in the chorus line to Bloc Party’s State of Flux.

The “it’s good to talk” assumption (frequently coupled with another assumption, “something must be done”) is one I come across from time to time in my day job in Child and Adolescent Mental Health Services (CAMHS). I periodically have to fend off (again, entirely well-meaning) requests from parents, teachers, social workers and GPs insisting that a child should have therapy about an adverse event, when the child shows no inclination to want to talk about it. In some cases the child has shown every indication of just wanting to keep their head down and not think about it. At such instances I’ve had to politely but firmly insist that if this is their coping mechanism, then we need to respect that, at least for the time being. Why risk doing more harm than good by ripping apart a coping mechanism?

There’s another area where “it’s good to talk” is widely assumed: bereavement counselling. Again, the evidence base is controversial, with some suggesting that it can do more harm than good. I’m not suggesting that nobody benefits from bereavement counselling, but as with trauma, the assumption that it will automatically be helpful can be simply wrong. I speak from a degree of personal experience on this. I’ve lost both parents, and in both cases I processed the loss without attending any counselling at all. this shouldn’t be too surprising: death is simply a part of life, and people recover from bereavement all the time without therapy. I certainly felt more distressed than helped by the number of people who kept telling me, “Seriously, you need to talk about it.”

Another potential adverse effect of therapy can be when it creates the impression that Something Has Been Done when in fact Something Else Needs To Be Done. I was recently on a child protection course attended by professionals from various agencies, and wound up triggering a huge argument. We were discussing a fictional scenario in which a small child was found to be unfed, in a house that was unheated, with a mother who was drinking heavily. At this point a counsellor from a voluntary sector agency piped up and said, “We need to be looking after the child’s emotional wellbeing. They should be sent for counselling.” At this point I replied, “You need to be looking after the basics first. There’s absolutely no point in sending a half-starving child to counselling.”

The response was uproar. The counsellor told me, “I disagree. We regularly support people children whose basic needs aren’t being met by the parents”, with several people lining up to support her view.

I found that quite a horrifying experience, and it left me worried not only about the counsellor’s practice (“So, you’re cold, you’re hungry and your Mum’s unconscious in her own vomit. How does that make you feel?”) but also about what assumptions would be created by such a child being sent to therapy – not just by the counsellor but by other professionals involved in the case. “We’ve solved the problem! The child’s been sent to a therapist!” In such a scenario there could be social worker, teachers, GPs all congratulating themselves that Something Has Been Done and The Child Has Been Helped because a therapy referral has been made. I’m sure they’ll all feel great about it right up to the point when the child is found battered to death.

I may have wandered slightly from the original point here, that therapy can cause harm even where there is no misconduct. Whereas trauma therapists and bereavement counsellors might be excused due to the paucity of evidence bases, the counsellor in the above anecdote ought to have had some basic awareness of Maslow’s hierarchy of needs, and her comments could raise potential concerns about the safety of her practice. I’m still forming my thoughts on this topic, so would appreciate the feedback of others, particularly where therapy has had an adverse effect that nobody could have predicted.

 

April 16, 2014

Another questionably lenient misconduct outcome by the UKCP

The UKCP may have now achieved accredited voluntary register status with the Professional Standards Authority, but even now some of its misconduct decisions can raise a few eyebrows. In January 2014 they gave a Jungian analyst, Rob Waygood, a 6 month suspension for serious sexual misconduct with a client. With statutory regulators such as the General Medical Council or Nursing and Midwifery Council, such behaviour pretty much guarantees a striking-off, not 6 months on the naughty step.

Here’s another decision by UKCP that raises concern. In December 2013 an outcome was reached for Susan Clancy, a psychotherapist who seems to have inadvertently traumatised a client through some intervention that involved holding them. Misconduct was proved, but the UKCP simply decided not to issue a sanction. Continue reading

April 16, 2014

Cast your nominations for the #MindAwards 2014

Today the categories were announced for the Mind Media Awards, and you can nominate your favourite mental health voices to win.

Although most nominations cost £165 per nomination, there is no charge to nominate for the journalist, student journalist or blogger categories.

The blogger category seems to be replacing what was previously known as the Mark Hanson Award for Digital Media. In many ways I think that’s a shame, because there’s a lot of good stuff being done on other forms of social media (e.g. vlogs, Twitter) to talk about mental health. Then again, the winners from the last three years have all been blogs. In 2011, it was won by Confessions of a Serial Insomniac for her account of recovery from child sexual abuse and borderline personality disorder. In 2012 Mental Health Cop received the award for his detailed analyses of the intersection between policing and mental health. Purple Persuasion won in 2013 for her blog about recovery from bipolar disorder. Continue reading

April 4, 2014

The hollow shell of voluntary “regulation” for psychotherapy

Earlier this week I published an appalling press release from Regent’s University London. A psychotherapist, Andrea Scherzer, was struck off by the British Association of Counselling and Psychotherapy due to alcohol addiction, combined with what reads like a spectacular failure to engage honestly with her misconduct hearings at the BACP. Despite this, she continues to teach psychotherapy at Regent’s.

What does this say about the new system of “accredited voluntary registration” for counselling and psychotherapy?

It says to me that it’s a miserable failure. Continue reading

March 31, 2014

The struck-off therapist teaching psychotherapy – Regent’s University’s horrifying response

Last week I commented that a psychotherapist who has been struck off by the British Association of Counselling and Psychotherapy was still lecturing in psychotherapy at Regent’s University London. Andrea Scherzer had turned up to a therapy session drunk, leading not only to her striking-off but also dismissal for gross misconduct from an NHS trust. I didn’t get a response from Regent’s prior to publication, but they did promise they’d send me one today.

I’ve now had their response, and it’s….not what I expected. Actually it’s quite spectacularly jaw-dropping. I’ll quote it in full, interspersed with commentary from me. Continue reading

March 28, 2014

Something rotten in the psychotherapy dept at Regent’s University London?

A couple of weeks ago Jo D Baker sent me a spreadsheet of what’s happened to the 53 people struck off by the British Association of Counselling and Psychotherapy since 2005. Worryingly, 22% of them seemed to be still practising as counsellors or psychotherapists. Even more alarmingly, three of them were still registered with Britain’s other main therapy body, the UK Council for Psychotherapy.

If all that wasn’t concerning enough, one of those struck off by BACP but still with UKCP seemed to be teaching psychotherapy. Andrea Scherzer is a lecturer in the Department of Psychotherapy and Psychotherapy at Regents University London.

I decided to explore further. What happened next wasn’t in the least reassuring. Continue reading

March 26, 2014

Exeter counselling “cult” condemns British Association of Counselling and Psychotherapy

The story so far…in February an Exeter-based counselling service, Palace Gate Counselling (also trading as Phoenix Counselling) took the unusual step of publishing a lengthy blog post, “The Conflict”. They stated that two other therapists have accused them of running a “therapeutic cult” (which they strongly deny) and that they were close to a disciplinary hearing against their firm. They didn’t state in “The Conflict” who the hearing was with, but it was clear from elsewhere on their blog that it was with the British Association of Counselling and Psychotherapy.

Today, Palace Gate have published a follow-up post, “Our Service, the BACP and the regulation debate”. As with the original post, it’s rather lengthy, but I’ll attempt to summarise it here: Continue reading

March 22, 2014

Guilty pleasures time! The Eurovision Song Contest and Me

Those of you who’ve tuned into my Twitter in recent weeks, expecting me to be talking about mental health, politics and therapy abuse, may have been rather disconcerted to find me live-tweeting various national selections from the Eurovision Song Contest. It’s been a fun and at times surreal ride for me, watching all these shows from across Europe and parts of Asia. I’ve seen Belarusians sing about cheesecake, Latvians sing about cake-baking. Electro-swing from Moldova! Irish sea-shanties from Germany! Oh yes, and possibly the most bizarre appeal for peace I’ve seen about the Ukraine crisis (from 2004 winner Ruslana, performing at the Belgian national selections). Continue reading

March 12, 2014

Does striking off a counsellor or psychotherapist stop them from working?

I’ve just been handed a pretty scary set of data-crunching. Jo D Baker is a regular commenter on this blog. He looked at this page which lists all the people struck off by the British Association for Counselling and Psychotherapy since October 2005. He then did web searches to see if there was any evidence of them advertising their services as counsellors and psychotherapists. He collated the results into a spreadsheet which I’ve uploaded here – Copy of BACP Sinners & Outcomes 06032014.

The results were startling. Of the 53 counsellors and psychotherapists struck off in that period, 22% gave positive hits to websites that appeared to be advertising their services. Even more concerningly, three of them seem to be still registered with Britain’s other major psychotherapy organisation, the UK Council for Psychotherapy.

Here’s a few highlights from Jo’s spreadsheet. Continue reading

March 8, 2014

The Exeter counselling service denying “cult” allegations – Palace Gate responds

Last week I wrote about Palace Gate Counselling Service (also known as Phoenix Counselling Service), a firm in Exeter which recently made an online announcement that they are facing complaints from two therapists who accuse them of running a “therapeutic cult”. They state that these complainants have (unsuccessfully) reported them to a number of agencies, including the police, Adult Safeguarding, the Employment Tribunal Service and the Advertising Standards Authority.

Palace Gate strongly deny any wrongdoing, and accuse the complainants of acting out of commercial motivations. They state that there is a misconduct hearing pending, but decline to say who with. However, it appears to be with the British Association of Counselling and Psychotherapy (BACP).

The dispute seems to have triggered a decision by Palace Gate not to renew their membership of the BACP.

Since then I’ve had a couple of responses from Palace Gate via the comments threads to various blog posts, so I’ll collate them here. Continue reading

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