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PCU Statement against Prevent

PCU Statement against Prevent

As part of the Prevent statutory duty, you may be aware that the UK government now designates healthcare settings a ‘pre-criminal space’. Since 2015, NHS staff must demonstrate ‘due regard’ in identifying and reporting individuals they suspect may be vulnerable to radicalisation. Prevent policy remains controversial and a number of organisations and groups have issued a statement on Prevent policy. A UN human rights expert has recently raised serious concerns with the Prevent policy, with its foundations based on “vague criteria in a climate of national anxieties in which entire religious, racial and ethnic groups are presumed to be enemies.” The Royal College of Psychiatrists have stated there is no evidence to support the relationship between terrorism and mental health concerns. Furthermore, whilst stating that “mental health provider organisations must […] fulfil their statutory and professional duties for Prevent”, NHS England’s ‘Guidance for mental services in exercising duties to safeguard people from the risk of radicalisation’ (published Nov. 2nd, 2017) admits further research is needed to determine links between terrorism and mental health. Crucially for our practice, an article published in the Journal of Psychodynamic Practice warns that Prevent potentially limits the boundaries of acceptable speech, thereby threatening the very conditions on which psychotherapy depends.

Despite all this, a recent report has found that several mental health trusts across the Midlands are now routinely screening for vulnerability towards radicalisation with all patients. It appears the government is increasingly co-opting mental health bodies for mandatory Prevent without any evidence to support the expansion of the policy in this field.

We add to this that Prevent policy must be reviewed for its lack of evidence-base in the development of the programme, and for its elusive definition of “radicalisation” which relies heavily on ‘gut feelings’.

The Psychotherapy and Counselling Union (PCU) argue that duties undertaken as part of Prevent fall outside the remit of clinical mental health care and wellbeing treatment. The implementation of this policy is likely to be detrimental to mental health care, creating mistrust between service users and professionals.

Preventing Therapy

Preliminary results from a British Academy project indicate that British Muslims are less likely to seek mental health services, knowing that mental health trusts are now screening for individuals vulnerable to radicalisation / extremism in their comprehensive risk assessments.

Whilst statistics for Prevent duty indicate a recent trend towards increased referrals regarding far-right extremism, the programme continues to disproportionately target Muslim communities on a vast scale. Analysis of a governmental report published in 2017 demonstrates that Muslims are 41 times more likely to be referred to Prevent than non-Muslims.

If Prevent is preventing therapy for certain groups, then it is divisive and it is discriminatory.

Against Ethical Guidelines

We note that psychotherapy and counselling regulatory bodies all have ethical guidelines against discrimination, advising members to not allow “colour, race …social, economic or immigration status, lifestyle, religious or cultural beliefs to adversely affect the way they relate to the client” (to quote UKCP’s section 2.2 for example). The Prevent Programme’s disproportionate impact on Muslim communities, which we believe is clearly discriminatory, raises serious concerns whether ethical guidelines are breached where the policy is implemented.

Speaking Out
As a union, we are deeply concerned that Prevent is likely to erode the employment rights of counsellors and psychotherapists working within NHS and state settings, since individual practitioners may be sanctioned for their non-clinical actions or inactions associated with this controversial programme.

We believe that psychotherapists and counsellors must be supported in their holding of uncertainty within the therapeutic space, and that the ambiguity of client/patient expression should be respected (fantasy and so-called reality are not clearly distinguishable in our practice). Further, we believe that this policy is part of an increasing erosion and undermining of confidentiality and privacy, so crucial to psychotherapy and counselling.

We believe further action is required to fight back against the creep of state interference into the consulting room, in the name of confidentiality and privacy, and to encourage once again the free expression of thoughts and fantasies without fear of punishment.

We call on all professional bodies and employers to support their members/employees, to ensure that no longer will any therapist/counsellor be disciplined for breaching Prevent duty, and to clearly declare that it is not a fit policy for our practice.

Psychotherapy and Counselling Union
http://www.psychotherapyandcounsellingunion.co.uk/


This statement was written by members of the PCU East London group eastlondonpcu@gmail.com and has been endorsed by the Chair and Committee of the Psychotherapy and Counselling Union.

 

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Following feedback from members and other groups, the Committee has agreed the following statement to clarify our position.

The Psychotherapy and Counselling Union does not accept the practice of 'conversion/ reparative therapy', or any forms of therapy that attempt to change the client's sexual orientation, gender identity, or consenting sexual expression    Such approaches are inherently unethical and potentially harmful. We do not recognise them as valid forms of therapeutic practice. Therefore, those overtly or covertly practicing 'conversion therapy' are not welcome as members of the PCU and will not be represented by the PCU.

For further information on this issue, see UKCP's statement

https://www.psychotherapy.org.uk/wp-content/uploads/2017/11/Reparative_Therapy_Paper_28022011.pdf

and the Memorandum of Understanding

https://www.psychotherapy.org.uk/wp-content/uploads/2017/10/UKCP-Memorandum-of-Understanding-on-Conversion-Therapy-in-the-UK.pdf

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What should any new mental health strategy post-2021 focus on? 

Submission by the Lateef Project in collaboration with the Psychotherapy and Counselling Union regarding minority communities specifically the Muslim community

The five year Forward View for Mental Health is failing it its 2010 Equalities Act duties with regards to religion, beliefs, race and ethnicity. The specific duties it fails in relation to, when making decisions, are the duty to take into account the need to: eliminate discrimination, harassment and victimisation; and to advance equality of opportunity. This is not just a failure of the strategy - it is a systemic failure across statutory health provision that also impacts the strategy.

Context: NHS England acknowledged ethnic mental health inequalities in 2003.1 

Yet these inequalities continue regarding race/ethnicity and religion/belief. The strategy refers to such inequalities, to ethnicity and race not religion, and belief. These afford the impression of appearing to take inequalities into consideration and in line with the legislation, whilst also demonstrably failing to do so. 

 

The strategy is evidence-based and reports that 90% of presenting mental health patients are seen in primary care. In this context, IAPT is the main strategic provision. Although DSM-52 is referred to in the NICE recommendations regarding assessment of common mental health problems treated by IAPT, no mention is made of DSM-5 supplements regarding the (new) Cultural Formulation Interview (CFI).2 The implication of this is that these factors are not considered in the majority of assessments of ethnic, or faith minority patients. Hence there is not the evidence of difference to take into consideration in treatment, to eliminate discrimination, or to make evidence-based decisions individually or systemically. 

In ignoring culture, the strategy does not accept that presentations of mental illness can vary across cultures. For example, Afghans suffering from depression are more likely to present as ‘angry’ than ‘sad’. Research shows the most significant factor in therapeutic change is what the client feels safe to bring to the therapeutic relationship. IAPT is monitored in relation to its impact in regard to faith communities. However, IAPT’s3 2016 report identified that the Muslim faith is the second largest faith community and also the second least served faith community. As there is a lack of data collected in regard to faith across the system this has not fed into a process or re-evaluation of the strategy. This means IAPT-related practices potentially include unconscious bias in a time of well-documented increased Islamaphobia.

The strategy has not considered the data that exists indicating the complex nature of mental ill health within the community (see Amer & Hovey’s4 2011 study of Anxiety and depression in post-September 11 Arabs and Aslam, Zaheer, & Shafique5 (2015) research on Muslim women and the vertical transmission of domestic violence through victims. Additionally, the strategy has not considered IAPT’s access issues such as diversity of primary language within these communities, the lack of such diversity in its staff complement, the lack of appropriate training for mental health work amongst NHS commissioned translation services, the lack of languages availability in written IAPT self-assessments and the significant proportion of minority communities where the first language is oral not written.

Common mental health problems, anxiety, depression and PTSD are states that are often responses to life events and or negative conceptions of self-worth. Hence recovery is a personal process related to the restoration of value for the individual in a process that is valid for them. Recovery from these states relates to a person’s lived reality and identity. Research shows that the therapeutic relationship is as important as the model in determining outcomes (Norcross 2010)6 key to this being what the client can bring to therapy and what the therapist can empathise with. Further, clients consider that religious issues are generally appropriate in the counselling session7 research regarding the significance of faith in well-being is well documented (The Mental Health Foundation 2006)8. By its own statistics, and at best, IAPT has been shown to equate the long-term recovery rate of chance perhaps as low of 7% of referrals.9 Without a strategy to recognise religion and faith as salient factors in mental health the new mental health strategy post-2021 is unlikely to meet the needs of a significant minority of people. With the need for more effective treatments established, good models have grown from within the Islamic faith communities. These include: Mir et al.’s Adapted behavioural activation for the treatment of depression in Muslims 201510 and the independently evaluated long term studies of Islamic counselling as applied to anxiety and depression co-morbid with long term conditions or somatisisation, (Lateef Project 2014)11 However, while able to prove greater effectiveness in the Muslim community than the standard IAPT approach, and despite being innovative, these have not yet been scaled up to RCTs research to prove efficacy.

Instead, agencies working with Muslim communities such as Paiwan11 in North London, the Lateef Project in Birmingham and Nafsiyat12 in London that try to engage with the NHS through the strategy, receive the complex presentations referrals that statutory services cannot respond to. Informed organisations such as Paiwan, the Lateef Project and Nafsiyat are expected to address mental health issues with short-term interventions whilst also being under resourced. This is within the context of a quota driven strategy, where in 25% of people with mental health problems who are targeted to receive talking therapies, priorities 2 and 3 of the strategy are undermined in relation to Muslim communities. The undermining is by enabling statutory services to cherry pick patients who can more easily hit a services targets, whilst potentially avoiding more complex presentations amongst Muslims. Further, a strategy that does not recognise Muslims makes no connection between the mental health of Muslims and PREVENT, which operates within mental health. Recent research at Warwick University13 has shown some of the spurious reasons why Muslims are referred to PREVENT such as for watching Arabic TV or going on pilgrimage to Mecca. This not only decreases trust in the Muslim community of mental health services, it also indicates the way in which Muslims can experience unconscious bias instead of care.  

When revising the policy, the Lateef Project recommends: NHS England ensure that the strategy complies with its Equalities Act statutory duties and within the UK’s pluralistic society, unconscious bias and Eurocentric notions of mental illness be considered in all aspects of service commissioning, provision, monitoring and development when revising the policy; that the mental health team in collaboration with affected parties investigate the factors which lead to lower recovery rates in minority faith and minority ethnic communities; that a general greater consideration of diversity be given to all minority communities; that any revision of the strategy monitors the lack of impact in the Muslim community and addresses the underlying mental health inequalities experienced; that the Cultural Formulation Interview (CFI) be applied where appropriate, that monitoring in relation to faith include the monitoring of the nature of treatments commissioned and how,  treatment accessed, assessments, treatment outcomes and developmental planning in relation to felt/expressed need. Examples of good practice be prioritised and consulted, such as Islamic counselling (Birmingham) and Adapted behavioural activation (Leeds).

References

  1. Sashidharan, S. P. Inside Outside: Improving mental health services for black and minority ethnic communities in England, 2003, Crown copyright. (Accessed 15 June 2018) http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084558
  2. American Psychiatric Association (2013). Cultural formulation. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 749-759. Washington, DC: American Psychiatric Association.
  3. NHS Digital. Psychological Therapies: Annual report on the use of IAPT services England, 2016-17. (2017). (Accessed 11 June 18) https://digital.nhs.uk/data-and-information/ publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/ psychological-therapies-annual-report-on-the-use-of-iapt-services-england-2016-17.
  4. Amer, M. M. & Hovey, J. D. Anxiety and depression in a post-September 11 sample of Arabs in the USA. Social Psychiatry 47(3), 61, 409-18. February 2011. 
  5. Aslam, S. K., Zaheer, S. & Shafique, K. Is Spousal Violence Being "Vertically Transmitted" through Victims? Findings from the Pakistan Demographic and Health Survey 2012-13. PLoS ONE 10(6), June 2015 
  6. Norcross, J. Evidence Based Therapeutic Relationships, November 2010. www.Scribd. com/document/199113604/Norcross-Evidence-based-Therapy-Relationships.
  7. Rose, E., Westerfeld, J., & Ansley, T. Spiritual issues in counseling: Clients' beliefs and preferences. Journal of Counseling Psychology, 48(1), 61. 2001.
  8. Cornah, D. The impact of Spirituality on Mental Health: A review of literature The Mental Health Foundation, 2006. (Accessed 15 June 2018) www.mentalhealth.org.uk/sites/default/ files/impact-spirituality.pdf
  9. Pybis, J., Saxon, D., Hill, & Barkham, M. The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies.BMC Psychiatry, 17:215, 1-13. (2017). (Accessed 11 June 2018) doi: 10.1186/s12888-017-1370-7.
  1. Mir, G., Meer, S., Cottrell, D., McMillan, D., House, A. & Kanter, J. W. Adapted behavioural activation for the treatment of depression in Muslims. Journal of Affective Disorders. 180,190-199. 2015.
  2. Lateef Project Description and Evaluation 2014 unpublished.
  3. Paiwan (see Lateef Project. Community led Islamic counselling service. Birmingham. http://www.lateefproject.com/.
  4. Nafisiyat. Intercultural therpay centre, London, UK. http://www.nafsiyat.org.uk/
  5. Heath-Kelly, C. & Strausz, E. Counter-terrorism in the NHS - Evaluating Prevent Duty Safeguarding In The NHS. Warwick University. 2017. (Accessed 15 June 2018) https:// warwick.ac.uk/fac/soc/pais/research/researchcentres/irs/counterterrorisminthenhs/

 

Stephen Abdullah Maynard chair of The Lateef Project Registered Charity Number 1168459 June 2018 email stephenmay@mac.com

Dr Philip Cox (Psych.D, C.Psychol) committee member the Psychotherapy and Counselling Union. https://pandcunion.ning.com/

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The Psychotherapy & Counselling Union’s submission to the

NICE ‘exceptional’ second consultation on its depression in adults draft guideline

       At the level of policy to service delivery, IAPTs own end of treatment outcome data reports an outcome probability to increasing well-being that is equal to chance i.e. around 50%/50% (treatment/no-treatment; NHS England, 2018). IAPT treated 1 million people (2009-2012) with a recovery rate of 45% (Department of Health, 2012). Of more serious concern is that from its own data, IAPT may be reducing levels of well-being. Gyani, Shafran, Layard, & Clark, 2013) reported that 6.6% of patients showed reliable deterioration. Translating this to experiences, 66,000 people experienced IAPT as iatrogenic. IAPT is due to scale-up to treat 1.5 million people annually (Clarke, 2016), which could translate into 99,000 people feeling harmed by attending public sector therapy (Cox, 2018). For socio-economically diverse or marginalised populations, public sector therapy may be the only support available. Therefore, it needs to be fit for purpose.

       At one-year follow up the outcome data reports a recovery rate of 40% (Gyani et al., 2013) of the 50% i.e. at best 20% of those who began treatment. A fine grained analysis of Pybis, Saxon, Hill, & Barkham’s (2017) analysis of IAPT’s data suggests that only 7% of those referred to IAPT show improvement. Additionally, alternative approaches to IAPT report outcomes for counselling and CBT in the treatment of depression that are comparable, and that efforts should focus on factors other than therapy type, which may influence outcomes (Pybis et al., 2017). Therefore, and by its own assessment, IAPT is not delivering the claimed social or economic programme to the general population (Timimi, 2018). The Centre for Social Justice’s (2012, p. 2) review of the effectiveness of IAPT services found only 15% of people referred to its project were achieving ‘recovery’ by the time they left. From this finer analysis of IAPT’s data, serious philosophical, political and ethical questions emerge regarding the continued support of IAPT.

       The Psychotherapy and Counselling Union’s submission suggests that diverse and marginalised patient populations are particularly vulnerable to their health being affected in the negative direction. Since alternatives to treat adult depression that are comparable or greater than IAPT are effective (Pybis et al, 2017), there is reason to question whether IAPT in its current form is suited to meet the needs of adults experiencing depression. Members of the Psychotherapy and Counselling Union (PCU) who are both providers and receivers of NHS well-being care, report that such issues are particularly pertinent for their clients from diverse and marginalised backgrounds. Although beyond the remit of the consultation, we ask that consideration be given to a key concern strongly registered by our members; the extension of IAPT into Jobcentres, also known as psycho-compulsion (Friedli & Steam, 2015).

       The Psychotherapy and Counselling Union appreciates that many submissions will provide concerning Evidence-based practice, critiques of the quantitative research data supporting IAPT. This is because marginalised groups are particularly impacted by IAPT’s narrow data perspective and its narrow focus omits consideration of alternative ways to work with adult depression, to meet the needs of those connected with IAPT, or the impact of political, economic and social factors. The PCU represents members who work in a range of settings. Similar to IAPT staff, our members report increasing dissatisfaction with their roles, measured by increasing works days lost to sickness, low staff morale and the low retention rate of staff relative to similar services. As these issues are well-documented in NHS and IAPT reports we will not reiterate them here (Rao et al., 2016; Westwood, Morison, Allt, & Holmes, 2017).

       The PCU’s submission will focus on equality, diversity and marginalisation. For instance, the LGBT+ communities experience poorer outcomes of NHS therapy (King et al, 2008: Semlyen, King, Varney, & Hagger-Johnson, 2016). Also, ethnic minorities consistently report receiving poorer access to, and levels of, therapy (Ade-Serrano & Nkansa-Dwamena, 2016). Due to space restrictions, the PCU’s will focus on one diverse group, which reflects the issues experienced by all diverse groups. The Union’s rationale is that we are particularly concerned about diverse groups who remain hidden within the perspective of the draft consultation.

       The 2010 Equalities Act (Legislation.gov.uk, 2010) is required to also address faith. Generally, IAPT does not. The lack of cultural awareness in specific relation to adult depression means that ethnic identifications are often conflated with religious identifications. This is particularly serious given the current social climate of islamophobia, where many patients from Muslim backgrounds are subject to increasing levels of antagonisation and poor practice in regard to IAPT provision. Muslims represent approximately 5% of the population. Approaching a faith community primarily with a secular model to address their psychological well-being may be at worst damaging, and at best lead to low levels of engagement. The 2016 IAPT report shows that recovery rates are highest amongst Jain, Christian and Jewish patients, and lowest amongst Pagan and Muslim patients (NHS England, 2018). There is a strong correlation between relative deprivation and mental ill health with nearly half (46%) of the Muslim population residing in the bottom 10% of the most deprived local Authority Districts in England, and are therefore more likely to be impacted by poor mental health (Bhui et al., 2005). IAPT has identified its poorest outcomes are in socio-economically deprived areas (House of Commons, 2018).

       Within this frame, diverse and marginalised communities are expected to be able to move to recovery within 6 sessions. This is also assuming that the assessment has developed a shared understanding between patient and practitioner of the presenting problem and the underlying cause - the levels of somatisation in communities where English is not the first language indicates the degree to which this is not possible. This has not been addressed through widespread use of PHQ 15 testing, or any other strategy. Black and minority ethnic (BAME) communities also experience complex life events that lead to complex mental ill health presentations. These can include asylum seeking, previous experience of war, Domestic Violence, Female Genital Mutilation and intergenerational trauma. To expect that such complex experiences can be unpacked and addressed in short standardised interventions risks introducing iatrogenic practices into a process intended to enhance well-being.

       The Cultural Formulation Interview (CFI: APA, 2013), assesses both the cultural or ethnic groups that the patient belongs to, and the ways in which those groups understand a problem such as depression, and how this affects a person’s experience of DEPRESSION. Many diagnoses don’t take into account cultural formulation at all. The significance of this in relation to assessment compounds the invisibility of BAME experience of mental illness and related outcomes. This needs to be highlighted within the guidelines and pathways identified specifically with regard to mental health inequalities.

       With regard to hyper-diverse communities, IAPTS provision is not available in many of the languages patients use to make sense of their social world. Translation facilities within the NHS are also often inadequate with interpreters ill equipped to work with mental health or counselling. In addition, translations of IAPT assessments GAD7 and PHQ9 are not available in the variety of languages. The PCU suggests that, “What is being suggested here is that racism and other environmental stress factors can cause psychic collapse and ... Therapists who will be challenged to work with this particular form of ‘mental health’ presentation should take into consideration ... Eurocentric notion[s, ideologically-driven motivations to control resources, patriarchal- and colonial-based power relations and cisgendered views] of disease and mental illness” (Allyene, 2009, p. 166).

       When revising the guidelines, the PCU recommends: within the UK’s pluralistic society, consideration be given to how the above points impact notions and treatment of adult depression; that IAPT investigates the factors which lead to lower recovery rates in socio-economically deprived areas; that a greater consideration of diversity be given to all minority communities; that the strategic revision of IAPT monitors the lack of impact in the Muslim community and addresses the underlying mental health inequalities experienced; and the Cultural Formulation Interview (CFI) be applied where appropriate. Examples of good practice be consulted such as the Lateef Project’s community led Islamic counselling service (Birmingham) and Adapted behavioural activation (Leeds: Mir et al., 2015).

References

Ade-Serrano, Y., & Nkansa-Dwamena, O. (2016). Voicing the uncomfortable: How can we talk about race? Special Edition: ‘Race’ and Counselling Psychology. Counselling Psychology Review, 31(2), 5-9.

Alleyne, A. (2009). Working therapeutically with hidden dimensions of racism. In S. Fernando & F. Keating. (Eds). Mental health in a multi-ethnic society: A multidisciplinary handbook. (2nd edn.). Chp. 12, 161-173. East Sussex: Routledge.

American Psychiatric Association (2013). Cultural formulation. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 749-759. Washington, DC: American Psychiatric Association.

Bhui, K., Stansfeld, S., McKenzie, K., Karlsen, S., Nazroo, J. & Weich, S. (2005). Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom. American Journal of Public Health, 95(3), 496-501.

Centre for Social Justice. (2012) Break state monopoly over mental health counselling, urges major new report. (accessed 11 June 2018). www.centreforsocialjustice.org.uk/ core/wp-content/uploads/ 2016/ 08/Talking-Therapies-FINAL.pdf

Clark. D. M. (2016). The improving access to psychological therapies (IAPT) programme: Background, strengths, weaknesses and future direction. Keynote, Division of Counselling Psychology annual conference, 8th July 2016. Brighton, UK

Cox, P. (2018). Can therapy make things worse? Brighton Therapy Partnership. (accessed 11 June 2018) www. brightontherapypartnership.org.uk/can-therapy-make-things-worse/.

Gyani, A., Shafran, R., Layard, R. & Clark, D. M. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51(9), 597-606. doi.org/10. 1016/j.brat.2013.06.004.

House of Commons Library. (2018). Are NHS mental health therapies working for everyone? (accessed 11 June 2018). https://commonslibrary.parliament.uk/social-policy/ health/ are-nhs-mental-health-therapies-working-for-everyone/.

King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D. & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70.

Lateef Project. Community led Islamic counselling service. Birmingham. http://www.lateefproject.com/.

Legislation.gov.uk. (2010). Equality Act 2010. (accessed 11 June 2018). www.legislation.gov.uk/ukpga /2010/15/contents.

Friedli, L., & Steam, R. (2015). Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes. Critical Medical Humanities, 41, 40-47. (accessed 11 June 2018) doi:10.1136/medhum-2014-010622.

Mir, G., Meer, S., Cottrell, D., McMillan, D., House, A. & Kanter, J. W. (2015). Adapted behavioural activation for the treatment of depression in Muslims. Journal of Affective Disorders, 15(180): 190-199. doi: 10.1016/j.jad.2015.03.060.

NHS Digital. (2017). Psychological Therapies: Annual report on the use of IAPT services England, 2016-17. (accessed 11 June 18) https://digital.nhs.uk/data-and-information/ publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/ psychological-therapies-annual-report-on-the-use-of-iapt-services-england-2016-17.

NHS England. (2018). 70 years of the NHS 1948-2018. (accessed 11 June 2018) www. england.nhs.uk/mental-health/adults/iapt/service-standards/.

Pybis, J., Saxon, D., Hill, & Barkham, M. (2017). The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies.

BMC Psychiatry, 17:215, 1-13. (accessed 11 June 2018) doi: 10.1186/s12888-017-1370-7.

Rao, A., Clarke, J., Bhutani, G., Dosanjh, N., Cohen-Tovée, E., Hacker-Hughes, J. & Neal, A. (2016). Workforce Wellbeing Survey 2014 – 2016. British Psychological Society, Division of Clinical Psychology & New Savoy Conference. (accessed 11 June 2018) www.Newsavoypartnership.org/2017presentations/dosanjh-g-bhutani.pdf.

Semlyen, J., King, M., Varney, J., & Hagger-Johnson, G. (2016). Sexual orientation and symptoms of common mental disorders or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry, 16(67), 1-9. doi: 10.1186/s12888016-0767-z.

Shedler, J. (2017). Where Is the Evidence for “Evidence-Based” Therapy? Psychodynamic Psychiatry, 41(2), 319-329. doi: 10.1016/j.psc.2018.02.001.

Timimi, S. (2018). The diagnosis is correct, but National Institute of Health and Care Excellence guidelines are part of the problem not the solution. Journal of Health Psychology, 1, 13. doi: 10.1177/1359105318766139.

Westwood, S., Morison, L., Allt, J. & Holmes, N. (2017). Predictors of emotional exhaustion, disengagement and burnout among improving access to psychological therapies (IAPT). Journal of Mental Health, 26(2), 172-179. doi: 10.1080/09638237. 2016. 1276540.

 

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Latest message from Martin Pollecoff, Chair of UKCP, which reflects the significant shift in the professional bodies' approach to unpaid work. I have been in touch with Martin about this, this week and previously, and it seems clear that he wants to see a real change. As his letter says, the PCU and other grass-roots groups like Counsellors Together, have had a crucial impact in pushing for change. We'll are thinking about how PCU responds to continue to push this forward. Richard Bagnall-Oakley, PCU Chair

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Dear friends

Over time an accommodation that was originally beneficial to everyone involved has grown oppressive and the unpaid nature of trainess doing their hours in charities has become a problem for us. I am strident upon this issue and plavce it on the agenda of every meeting with our close partners BACP and we try and get our heads round solutions that support our trainees and the charities.

I have the backing of our board who agree that we have to come to some accommodation with the charitires and work with them on this difficult issue.

 
At a time when employment has become precarious and real wages have fallen, who can afford a working day without pay, especially when that’s a day a week for several years?  
 
I am sure that every charity and charity worker supports the spirit of the Minimum Wage Act wage and all it entails: being able to put food on the table and feeling that you and your work are of value. But there is a let out clause in that act – volunteers in a charity are exempt from protection. 
 
The Charity Commission emphasises the importance of social mobility and diversity, every charity would agree and that’s impossible without payment for trainees.
 
Fifteen years ago trainees were pretty much assured jobs in the NHS. Today the jobs advertised in the NHS are not for psychotherapists or counsellors, with the exception of family therapists. These approaches are derided within the Savoy Group, yet the NHS and charities are eager to use our trainees for free whilst our graduates are excluded from the paid workforce. The social contract has been broken, but not by us.
 
Of course, people demand change. The Facebook page Counsellors Together UK is about this single issue and it has 2800 members. The Psychotherapists and Counsellors Union are all over this.  
 
We prepare our students well – charities get good therapists - mature graduates who already have far more training than any qualified IAPT worker. They are eager to be of service but between us we have created a situation that, in any field, would be considered abusive.
 
The solutions are not easy and I would welcome your suggestions: martin.pollecoff@ukcp.org.uk
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All PCU members are warmly invited to the PCU AGM to be held on Saturday 5th May 2018 from 10am to 5pm at Resource For London, Holloway Road, London N7.

There will be a free workshop open to members and non-members Mapping transferences in complaints procedure: The shadow of therapeutic work from 10am to 1pm (see details below) and the AGM will be held from 2pm to 5pm.  Please let Jane know if you will be attending the workshop, the AGM or both by e-mail: pcu.union@gmail.com

The AGM has to have one-tenth of the membership or 21 members, whichever is less to go ahead on this date. As there are approx. 335 current members, at least 21 members will need to be in attendance. Fuller details about the AGM for members can be found on our AGM events forum where as a member you are invited to post/discuss AGM related comments, thoughts and ideas https://pandcunion.ning.com/pcuevents/agm2018

Workshop 10am - 1pm - open to members and non-members

Mapping transferences in complaints procedures: The shadow of therapeutic work - Philip Cox and Robin Shohet 

In this interactive workshop, we will look at all the stakeholders involved in a complaint and how they interact in ways that might not be useful. We aim to experientially highlight how the interactions serve different and sometimes contradictory needs within the system, and how mapping this out can lead to working in a way that is less adversarial and more humane.

Complaints contain a transformative seed. People don’t generally complain about something they don’t care about. Beneath the surface torrent of complaining lies a hidden river of our caring. We and the professional registration bodies could treat complaints as a doorway to deeper commitments. The language of complaints tells us what we can’t stand. The language of commitment tells us what we stand for (Kegan & Lahey, Immunity to Change, 2009).

The PCU is committed to change how complaints are worked with, and how to support professionals complained against. The underlying philosophy is that by standing up for therapists we are standing up for clients. 

In this workshop, our aim is to explore and understated the forces at work in us, in our professions and how they may reflect in wider society as a whole, ways that relationships break down. What are the unconscious dynamics at work? What might be the feelings, unmet needs and values that have not had a voice? How can we embrace uncertainty, humility and being human in a way that will help us to move towards a more compassionate, systemic view in the face of inevitable challenges? (Shohet, 2017).

The PCU CommitteeRichard Bagnall-Oakeley, Viviane Carneiro, Victoria Childs, Jane Clements, Phil Cox, Jamie Crabb, Robbie Lockwood, Juliet Lyons, Andy Price 

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Therapy Today’s article, “Working for Free” (April edition online here: https://bit.ly/2ExJQq4) claims to offer “views from both sides of the argument about whether qualified counsellors should work unpaid.” 

We are therefore surprised and concerned to note the omission of any reference to the Psychotherapy and Counselling Union (PCU) and its active campaign around unpaid work https://pandcunion.ning.com/.  Moreover, we note that the piece conveys, without correction, the view that 'we don't have a union to represent us'.

PCU is known to BACP, particularly in regard to support in complaints procedures. Therapy Today ran its own news piece following our launch two years ago and has published letters from us previously. We are therefore puzzled by this omission.

We respectfully request that Therapy Today offers a correction to the article and makes available to its members, in that correction, the information that a union is in existence, uniquely, for the benefit of its members and all counsellors and psychotherapists in the UK, and which is actively campaigning for the rights of both trainee and qualified therapists in the arena of unpaid work. 

Richard Bagnall-Oakley - Chair, on behalf of the Psychotherapy and Counselling Union (PCU)

PCU also note that BACP is yet to update membership criteria to include the PCU exception for PsychD Trainees who progress rather than graduate from M level to D level for which PCU was recently involved - see:

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Hello fellow members,
 
Phillip Cox will be representing the union at this timely event, which may be of interest to members. If anyone is going and would like to link in with Phil, we have the organiser’s agreement to hand out leaflets.
 
It’s interesting to see that many of the organisations that have given the union special status are involved on the organising committee.  Phil
 
Is there a future for a unified profession of psychotherapy? by Society of Psychotherapy, Sat 26 May 2018, 09:00-16:00, British Library, 96 Euston Rd, NW1 2DB
 
Is psychotherapy in the UK a profession, or is it a technique used by many professions, including counsellors, psychologists, psychoanalysts, cognitive behavioural therapists, hypnotherapists, mental health workers? Where does the answer leave private practitioners who may not have any other professional identity, or network? Speakers include Martin Pollecoff (chair UKCP), Susanna Abse (executive member of the British Psychoanalytic Council), Maureen McIntosh (Chair, Counselling Psychology Division, BPS), Malcolm Peterson (Chair, Society of Psychotherapy), Emmy van Deurzen (Principal, New School of Psychotherapy and Counselling), Digby Tantam (Trustee, Federation of Existential Therapists in Europe): 
 
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PCU at Pink Therapy’s conference: ‘Sex works! – The intersection of mental health and sexuality professionals’

http://www.pinktherapy.com/

The 6th annual Pink Therapy conference titled, ‘Sex works! – The intersection of mental health and sexuality professionals’ took place 23-24th March 2018. Eighty people attended this sold out beyond cutting edge event. Day 1 focused on conference presentations, workshops and spaces to meet with various sex-work and body-work disciplines. These included Urban Tantra, Conscious Kink, Sex Coaches, Sacred Intimates, Surrogates and Sexological Body Workers. Day 2 focused more on ethics. The day began with the personal perspective from three speakers around ‘Being a therapist and a sex worker’. Issues covered working in different sex-related areas with some not involving physical contact, “being denied the opportunity to be myself in training”, and curiously being accepted by a university training team yet stigmatised by peers for having the dual roles of trainee and sex worker. A qualified therapist and Dom explained that as sex work pays much more than individual therapy, the level of commitment to practice mainstream therapy is high.

Moving from the personal lived experience to the regulatory bodies, senior representatives from BACP and then UKCP discussed, ‘Working within current ethical frameworks’. Looking through the lens of exploring how sex works and the intersection of mental health and sexuality, these speakers seemed to raise more questions than answers. Many delegates felt unsupported and distrustful of training institutions and of the regulators, who the delegates felt lacked appreciation of what their practices contribute to therapy. Delegates also spoke of the regulators’ negative contribution to the mental health of dual trained sex workers. The Association of Somatic and Integrative Sexologist (ASIS) then introduced its own ethical code. The ASIS code not only seemed a better fit with the breadth of Sex Works, yet also offered a far less quasi-judicial and fairer (transparent) process for professionals receiving complaints.

The PCU was invited to attend the end of conference panel discussion alongside reps from the College of Sexual and Relationship Therapists (COSRT), BACP and UKCP to explore ‘Moving forward – Protecting dual-trained therapists’. Unfortunately, the UKCP ethics representative cancelled without offering a replacement. As the PCU rep, it seemed important to emphasise that our position is the inclusion of all who self-identify as therapists – we are not regulators, moral monitors, the social police or agents of the state. The panel was invited to speak about ‘what have you heard this conference’? As your union rep, I heard how sex works through different forms of body therapies, and serves the many different needs of clients that talking therapies are unable to fulfil. Yet I also heard an undercurrent of fear because the dual-trained therapists said they lacked protection. As one dual-trained delegate said, “Who’s got my back?” Where therapists were engaging in sex work and also in more mainstream practices, many spoke of fearing complaints and the shame of being called into meetings or publicly outed. The delegates offered many painful examples.

The delegates were clear that the panel did not ‘get’ the full lived experience of being a dual-trained/trainee sex worker. Only one of the panel had openly declared their sexuality. A delegate commented that in the psychotherapy world there is so much fear that as a profession we seem deceitful – this is exemplified by the topic of this conference, which focussed less on widely accepted talking therapies and more on widely disavowed variations of bodywork. As a striking example, a dual trained bodywork therapist spoke of how she could be struck off for simply referring to a surrogate sex worker; even if that was a considered intervention to meet a client’s needs. Addressing this was the strength of the ASIS complaint procedure and what it offers the wider profession. The weakness was the panel’s lack of connection with the delegates. BACP, UKCP and particularly COSRT were critiqued for a lack loyalty towards all their members. As the panel was tasked to discuss ‘Moving forward’, the union’s position to unequivocally support all therapists, including with complaint procedures was welcomed yet also raised concerns.

These concerns left me wondering about where the PCU’s stands on who we accept as members, where our boundaries sit regarding what counts as therapy and who can access the benefits that membership confers. The conference feedback was that conversion therapy (CT), which religiously sells itself as repairing ‘wrong gender identity choices’ currently presents a dilemma for the PCU. People practising CT, either overtly or covertly, can be PCU members and if a professional complaint is made, access PCU support. This position, which seems completely contradictory to the philosophy underpinning this Pink Therapy conference and seemingly PCU, is now being discussed within the union. Pink Therapy is to be commended for organising a conference that is beyond the cutting edge. The take home message is that therapists who do sex work are often being harmed – by the field of therapy.

Dr Philip Cox (Psych.D. C.Psychol)

PCU executive committee member

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BPS Doctoral students can now gain BACP individual membership

For Clinical Psychology, Counselling Psychology and similar doctoral trainees, progression to ‘D’ level will henceforth be recognised as sufficient for Individual BACP Membership (BACP levels of accreditation). Please note that this initiative is intended to enhance professional opportunities and be an addition to BPS, UKCP or other memberships. This exception was arranged for BPS trainees by the Psychotherapy and Counselling Union (PCU).

In order to take advantage of this new way to join the BACP as an Individual Member, you will need to ask for a Letter of Confirmation re your progression, from your Course Director. For more details contact the union: pcu.union@gmail.com

This exception was only made possible because the Psychotherapy and Counselling Union (PCU) liaised with BACP. In achieving this exception PCU has clearly demonstrated the benefits of union membership.

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Members in Scotland informed us that  COSCA (the national professional organisation for counsellors in Scotland) has been telling trainee counsellors to cross UCU picket lines at Edinburgh University. The message below has been sent from PCU to COSCA, UCU, and the Head of the relevant School in Edinburgh.
 
The Psychotherapy and Counselling Union are very concerned to hear from our members at Edinburgh University that COSCA and the School of Health in Social Sciences are instructing students to cross picket lines at Edinburgh University rather than show their support for striking academic staff.

Many students, including trainee counsellors, are rightfully concerned at the marketisation of higher education and the erosion of the terms and conditions of staff. The issues being protested by UCU members and their supporters are also very relevant to counsellors and psychotherapists in all areas.

As this recent piece
https://www.psychologytoday.com/us/blog/what-doesnt-kill-us/201803/why-i-decided-strike
reminds us, counselling is not politically neutral, and training in personal growth cannot be separated from engagement with social issues.

We urge COSCA and the School to change their positions on this issue, so that students' ethical and socially responsible choice to show their support for academic staff is recognised and validated.

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New Savoy Leaflet 1 New Savoy Leaflet 2                                                                                            PCU Members will be demonstrating at the Alliance for Counselling and Psychotherapy Demonstration and Lobby at the New Savoy Conference

Wednesday 21st March 2018 from 8.15am Millennium Conference Centre
4-18 Harrington Gardens South Kensington, London, SW7 4LH Venue details here

The New Savoy Conference is the annual gathering of professional and charity bodies providing psychological therapies (IAPT) in NHS primary care.

IAPT is an assembly-line service providing short-term therapies to over a million people every year. Despite the commitment of its frontline therapists and psychologists, IAPT is failing the mental health needs of communities all over England, while working with government policies that themselves generate psychological distress and social alienation.

  • Second-class therapy for people who can’t afford ‘real’ talking therapy

  • Partnering the DWP on welfare reform, psycho-compulsion and the

    work cure

  • Outcomes made up of massaged statistics and lies

  • An evidence base that exposes failure

  • NICE guidelines supporting restricted practices

  • A workforce depressed, overworked, and burning out

    Come and join therapists, mental health activists, psychologists and welfare campaigners. Meet at the Harrington Gardens entrance of the Millenium Conference Centre (Gloucester Road tube) from 8.15am to greet conference goers.

Contact info@allianceforcandp.org for more information

 

 

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The Psychotherapy and Counselling Union stands in solidarity with the Time’s Up movement. We recognise the “systemic inequality and injustice in the workplace that have kept underrepresented groups from reaching their full potential”, and see the effects of this every day in our own work with people in distress. We also recognise that our own professions are not separate from embedded gender inequalities and work to bring awareness and change within our own work places and networks.
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PCU Member Feedback

I can’t recommend the PCU highly enough. There is no doubt that in 2017 they saved my self-belief and my career!  In 2017 I faced an extremely upsetting and complex problem at work, being accused of professional wrong-doing.  A total lack of support and bullying by my line manager and senior management left me worn down and doubting myself.   Despite the fact I had not been a member when the incident happened PCU immediately agreed to help me. They offered me unconditional emotional support and practical advice for 6 months.  Without them, I would definitely not have been able to move on and find the strength to find a new counselling and psychotherapy job.  As a result of my experience  I would urge everyone who works as a counsellor and psychotherapist to join the PCU in case, and before, any problems arise - PCU Member 2018.

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PCU supports UCU industrial action

The message below was sent today to Sally Hunt, Chair of UCU, in support of their industrial action.
 
Dear Sally Hunt

The members of the Psychotherapy and Counselling Union express our full support for UCU members taking strike action to defend the pensions of university staff. A number of our members work in universities, and we hope that this necessary industrial action is strong and successful.

In solidarity

Richard


Richard Bagnall-Oakeley
Integrative Adult & Child Psychotherapist (UKCP Reg.)
Chair, Psychotherapy and Counselling Union
https://pandcunion.ning.com/

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Dehra Mitchell is organising and co-ordinating free therapy for the residents and victims of the Grenfell Tower fire.
He is working with the North Kensington Law Centre to set up a database of therapists willing to offer free therapy for the current situation and on an ongoing basis.
At the moment what is being offered is short-term therapy of 3 sessions with the possibility of drop-in sessions as well.
What would be helpful is if therapists were able to offer a few hours on a particular day each week but if that's not possible offer what they can.
There are rooms available to use 
There is likely to be a need for group therapy at some point for the lawyers working in the North Kensington Law Centre. 
Volunteer Therapists need to be prepared to deal with trauma, there is a need for experience of working with families and children.
He is doing this on his own so may well need some help with organising this.
If you are interested in getting involved with this contact Dehra Mitchell 07973 821446 or e-mail dehra@gmail.com  
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The Guild of Psychotherapists are hosting an exciting afternoon of drama and discussion on July 1st, 2017

Venue: Kings College Waterloo Stamford Street London SE1 8WA. Arrive at 1pm performance starts at 1.30pm. Panel discussion until 5pm.

Called The state we are In, Psychotherapy for interesting times,  the afternoon begins with  a vibrant  professional reading of Josh Appignanesi's new play,  where  rival therapists go head to head over dinner, exposing each other's limitations - whatever the cost.  Josh says that Well, Being 'tackles with comic aplomb the clash between cognitive behavioural and psychoanalytic therapies - and how these two approaches relate to the modern managerial State's desire to quantify and control'.

Afterwards, a fabulous panel of discussants respond  to the play,  bringing wide ranging perspectives about  the most urgent priorities for contemporary  psychotherapy:

Josh Appignanesi , Filmmaker (The New Man, The Infidel) and playwright

Haya Oakley, Psychoanalyst

Dr Judith Anderson, Jungian Analytic Psychotherapist, of the Climate Psychology Alliance

Dr Phil Mollon, Psychoanalyst and Energy Psychotherapist

To book tickets, contact info@psychoanalyticpractice.co.uk or 07833 746569, stating your name, contact details and the number of £15/£20 tickets required. Ticket prices are affordable to encourage a broad participation and any additional donations are very welcome.

As this is a fundraising event for the Guild's reduced fee psychotherapy clinic, underwritten by a few individuals, we would really appreciate you passing on this information to all your networks of colleagues and friends who would enjoy being at this innovative and exciting event.

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A pop-up meeting organised by 

Psychotherapists and Counsellors for Social Responsibility www.pcsr.org.uk 

Association of Jungian Analysts www.jungiananalysts.org.uk

Confederation for Analytical Psychology  www.confederation-an-psych.uk

Saturday 3rd June 2017    10am - 1pm

Venue: Association of Jungian Analysts,  7 Eton Avenue London, NW3 3EL

Nearest tube stations:   Belsize Park and Swiss Cottage Bus:  C11

No payment in advance needed, but please book your place so that we know numbers for seating and refreshments.

Donations on the day will be much appreciated.   To book your place email: beatrice@bmillar.com

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