OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP

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OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
ISSUE 76 / WINTER 2021             ISSN 2516-7162 (ONLINE)

           OPENING DOORS
            How can we boost access to psychotherapy?

OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
                                                           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,

   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
                                                                                                      working in the health service – from
   Advertising: Harvey Falshaw, harvey.                                                               finding a job as a psychotherapist in,                                                                     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                                                                        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
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 –
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                                                      
expressed are those of the author and not of the            ANNA SCOTT                                               UKCouncilForPsychotherapy
editor or of UKCP.
ADVERTISING POLICY                                                                                         
Advertisements are the responsibility of
the advertiser and do not constitute UKCP’s
endorsement of the advertiser, its products or                                                             
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                                                                     New Psychotherapist / Winter 2021
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
Contents  I S S U E 76 / W I NTE R 202 1

38     Finding new ways of
       working remotely

                                                                                                     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
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                                                                             
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                                                                  
health issues are often the least able
to access quality therapy. So what is
the impact of this?                                                                                  
22 Working with diabetes                                                                             
How psychotherapy can help with                                                                                psychotherapiesuk
diabetes management

          Helen Mary Jones, MS for Mid and West
          Wales in Senedd Cymru – Welsh Parliament                                               New Psychotherapist / Winter 2021
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
                                                    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


               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.
                  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

                                                         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
                          The research team at the UCL          of children and adolescents in the
                           Centre for Longitudinal Studies          context of COVID-19’ is published in
                                                         analysed data based on parents’          the Journal of the American Academy

          psychotherapiesuk                              current income, taken when children      of Child and Adolescent Psychiatry.
                                                         were age 11, as well as their average

    New Psychotherapist / Winter 2021
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
                     Sleep on it
                     Exploring the therapeutic
                     benefits of dreams
                     Page 46

COMMUNITIES                                                                             RESOURCES
                                                                                        CALL FOR COUNSELLORS IN
MENTAL HEALTH SUPPORT                                                                   SCHOOLS IN ENGLAND
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,
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
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
Smooth transitions
                             How members have adjusted to working
                             remotely during the pandemic
                             Page 38


    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
             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                      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
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
OPENING DOORS - ISSUE 76 / WINTER 2021 - How can we boost access to psychotherapy? - UKCP
                   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
              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
              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 2021

      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,
      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.


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:
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 2021
                                                                                                                                                Have your say
                                                                                                                                                Tell us what you think
                                                                                                                                                of this issue. Email

                  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
                  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.


       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:
       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 2021
THE BIG                Feature / Improving access

            A MEANINGFUL
              CHOICE OF

           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 2021
Feature / Improving access


   Though some of the counselling              Nicola Airey, higher assistant
services in the voluntary sector are        psychologist at NAViGO Health and

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.

                                               ‘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 2021
THE BIG                  Feature / Improving access

                                                   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.
         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 2021
Feature / 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)
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)
our members’ livelihoods and secure           value of psychotherapy. ‘We are calling      uk/20180328140249/
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)
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)
Association for Counselling and                                                            how-our-members-work/
Psychotherapy (BACP) and the British                  What do you think?                      (5)
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                       wake-of-covid-19-crisis/

                                                                                           New Psychotherapist / Winter 2021
THE BIG                Feature / Social justice


          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 2021
Feature / Social justice


New Psychotherapist / Winter 2021

                                                    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
      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 2021
Feature / 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)

                                people’s mental and                            effect on society. As most therapists
                                                                               and patients know, if one person has
                                emotional wellness’                            psychotherapy, the effects are felt by         (3)
                                                                               partners, children, families, colleagues       (4)
                                                                               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
                                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)
                                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)
                                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)
                                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,
Illustrations: Dettmer / Ikon
Vignette / Working in a diabetes clinic

                                                                              ‘For every £1 the
                                                                              hospital spends on
                                                                              psychotherapy, it
                                                                              saves £29 in costs’
                                 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
                              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 2021
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