Archive for the ‘social therapy’ Category

Following last weekend’s joint conference of Psychotherapists and Counsellors for Social Responsibility, and the Alliance for Counselling and Psychotherapy, the Psychotherapy and Counselling Union is being formed.

In their own words, the PCU aims to:

  • bring together counsellors, psychotherapists and other practitioners from every corner of the field, including trainees on an equal basis
  • campaign for true diversity and equal opportunities in the therapy world, and support individuals who are discriminated against
  • campaign to reform IAPT and other ‘therapy-lite’ substitutes, while at the same time supporting IAPT practitioners with their grievances
  • campaign against the use of therapy to get people off benefits and/or back to work
  • change the system whereby starting practitioners have to work unpaid, often with very complex issues and without adequate support
  • campaign to defend and extend the provision of open-ended therapy which is free at the point of contact, and where the client can choose their practitioner and modality
  • support and defend practitioners in disciplinary hearings, and also against bullying and harassment
  • support and defend therapy against attacks from government and media, and against creeping medicalisation
  • establish a policy and research unit to develop solid positions on a wide range of issues

unions image
I’m particularly pleased to see issues like diversity in the profession, and campaigning against “benefits therapy” included in the list. This is an exciting development, emerging out of the pull many psychotherapists and counsellors feel towards some kind of activism. I look forward to getting involved and seeing where it takes us.

For further information, or to sign up as a supporter, check out the psychotherapy and counselling union flyer (pdf).

Image credit: Daily Kos

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A while back, I registered my private practice with the Bristol Pound. So Bristolians can now get support for themselves at the same time as supporting independent local trade by paying for therapy in Bristol Pounds. And by text message (how txt2pay works) no less.

I would like to see Bristol’s counsellors and psychotherapists adopt the Bristol Pound, as I think we generate an interesting economic microcosm. Every therapist has a supervisor; that supervisor has a supervisor; who in turn has a supervisor, ad infinitum. In fact, there’s a great therapy film waiting to happen about a therapist seeing a supervisor whose therapist is her supervisee’s client (Shakespeare would soil his/their pants).

Furthermore, the main counselling and psychotherapy professional bodies (BACP & UKCP respectively) require their members to attend to their Continuing Professional Development. Which is a bit like requiring cats to lick themselves, because CPD basically means attending trainings, workshops, writing articles, etc in all the interesting things to which counsellors and psychotherapists are already naturally drawn.

Consequently, if a client pays me in Bristol Pounds, it is highly likely that between my room hire, supervision, personal therapy, and CPD, I could probably hand over all that money to other therapists. Who will hand that money over to other therapists. And so on. And so on. Until someone finally buys a latte or a person centred scarf (sorry) from someone outside of Therapy World.

My point being, of course, that therapists end up handing over a significant proportion of their client fees to other therapists.

And the gestalt therapy angle on this is field theory. Gestalt therapy models a person as an organism in an environment. One dimension of my environment is the economic environment.

I’m thinking now of money as water, the economy as the water cycle, and the Bristol Pound as a dye trail showing how money flows around the local economic system.

Where does the money flow? Businesses that spend a high proportion of their income within Bristol are keeping money flowing around the local system. This is in contrast to businesses like, say, Starbucks and Vodafone, that spend a low proportion of their income within Bristol. If money is water, then the long-term prospects for a Bristol that loses more water than it takes in is economic dehydration.

Which is kind of the raison d’etre of the Bristol Pound: to increase local water retention. It has the potential to highlight who moves money around Bristol most effectively, and adds substance to an important discussion about what local economies are, and how they relate to regional, national, and international economies.

Perhaps most importantly, it connects the individual with the collective in a tangible way. And that’s the essence of field theory in gestalt: an individual is an organism, and an organism is both an expression and shaper of the environment from which it continuously emerges. A change in individual behaviour as simple as buying coffee (with Bristol pounds!) from an independent local coffee shop instead of Starbucks, scales up to a dramatic shift in how the local economy works.

Check out the directory of businesses accepting Bristol pounds to investigate how relevant to you this might be. And remember, the more a trader hears the question, “do you accept Bristol pounds?”, the more likely they are to get involved.

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Image scavenged from Positive Money’s “The Telegraph: Bristol Pound to Launch in September”.

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My name is Simon Stafford-Townsend. I am a gestalt psychotherapist in private practice in Bristol and Cardiff. My private practice website is Silver Cat Psychotherapy.

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Recently, the Centre for Social Justice published the report “Commissioning Effective Talking Therapies” (pdf).

I find this interesting politically, as the CSJ was started by Iain Duncan-Smith, and so is broadly aligned with the Department for Work and Pensions. As the commissioning of talking therapies is the business of the Department of Health, this is an interesting intervention, about which I will have more to say in a future post.

The central message is fairly simple: to commission effective talking therapies, the service should be opened up to the private sector. Now, there’s not much in the way of hard stats on why that should be the case, which makes the report’s one key statistic a bit of a silver bullet to the head of the Improving Access to Psychological Therapies (IAPT) service.

Frankly, when what looks like a hatchet job in the name of free market economics rests its case on pretty much one damning statistic taken from one quarter of key performance indicators, I smell an undead gerbil. And so, inspired by the many, many smack downs delivered to the makers of suspect claims by Cathy Newman’s Fact Check blog, I thought I’d have a go at Fact Checking this core statistic for myself.

The claim:

“The Government has committed to spend an additional £400 million over the next four years on a limited range of National Institute for Health and Clinical Excellence (NICE) approved talking therapies, despite a recovery rate of only around 15% of all referrals” (p4)

The authors are unequivocal about this key fact: the IAPT service has a recovery rate of only around 15% of all referrals. Not only that, but the NHS is actually engaging in statistical skullduggery to disguise this alarmingly low figure:

“In the case of IAPT, it cites ‘recovery rates’ as a proportion of patients treated and also above ‘caseness’, rather than as a proportion of the baseline (patients referred), thus improving the outcome percentage. As described in more detail below, IAPT figures claim recovery as over 40 per cent… but from the point of view of commissioners and referring GPs, 86 per cent are not being helped by the IAPT service” (p37)

The background:

With the passing of the Health and Social Care Act 2012, NHS services are rapidly being opened up to tender by any qualified provider (AQP). The Act specifically opens up NHS services to tender from the private sector; de facto privatisation.

One of the areas open to AQP is adult psychological therapies. Currently, the vast majority of this service is delivered through IAPT. In order to prevent commissioning clusters from effectively defining AQP as an IAPT equivalent service, the CSJ’s report aims to demonstrate that IAPT is failing its users.

The analysis:

First, let’s get our terms clear. The IAPT service uses a peculiar language that aims to do what the majority of therapists tend to claim is not doable; quantify human suffering in statistically measurable terms. When someone is referred to IAPT, they are assessed for ‘caseness’. If someone has caseness, it means they meet the clinical definition for anxiety and/or depression as measured by a specific statistical tool. At the end of someone’s period of therapy, there is a final assessment; if the person’s scores have dropped below ‘caseness’ then they are deemed to have achieved recovery.

The report authors cite the IAPT key performance indicators for Quarter 1 2011/12 (April to June 2011). These figures claim a recovery rate (in England) of 42.5%. Step by step, we get there by:

Step 1. Taking the number of people who a) completed treatment in the quarter, and b) are moving to recovery (this is KPI 6a, and the number is 28,470)

Step 2. Taking the number of people who have completed treatment in the quarter (this is KPI 5, and the number is 75,697)

Step 3. Taking the number of people who a) completed recovery in the quarter, and b) were not at caseness at the start of treatment (this is KPI 6b, and the number is 8,725)

Step 4. Remove the people who didn’t have caseness to start with (step 3) from the total completed cases in the quarter (step 2) to get the number of people who a) completed recovery in the quarter, and b) had caseness at the start of treatment (the number is 66,972)

Step 5. Work out Step 1 as a proportion of Step 4 to get the percentage 42.5%

Phew! At least the stats add up in the way they’re supposed to; so far so gravy, though frankly, a 42.5% recovery rate is not exactly inspiring. But where has this 86% failure rate come from?

Well, the report authors’ claim is based on different stats. They work things out by:

Step 1. Taking the number of people who a) completed treatment in the quarter, and b) are moving to recovery (this is KPI 6a, and the number is 28,470)

Step 2. Taking the number of people who have been referred for psychological therapies in the quarter (this is KPI 3a, and the number is 206,918)

Step 3. Work out Step 1 as a proportion of Step 2 to get the percentage 13.8%

Now, pop-quiz, have you spotted the two sleights of hand that qualify the report authors’ calculations as bad science? Watch carefully:

Sleight of hand 1. The report authors use a suspicious tone of voice whilst pointing out that the NHS are using a smaller subset of the total available stats. This allows them to remove KPI 4 from view, an indicator that gives the number of people who have actually entered psychological therapies during the quarter. This is 123,792, meaning only 59.8% of referrals actually enter therapy. How can someone reach recovery when they’ve never even entered therapy? As a bonus, by the way, these figures contain a clear footnote stating that the number of people referred in a quarter don’t necessarily complete therapy in that same quarter; this is a totally unreliable figure to use as a baseline.

Sleight of hand 2. This one is the smarter move, and takes advantage of the ridiculous language IAPT is using. The very word ‘caseness’ presses the jargon button of all who hear it, making it a great primer for anti-IAPT sentiment from the outset. And so, because we all think we know what recovery means, but have only a vague idea of what caseness means, we are invited to stick with what we know and ignore a vital piece of causation: without caseness, there is no such thing as recovery. By definition, recovery means going from caseness to non-caseness; how can someone reach recovery when they didn’t have caseness in the first place?

The verdict:

It is incorrect to assert that IAPT has a recovery rate of only around 15%. Out of the total number of people referred into the IAPT service in the quarter examined, only 59.8% received therapy. Furthermore, people entering therapy in the quarter didn’t necessarily finish therapy in that quarter, making the figure unreliable for calculating recovery. Besides which, recovery in IAPT terminology means going from caseness to non-caseness using a specific measure. The inclusion of people who started therapy below the threshold for caseness invalidates the recovery rate because these people have nothing to recover from!

Let’s be frank, even if we’re convinced that recovery can be statistically measured (and whilst that’s an a priori assumption of the NHS, it is by no means a consensus in the wider professional field), a recovery rate of 42.5% is not inspiring. It’s enough to criticise IAPT using its own stats; the use of smoke and mirrors to make it look like a failing service is disingenuous at best, dishonest at worst.

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I have just finished my first week of paternity leave from therapy practice. Baby is due today and, so far, is declining to make an appearance. What does this have to do with May 3rd’s city wide referendum on whether or not Bristol should have a directly elected mayor? Pretty much everything.

As I started exploring in psychotherapy in a time of political crisis, I am already alive to the overlap between therapy and politics, and to therapy as a distinctly political activity in its own right. Now, it is a gestalt axiom that need organises the organism/environment field, the dynamic interplay between self and situation.

Accordingly, as I start to feel the physical reality of becoming a parent, I become increasingly aware of the social world into which my child will be emerging. The challenge this throws me is simple, difficult, and powerful. I look around me at my situation, and I tune in very quickly to the political domain. I feel urges towards action rise within me and… I explain them away. I’m a therapist, not a politician. There’s no point, I should focus my action in a better direction. Many of the self-same justifications for inaction that I support people in working through in therapy so that they can more fully be who they really are, not who they have been moulded to be.

My experience of starting to become a parent is of suddenly experiencing a need to take action that is stronger than my need to refrain from taking action. It’s not quite that I feel responsible for the world into which my child is being born in a way that I didn’t before, though that is a factor. It’s more that the projection of how my child might see me has revealed to me more starkly how, out of awareness, I am viewing myself. That is, I am fully in contact with the consequences for me of not acting on my political needs. Realising that I owe it to my child to be as fully myself as I can is a bridge to realising that I owe the same to myself. As a therapist, I am constantly re-learning this.

On 3rd May 2012, there will be a city wide referendum on whether Bristol should have a directly elected mayor. There is a yes lobby. There is a no lobby.

The key arguments in favour involve the direct accountability of the mayor vs a current leader who is elected by Council; the transfer of more powers and money (of an as yet undescribed nature) from Westminster to Bristol if we vote yes; and to shake up a tired political system.

The key arguments against involve the belief that the cost of implementing the mayor model will be too high; that the election will descend into a Ken vs Boris style personality contest; that the mayor will not be accountable to Council in the way the current Leader is; and that the candidates will be uninspiring.

In the midst of making up my own mind, I saw Salma Yaqoob‘s article ‘Yes’ to a Mayor who says ‘No’ to Austerity and realised what I want. I want to switch to the directly elected mayor system, and actively seek out the kind of candidate I want to vote for, instead of passively waiting for existing interests to make their offers. In parallel, I’m also seeking to form a political party with a mission to forge a politics of compassion grounded in core therapeutic principles.

I am unlikely to pull off such a feat on my own, so this is my call for support. Here is the kind of Mayoral candidate I am looking for:

A Mayor who opposes austerity: the austerity drive has failed and continues to fail. Britain is not only in a double-dip recession, but in a depression that is now more prolonged than the Great Depression of the 1930s. I want a Bristol Mayor who will actively oppose austerity.

A Mayor who will devolve power: one of the dangers of an elected mayor is that power becomes more centralised. I would like to see Bristol become a functioning e-democracy in which any Bristol citizen with an interest can be part of the decision making process. I want a Bristol Mayor who would seek to make that a reality.

A Mayor who is a woman: the mayor debating panels have been dominated by the usual white, middle-aged men, and the candidates so far proposed belong to this demographic. According to the 2001 Census Bristol’s population was 51.2% female. Austerity measures disproportionately affect women, who, absurdly, form the majority of the population but hold a minority of political posts. I want a woman for Bristol Mayor.

A Mayor who places humanity above economy: we are living through a time of atrocity in the name of balancing a national budget sinking under the weight, not of excessive public spending, but of bailing out the banks. Welfare is under attack, and the NHS is being thrown to the wolves. This is not unique to the Coalition; all three main parties are part of a neoliberal consensus that equates human activity with economic activity. This then justifies the most ruthless of decisions, as economy and humanity are one. I want a Bristol Mayor who will place humanity above the economy.

You might not want what I want, and that’s fine (and if I’ve inspired you to do the same thing as me but for a different kind of candidate, then even better!). Possibly I will get no further with this than the warm glow I get after publishing a new blog post. And if Bristol votes no on 3rd May, it’ll all be fairly academic anyway.

But suppose you want the same thing as me. And suppose Bristol votes yes on 3rd May. Then maybe you can take your own step towards action, and instead of waiting for the usual suspects to offer us up a selection of the same old faces, lend me your support.

Let’s get together, and find a candidate worth voting for.

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I look around the room at the couple of dozen people making a rough circle; some sitting, some getting coffee or tea, a couple of groups chatting. It’s coming up for the scheduled 2pm start, so I decide I’ll use the toilet then come back and call everyone together to get started. Off I go.

Returning about five minutes later, the circle has expanded and a steady flow of people is coming into the room. Before I know it, a couple of dozen people has become more like sixty or seventy, and I’m wondering what the hell I’ve got myself into. As it happens, I don’t have enough time to give that question full consideration; there’s an Open Space meeting to start…

That’s pretty much how the first event of The People’s Bristol 2050 got going. This is a response to another Bristol 2050, a business vision of what Bristol should look like in 2050. Co-ordinated by Business West, it “provides a clear statement about jobs, housing and infrastructure requirements to meet the needs of the area and to continue to develop and grow as the economic powerhouse of the South West”. As usual, these are the needs of the area according to business leaders; after all, business leaders have been doing so well in addressing society’s needs lately.

Whether historical coincidence or zeitgeist we may never know, but at about this time, Occupy Bristol had developed into two branches; one that wanted to move on from College Green, and one that wanted to resist eviction. The question of what happens to Occupy Bristol as a movement is one that will be addressed in a public meeting on Saturday 4th February, 2pm to 4pm, location to be announced (the facebook page for this is here).

Among the people who wanted to move on, the idea of developing a People’s Bristol 2050 to rival the business vision offered a new direction in which to aim some of the raw energy of Occupy. What these events demonstrate is that the Occupy Movement as a whole is a crucible from which many different things have the potential to emerge; it all depends on who directs their energy into the mix.

In more gestalt terms, the open space event on Saturday created a fertile ground with the potential to mobilise a wide variety of social actions. There is a buzz that I’ve noticed in every open space event I’ve been involved with, and I can only describe it as being plugged into a circuit of human power, rich with potential.

The downside to many open space events is that, as stand alone events, that buzz inevitably fades, leaving people with a sense of potential unachieved. This makes the People’s Bristol 2050 extra fascinating to me because the next event is already being planned for roughly four weeks time, with the intention being for a series of these meetings to take that buzz and develop it.

Except that there is no one centrally to develop it into anything; the idea is to support a process that challenges the people who turn up to take action for themselves. The idea is to move from a sense of “someone should really…”, to “I am going to…”. Instead of handing over power to someone else, the spirit of open space is to take a group of people and give them the minimum structure necessary to support self-regulation.

And to me, that sounds like gestalt therapy in action as a progressive social force.

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