6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

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Similarly, the ‘equivalence’ that the PRaCTICED trial established between CBT and PCET faded away after the initial six-month assessment. By one year, people who had received CBT were doing better than those who had PCET and more of those in the PCET group were looking to return to therapy, while those in the CBT group were more likely to be using the techniques they had learned in therapy to help them through recurring difficulties. Menzies RE, Neimeyer RA, Menzies RG. Death anxiety, loss, and grief in the time of COVID-19. Behaviour Change 2020; 37(3): 111–115. Research into humanistic counselling has been given a major boost by the findings of two randomised controlled trials (RCTs) published earlier this year. The PRaCTICED trial, 1 which was funded by BACP and conducted at the University of Sheffield, established that person-centred experiential therapy (PCET) does achieve comparable results with CBT when delivered in an IAPT setting – as analysis of practice-based data had already indicated. The ETHOS RCT, 2 which was supported by funding from the Economic Social Research Council (ESRC) and led by a team at the University of Roehampton, found clear benefits for children receiving person-centred school-based counselling in terms of achieving their goals. Stroebe M, Schut H. Bereavement in times of COVID-19: a review and theoretical framework. OMEGA–Journal of Death and Dying 2021; 82(3): 500–522.

The need to connect is perhaps one reason why there are several thriving and lively Facebook groups for therapists, often the result of an individual practitioner taking the initiative to set up a group where they saw a need. One such therapist is Katie Rose, who recently started a Facebook group for UK therapists working for the US platform BetterHelp. The offer to clients of ‘24/7’ access to their therapist via messaging is just one reason why this subscription-based platform is controversial, but few practitioners are in a position to outright dismiss new potential sources of income. Rose set up the group to help UK therapists make working for the platform work to their advantage. In our ‘Big issue’ feature this month, I take a look at the other reasons why this platform is considered controversial, plus some of the home-grown versions, and the pros and cons for both therapists and clients of accessing and providing therapy this way. She also had concerns about the ‘unlimited’ messaging that clients are promised as part of their subscription. ‘I’d get messages from a client saying they’d just had an argument with their boyfriend and what should they do, or they woke up feeling anxious,’ she says. ‘But having instant answers isn’t what therapy is about and my feeling is that it could develop a dependency. It’s up to the therapist when they respond to messages, but you’ve constantly got “red flag” notifications that your “account actions are overdue” – some people might be able to ignore that but it sent my stress levels through the roof.’Meantime, the July issue offers rich reading, not least Phil Hills’ and Rachel Lawley’s description of how they, as newly qualified counsellors, set up and are now taking a specialist counselling service into schools to offer support to the teachers. It’s a story of head, heart and sheer business-mindedness that, as they say, has meant they can work to the values and principles that brought them into the profession. Fausto-Sterling A. Sexing the body: gender politics and the construction of sexuality. New York: Basic Books; 2000. Says Dr Clare Symons, BACP Head of Research: ‘Broadly for both trials, the findings remain very helpful and supportive because both underline the effectiveness of counselling and equip us with evidence that we are criticised for not having much of, by comparison with CBT. While we argue that RCTs are not the single most effective way of evidencing effectiveness, we are hampered if we can’t say we have RCTs that show this too. Our argument is that people should have a choice of effective, evidence-based therapies and are not confined to the one therapy for which there is a greater amount of RCT evidence, and we can do that now.’

However, not every therapist has had a negative experience. BACP registered therapist Katie Rose, who has set up a Facebook group for UK therapists working for BetterHelp to share tips, says you can make it work for you: ‘Yes, clients can message you at any time of day, but you don’t need to respond at any time of day. I respond during my normal working hours. The system does pester you if you don’t respond within 24 hours but you’re not expected to respond immediately or at the weekends,’ she says. ‘Plus, you do get paid for messaging so for me, there is an incentive to respond.’ Case studies make interesting and valuable reading. Try to include the client's voice wherever possible, either through first-person accounts or by using brief, anonymised case studies to illustrate your points. See guidelines on client confidentiality below. Figures Given the scale of probable need – unsurprising, given the massively increased exposure to bereavement stressors – how do services meet it, and in a timely way? John Wilson is Director of the Bereavement Service at York St John University Counselling and Mental Health Clinic (CMHC), and an honorary research fellow of the university. He set up a Facebook group for people bereaved by COVID in the very early weeks of the pandemic. It was, he and colleagues decided, the best way to reach people who would be needing help now and, moreover, because it was online and so global, would be a resource that would be available 24 hours a day every day; given time-zone differences, someone somewhere would be there for people to talk to at any time of day or night. US family therapist, academic and writer Dr Pauline Boss is taking a different approach. Originator of the concept of ‘ambiguous loss’, after years of writing, teaching and training practitioners, she has written her latest book, The Myth of Closure, 9 for the general public (reviewed in this issue). ‘Ambiguous loss’ may be physical or psychological. Physical ambiguous loss refers to deaths where there is no verification of the death itself – no body, no death certificate, for example. It can also apply to other losses, such as a job, money, and even the ability to mourn together, as happened in the time of COVID. ‘Psychological losses are amorphous and much harder to identify and quantify,’ Boss says. ‘For example, they could be loss of trust in the world as a safe place, loss in trust that your friends are safe enough to be physically near you, loss of feeling secure about going to buy groceries, of being able to go about your daily routine, go out of your house and feel safe. It is a really long list.

Neimeyer R, Milman E, Lee SA. Apocalypse now. In: Pentaris, P (ed). Death, grief and loss in the context of COVID. Abingdon: Routledge; 2021 (pp.40–59). If you use any information obtained privately, for example in conversation, correspondence or discussion with third parties, please confirm that you have referenced all the individuals concerned and have their permission to use the material. Family members

Another highlight of this issue for me is our ‘Experience’ piece, in which Max Marnau, a BACP senior accredited counsellor, shares the dilemma of whether to ‘come out’ to clients about her late diagnosis of autism. She also questions why therapy for autists still focuses on helping them conform to a neurotypical world. W]hether they are a person living with dementia, supporting a relative or friend, or someone concerned, [the film] could be used as a staff development tool but also as a vehicle for allowing people with dementia and their families to open up about their feelings and the impact of the condition on their relationships.’ If you include material about individuals (clients, colleagues or participants in any research or study), please provide written confirmation that you have their permission to publish the material in a print and online journal and that you have anonymised all identifying details. Depending on the nature and detail of the material, we may also ask you to confirm that they've read the article. Conversations and correspondenceTimeliness of support is also important, and here too, the Bereavement During COVID study showed that people faced difficulties and long waiting times to get help, exacerbating their isolation and potentially impeding their ability to process their loss. What helps is revisiting and talking about the death, the loss, again and again – whether that is with a therapist, a volunteer supporter, or with peers. But people don’t notice psychological ambiguous loss; we know about deaths, we generally know what to say, and we have the rituals to mark those losses and give comfort to the griever. They all involve community, people offering comfort to the bereaved. With ambiguous loss, because it is unclear, it is unnoticed, which means the person is suffering alone, in isolation.’ If we ask you to provide us with any written client or other third-party consent, this should be done via one of the secure methods above. We will delete the consent from our system once we have seen them. Carolyn Mumby, who currently chairs BACP Coaching, followed a similar professional trajectory, starting out as a person-centred counsellor working with young people and progressing to train in coaching and leadership. She relates strongly to the ETHOS finding that young people aren’t always comfortable with the person-centred approach. ‘What I found is that they didn’t respond to only being told “this is your space” – they were often coming with a particular problem that they wanted to solve. Some young people do need more of a holding space where they can have that sense of relationship, but what I found when I was running a service for young people was that practitioners were beginning to engage them in a more proactive way – working with them on how to make decisions and resolve problems, giving them information and techniques that they could use to help them move forward.

Many others struggled with relationships and compulsive sex. It seemed drugs were omnipresent on the gay scene. At Attitude, I noticed a pattern of staff taking Mondays off. I found one asleep on his desk. Then the gay brother of our advertising manager, someone who worked with us for a while, who had struggled with drink and drugs, took his own life. If we receive a written complaint of plagiarism, we will raise the complaint with the author or authors. You must provide evidence that you have permission to use any written or visual material from a third party, such as extracts, pictures or diagrams. And the result is widespread anxiety and sadness. But, she stresses, ‘anxiety and sadness are normal reactions to abnormal situations – and we have had an abnormal situation for going on three years now. And the treatment for such sadness is human connection.’For me and, I am guessing, for thousands of other practitioners, reading Yalom’s books provided a beacon of hope during the early years of training, promising that, at some point, all this hard work would pay off in the creation of human connections like no other. It seems that, at the age of (almost) 90, Yalom is still creating those connections. Don’t miss our extraordinary ‘Big interview’ this issue. Taking outcome measures can help validate a client’s sense of distress – that they really do need help, which for some is important if they are to engage with therapy. Continuing to do so then provides a measure of progress, or an alert that progress has stopped. But McInnes’ own main reason for doing it originally was curiosity, he says. ‘I wanted to know how I compared with the overall effect rate. What’s my effect size? I’d be disappointed if therapists had no curiosity to know what difference they are making.’ Caltrider compares the sharing of data relating to our mental health as the equivalent of ‘putting up a sign outside your house that says, “Hey, I’m depressed, I have a drinking problem and I’m meeting with my therapist from six to seven.” We don’t put that on the outside of our house, for obvious reasons. Yet when you hand this sort of data over to a company, that becomes something they can treat as a business asset and use, share or even sell to target you online with ads.’ The root cause of these problems is trauma caused by shame. Many of us learn very early on that not conforming to gender expectations, let alone expressing our sexuality, is met with negativity, shame and sometimes even violence, from families, friends and wider society. For instance, I loved musicals and hated football – something that should not be a big deal but that attracted derision and bullying from those around me at school. When a child is told enough times that they are not OK, eventually they begin to believe and internalise it. And, of course, the stress of living in a prejudiced world as an adult can also take its toll.