OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
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ISSUE 76 / WINTER 2021 ISSN 2516-7162 (ONLINE)
OPENING DOORS
How can we boost access to psychotherapy?
THE MAGAZINE FOR MEMBERS OF THE UK COUNCIL FOR PSYCHOTHER APY
Welcome
New
Interview / Susie Orbach
The magazine of the
UK Council for Psychotherapy
Editorial address: UK Council for
Psychotherapy, America House,
I S S U E 76 / W I NT E R 202 1
2 America Square, London EC3N 2LU
Published by: James Pembroke Media,
90 Walcot Street, Bath BA1 5BG
Editor: Anna Scott, editor@ukcp.org.uk
A
Issue 76 consulting editors:
Sarah Jackson, Sarah Niblock, s a psychotherapist working in
Martin Pollecoff, Sandra Scott a diabetes clinic within an acute
Head of design: Simon Goddard NHS trust, Kate Hardenberg
Senior project manager: knows first-hand the challenges of
Marianne Rawlins, marianne.rawlins
@jamespembrokemedia.co.uk
working in the health service – from
Advertising: Harvey Falshaw, harvey. finding a job as a psychotherapist in
falshaw@jamespembrokemedia.co.uk, the first place, to accessing funding and
020 3198 3092 proving the efficacy of psychotherapy to
Subscriptions: New Psychotherapist
colleagues and patients.
is free to members of the UKCP. Non
members can view the magazine at In this context, she has conducted research
psychotherapy.org.uk/join/the- which shows that – far from the common
psychotherapist ANNA SCOTT perception that psychotherapy is expensive
Anna Scott has been a journalist and and unproven in its effectiveness – for every
editor for 20 years, writing about health, £1 her hospital spends on psychotherapeutic
education and management issues. care, it saves £29 in costs (page 22).
She also works part time with primary
Other psychotherapists who work in
school-aged children, and has a keen
interest in psychotherapy, along with the NHS, or with charitable and public-
psychology, completing a Bachelor of sector organisations, are able to show
Science in Psychology in her spare time the impact their work has on people who
would otherwise not be able to access
DIVERSITY AND EQUALITIES STATEMENT
The UK Council for Psychotherapy (UKCP) promotes
psychotherapy. They are working in multi-
an active engagement with difference and therefore professional teams, helping to address not just physical and psychological health
seeks to provide a framework for the professions of
difficulties, but issues related to housing, employment, education and more.
psychotherapy and psychotherapeutic counselling 3
which allows competing and diverse ideas and The people they help range from children with serious physical illnesses
perspectives on what it means to be human to
be considered, respected and valued. UKCP is (Kate Waters at Great Ormond Street, page 34), to parents and infants who are
committed to addressing issues of prejudice and struggling with attachment (Yvonne Osafo at West London Action for Children
discrimination in relation to the mental wellbeing,
political belief, gender and gender identity, sexual and Croydon Parent Infant Partnership, page 26), and people with addictions
preference or orientation, disability, marital or (Andy Ryan at Changing Lives, page 30). Many would not be able to access
partnership status, race, nationality, ethnic origin,
heritage identity, religious or spiritual identity, age psychotherapy any other way.
or socioeconomic class of individuals and groups. But these examples are not typical – provision of psychotherapy within
UKCP keeps its policies and procedures under review
in order to ensure that the realities of discrimination, the NHS across the UK is patchy, at best. There is little patient choice of
exclusion, oppression and alienation that may form talking therapies and there are too few opportunities for psychotherapists to
part of the experience of its members, as well as
of their clients, are addressed appropriately. UKCP work in NHS services. This not only limits the choice of working context for
seeks to ensure that the practice of psychotherapy psychotherapists, it also denies a choice to NHS service users in many parts of
is utilised in the service of the celebration of human
difference and diversity, and that at no time is the country who cannot access the talking therapies they need.
psychotherapy used as a means of coercion or
oppression of any group or individual.
Increasing access to psychotherapy for all will be crucial as we begin to
understand the impact of the pandemic on mental health in greater detail –
EDITORIAL POLICY
New Psychotherapist is published for UKCP
specifically that mental health issues have got worse for certain groups, including
members, to keep them informed of developments children, people from ethnic minorities and people from low-income households.
likely to impact on their practice and to provide
an opportunity to share information and views
The pandemic has also had an impact on how many of us are dreaming
on professional practice and topical issues. The and Melinda Powell explains how dreams can provide a kind of ‘nocturnal
contents of New Psychotherapist are provided for
general information purposes and do not constitute therapy’ (page 46). Elsewhere this issue, Sarah Niblock outlines how UKCP
professional advice of any nature. While every effort members have experienced the delivery of psychotherapy via telephone or
is made to ensure the content in New Psychotherapist
is accurate and true, on occasion there may be online (page 38). Enjoy reading.
mistakes and readers are advised not to rely on its
content. The editor and UKCP accept no responsibility
Get in contact
or liability for any loss which may arise from reliance Share your views and ideas on our
on the information contained in New Psychotherapist. profession and this magazine:
From time to time, New Psychotherapist may
publish articles of a controversial nature. The views editor@ukcp.org.uk
expressed are those of the author and not of the ANNA SCOTT UKCouncilForPsychotherapy
editor or of UKCP.
Editor
ADVERTISING POLICY twitter.com/UKCP_Updates
Advertisements are the responsibility of
the advertiser and do not constitute UKCP’s
psychotherapy.org.uk
endorsement of the advertiser, its products or instagram.com/psychotherapiesuk
services. The editor reserves the right to reject or
cancel advertisements without notice. Display ads:
for a current advertising pack and rate card, please
contact Harvey Falshaw on 020 3198 3092 or email
harvey.falshaw@jamespembrokemedia.co.uk New Psychotherapist / Winter 2021
Contents I S S U E 76 / W I NTE R 202 1
38 Finding new ways of
working remotely
26
Using psychotherapy to help build
better parent-infant relationships
On the Cover
This issue, we celebrate the work of
psychotherapists within the NHS
REGULARS 26 Parent-infant psychotherapy
The importance of early intervention
06 Bulletin
Research and member news to 30 Multidisciplinary teams
keep you informed Exploring how a joined-up approach
can benefit addiction treatments
5
10 Reviews
Recommended reading and 34 Working with families
podcast listens The role of a systemic and family
therapist in the NHS
52 Spotlight
Ed Fellows on his two decades 38 Remote therapy
working as a trauma psychotherapist The ways in which psychotherapists
in the NHS adapted during the pandemic
54 On Screen 42 Interview Join today!
An analysis of group dynamics in the Plaid Cymru MS Helen Mary Jones UKCP membership is a
BBC comedy, Fleabag outlines her views on social justice and recognised quality standard – being
medicalising mental health able to use the UKCP members’ logo
will demonstrate the calibre of your
training and practice to potential
FEATURES 46 Dreams
clients and employers and among
The therapeutic benefits of dreaming colleagues within the profession.
14 Improving access psychotherapy.org.uk/join
How a ready psychotherapeutic
workforce is demonstrating value
Get in contact
Share your views and ideas on our
18 Social justice profession and this magazine:
The people worst affected by mental editor@ukcp.org.uk
health issues are often the least able
UKCouncilForPsychotherapy
to access quality therapy. So what is
the impact of this? twitter.com/UKCP_Updates
psychotherapy.org.uk
22 Working with diabetes instagram.com/
How psychotherapy can help with psychotherapiesuk
diabetes management
42
Helen Mary Jones, MS for Mid and West
Wales in Senedd Cymru – Welsh Parliament New Psychotherapist / Winter 2021
Bulletin
I S S U E 76 / W I NT E R 202 1
News, CPD, reviews and member updates – here’s what’s
happening in the profession now
RESEARCH
Children in low-income households
have poorer mental health outcomes
Poor mental health outcomes
for children living in poverty
have been demonstrated by
two new pieces of research
T he links between poverty and
children’s mental health have
been demonstrated by two large-scale
research studies, as UKCP calls for a
review of the government’s mental
health plans for children.
6
The Co-SPACE study, in which the
University of Oxford has been tracking
parents’ and children’s mental health The study tracked the mental
during lockdown, found that children health of children during lockdown
living in low-income households were
two-and-a-half times more likely to wealthier households. Behavioural income, taken over the preceding
have greater emotional and attentional difficulties for primary school-aged ten-year period. They also examined
difficulties after one month than those children from low-income households links with children’s outcomes, using
in higher income households. were also more common. parents’ reports of children’s mental
In addition, parents and carers from UKCP’s policy and public affairs and physical health, and results from
low-income households reported that manager Adam Jones said any cognitive tests, all taken at age 11.
their children, aged between four and behavioural issues at school arising The researchers found that it was,
16, had higher levels of unhappiness from these circumstances must not in fact, only housing wealth that was
and worry, were more clingy and simply be met with exclusions. ‘It associated with children’s mental
experienced more physical symptoms is essential that there is support in health. ‘As housing wealth inequalities
associated with worry than those in place to address these issues. The increase, it is possible the divergence in
government’s existing plans for children’s emotional and behavioural
children’s mental health support do problems could be intensified,’ said
not go far enough,’ he said. Dr Ludovica Gambaro, co-author of the
Research ongoing since before the study, published in Child Development.
Get in contact lockdown – the Millennium Cohort See also feature, page 18.
Let us know what you think of your
Study of 8,500 children born in the UK
redesigned member magazine:
at the turn of the century – has also ‘Rapid Systematic Review: The
editor@ukcp.org.uk
found a link between a family’s assets impact of social isolation and
UKCouncilForPsychotherapy and their children’s mental health. loneliness on the mental health
twitter.com/UKCP_Updates The research team at the UCL of children and adolescents in the
psychotherapy.org.uk Centre for Longitudinal Studies context of COVID-19’ is published in
analysed data based on parents’ the Journal of the American Academy
instagram.com/
psychotherapiesuk current income, taken when children of Child and Adolescent Psychiatry.
were age 11, as well as their average tinyurl.com/rapidsystematicreview
New Psychotherapist / Winter 2021
Bulletin
Sleep on it
Exploring the therapeutic
benefits of dreams
Page 46
COMMUNITIES RESOURCES
CALL FOR COUNSELLORS IN
MENTAL HEALTH SUPPORT SCHOOLS IN ENGLAND
‘NEEDED FOR CHILDREN LIVING
OUTSIDE CITIES AND TOWNS’ Fewer than half of state schools in England
can offer their pupils onsite counselling in
the wake of the pandemic, a recent report
Those living in remote communities risk feelings of isolation has found.
In its report ‘The New Normal: The Future
of Education after COVID-19’, think tank the
C hildren living in remote rural
and coastal communities in
the UK are at risk of missing out
to find a specialist for someone
looking for therapy for their
child,’ she said. ‘Currently there
Institute for Public Policy Research found
that 48% of nearly 7,000 teachers surveyed
after the first wave of the pandemic said
on mental health support because are two centres I can suggest for their schools offered onsite counselling to
of poor digital connectivity, eight to 13 year olds [to receive students. The think tank said the government
limited public transport and a lack therapy], which are both an hour’s should introduce a national entitlement to key
of safe spaces, a report has found. commute in a car from the village support services, such as onsite counselling,
In particular, those aged I live in.’ in schools after the pandemic.
between eight and 13 years living One reason for this shortage is UKCP organisational member the Institute
in poverty and marginalised the unavailability of specialised for Arts and Therapy in Education has, along
communities, with a disability, training for therapists, and people with the Centre for Child Mental Health and
or those whose gender or sexual having to travel long distances for Trauma Informed Schools UK, provided trauma
identity is different from most training. ‘Long-distance training and mental health training to 311 schools and
of their peers, face disadvantages is not just associated with greater community organisations across Cornwall,
7
in rural areas, according to ‘The financial costs – such as paying after becoming the workforce training provider
space between us’, published by for accommodation – but also for a Big Lottery funded project with Cornwall
the Centre for Mental Health. loneliness and the wellbeing Council and HeadStart Kernow in 2017. Nearly
Rural poverty is less visible of those training,’ she added. 1,000 practitioners have accessed a ten-day
than in urban areas, but can leave ‘When I started training, some diploma and two-day training and a further
children especially isolated and of the people on my course were 3,500 have accessed whole staff training. The
excluded, and rural areas are often taking an hour or more to drive programme will run until June 2021.
poorly served by specialist mental to Norwich, with no public Dr Margot Sunderland, co-founding
health services, the report, funded transport available, and if they director of IATE, said: ‘There are one million
by BBC Children in Need, found. wanted to specialise in therapy for children in the UK with a mental health
‘We need to take action now to children they would need to add problem. All the research on adverse
ensure no child’s mental health is at least another hour-and-a-half’s childhood experiences (ACEs) shows that
put at risk because of where they travelling to reach another city.’ having one emotionally available adult
live,’ said Centre for Mental Health (EAA) before the age of 18 can interrupt the
deputy chief executive Andy Bell. trajectory from ACEs to long-term mental
Children living in remote
‘This means investing in rural and and physical ill-health. We have found that
communities could be
coastal areas, from parks, schools missing out on vital
teaching counselling and active listening
and community centres to mental mental health support skills to selective emotionally aware school-
health services, and reaching out staff can provide so many more children with
especially to children facing the an EAA.’
biggest disadvantages in life.’ Harry Quilter Pinner, lead author of the
UKCP psychotherapeutic report, added: ‘Many schools are unable to
counsellor, Natalija Stevens, provide the support young people need to
who operates in rural Norfolk, thrive. Without urgent government action
added that a shortage of available to ensure every school can provide vital
therapists in rural areas services such as counselling and after-
compounds this issue. ‘There have school clubs, there is a profound risk that the
been emails circulating from one legacy of the pandemic will be even bigger
local therapist to another trying educational and health inequalities.’
New Psychotherapist / Winter 2021
Smooth transitions
How members have adjusted to working
remotely during the pandemic
Page 38
COMMUNITIES
Investment in
mental health
‘urgently’ needed for
COVID-19 recovery
Increased funding for mental
health services must be a priority,
according to new reports
M ental health provision in NHS,
community and voluntary
sector settings must be prioritised as More funding in mental
part of any COVID-19 recovery plan, health services is needed
8
according to UKCP, as councils in
England warn that failing to invest
in mental health immediately will
settings. That’s why UKCP is
calling not only for more funding,
‘The long-term mental
undermine the country’s recovery. but for the government to work health consequences
‘The long-term mental health with us to address the structural of the pandemic are
consequences of the pandemic are barriers to psychotherapists
plain to see, but there has so far been working in publicly funded settings.’ plain to see’
little indication that the government (See feature, page 14.)
has got to grips with the scale of His comments came as the Local ‘Our place: local authorities and the
response required,’ said UKCP’s Government Authority called for public’s mental health’, written with
policy and public affairs manager, funding for councils to spend the Centre for Mental Health, shows
Adam Jones. ‘Furthermore, the level with local partners on meeting how collaboration between councils,
of demand can only be met if the communities’ mental wellbeing the NHS and community groups
psychotherapy and counselling needs, which, it states, will play can form part of a wide range of
workforce is successfully deployed in a crucial role in every aspect of approaches and strategies in tackling
the NHS, community and voluntary recovery planning. the determinants of mental ill-health.
UKCP systemic psychotherapist
John Woolner welcomed the report’s
focus on ‘moving away from the
FIFTH OF POPULATION COULD NEED MENTAL HEALTH narrow lens of a medical model’.
SUPPORT FOLLOWING PANDEMIC ‘This mirrors the relational nature
A model devised by the NHS and Centre for health difficulties will be children and young of systemic psychotherapy, which
Mental Health has forecast that up to 10 million people under 18. According to UKCP, ‘meeting moves comfortably between internal
people will either need new or additional this need will require the work of all the systems of attachment and trauma,
mental health support as a direct consequence psychological professions, including greater use to the wider focus of how our lives,
of the pandemic. of psychotherapists and counsellors in the NHS.’ relationships and mental health are
The Forecast Modelling toolkit, devised
For further information, visit shaped by global events and powerful
for local areas to calculate a forecast of
additional demand for these services, also centreformentalhealth.org.uk/ discourses in relation to such things
shows that 1.5 million of those with mental forecast-modelling-toolkit as gender, age, race, religion and
sexuality,’ he added.
New Psychotherapist / Winter 2021
Reviews
Psychotherapists review new and recent work in their own fields,
and recommend essential additions to your bookshelves
This Book Will Change
Your Mind About Mental Health
I t’s an old cliché to say a book had you
hooked from the first line – but when
that line is ‘I remember the first time that
fascinating section on the hierarchy of
perception. Filer uses the controversial
diagnosis of ‘schizophrenia’ as the core of
I forcibly medicated a person against his his book, from which all discussions
will’, are you surprised? branch. These always begin with the
Filer is a fine writer; this book is in a brilliantly told story of an individual
conversational style, but without affected by ‘schizophrenia’, which really
Details
compromising on rigour. He deals with captures the often gradual onset of ‘illness’ Reviewed by: Nick Campion,
difficult issues deftly, with even-handedness and the mix of social factors, emotional integrative psychotherapist
and a huge dose of humanity. He takes in need and an undeniable internal logic that Author: Nathan Filer
all the key waypoints regarding mental generates the sufferer’s delusions. Publisher: Faber & Faber
health, how we conceive it and how we deal We come away with a sense of how Price: £9.99
with it, making this a brilliant primer for blurred the lines are between psychosis and ISBN: 9780571345977
anyone thinking of studying mental health. reality, questioning assumptions around
But there’s also plenty for those already diagnosis and treatment, hit hard by the
10
in the field, not least the most concise sufferers’ stories – and the effect on those
primer on medications I’ve yet read and a who love them. Some stories are devastating.
Compassionate Mindful Inquiry in
Therapeutic Practice: A Practical Guide for
Mindfulness Teachers, Yoga Teachers and
Allied Health Professionals
A s both a psychotherapist and
teacher of mindfulness practices,
I was drawn to this book. Atkinson
chapter by Dr Trudi Edginton exploring
the neuroscience of mindfulness and
compassion; for me this was the most
Details explores the relationship between useful element of the text.
Reviewed by: Fe Robinson, compassion and mindfulness, The book is practical throughout,
UKCP psychotherapist presenting a model of Compassionate offering example questions to stimulate
(including EMDR and couples Mindful Inquiry that resonates with the inquiry, as well as exploring how
work) and clinical supervisor therapeutic process. She presents the practitioners can be at their most
Author: Karen Atkinson core stages as paying attention, reflective authentic and embodied through their
Publisher: Singing Dragon, dialogue and linking, and develops this own mindfulness practice. It’s focused
an imprint of Jessica Kingsley model using examples from her years on teaching mindfulness in groups; and
Publishers teaching mindfulness and yoga. speaks to a broad therapeutic audience,
Price: £17.99 Atkinson goes on to provide a rather than a psychotherapeutic one
ISBN: 9781787751750 method for creating a space within specifically. Any therapist who is
which clients can be mindful, and interested to learn about mindfulness
establish wise action (compassion) and compassion, and how they can be
arising from this. The book includes an integrated into therapeutic work, will
insightful and easy-to-understand find this a useful read.
New Psychotherapist / Winter 2021Reviews
Understanding, Nurturing and Working
Effectively with Vulnerable Children In
Schools: ‘Why Can’t You Hear Me’
I n this book, Angela Greenwood
manages to bridge the sometimes
difficult divide between the therapeutic
author offers the concept of Nurture Base,
a space ideally present in every school.
Perhaps for readers not familiar with
and educational setting. The volume is the UK educational system in detail it
aimed at anyone working in the would be useful to have a brief overview Details
educational setting – teachers, teaching of what is available in terms of support. Reviewed by: Pavla Radostova,
assistants, counsellors and others, But there is a wealth of resources on how psychotherapist and presenter
however, even as someone not involved to support children struggling with Author: Angela Greenwood
with that setting, I found myself separation, transition and change, Publisher: Routledge
immersed in her words. endings, working with metaphor and Price: £22.67
Greenwood’s approach is rooted in play, and containment, as well as working ISBN: 9780367025441
attachment theory and developmental with parents or looked after children, that
needs. Her holistic approach focuses on is impressive.
working not only with children, but also Greenwood offers practical options for
with parents and whole family systems, practitioners working in schools or
as well as teachers and the rest of hoping to set up psychological support in
school staff. their school, or to set up their own
As you read you can feel the experience version of the Nurture Base. In this book
from the pages. This book provides plenty we experience the kind of holding,
11
of practical suggestions and examples to security and nurture we would like to see
transfer theoretical understanding into in schools, whether for our younger
practice within the school setting. The selves, or for our children.
PODCASTS WE’RE LISTENING TO
THE NAKED It is this reluctance which the their mental health, some of whom are Details
PROFESSORS podcast The Naked Professors aims described as ‘perceived heroes’. If you Reviewed by: Kirsten
to address, by offering relatable are looking for a careful unpicking of Bickford, psychodynamic
One in eight men in the UK suffer discussion about mindset and the dissonances in our psychological therapist
from a mental health disorder. personal growth. Host Ben Bidwell is notions of gender, you are unlikely to Creator: Matt Johnson and
Suicide remains the biggest cause neither a professor, nor naked; rather, find it here. It rarely gets beyond the Ben Bidwell
of death for men under 35 and the show’s name is a nod to Bidwell’s familiar podcast premise of providing Available: play.acast.com/s/
nearly 40% of men say they have mission to ‘strip off emotionally’ (he shared truths to help normalise the thenakedprofessors
noticed a negative effect on their also gained notoriety for his nude more unmentionable aspects of human
mental health since lockdown, Instagram images, documenting his experience. But it is a light-touch
according to the Samaritans. But, journey to becoming a life coach). conversation starter on interesting
says Men’s Health Forum, men are Bidwell wants to represent a form questions about how we raise boys,
also much less likely to seek support of masculinity that is comfortable what healthy masculinity looks like
and access psychological therapies talking about male vulnerabilities. He and how men can find spaces to speak
than women. does this by interviewing guests about more honestly about their fears.
New Psychotherapist / Winter 2021Reviews
Have your say
Tell us what you think
of this issue. Email
editor@ukcp.org.uk
Conversations with a Blank Canvas:
From Nowhere to Somewhere
Decades of Change and Transformation
I n this memoir, author, arts
psychotherapist and UKCP
member Isa L Levy shares an honest
more authentic self, showing her
psychological, artistic and spiritual
processes through images, poetry and
and thought-provoking self-assessment words, as she evolves to reach a state
of her life journey. Psychologically it of ‘belonging’. Details
is reflective in ways which invite the As well as photographs relating to Reviewed by: Pat Devereaux,
reader to engage more consciously her life and relationships, Levy has freelance journalist
with their own journeys. included colour plates of her vivid Author: Isa L Levy
It follows a chronology of eight paintings in the book. She is an Publisher: Independently
decades in Levy’s life, revealing her accomplished artist, who completed published
growth and evolution. The dominant a master’s in arts and psychotherapy Price: £20.00
metaphor is that of engaging with in her early sixties. In her seventh ISBN 9798652896898
a blank canvas before one begins decade, Isa has a whole new career as
to paint and it includes the themes an arts psychotherapist. In her eighth
of evolving from the ‘black and decade she returns to the stage in a
white’ feelings of depression and musical production based on Susie
loneliness to reaching a more Orbach’s book Fat is a Feminist Issue.
meaningful ‘colourful’ life through Ultimately, Conversations with a
12
psychotherapy, creative expression Blank Canvas is a story about change,
and spiritual rejuvenation. Over in which Levy offers insight into her
the decades Levy reveals how she own healing process so that others
journeyed from a false self to a may embrace theirs.
PODCASTS WE’RE LISTENING TO
MENTALLY YOURS each week and discuss all the weird ‘The Art of Rest’ provides Details
stuff going on in our minds’. succour to the relentless Reviewed by: Mark
Mentally Yours isn’t just one of Anne Both Castor and Scott have an commodification of time. As Hammond, psychotherapist
Uumellmahaye’s wedding vows to easy rapport with their guests and mental health professionals we Creator: Yvette Castor and
Dr Michael Hfuhruhurr in the Steve topics run the gamut of mental health are ethically bound to self-care Ellen Scott
Martin classic The Man With Two issues, including imposter syndrome, and sending the message to the Available: metro.co.uk/tag/
Brains, it’s a Mind Media Awards- unconscious bias, how to sleep wider world that we can all try mentally-yours-podcast/
nominated podcast. Yvette Castor well, trauma, alcoholism and, most to be gentler with ourselves and
and Ellen Scott, both journalists intriguing to me, the art of rest. In simply ‘be’ rather than strive ‘to be’
for the newspaper Metro, have this episode, broadcaster, author and anything else is a deeply supportive
combined their extensive and academic Claudia Hammond joins the message. Here is a podcast for
versatile experience (a lot of which team to shine some much-needed these difficult times. Put your feet
already centres on mental health light on what I think a lot of us don’t up and have a listen. The time is
matters) to ‘chat to a mystery guest take as seriously as we could. (mentally) yours.
New Psychotherapist / Winter 2021THE BIG Feature / Improving access
REPORT
PSYCHOTHERAPY
IN THE NHS
A MEANINGFUL
CHOICE OF
THERAPY
ACCESS TO A RANGE OF NHS TALKING THERAPIES, ESPECIALLY
PSYCHOTHERAPY, IS LIMITED ACROSS THE UK. YET A FULLY TRAINED
14 PSYCHOTHERAPEUTIC WORKFORCE HAS DEMONSTRATED ITS VALUE
DURING THE PANDEMIC. HAZEL DAVIS REPORTS
I
t’s hardly newsworthy that the for many people to take and it can be Opening up about your mental health is
UK is facing a mental health very disheartening – and sometimes hard enough. To be then cruelly cut off
crisis. Almost one in five adults damaging – if your first experience of and dismissed is downright damaging, in
(19.2%) were experiencing some form mental health support doesn’t meet your my opinion.’
of depression during lockdown in needs. That’s why we’re calling for a
June 20201. Before the pandemic, an better range of interventions to be made GEOGRAPHICAL VARIATIONS
estimated one in six people in England available, so people across the UK have Access to psychotherapy in the
alone reported experiencing a common access to what’s right for them.’ NHS can vary radically from region
mental health problem in any given When Sara Jones tried to access to region, from nation to nation, and
week2. Yet one in ten people wait more psychotherapy in Manchester earlier between urban and rural locations
than six weeks for talking therapy this year, her experience was far from within the UK. For example, self-referral
within the NHS via IAPT (Improving ideal. ‘I had a bit of a breakdown and for talking therapy is not routinely
Access to Psychological Therapies) ended up in A&E,’ she explains. ‘I was available on the NHS in Scotland.
services, usually CBT3. sent home with a number that promised ‘Most of the so-called “psychotherapy”
Provision of psychotherapy within the 24-hour support. I rang them and services available through the NHS are
NHS across the UK is patchy at best, and they proceeded to tell me their rules. usually very limited and very selective,’
is seen as an expensive and long-term I could call as often as I liked but calls says Galashiels-based psychotherapist
commitment, which isn’t necessarily are capped to 20 minutes. After ten or Courtenay Young. ‘There is almost no
the case. ‘There’s a real lack of choice so minutes explaining this they asked counselling now available through the
for people seeking support,’ says Adam why I had called. I started to open up. NHS as there has been a long-term policy
Jones, UKCP’s policy and public affairs Suddenly I was told, “Your 20 minutes to phase it out as an available treatment,’
manager. ‘Seeking help is a big step are up, goodbye” – literally mid-sentence. he adds.
New Psychotherapist / Winter 2021Feature / Improving access
15
Though some of the counselling Nicola Airey, higher assistant
services in the voluntary sector are psychologist at NAViGO Health and
19.2%
partially funded from within the NHS Social Care CIC, a not-for-profit social
Trust budgets, Young says, ‘This type enterprise that emerged from the
(almost one in
of funding is generally quite limited, NHS to run all local mental health
five adults) were experiencing
either geographically (to a particular and associated services in North East
some form of depression during
area or NHS Trust), or to a certain fixed Lincolnshire, says there is an essence
lockdown in June 20201
number of sessions, and they are liable of rigidity in talking therapy provision.
either not to be increased in line with ‘Patients become hardened to services
inflation, or to be wound down over a when they go through the “revolving
few years and then eventually cut.’ door” [people with mental health issues
who get better, then relapse, and are in
and out of therapy or hospital] – and
understandably so.
21%
‘Individual differences need to be
recognised and acknowledged, and
of psychotherapists therapy adapted to meet them. People’s they finally reach the therapy chair,’
currently work in NHS-funded lives can change while they’re sat she adds.
settings – 87% in paid roles and waiting for therapy. For some, their
12% in unpaid support roles4 issues may resolve, but for others WHAT IT COULD LOOK LIKE
the outcomes are catastrophic. It’s According to UKCP’s survey of its
disenchanting and can often lead to 10,000 members in January 2020, 21%
hardening toward services when of psychotherapists currently work in
New Psychotherapist / Winter 2021THE BIG Feature / Improving access
REPORT
PSYCHOTHERAPY
IN THE NHS
NHS-funded settings – 87% in paid roles productivity caused by mental ill-health
and 12% in unpaid support roles (the in the workplace; secondly, it will reduce
remaining 1% preferred not to say). In the pressure on addiction services, the
addition, 74% of the paid NHS work is social care bill, and lessen the likelihood
the result of direct employment by the of people falling foul of the criminal
NHS, and 87% of UKCP members working justice system. Thirdly – and perhaps
Complex needs
in the NHS are paid at Band 7 or higher. most importantly in the current context
Forty-five per cent of psychotherapists – psychotherapy unlocks potential and
Talking Therapies show an interest in working for the NHS4. builds resilience for our handling of
There are some powerful examples future emergencies.’
Taskforce of psychotherapists working alongside Adam Jones says that better
other mental health and healthcare connections between NHS training
The Talking Therapies Taskforce professionals in the NHS, such as the pathways and existing psychotherapy
(TTTF), of which UKCP is a part, aims psychotherapy service within the training are needed. ‘We are lobbying
to develop a national infrastructure neurology department of the Royal Health Education England (HEE) to
for psychological therapies for people Hallamshire Hospital (see panel, facing provide more funding specifically for
with complex mental health needs. page). Crucial work is undertaken across psychotherapists and counsellors so
For the last year the focus has NHS hospitals – including helping they can take up trainee posts and work
been on a collaboration with Devon children experiencing serious physical in paid roles regardless of whether they
Partnership NHS Trust and West illness (see feature, page 34) or adults with have completed the top-up trainings
London NHS Trust and the Centre for diabetes (see feature, page 22) – and with required to work in NHS settings.
Mental Health, looking at the health primary care organisations in the NHS or ‘We also have a job to do to ensure
economic evaluation of the cost of other public sector and voluntary bodies, that UKCP trainings are linked with paid
highly complex relational disturbance such as helping people with addictions NHS training placements where possible.
16
in public-sector health and social care (see feature, page 30) and mothers and This would have the dual benefit of
services. ‘There’s evidence that those infants that need infant psychotherapy reducing costs for trainees and giving
particular Trusts have a high volume (see feature, page 26). This work has a therapists the experience of working
of this type of intensive user, who can demonstrable impact on not only mental under NHS structures right at the start
often end up as long-term inpatients in health outcomes for patients, but also of their careers.’
physical care settings, costing Trusts cost savings for both the health service Integrative psychotherapist Dr
thousands of pounds each year,’ says itself and across wider public-sector Christian Buckland, who has held
Adam Jones. ‘This money would be bodies, including local authorities, social positions in the NHS and works
far better spent if it were redirected services and the criminal justice system. alongside consultant psychiatrists and
to specialist psychotherapy services ‘It makes financial as well as health clinical and counselling psychologists,
that can better meet the needs of this sense to increase access to talking believes that psychotherapists need to
patient group.’ therapy,’ says UKCP chief executive adapt or expand their training to align
The other members of the Professor Sarah Niblock. ‘While it will skills more closely with the needs of
TTTF are the Association for entail some upfront investment, the the NHS. ‘Whether or not we agree with
Psychoanalytic Psychotherapy in medium- to long-term savings will the medical model used within mental
the NHS, the British Association for be very worthwhile. Firstly, it will health services in the UK, its usage is
Counselling and Psychotherapy, the reduce the acute financial toll and lost prevalent, and psychiatric language
British Psychoanalytic Council, the
Psychotherapy Faculty at the Royal
College of Psychiatrists and the
Society for Psychotherapy Research.
87% of UKCP members working in
the NHS are paid at Band 7 or higher4
New Psychotherapist / Winter 2021Feature / Improving access
100,000 There are more than 100,000
highly trained psychotherapists and psychotherapeutic
Good practice
counsellors at the forefront of the mental health sector, Royal Hallamshire
supporting hundreds of thousands of the UK’s most
vulnerable people5 Neurology
Psychotherapy Service
The Neurology Psychotherapy Service
at the Royal Hallamshire Hospital in
Sheffield is an example of good practice
in psychotherapy in the NHS. For patients
remains the dominant discourse,’ he 2020. They highlighted the more than
experiencing extreme physical symptoms,
says. ‘Therefore, if we want to have more 100,000 highly trained psychotherapists
seizures and paralysis, for whom the
psychotherapists working within the and psychotherapeutic counsellors at
causes are psychologically driven, the
NHS it is important for our training to the forefront of the mental health sector,
service has a seven-strong team of experts
acknowledge this, and know how to work supporting hundreds of thousands of the
in CBT, gestalt therapy, lifespan integration,
with this model, while also knowing UK’s most vulnerable people, and who
integrative, intensive short-term
other ways of working.’ are ready to work in the NHS, to help
dynamic psychotherapy and acceptance
to alleviate the great many pressures
and commitment therapy. ‘Our goal is to
A READY WORKFORCE it faces in relation to the provision of
improve quality of life,’ says neurology
‘However,’ adds Buckland, ‘when the mental health services5.
psychotherapy manager Aimee Morgan-
lockdown was introduced in March 2020, The letter calls on the government
Boon. ‘We offer four to 20 hour-long
psychotherapists had to adapt quickly in to make a commitment to provide a
sessions and we see 3,000-4,000 patients 17
order to continue to support those who genuine choice of talking therapies
a year, with a waiting list of 12 to 18 months.
needed our services. We did it, and the through primary and secondary care
This is likely to increase if people already
speed at which we adapted to a new way NHS services across the whole of the
disposed to psychological challenges have
of working is something we should be UK. And among the UKCP’s other
a difficult COVID-19 experience.’
extremely proud of.’ policy objectives is a call for longer
According to UKCP’s survey, 40% term talking therapies to be offered
of members donated their expertise to people with complex mental health
by spending some time working on pro- problems with the aim of eradicating
bono contracts and supporting the NHS the so-called ‘revolving door’ of people
and voluntary sector. This figure has with serious mental health issues,
dramatically increased since the outbreak and for funded trainee places in IAPT
of COVID-19. ‘Psychotherapists are one (Improving Access to Psychological
of the groups of hidden key workers in Therapies) for non-CBT practitioners.
References and reading
this crisis,’ says Sarah Niblock. ‘While we Sarah Niblock points out that UKCP
applaud all our members who have been is working hard to secure more funded (1) ons.gov.uk/peoplepopulationand
able to volunteer their time and skills to training and work opportunities community/wellbeing/articles/coronavirus
support others, we will continue through within the NHS and to increase public anddepressioninadultsgreatbritain/june2020
our policy and campaigns work to protect awareness and understanding of the (2) webarchive.nationalarchives.gov.
our members’ livelihoods and secure value of psychotherapy. ‘We are calling uk/20180328140249/http://digital.nhs.uk/
the recognition and paid opportunities on the national government, local catalogue/PUB21748
our members need in order to provide government, MPs and the NHS to take (3) digital.nhs.uk/data-and-information/
crucial support in an accessible and action now to provide a genuine choice publications/statistical/psychological-therapies-
sustainable way.’ of talking therapies through primary and report-on-the-use-of-iapt-services/april-2019-
The UKCP is among a number of secondary care NHS services across the final-including-reports-on-the-iapt-pilots
organisations, including the British four nations.’ (4) psychotherapy.org.uk/blog/a-snapshot-of-
Association for Counselling and how-our-members-work/
Psychotherapy (BACP) and the British What do you think? (5) psychotherapy.org.uk/ukcp-news/
Psychoanalytic Council (BPC), which Share your thoughts and midweek-mindset/our-call-for-government-
wrote to the Secretary of State for Health opinions by emailing: action-on-psychotherapy-and-counselling-in-
and Social Care, Matt Hancock, in spring editor@ukcp.org.uk wake-of-covid-19-crisis/
New Psychotherapist / Winter 2021THE BIG Feature / Social justice
REPORT
PSYCHOTHERAPY
IN THE NHS
A MATTER OF
SOCIAL JUSTICE
THE PEOPLE WORST AFFECTED BY COVID-19 AND MENTAL HEALTH
ISSUES ARE OFTEN THE LEAST ABLE TO ACCESS HIGH-QUALITY
THERAPY. HAZEL DAVIS INVESTIGATES THE IMPACT THIS WILL HAVE
S
o often mental health is seen mental illness, people living with population as a whole. As well as the
through the prism of poverty; children and those living in urban threat to physical health from COVID-19,
many indicators of poverty are areas, even after some lockdown pandemics are not dissimilar to natural
indicators of mental ill health. measures were eased in June 20203. disasters in terms of the way they affect
Levels of anxiety and depression The mental health of women has individuals’ mental health. People who
remain highest among people with been particularly badly affected since have not previously suffered will be
a lower income1. Emotional and lockdown4, and people from ethnic experiencing mental health difficulties
attention difficulties are two-and-a- minority backgrounds have had lower for the very first time. The damage is
half times higher in children from levels of happiness and life satisfaction also long term: research from the SARS
lower income households2. – 23% reported being lonely during and MERS epidemics has shown that the
But these aren’t the only indicators lockdown, compared with 17% from effects on mental health are felt a long
of poor mental health. Anxiety and white backgrounds5. time afterwards6.
depression levels remained high among Yet the effects of the pandemic ‘Research data shows that,
young people, those with a diagnosed have been indiscriminate across the increasingly, people
New Psychotherapist / Winter 2021Feature / Social justice
19
New Psychotherapist / Winter 2021THE BIG
REPORT
PSYCHOTHERAPY
IN THE NHS
as poverty, crime and poor physical its doors seeking help for mental health,
‘It has become health, will continue to worsen. In its according to integrative counsellor and
even harder to get 2017 report, ‘Dying From Inequality’,
Samaritans found that socioeconomic
psychotherapist Dwight Turner.
‘Lockdown has shown up degrees
access to mental factors including poor living conditions, of privilege and highlighted how
unemployment and debt contributed to disproportionately affected by this
health support’ higher suicide figures, with men feeling illness minorities have been across
more susceptible to the negative effects the western world,’ he says. ‘Often on
of recession than women7. Those who the frontline, they’re the ones on the
from all walks of life are experiencing are unemployed are two to three times receiving end of the traumatic impact of
worsening mental health,’ says more likely to die by suicide than those what’s going on, not to mention racism
UKCP’s chief executive Sarah Niblock. who are in employment. Low educational and prejudice. With local lockdowns it’s
‘Taking into account the recession, levels and not owning a home also often been the minorities who have been
the acute uncertainty over our increase the risk of suicide. considered at fault. We’ve seen an awful
health, our livelihoods, Brexit and the ‘We know that people who are lot of stereotyping and prejudice and the
environmental crisis, I am worried that socioeconomically disadvantaged are less wooliness around the rules has made
families and communities will become likely to request help for any emotional divisions even worse, with people being
even more fragmented and split and or mental health issue than those pitted against each other.’
there will be an overall health impact. less disadvantaged,’ says integrative Just over 22% of mental health staff
Loneliness, for example, is as serious a psychotherapist Dr Christian Buckland, in the NHS have a minority ethnic
physical health threat as it is mental – who works alongside other mental background9. Yet systemic racism is
akin to smoking 15 cigarettes per day. health professionals, such as consultant all-pervasive and self-perpetuating, even
‘The pandemic and the climate psychiatrists, counselling and clinical among well-meaning people. ‘The classic
emergency will have an unimaginable psychologists. ‘These findings also example is a workshop on race where a
psychological toll on the emotional and indicate those from socioeconomically person of colour might be expected to
20
mental wellbeing of our entire species,’ disadvantaged backgrounds are not as speak for everyone of colour,’ he adds.
she adds. ‘In the wake of the pandemic, likely to receive a referral to specialist
we know that it has become even services from GPs in relation to self-harm URGENT INVESTMENT NEEDED
harder to get access to mental health than those in less-deprived areas.’ And psychotherapists can play a major
support. How the UK government role in ensuring the voices of their
responds to the scale of this challenge PRIVILEGES patients and clients are heard. ‘We are
will have dramatic repercussions So where are people accessing help for the ones on the frontline hearing the
for all our mental wellbeing and our mental health difficulties? Charity Mind levels of despair,’ says Buckland, ‘and
recovery economically.’ found that since April, 27% of nearly I am anticipating the suffering will
9,000 people they surveyed who had significantly increase over the next year,
A LONG-TERM PROBLEM been able to receive therapy, accessed whether this is additional distress from
But accessing treatment via the mental health support through a the loss of loved ones from a pandemic,
NHS for mental health difficulties is private provider, 16% got help through result of redundancy and job loss,
particularly difficult and, same as it ever charities, and 49% received support loneliness and isolation, humiliation
was, the ones who are most adversely through the NHS8. and shame from loss of job or exclusion
affected are the ones who can’t get the ‘We’re concerned that the government from communities, exacerbation of
treatment. ‘The driving force behind will continue to rely on the voluntary existing mental health issues, illness
UKCP’s campaign to push for more sector to pick up additional demand post from medical conditions that have been
psychotherapy in the NHS is a simple COVID-19,’ Niblock says. ‘That would left undiagnosed, operations postponed,
question of social justice,’ says Adam be unacceptable to a patient needing breakdowns in relationships due to the
Jones, UKCP’s policy and public affairs physical treatment, so it beggars belief divide in opinion relating to race, pandemic
manager. ‘We’re tired of the fact that the that it is seen as acceptable for mental restrictions or the erosion of civil liberties.’
brilliant work of our members is so often health treatment.’
available only to people who can afford For those people hardest hit with mental
to pay for therapy privately.’ health difficulties, the lack of access to ‘People who are
Psychotherapy can help alleviate many appropriate talking therapy through the
issues, from addiction to enabling people NHS can be devastating. For example, disadvantaged
to overcome mental illness and return
to work. But without better provision,
the NHS needs to be better prepared
for the inevitable influx of minority
are less likely to
many elements of social injustice, such groups that are going to come through request help’
New Psychotherapist / Winter 2021Feature / Social justice
‘We have to invest Addressing these issues is crucial,
not just in response to the pandemic,
References and reading
in protecting but in having a hugely beneficial (1) covidsocialstudy.org/
people’s mental and effect on society. As most therapists
and patients know, if one person has
(2) cospaceoxford.org/findings/changes-in-
children-mental-health-symptoms-september-2020/
emotional wellness’ psychotherapy, the effects are felt by (3) covidsocialstudy.org/
partners, children, families, colleagues (4) ifs.org.uk/uploads/The-mental-health-effects-
and even communities. ‘If we want a of-the-first-two-months-of-lockdown-and-social-
There are real worries among specific resilient, agile society where people can distancing-during-the-Covid-19-pandemic-in-the-
groups. ‘My concern is the level of thrive, where children’s life chances UK.pdf
suicide may have already significantly are massively improved (given that the (5) b6bdcb03-332c-4ff9-8b9d 28f9c957493a.
increased this year and will continue to seeds of 75% of adult mental health filesusr.com/ugd/3d9db5_17cc74c304664db8ac9
do so as the economic and health effects issues are planted in childhood), then ea56e1dd301ae.pdf
and responses to the pandemic are felt we have to invest in protecting people’s (6) ucl.ac.uk/news/2020/may/analysis-coronavirus-
for the years to come,’ adds Buckland. emotional and mental wellness,’ Sarah affects-mental-health-too-heres-what-we-know
‘We are told that the lockdown has Niblock says. ‘We know that too many (7) media.samaritans.org/documents/Samaritans_
significantly impacted those who have people are arriving at the therapist’s Dying_from_inequality_report_-_summary.pdf
previously had issues with alcohol, door as a last resort after other methods (8) mind.org.uk/news-campaigns/news/mental-
eating disorder charities have stated a to address their issues – such as short- health-charity-mind-finds-that-nearly-a-quarter-
significant rise in calls to their helplines term interventions and medication – of-people-have-not-been-able-to-access-mental-
during the lockdown.’ have failed.’ health-services-in-the-last-two-weeks/
(9) NHS Digital. (2020). NHS Hospital and
Community Health Services: Mental Health staff by
ethnicity, in NHS Trusts and CCGs, as at 31 July 2020,
headcount
21
Illustrations: Dettmer / IkonVignette / Working in a diabetes clinic
‘For every £1 the
hospital spends on
psychotherapy, it
saves £29 in costs’
I
have type 1 diabetes and two of my FOR TEN YEARS, KATE HARDENBERG HAS WORKED AS A
childhood friends died from diabetes-
SPECIALIST PSYCHOTHERAPIST IN A HOSPITAL DIABETES CLINIC.
related self-harm. When I was doing
my psychotherapy training, I wanted to SHE EXPLAINS WHAT LIFE IS LIKE IN AN ACUTE NHS TRUST
do a placement within a diabetes clinic
because I knew a lot of people who
struggled with the illness. But at the time, to help people with diabetes in distress 180 people) for patients to have a weekly
22
few hospitals provided psychological who may not incur such costs. session. I might check in once a month
care around diabetes. For example, if someone has got type 1 with a patient but, to an extent, I have to be
I asked a diabetes consultant at the Royal diabetes and is also homeless or has got flexible about it. Generally I see between
United Hospitals Bath NHS Foundation mental health problems, they need a lot of eight and ten people each week.
Trust (who was my own doctor) if they help. And an overnight stay in hospital can I see anyone who has to take insulin,
would let me, as a psychotherapy student, cost about £2,000. We don’t need to do a mainly those with type 1, but some with
do a placement in the clinic. They agreed lot of psychotherapy work with somebody other types. When a patient with diabetes
after some persuasion; but they wanted me to actually bring these costs down is admitted to hospital the team of
to do it for at least two years – they didn’t quite considerably. The NHS targets for inpatient specialist diabetes nurses, who
want to set up a service and build demand diabetes outcomes are partly based on are the first point of contact for anyone
only to lose it again. I ended up doing patients’ average blood sugar levels with diabetes, will be informed, and they
the placement for nearly three years and over three months. I can tell from the have the specialist skills and knowledge
in that time the consultants managed to numbers that if I can work with someone to treat them. That team of nurses inform
secure funding to continue the role. psychotherapeutically for a period of me so I can visit the patient too.
It is always very tough to get time, I can bring their average blood This allows me to build a relationship
psychotherapy funded by the NHS and sugar level down quite considerably. with the patients, especially if they later
when trusts receive funding it is normally return to the hospital as outpatients. Some
for psychology. Within diabetes that Hospital life of our patients are hard to reach and won’t
funding is usually for children. I knew I work two-and-a-half days a week at the normally visit a doctor, so the opportunity
that Clinical Commissioning Groups hospital (the rest of my time is spent in to build this relationship is really important.
(CCGs) would be mostly interested in private practice), mainly with outpatients For example, a homeless person admitted
the efficacy of the clinic, so I collated in the clinic as part of a multidisciplinary as an inpatient might not want to engage
data for several years to try to prove team of doctors and nurses. I work in a at all, but if I’ve said ‘hello’ to them five or
the value of psychotherapy. I was able clinic room and patients have 50-minute six times they might start to respond and
to demonstrate cost savings equating sessions. My waiting list is too long (about we can start to build a relationship. As
to every £1 the hospital spent on
Photo: Joseph Branston
psychotherapy it saved £29 in costs. It
has been useful for getting the CCGs
to provide funding based on money
‘The nurses and doctors I work with are really
savings with the most costly patients, switched on to the benefits of psychotherapyʼ
New Psychotherapist / Winter 2021You can also read
