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!
​



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

Subject: Suicide Awareness & Response


Dr Andrew Tresidder & Alison van Laar


​Participants of the latest TAP Saturday workshop braved a wet and cold wintry morning on the 9th  Nov 2019 to attend a training day by Dr Andrew Tresidder, and Alison van Laar entitled `Suicide Awareness and Response`. Introduced by TAP chair Helena Trump, Andrew and Alison firstly established how the group would work together throughout the day including looking after each other and confidentiality on what can be a distressing and difficult subject. Expectations of the group were examined, which included learning more about suicide running in families, fear of using the word in therapy and therapist’s responsibilities among many others.

Setting the scene with some statistics, workshop participants heard that nationally, of those taking their own life only 30% had any contact with any Mental Health Services in the 12 months before their death.  Research shows that 75% of suicides are male and the highest rate occurs in men aged between 30–59 years old although recently a rise in female rates of suicide has been recorded. In the UK it is said that 1 in 30 of us experience suicidal thoughts each year and that 1 in 10 act upon these thoughts.  Suicide is the commonest cause of death in men and women aged 20-35, significantly above the rates for road traffic accidents, murder and heart disease. 

No longer classed as a `crime` reports of suicide has seen the declining use of the verb `commit`, instead `complete` is more often used. This is in sharp contrast to England in the 13th Century where suicide was condemned as a mortal sin in the eyes of the Church and if proven the person would denied a proper burial and instead would be taken to a crossroads outside of the village in the dead of night and buried in a makeshift grave with no clergy or mourners.  It was not until 1961 that suicide was decriminalised in the UK.
 
Working in pairs or triads, workshop participants were asked to consider when they have had someone concerned about suicidal thinking come and talk to them and to reflect on how it went and any risk factors identified. It was heard that `risk` is heightened by access to means, being bereaved, alcohol abuse, living alone and isolation, financial and legal problems, criminal proceedings, divorce, being bullied and unemployment among many other influences.
 
Andrew and Alison offered the view that suicidal thinking does not lead inevitably to the actual act and that suicidal thoughts occur in response to emotional or physical pain. It’s thought that most people just want to feel better in the present time and not end their life forever. Encouragingly the most powerful medicine for people with suicidal thoughts is `Hope`.
 
Andrew Tresidder is an accomplished author and copies of his book `Health and Self-Care` were on sale to participants of the workshop. For those keen to stay `paperless`, a free download of the book can be obtained here:  www.healthandself.care

The day was punctuated with breaks for coffee, lunch and tea, which gave the group time to interact with each other, the presenters and to compare notes.  By the end of the day it was clear that the workshop had been a great success and Alison and Andrew were thanked with a warm round of applause. Those interested in future TAP workshops are encouraged to regularly visit this website to view exciting new events for 2020. Remember, all welcome.
 
Workshop write-up provided by TAP Council Member David Trott

​​
Open to the general public as well as professionals, Taunton Association of Psychotherapists (TAP) hosted another interesting talk on Friday the 15th November at the Quaker meeting House in Taunton. The talk, ‘Diversity in Practice’ was given by Berkeley Wilde, founder and director of The Diversity Trust.

Berkeley has extensive experience within the field of diversity stretching back 30 years and encompassing a variety of settings including Relate, Terrence Higgins Trust, Department of Health, an All Parliamentary Group and with the European Men's Health Forum in Brussels. Berkeley also received the Ann Wood Award for making an Outstanding Contribution to Tackling Domestic Abuse in 2016.
 
The Diversity Trust, established in 2012, provides training and consultancy across a range of services; private, public sector and social purpose, to support and promote equality and inclusion. Berkeley describes the core tenets of the trust as research and evidence-based, this includes established links with higher and further education and researcher partnerships. The trust is also ethics led, this is clearly demonstrated by their policy of ‘open access’, making large amounts of research and materials freely accessible to the general public from their website www.diversitytrust.org.uk 

Berkeley covered a huge amount of information, delivered in a relaxed and engaging way, which made a potentially challenging topic accessible to all. Not only was the historical and political context of gender and sexuality outlined, but also a critical eye was cast over the complexities and impact of language. In addition, how these and other barriers experienced by members of the LGBT+ community may prevent support seeking and inclusion and how services can make small alterations to indicate their recognition of diversity, making them a safe space.
 
Diversity and inclusion, whilst terms increasingly common, are arguably, nuanced concepts, the depths of which are not often explored. By using easy to understand models and case studies to help people visualize the concepts being discussed, interesting insights were gained by all who attended.
 
This talk also whets the appetite for TAP’s March conference ‘Exploring Gender Diversity and Bias in Therapeutic Settings’ with eminent speakers Dr Jay Stewart, MBE and Russell J. Thomas, which presents professionals and public alike the opportunity to gain a wealth of understanding about issues related to diversity, structural and unconscious bias.

Talk write-up provided by TAP Council Member - Caroline Barrett

The next TAP talk takes place on the 17th January 2020 with speaker Mark Conway on ‘Working with trauma and emotional dysregulation from a skills based perspective’.  
​All are welcome.

If you would like to attend the next talk, please register your interest on the form below or e-mail taplimited@hotmail.co.uk

Widely anticipated as an especially valuable and useful presentation for TAP members and guests, a large audience gathered on 18 October to hear Dr Jane Woodend present her talk.

​The Talk was built around Jane’s research, findings and learning for her PhD (and included theory from Freud) together with the some of the life stories she heard from interviewees. Jane’s early career included working as an Occupational Therapist and NHS Manager and following her training as a psychodynamic counsellor she then completed a post-graduate training and is now with Five Valleys Counselling in Gloucestershire where she works with individuals and couples with a wide variety of issues. Jane also has a MSc in applied Psychology. 

With the aid of slides, Jane offered the observation that endings were an inevitable part of life and can be experienced in personal relationships, family life, work and social life and of course in counselling and psychotherapy. The impact of these endings on our lives and how that plays into our endings in therapy was examined and looked at from the perspectives of both the client and the therapist. The rationale behind Jane’s work was revealed and may have surprised the audience who might have expected Jane to have experienced a raft of dreadful endings: the reality was very different.  Jane explained that within her childhood there had been no divorces, house moves or deaths and her education was comparatively local. Her upbringing had been happy and consistent and this very state of affairs had spurred her into her research.

The title of Jane’s Talk comes directly from her investigation for her PhD where the 1953 book The Long Goodbye by Raymond Chandler was studied. The book concerns the nature of attachments and the illusion of endings, cleverly presented within the genre of detective fiction.  A literature review early on in her research took Jane to Freud and she spoke about what he had to say about endings including the quote “We must first of all decide what is meant by the ambiguous phrase ‘the end of an analysis’…”.  The audience heard how Freud addressed issues of loss in his 1917 paper ‘Mourning and Melancholia’, where he defines `mourning` as the reaction to the loss of a loved one or one’s country, liberty or an ideal. So we see that Freud is writing about mourning and loss and not exactly endings.  Jane suggested that Freud inadvertently set the theory and practice for ending psychotherapeutic relationships where we see the connection between endings and death running through the psychodynamic model.

All too soon this beautifully sculptured and presented Talk came to a close and ended with a number of thought provoking questions, observations and a warm round of applause.  

Talk write-up provided by TAP Council Member - David Trott

The next TAP Talk takes place on 15 November 2019 when BERKELEY WILDE presents 'Diversity in Practice', which addresses how professionals can improve the engagement, services and support offered to Lesbian, Gay, Bisexual and Transgender people. All are welcome. 

If you would like to attend the next talk, please register your interest on the form below or e-mail taplimited@hotmail.co.uk

The talk subject: "Perspectives on Fibromyalgia"
​
On 20 September, the Taunton Association for Psychotherapy opened it’s doors after the summer break and welcomed members and guests to another of it’s legendary Talks.  In a change of speakers due to ill health, TAP Council member Caroline Barrett introduced Beth Livingston and Maddy Newson who presented Perspectives on Fibromyalgia : a fascinating and informative talk on a debilitating and often misunderstood condition.  Both speakers revealed their own struggle with Fibromyalgia while living busy and demanding lives: Beth is a psychotherapy trainee, currently in her fifth year of a six year training at the Bath Centre for Psychotherapy and Counselling, while Maddy runs a private practice in Wiltshire and is in her fifth year of training also at the Bath Centre for Psychotherapy and Counselling.

The Guest Speakers: Beth Livingston (Left) & Maddy Newson (Right)

Beth and Maddy freely admitted that they don’t have the answers to this mysterious condition; instead they work with their own experience.  Labelling themselves as `Research Queens`, they spoke of amassing a huge amount of knowledge and information in the journey to teach themselves about Fibromyalgia. It was explained that Fibromyalgia is a long-term, chronic, widespread pain condition which causes no tissue damage, can’t be seen, cannot be tested for and is not fatal, which makes diagnosis very difficult. Sufferers sometimes find medical professionals quite dismissive of their condition, which adds to an often lengthy period of diagnosis, which can run into years. It was recommended that sufferers should keep returning to their GP and restate the fact that they didn’t feel like this before. If a Fibromyalgia sufferer is referred, the first port of call will be Rheumatology and then after that Neurology. If these avenues fail then the patient’s mental health can be looked into.

The link between trauma and Fibromyalgia was examined and the audience heard that people who are depressed or have suffered physical, verbal or sexual abuse are very much more likely to develop the condition than others of the population. The range of symptoms of Fibromyalgia are enormous and include insomnia, nausea, joint and muscle pain, numbness, pins and needles, muscle knots and spasms, restless legs, sensitivity to light and noise, confusion, anxiety and depression among countless others.  These symptoms vary from day to day and from person to person. Medication used to help with these symptoms include: painkillers, antidepressants, muscle relaxants, anticonvulsants and antipsychotics. Other approaches include diet control, exercise, acupuncture, massage, CBT, Psychotherapy, relaxation techniques, CPD oil and supplements.

The NHS estimates that 2-4.5% of the UK’s population, which equates to almost 3 million people; suffer from Fibromyalgia, of which 75%-90% are women.  The speakers suggested that with this significant figure it is highly likely that therapists will encounter a client with the condition at some point and so it’s useful to have a basic knowledge of it. This would enable the therapist to make the necessary adjustments to the therapy room, such as lighting, chairs etc. 
Finishing on an alternative view of the causes of Fibromyalgia, Beth and Maddy explored the possibility that sufferers might find that the symptoms actually serve them in some way. Do they protect them? Do they form a barrier? Has the body found a way of putting something in place to help them keep a distance from people and help them hide? Not wanting to imply that it’s something that the sufferer has made up, it was offered that counselling might uncover some unconscious aspect to the condition.

At the meeting TAP Council member Robin Pfaff gave the vote of thanks and discussion around this intriguing and enlightening presentation continued over hot beverages and the now celebrated biscuits.

The next TAP Talk takes place on 18th October 2019 when Dr Jane Woodend presents The Long Goodbye (A psycho-social investigation of endings in life and therapy).

All are most welcome - to book your place complete the form here: (www.taplimited.org.uk/talks.html)

Talk notes by David Trott - Council member

A warm summer’s evening on 21 June welcomed Rachel Freeth back to TAP, to present her Talk 
entitled "Psychiatric Diagnosis - What might this mean for your client and you?" Rachel is a 
psychiatrist, counsellor and author and works in General Adult Psychiatry in Herefordshire.  
Having trained as a Person Centred counsellor in the late 1990’s, she now ​straddles the world 
of Psychiatry and counselling. 

rAnother assumption is that a diagnosis is the ​duty of a doctor​and that it is made through 
assessment and examination of the person using a formal medical process that focuses on the
symptoms and signs of the patient. 

Posing the question; What is a diagnosis?  Rachel explained that the name of a physical illness 
gives information about the condition, whereas in a psychiatric diagnosis that information 
is not provided.  Therefore the psychiatric diagnosis is not based on knowing what and where the underlying mental disturbance is.  It was surprising for many of the audience to learn that after 
decades of research we still only have a range of theories on the causes of mental distress and 
disturbance, we do not have any conclusive scientific evidence on it’s origins. 

Rachel moved on to Psychiatric classification and the audience heard how the American 
Psychiatric Association publishes The Diagnostic and Statistical Manual of Mental Disorders 
(DSM), which is used by clinicians and psychiatrists to diagnose psychiatric illnesses.  
Another clarification is the International Classification of Diseases (ICD) which is published by 
the World Health Organization and is currently in it’s 10th edition.  The ICD 11 has now been
published although it is not due to come into full effect until 2022.  Importantly, in a world of 
7.4 billion people speaking nearly 7000 different languages, the ICD provides a common 
vocabulary for recording and monitoring health issues. 

How the diagnosis affects our attitude towards the person given the diagnosis was discussed 
and how the diagnosis affects how that person sees themselves.  It was suggested that there is a possibility that the patient will be influenced by the `label` assigned to them and consequently 
adopt that role.

Following the vote of thanks, the discussion continued over tea and coffee and the now 
legendary biscuits, where it became apparent that many of the audience would take away 
something useful to integrate into their own work.  

The next TAP Talk takes place on September 20 after the summer break, when Lizzy Oakley 
presents: "Fibromyalgia – Journey to acceptance".  All are most welcome. 

​Article by David Trott - TAP Council member.

If you would like any information about the benefits of being a TAP member, follow this link: www.taplimited.org.uk/join-tap.html