It's a pleasure to introduce our new talk by Rachel Freeth - 'Who are mental health services for? A Psychiatrist’s perspective', which explores the current context of mental health services and some of the implications of this.  We have used Facebook to host the video but don't worry, you don't have to be signed up to Facebook to see it on the platform!

Facebook: https://www.facebook.com/TAPLimited

If this talk has peaked your interest, Rachel's book - 'Psychiatry and mental health, a guide for counsellors and psychotherapists', is currently available at an introductory price on PCCS Books website by clicking here:

Psychiatry and Mental Health: a guide for counsellors and psychotherapists

or join her at her next Online Conference here

It’s October 2020 and the Covid-19 pandemic continues to devastate families across the world. Here in the UK most shops and facilities have reopened but we are witnessing an increase in cases again. However we now see people in conversation on the street, seemingly more relaxed about meeting others but still mainly social distancing.   
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From my own experience one of the first question asked on meeting someone is `How are you?` This might be genuine concern for the other’s well being or a testing of the water as to whether it’s safe to converse with this individual or should we leap five paces back and put on our space helmet.

How are you? Is a question that is used by millions of people every day since King Arthur enquired about Guinevere’s headache?  However it’s often asked in a superficial, shallow way just as a means of breaking the ice in a conversation. In the counselling world it’s a genuine and meaningful question that provides an insight to the client’s world but often the reply is guarded, stilted and vague.  Here are some examples of how we might reply to `How are you?` and what actually might be being said.  

`I’m ok`
If you had just had a meal at a restaurant or pub and someone asked how you enjoyed it and you said it was `ok` what would that say about the meal?  `I’m ok` often shuts down further enquiries.
 
`I’m alright`
You have just had your living room decorated and your friend asks if you are pleased with the result, to which you say `it’s alright`.  `I’m alright can also shut down further dialog on the subject of `you`.
 
`I’m fine`
Short sharp response to a question about your wellbeing. Discourages any further discussion about how you are. Can be used to cover up one’s real feelings.  FINE is a well known light hearted acronym in the counselling world, often seen as - Feeling Insecure, Neurotic and Excitable or similar. 
 
`Not bad`
Apples sometimes go` bad` so you’re saying that you’re not mouldering like overripe fruit.  Some honesty here.
 
`Pretty good` 
Crossing the Irish Sea can cause seasickness when it’s rough.  Other times it can be `pretty good` but still a little choppy.  `Pretty Good` is better than it could be but not as good as one may like it to be.
 
`I’ve been better`
There’s honesty here and invites the listener to enquire further as to what might be wrong.
 
`Rubbing along` or `I’m hanging in there`
This answer once again reveals that the speaker is having a rough time and invites the listener to ask for clarification.   
 
`I’m not good`. `I feel awful.` `Things are terrible`. `I’m so miserable`. `I’m really sad`.
Real honesty and openness. Saying how it really is.  Encourages the listener to enquire more.
 
Fishermen are hardy souls, sitting by lakes and canals for hours on end, seemingly impervious to our sometimes inclement weather. However, have you noticed how often you see fishermen wearing sunglasses even on dull and overcast days?  No? Well they do. And this is not some vain attempt to look like Tom Cruise in Topgun but a calculated use of technology to outwit those shrewd and cunning fish. For those sunglasses are polarised which allows the wearer to see below the surface of the water to those crafty creatures below. 
 
As therapists we do this all the time, deciphering what lies below the surface of our clients, only we don’t need to wear sunglasses or have polarised ears to do it, we just do it.  So next time we hear someone on the street asking another how they are, loiter slightly and hear what they say. Are they ok, alright, fine or something else? Are they guarded or open? Vague or specific? It’s an interesting exercise.

© 2020 David Trott – TAP Council Member

Beth Livingston presented a popular talk at TAP 'Perspectives on Fibromyalgia' alongside Maddy Newson in 2019. The landscape of Counselling and Psychotherapy has been through an upheaval since then, prompting questions for many about how we practice within current and potentially ongoing restrictions. For some therapists this may have led them to consider the option of working outside. As such this timely talk from Beth examines Ecotherapy and the act of moving psychotherapy outside. Beth is relatively new to Ecotherapy and does not present herself as an expert but, as someone who has started down this path, is able to bring insight from her experiences and learning. 

Whilst this format of talk prevents the usual Q&A and networking we all associate with a TAP talk, Beth has invited anyone with further questions to contact her directly by email: beth@bethlivingston.co.uk .

Further details about Beth and the therapy she offers, are available from her website http://www.bethlivingston.co.uk/

Finally on behalf of it's members, TAP would like to thank Beth for her generosity in providing this talk.

Without further ado and a virtual round of applause we are pleased to present;

​Beth Livingston - Ecotherapy and the act of moving psychotherapy outside.
Click on this link to view the presentation;

youtu.be/tI0OpAOM4L0

Sometimes I feel that we are being snowed under an avalanche of initials and acronyms in our lives. For example we might intend to drive our SUV to the GP but the ABS has gone AWOL so we send an SOS to the AA or RAC because it’s not a DIY job. They come ASAP after helping at a RTA where a BMW and VW were clipped by a classic MGB GT. Back on the road again we follow a cheerful yellow JCB pulling a trailer with a heavy RSJ on it. We make it to the GP but they send us to A&E where we show our ID and give our DOB. In return we’re given a sheet of FAQs and an ECG. All is well so we’re LOL and go for some R&R and a G&T.

​It’s really no different for us as practitioners with our own collection of initials and acronyms including ADHD, BACP, CBT, DNA, WHO, NICE, PTSD and of course TAP. However there’s one set of initials that can enliven us just by its very sound: CPD.  As we know `Continued Professional Development` is an ethical requirement for most of us and comes in all shapes and sizes. The BACP is generous in it’s definition and explains CPD as; "Any learning experience that can be used for the systematic maintenance, improvement and broadening of competence, knowledge and skills to ensure that the practitioner has the capacity to practise safely, effectively and legally within their evolving scope of practice. It may include both personal and professional development."
 
So, the scope, range and possibilities of CPD are virtually endless but do we see these infinite opportunities as such or have we fixed ideas on the subject which influence what we may or may not try?
 
Here at TAP Towers the committee is pacing up and down the long corridors wondering how best now to provide a little of what it’s members have come to expect: quality Talks and Workshops which historically has fulfilled much of it’s participants requirement for CPD at a reasonable cost. The dilemma of course is caused by the Covid-19 pandemic which has changed the way we live our lives and the way we do things.
 
It seems likely now that any Course, Workshop or Training Programme will be delivered by an online communication tool such as Skype or Zoom for the foreseeable future because of the restrictions around the pandemic. But how do we relate to these new ways of learning as opposed to in the flesh, face to face interactions? I guess we are all fairly use to seeing commentators on the TV reporting on some event or another from their own home (usually in front of a huge bookcase filled with hugely intellectual tomes). Often the quality is good but sometimes they disappear in pixelated chaos or take on the voice of a Dalek. The positioning of the laptop camera is vital here, so that we do not focus solely on the commentator’s nasal hair.
 
The concept of Distance Leaning of course is not a new one as anyone who has studied with the Open University will confirm. The OU was set up in 1969 by the Labour Government of the time under Prime Minister Harold Wilson and has been a great success. However Distance Leaning goes back a lot further to 1728 when Caleb Phillips advertised his new method of learning Short Hand through weekly mailed lessons.
 
Many of us will keep a record of the books that we read related to our work as proof of our learning. This can also be applied to informative TV programmes such as Panorama when topics such mental health are explored and possibly some movies with an educational element to them, Analyze This (1999) Analyze That (2002) and Anger Management (2003) contain some useful thought provoking snippets. The relationship between Freud and Jung is examined in A Dangerous Method (2011) and is an excellent way to spend 99 minutes. We can also organize our own field trips to places such as the Freud Museum in London or Anne Frank’s House in Amsterdam now both open for a timed visit.
 
For myself I went to Aberfan in South Wales three years ago to visit the site of Pantglas Junior School.  As many will remember, this is where on the 21st October 1966 a spoil tip belonging to the local colliery collapsed after heavy rain sending thousands of tons of black mud and slurry onto the school and nearby houses killing 116 children and 28 adults.  The aim of the visit was not some macabre curiosity but an investigation into the amount of residue trauma remaining in the village after all these years.  My learning from this trip was immense, partly because I was able to interview ten people, one of which was pulled from the wreckage on that dreadful day.  So with the aid of the photos that I took and the interviews I was able to put together a substantial description of Aberfan and the thoughts of it’s people in the present day.
 
Our professional development is just that `our` development and will be different from our colleague’s development because of who we are. Naturally this will be influenced by our upbringing, ethnicity, values, interests, finances, hobbies, sexual orientation and a whole raft of other variables. With this in mind it’s likely that there will be an overlap of our professional self and our personal self. The artistic, musical, practical, extroverted, outdoorsy, sporty, theatrical, reserved, petrol headed, peace loving, bookish, family minded and spiritual among us can pursue personal growth and in many cases address our professional development simultaneously. For example take the amateur artist critiquing her latest work.  What does it represent? What lies beneath? Why paint it now? Why those colours? What is left out and why? The work here could be quite valuable.
 
So we have established that CPD can be found almost anywhere from books, films, TV programs, museums and visits to motivating places all the way to this blog that you are reading right now and not just the Talks, Workshops and Training Programs that we all attended in person before the Lockdown. The only real limits to CPD are the ones that we impose on ourselves.
 
© 2020 David Trott - TAP Council Member

It’s July 2020 and the UK is slowly starting to emerge from the lockdown caused by the Covid-19 pandemic which has changed the way we all live our lives and which has brought suffering and misery to thousands. With the virus still out there in the community, people still becoming ill and many continuing to die every day from it, the powers that be deem it all right for certain businesses and services in England to open up and resume trading albeit in a careful and restricted way.

​Among those itching to restart will be Face to Face Counsellors, Psychotherapists and many other types of practitioners who have been unable to work over the last few months. Those of us who already delivered therapy through other mediums like Skype, Zoom or even the humble telephone, were able to continue with client sessions while the remainder had the choice to move across into the new electronic world or just not practice at all.

So what are the implications of returning to face to face client sessions and what thoughts and feelings are going to be thrown up?

Firstly let’s look at the practicalities of resuming sessions and the measures that we can put in place to help client and therapist stay safe. To kick off here’s a few ideas I’ve had for my own counselling room: 

• Complete honesty by the counsellor and client as to whether either is ill or has been ill recently and a promise to cancel the session if this is so.   
• Copious amounts of hand sanitizer available on entry and exiting of the therapy room
• Hot water, soap, paper towels and hand sanitizer available in the client loo.
• Client and counsellor to stay at 1metre plus apart throughout the session.
• No shaking of hands at beginning or end
• Water glasses replaced by disposable plastic cups.
• At least an hour between clients for wiping down of chairs and surfaces and a change of air.
• Many of the counselling aids and ornaments put away to aid easier cleaning. 
• New room layout has a coffee table between the client and counsellor‘s chairs to create distance. (Barriers like this have always been discouraged)
• Weather permitting; windows will be opened to allow fresh air to enter.
• Payment: If the client pays by cash or cheque they will place it in a small plastic basket located near to the client and not handed directly to the counsellor. Having the correct money will help this.

So the practical side of resuming face to face work is relatively straight forward to put together and maintain, but what of the psychological aspect of it? 

As we all know in counselling a key skill is active listening and this means really hearing what the client is saying, not just the words but the tone, inflections, the silences, the little nuances and of course body language. It’s hard work and to keep focused during the whole of the counselling hour can sometimes be a challenge. Most of us in our training will have worked with `blocks to communication` and high on the list of these is `distraction`. This can be the man outside with the pneumatic drill, the circling helicopter, the need to go to the loo, or illness among countless others. But we have a duty of care to our clients and the BACP code of ethics requires it’s members to put the wellbeing of their clients first by:‘making clients our primary concern while we are working with them.` The code also requires that members look after themselves and ensure `that our wellbeing is sufficient to sustain the quality of the work`. So there can be a balancing act going on between the client and therapist. 

But we are all in unchartered territory with this pandemic which has killed thousands in the UK alone and it would be unusual not to have concerns about it. As therapists we usually strive for transparency and genuineness in our work with clients but how will this authenticity be affected or compromised if we have worries and concerns about the health of our clients? Furthermore will our underlying anxiety collide head on with any unease that our clients have for being there with us? Honesty and self disclosure will play a big part here. If we discover our client has fears and worries about coming back to face to face therapy and we have similar thoughts then share those concerns, after all you are both on this journey together.

No one has the definitive answer to how best to go back to face to face therapy – it’s just theories and guesswork with rules and advice changing almost daily. It’s likely that this will be one of those occasions when we must go with our instincts and examine the evidence. How well do we know our client? Is it likely they are being completely honest with us over their health? Are we confident that the measures that we have put in place to reduce the risk are adequate?  We then need to balance all this with the evidence: How does the South West compare to other areas of the UK regarding the number of cases of Covid-19. What is the current `R` number for the region? Is this number rising or falling?  While juggling all these ideas, facts and figures we still have to consider asymptomatic transmission where an infected person, who has not yet developed symptoms, is still able to transmit the virus. So in essence we have to make a judgement based on a whole raft of variables, many of which are out of our control. However, despite the bizarre old saying `ignorance is bliss`  gen up on the virus and how it’s spread by visiting a reliable website like https://www.nhs.uk/conditions/coronavirus-covid-19/  and use facts and evidence in making your decision.

David Trott © 2020 Council Member of Taunton Association for Psychotherapy (TAP)

Find out more about BACP and their work on the website. Their Guidance and Resources regarding Coronavirus  for members can be viewed here; www.bacp.co.uk/news/news-from-bacp/coronavirus/

Unfortunately, the original scheduled speaker for the evening (Mark Conway) was unable to attend the event. The evening was well attended and required extra seating, so luckily for us, TAP Council member Caroline Barrett
stepped into the breach and heroically presented `Physical Wellbeing & Mental Health` with just twenty minutes notice!
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In a presentation that actively encouraged audience participation in a workshop style, Caroline firstly asked `What aspects of your physical wellbeing do you maintain, to support your mental health?   Together with - Are we being negligent if we do not reference our client’s physical wellbeing and how it affects their mental health?  Given a few minutes to work with people next to them, attendees soon shared interesting aspects of their own work and experiences around self care.  The issue of clients actively perpetuating their problems such as anxiety by their own life style was addressed and further posed the question of therapists working with this in their sessions.  An example might be the client staying up late playing computer games and not getting enough sleep or perhaps partaking of alcohol in the mornings. The audience was asked to reflect on how most therapists won’t gain any formal education in nutrition during their training and so their areas of expertise could be rather homespun.

With the aid of slides, Caroline offered more questions for the audience to work with including:   `Are we working from a place of knowledge privilege` and `How did questions about your personal health choices and your practice make you feel?  Do you think you could be asked about this topic in a way which doesn’t provoke an emotional response?`  With no shortage of input from attendees the evening moved swiftly along and Caroline was thanked profusely for rescuing the evening in the vote of thanks.

However, the debate continued over hot beverages and biscuits, when in a conversation with TAP blog writer David Trott, Caroline explained a little about the rationale behind her presentation. `I think the key point I was trying to get across is that whilst therapists are aware of the impact of physical health on mental health, using it a lot in our own self-care practice, there is a lot of chat about promoting wellbeing by our professional bodies and theoretically there is a lot of research to say that improving physical health improves mental health but we are not trained in it and lack theoretical models in most common counselling disciplines therefore it is important we take opportunities to reflect on where it sits within our client work.`

The next TAP Talk takes place on Friday 21st February 2020, when Claire Plews presents 'Resilience in Therapy', which once again promises to be an informative and valuable Talk.  

All are welcome. 

Talk write- up provided by TAP Council member David Trott