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Volume 17 Number 4 November 2002

The Journal of The British Psychological SocietyDivision of Counselling Psychology

CounsellingPsychology

Review

Counselling Psychology Review

Editor: Alan Bellamy Pembrokeshire and Derwen NHS Trust

Reference Library Editorand Consulting Editor: Waseem Alladin Hull University, Centre for Couple, Marital & Sex Therapy and

Hull & East Riding Health NHS Trust

Consulting Editors: Malcolm C. Cross City UniversityRuth Jordan Surrey UniversityMartin Milton Surrey UniversityStephen Palmer Centre for Stress Management and City UniversityLinda Papadopoulos London Guildhall UniversityJohn Rowan The Minster CentreMary Watts City University

Editorial Advisory Board: Alan Frankland APSI NottinghamHeather Sequeira St. George’s Medical SchoolSheelagh Strawbridge Independent Practitioner and Kairos Counselling and

Training Services, Hessle, East Yorkshire

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CopyrightCopyright for published material rests with the Division of Counselling Psychology and The British Psychological Societyunless otherwise stated. With agreement, an author will be allowed to republish an article elsewhere as long as a note isincluded stating: first published in Counselling Psychology Review, vol no. and date. Counselling psychologists and teachers ofpsychology may use material contained in this publication in any way that may help their teaching of counselling psychology.Permission should be obtained from the Society for any other use.

Counselling Psychology Review, Vol. 17, No. 4, November 2002

The British Psychological Society

Counselling Psychology ReviewVolume 17 ● Number 4 ● November 2002

Editorial 2Alan Bellamy

The three approaches to a therapeutic relationship: 3instrumental, authentic, transpersonalJohn Rowan

Accessing needs for psychological therapies in the context 11of the National Service Framework for Mental HealthRob Leiper

‘McDonaldisation’ or ‘Fast-food therapy’ 20Sheelagh Strawbridge

Book Reviews 27

Newsletter SectionLetter from the Chair 30Minutes of Division Annual General Meeting 31Divisional Committee 2002/2003 34Statement of Interest for Committees 37The National Assessors List 38Correspondence 39Conference Diary 40An introduction to The Register of Psychologists Specialising in 42Psychotherapy – principles and proceduresTalking Point: Freud, Psychology and Psychotherapy 45Ray Woolfe

Index to Volume 17 46

I would like to begin by thanking my prede-cessor as editor, Kasia Szymanska, for all herhard work over the past five years and forhanding on to me a journal that has an estab-lished place in the community of CounsellingPsychologists. I hope to maintain and ifpossible strengthen the position of CounsellingPsychology Review, by publishing high qualitypapers on qualitative and quantitativeresearch, psychological and philosophicalreflections on theory and practice, and casediscussions.

In this Counselling Psychology Review webegin with a paper by John Rowan in which heexplores the use of self in therapy and suggeststhree broad categories with which to describethe place of the self in the therapeuticexperience. This is followed by a paperdescribing the assessment of the needs forpsychological therapies within the localitiesserved by a specialist mental health NHS Trust,by Rob Leiper. The methodology and resultsare discussed in relation to their generalis-ability to other services and to the standards setout in the National Service Framework forMental Health for England. Then SheelaghStrawbridge draws these two themes togetherand returns the focus to the quality of thetherapeutic relationship in a paper in whichshe positions the current tendency to empha-sise technical expertise and packagedtreatments in the context of wider social-histor-ical processes, using in particular Weber’s

concept of ‘rationalisation’. How canCounselling Psychologists, she asks, resist‘McDonaldisation’ as we are drawn furtherinto the mainstream therapeutic services avail-able to the majority of clients. Versions of JohnRowan’s and Sheelagh Strawbridge’s paperswere presented at the Division’s 2002Conference in Torquay.

The academic papers are followed by a newsection, called the Newsletter Section. Thiscontains news of events and discussions fromwithin the Division and its various committees,groups and working parties, and more widelyfrom within the Society. It is hoped that thecontents of this section will be of interest bothto experienced practitioners and to studentsand trainees, and will help both groups to feelbetter informed about current activities andissues. The section ends with a new regularcolumn, entitled ‘Talking Point’, in whichinvited writers will be expressing their viewson a range of topical and sometimes controver-sial issues. As Counselling Psychologyexpands in number of practitioners andtrainees, in spheres of influence (for example inthe Health Service), and in geographicalactivity (for example in the devolved adminis-trations of Scotland and Wales),communication can become problematic. TheNewsletter Section, in conjunction with theDivision’s website (www.counsellingpsychology.org.uk), is intended to help in thisregard.

2 Counselling Psychology Review, Vol. 17, No. 4, November 2002

EditorialAlan Bellamy

Counselling Psychology Review, Vol. 17, No. 4, November 2002 3

I worked last year with Michael Jacobs on abook entitled The Therapist’s Use of Self, whichwill be coming out from the Open UniversityPress this Autumn. At first we thought interms of looking at various aspects of thisquestion from the points of view of variousschools of therapy. But as we started workingon the actual content, a strange phenomenontook place. We started to think in terms of theself. And it then appeared as though this wasa new way of looking at the question, whichwould avoid the dangers of taking schoolismfor granted. As Petruska Clarkson (2002) hasbeen saying for some time now, schoolism isnot something to be taken for granted, butrather to be questioned quite forcefully. Inrecent years I have been applying the ideas ofKen Wilber (2000) to the study of therapy (theterm I use to cover psychotherapy, coun-selling psychology, counselling and personalgrowth) and found him a very interestingguide. However, the ideas I shall outline heredo not come from him, but from my ownwork in the field.

It seems to me that we can think in termsof three broad definitions of the self, corre-sponding to three of Wilber’s waystations inthe process of psychospiritual development. I call these the instrumental, the authentic andthe transpersonal.

To the instrumental self, the client isusually regarded as someone who hasproblems, which need to be put right (either

by the client, or by the therapist, or by both),and this can lead to the therapist acting in asomewhat programmed way. Technical abilityis regarded as something both possible anddesirable. In Rational Emotive BehaviourTherapy, in Neuro-Linguistic Programming,in solution-based therapy, in many cognitive-behavioural approaches this is the preferredmode; and the treatment approaches in vogueunder Managed Care and EmployeeAssistance Programmes often take a similarview. There are specific techniques whichhave to be learned and put into practice intime-limited work, for example, which nearlyalways include identification of a clear focus,or problem. The client or patient is there to becured, and application of the correct tech-niques aims to achieve this in a highpercentage of cases. More and better tech-niques are the way forward, and to test theseobjectively is the main goal of research.Working with the unconscious can be just asmuch part of this approach as not workingwith the unconscious. It is equally possiblehere for the relationship to be long or short,close or distant, self-disclosing or anonymous,using transference or not, involving body-work or not, political or not, analytic orhumanistic, cognitive or emotive, or other-wise. The key thing is that there should be anaim. Every form of therapy resorts to this levelof working at times, and the famed WorkingAlliance is firmly based on it, but it is basically

The three approachesto a therapeuticrelationship:instrumental,authentic,transpersonalJohn Rowan, London

an I-It relationship rather than an I-Thou rela-tionship, in the terms made famous by MartinBuber (1970). It is concerned with treating theclient or patient. Key words here are ‘contract’,‘assessment’, ‘treatment goals’, ‘empiricallysupported treatments’, ‘boundaries’, ‘manuali-sation’, ‘questionnaires’, and so forth. I wouldargue that every therapist works in this waymuch of the time, and it is certainly somethingmainstream rather than a sideline.

To the authentic self, personal involvementis much more acceptable, with the therapistmuch more closely identified with the client,and more openly concerned to explore thetherapeutic relationship. The idea of thewounded healer is often mentioned, and so isthe idea of personal growth. The schools whomost traditionally and obviously favour thisapproach are the humanistic ones: person-centred, gestalt, psychodrama, bodywork,focussing, experiential, existential, etc. Yetthere is also considerable evidence that underdifferent names this same type of relationshipis very important to many psychoanalytic ther-apists, and even more, perhaps, to Jungiansand post-Jungians too. Clarkson (1995) calls itthe person-to-person relationship. Again it ispossible to work in this way whether onebelieves in the unconscious or not. Accordingto my own theoretical position, to work in thisway it is essential to have had some experienceof what Wilber (2000) calls the Centaur level of psychospiritual development, or what JennyWade (1996) calls authentic consciousness:again the analytic model may express it quitedifferently, but concepts of countertransferencein more recent usage are significant here, anddepend upon the openness of the therapist tosuch intuitive information. It is concerned withmeeting the client or patient as a person. Keywords here are ‘authenticity’, ‘personhood’,‘healing through meeting’, ‘being in the world’,‘intimacy’, ‘openness’ ‘the real relationship’,etc. I don’t know how many therapists work inthis way, but it seems that most of the peoplewho theorise about therapy have at least somefamiliarity with it.

For the transpersonal self, the boundariesbetween therapist and client may fall away.Both may occupy the same space at the sametime, at the level of what is sometimes termed

soul, sometimes heart, and sometimes essence:what they have in common is a willingness tolet go of all aims and all assumptions. Clarkson(1995) is clear that this is one of the five impor-tant relationships which have to beacknowledged in therapy. What she does notmake clear, however, is that to adopt this wayof working it is essential to have had someexperience of what Wilber (2000) calls theSubtle level of psychospiritual development, orwhat Buddhists call the Sambhogakaya. Againhere it is necessary to look for parallels outsidethe discourse of transpersonal or spiritual ther-apies, as for example in the analyst Bion’s ‘O’(1965). This is concerned with linking with theclient or patient. Key words here are ‘inter-being’, ‘transcendental empathy’, ‘resonance’,‘dual unity’, ‘communion’, ‘the four-dimen-sional state’, etc. It is the least well known ofthe three positions we have identified.

Each of these positions is based on a gooddeal of evidence, and it will be helpful perhapsto outline some of this evidence, to make it clearthat these three positions are not plucked out ofthe air or described in an arbitrary way.

The instrumental self is described byMaslow (1987) as the motivational positionwhere people need the esteem of other people.It is described by Kohlberg (1981) and his co-worker Gilligan (1982) as the conventionalmoral level, and by Loevinger (1976) in herwork on women and girls as the conformistlevel of ego development. Jenny Wade (1996)sees it as the (mainly masculine) achievementlevel and as the (mainly feminine) affiliativelevel of personal development. Belenky andher co-workers (1986) call it the level of proce-dural knowing; and Wilber (2000) describes itas the Mental Ego level of psychospiritualdevelopment. All these investigators are, ofcourse, using a stage model of development, asdo other well-known names such as Piaget(1950) and Erikson (1965). Such well-researched models have been found veryuseful in education, management training andsocial science generally.

The authentic self is described by thesesame authors as self-actualisation (Maslow),post-conventional moral positions (Kohlberg),true personal conscience (Gilligan),autonomous and integrated ego development


(Loevinger), authentic consciousness (Wade),constructed knowing (Belenky) and theCentaur stage (Wilber). So again there is a massof research supporting the importance of sucha level of development. There is also a richvariety of philosophical thinking which illumi-nates our knowledge of this level. Heidegger(1962) makes the distinction between authenticand inauthentic, which has been so influentialhere. Sartre (1948) has been even more pointedin his insistence that authenticity is very specialand has to be taken seriously in its existentialimplications. The person who has done most,perhaps, to naturalise the notion of authen-ticity into the realm of therapy is JamesBugental (1981), although Binswanger (1963)and Rollo May (1980) also made importantcontributions. This way of being is within therange of experience open to all of us.

The transpersonal self is less familiar thanthe other two possibilities, and many of thewriters mentioned do not go this far; but anincreasing number of therapists find it neces-sary. From the vantage point of what Wilbercalls the Subtle, it becomes clear that theauthentic way is limited by having strictboundaries. At the Subtle level, talk aboutboundaries becomes much more problematic.Wilber’s own book on therapy (1981) is entitledNo Boundary, and this is clearly quite central tothe thinking at this stage. Stanislav Grof haswritten a series of important books in this field(e.g. 1988); and two books that link therapywith the transpersonal are by Brant Cortright(1996) and William West (2000). A number ofpost-Jungians have made important contribu-tions to the area, such as James Hillman (1996)and Nathan Schwartz-Salant (1984, 1991).Seymour Boorstein has edited a book of read-ings on transpersonal psychotherapy (2nd ed.,1996). The Journal of Transpersonal Psychology,The International Journal of Transpersonal Studies,and in Britain the Transpersonal PsychologyReview, published by The British PsychologicalSociety are useful sources. One of the bestbooks in this area is the one on transculturalcounselling and spirituality by MaryFukuyama and Todd Sevig (1999), which spellsout in some detail how spirituality may inte-grate with therapy when working with clientsfrom other cultures. Other interesting books in

this area are David Brazier’s Zen Therapy (2001)and Mark Epstein’s Thoughts Without a Thinker(1996). The title of the latter, a phrase of Bion’s(1992: 326), shows another example of wherepsychoanalysis too, once thought to beformalised and rigid in its thinking andpractice, also has a voice or two reflecting onthis position. So we can say that for all three ofthese ways of seeing the self, there is a gooddeal of research to support it and show itsvalue and importance. Let’s now look at oneway of applying this thinking, by consideringthe importance of empathy at all three levels.

Tobin Hart (1999) has distinguished threephases of empathy, which develop in line withthe range and differentiation of a person’sfeeling capacity. The first phase is shown incolumn 1 of Table 1, which might be described(as do Mahrer et al., 1994) as ‘externalempathy’, where the therapist recognises whatthe client is experiencing but remains outsidethe experience of the other. This is in line withRogers’ description of empathy as ‘as if’,where to lose such a state is to become over-identified with the other. Hart (1999) refersboth to the self psychologist Heinz Kohut andthe object relations psychoanalyst HarryGuntrip in this context: Kohut suggests thatempathy is a type of ‘vicarious introspection’in which we ‘think and feel [ourselves] into theinner life of another person’ (1984, p.82).Guntrip similarly writes that ‘our under-standing is an inference based on ourknowledge of ourselves’ (1968, pp.370–371). AsHart (1999) puts it, ‘I know the other throughcomparing what I understand of their experi-ences to memories of my own experiences, alogical inference and extrapolation’. I suggest that this is ‘Column 1 empathy’, andbelongs with other technical abilities. This isthe kind of empathy that can be taught ontraining courses as a skill. It can be measuredon scales of empathy, as for example the onedeveloped by Robert Carkhuff (1969). It isrelatively ‘safe’, in the sense that the therapistis not going to be pulled in too deep. The therapist is defended against undueemotional involvement or pain. It couldperhaps be described as ‘limited liability’empathy. An example, taken from an approvedsession in a published journal, is this:

5Counselling Psychology Review, Vol. 17, No. 4, November 2002

Client: Feeling stubborn and gruff causesme to get isolated in a way…I mean, I’m alone then. It makes me break up myrelationships.Therapist: Hmhm. There’s somehow a tendency to break up relationships.Client: Yes…

The second level of empathyLet us now move on to a consideration of whatmight be called ‘Column 2 empathy’, which issometimes called ‘deep empathy’. Hartdescribes this briefly as follows: ‘In deepempathy a line is crossed toward a more directknowing of the other that is enabled by a post-conventional epistemic process. The activity ofknowing moves toward subject-object tran-scendence or a loosening of self/otherboundaries’ (Hart, 1999, pp.115–116). This leveldoes not exclude the first level of empathydescribed above, but it describes a morerefined quality: knowing the client moredirectly, the capacity to be as it were ‘in theirshoes’, of seeing through their eyes, but at thesame time retaining one’s own identity. Anauthentic meeting. As Alvin Mahrer puts it –‘The therapist senses what it is like to be wherethe person is, yet always maintains [his or her]own individuality’ (Mahrer et al., 1994, p.189).This quality of being able to pass to and fro

between the client’s experience and one’s ownis mentioned by a number of writers: MartinBuber speaks of ‘a bold swinging, demandingthe most intense stirring of one’s being into thelife of the other’ (Buber, 1988, p.71); WilliamHeard speaks about ‘imagining what the clientis wishing, feeling, and perceiving so vividlyand concretely that you experience the exis-tence of the client as your own while remainingin your own existence’ (Heard, 1995, p.251).Hart observes that the potential always exists‘for distortion and the basic confusionregarding ‘what is mine and what is theirs’ . . .and it is necessary to constantly ‘check out’material with the client and ‘check in’ withoneself’ (Hart, 1999, pp.116–117).

This level of empathy is given differentnames: deep empathy, embodied countertrans-ference, and projective identification. Someanalysts (e.g. the Jungian Kenneth Lambert)identify empathy with concordant counter-transference. In all the relationships describedabove, there is a clear difference between thetherapist and the client or patient. It is a kind ofmeeting, no matter how intimate the meetingmay be. It is not until we get into the transper-sonal type of relationship, described below,that the idea of meeting gives way to the ideaof merging.


Category Column 1 empathy Column 2 empathy Column 3 empathy

Self (Rowan) Mental Ego Real Self Soul

Self (Wilber) Persona/Shadow Centaur Psychic/Subtle

Type of boundary Tight Loose Let go

The self is … Defended Vulnerable Open to other

Therapist ‘label’ Expert at empathy Wounded Healer Alter EgoSoul mate

Aim of therapy Helping client Liberation Communion

Slogan ‘I am with you’ ‘I am open to you’ ‘I am you’

Analytic Yes Perhaps Perhaps

Humanistic Yes Yes Perhaps

Jungian No Yes Yes

Cognitive-Behavioural Yes No No

Family Yes Yes No

Transpersonal Perhaps Yes Yes

Table 1. Types of empathy

Buber is an eloquent and persuasive propo-nent of Dialogic Existentialism (Friedman,1976), and has inspired others, notably GaryYontef, who identifies five characteristics thatmark the dialogic relationship: (1) Inclusion (2)Presence (3) Commitment to dialogue (4) Noexploitation and that (5) Dialogue is lived(Yontef, 1993, pp.221–237). One of the moststriking exponents of this view is RichardHycner, who says that ultimately we have toadmit that we are wounded and incomplete,and to use that very knowledge in the work.‘The therapist must incessantly struggle tobring his woundedness into play in thetherapy…In fact, it is this struggling thatdevelops the self of the therapist. This strug-gling is so central because ultimately thetherapist’s self is the instrument which will beused in therapy’ (Hycner, 1993, p.15). This isperhaps one of the central insights of thissecond level.

Tobin Hart observes that ‘in empathicinclusion it is quite natural to experience theunconditional positive regard, even love, thatRogers advocated so strongly’ (1999, p.117).Hart compares this to the awakening of naturalcompassion (Dass & Gorman, 1996) or theopening of the heart chakra described in tantricyogic tradition (Nelson, 1994) or the experienceof moving from ‘I-It’ to ‘I-Thou’ for Buber(1970). Most discussions of empathy go nofurther than this, and the scale used byCarkhuff (1969) also stops here. An example ofthis type of empathy would be this, taken froma book of transcripts:

Client: I’m just getting a sense that maybe,um, what I have to do is – open up and,uh, and accept that whole world, that Iwant to – (Therapist: M-hm, m-hm, m-hm)That I want to reject and that wants toreject me. (Therapist: M-hm) Somehow toswallow that. (Therapist: M-hm, m-hm)and, uh –Therapist: Sounds like you’re sayingmaybe you sort of have to bypass thatfeeling that, that you’re rejecting the worldand the world is rejecting you, thatsomehow you have to open up tosomething more than that.Client: Yeah. Maybe that’s the only way todo it.

A third level of empathyLet us look again at Table 1 with its three levelsof empathy. We now need to examine the thirdcolumn, as an even deeper form of thatempathy which is so vital to every level of thetherapeutic process. Tobin Hart (1997) haswritten about transcendental empathy, referring both to transcendental counter-trans-ference and to psychological resonance. JeromeLiss (1996) refers to ‘the identification method’and describes very clearly how he uses thisability to open up to deeper or higher levelsboth in individual and in group work. To use itin groups obviously extends the experiencestill further.

Gestalt therapy recognises this as using theself as a ‘resonance chamber’ (Polster & Polster,1974, p.18). Unlike the transient fusion in theexperience of alignment, the phenomenologyof attunement describes the experience of twoselves connecting at a particular ‘frequency’ ofexperience. Such models as field theory (e.g.Sheldrake, 1988; Smith & Smith, 1996) implythat we are connected already through avariety of fields (e.g. electromagnetic, psychic,etc.). In such a reality it is not necessary tobecome the other or move into their ‘space’;instead one interconnects through a kind offrequency attunement.

Hart wonders whether projective identifi-cation, whereby the therapist is, as HannaSegal says, ‘possessed’ (Segal, 1964, p.14) byparts of the client is similar to the quality ofbeing ‘carried along by’ or reacting in unex-pected ways such as Carl Rogers describes:

‘When I can relax and be close to the tran-scendental core of me, then I may behave instrange and impulsive ways in the relationship,ways in which I cannot justify rationally, whichhave nothing to do with my rational thoughtprocesses. But these strange behaviours turnout to be right, in some odd way’ (Rogers, 1980,p.129).

As Hart concisely puts it ‘as ego defensive-ness decreases, one is free to experience theother more directly and spontaneously’ (Hart,1999, p.119).

The duality of self and not-self shifts in suchdirect knowing into an intersubjectiveexperience: what Thich Nhat Hanh (1995) namesas ‘interbeing’, which refers to the fundamental


connectedness of all things. Rogers describes this:‘It seems that my inner spirit has reached out andtouched the inner spirit of the other. Our relation-ship transcends itself and becomes part ofsomething larger’ (1980, p.129).

Phenomenologically, information is oftenencountered as if it were coming from anothersource, perceived as outside or deep inside.This is similar to the phenomena of inspirationwhich Tobin Hart has also described. (Hart,1998). Some describe this as tuning into theperson’s higher self. As the therapist opens tothis field of consciousness, other kinds ofmaterial become available (unexpected images,including possible archetypal themes, deeppatterns, etc.) that may not be available to theclient’s immediate awareness. Empathic infor-mation may also arrive in literal or symbolicform. This aspect of the matter can be particu-larly helpful when working with clients fromother cultures. Fukuyama and Sevig (1999)provide copious references to research on thetranspersonal relationship in the transculturalarea.

I have suggested elsewhere (Rowan, 1998),following research by Rosemary Budgell(1995), that we can subsume all these column-3phenomena under the heading of linking.Linking is that way of relating that refuses totake separation seriously, and assumes insteadthat the space between therapist and client canbe fully occupied and used by both, to theadvantage of the therapeutic work. This canonly be done in a state of subtle consciousnesswhere the fear of relating at such a depth can beovercome or set aside or just not experienced.Here is an example of empathy at this level,taken from a book on the sacred inpsychotherapy:

Therapist: What have you learned?Client: It’s like things are falling down allaround me, crumbling and cracking. But Iwill be OK.Therapist: The picture I get is one of astorm, with things swirling around you. Is it like that?Client: (Nods)This image of the storm proved to be very

helpful, and led to important new insights.Linking can be seen as a special kind of

empathy, a special kind of countertransference

and/or a special kind of identification. Variousterms, some of which have already beenreferred to above, can be found to be examplesof this phenomenon of linking such as ‘reso-nance’, ‘experiential listening’, ‘embodiedcountertransference’, ‘being aligned’, ‘workingat relational depth’, ‘the four-dimensionalstate’, ‘the unifying I/Me relationship’ and‘melding’. It is not a new therapy or a new tech-nique, but simply recognition of a relativelyunfamiliar human relationship, which has beenformally researched and described in a numberof sources. Budgell describes ‘linking’ as:

‘The experience is described as nearfusion, a communion of souls or spiritsand a blurring of personal boundaries. Toachieve this, both parties have to give upsomething of themselves while remainingseparate. It is not symbiosis but the otherend of the spectrum, as described byWilber (1980). It is the transpersonal senseof relinquishing self. Symbiosis is aboutbeing cosy, but this is about workingthrough pain and fear. It is a sacredexperience and yet natural and there allthe time. It comes from the spiritual ortranspersonal realm, being a step beyondempathy and the natural plain’ (Budgell,1995, p.33).Her research found over and over again

that therapists who had had these experiencesdid not want to reduce them to somethingwhich could be controlled. ‘It was a sense ofbeing joined or linked and of something goodand healing emanating from another person’(Budgell, 1995, p.63). The essence of it was thatit came unbidden.

By taking empathy as our example of theway in which these ideas can be applied, I donot mean to say that empathy is the only aspectof therapy which can be treated in this way.These categories of the instrumental, theauthentic and the transpersonal can be appliedto any aspect of therapy.

In conclusion, let me just say that the instru-mental approach is available to all of us,because it is the way of being in which we havebeen brought up and trained all our lives, andwhich is reinforced every day through the massmedia of communication. The authenticapproach requires some kind of initiation,


which is quite readily acquired throughtherapy. It involves dealing with the shadowside of our existence – all those aspects ofourselves which we are initially reluctant torecognise. And the transpersonal approach alsoneeds some kind of initiation, which has to beacquired through some form of spiritualpractice. It has to be some form of practicewhich teaches us, on an experiential level, thatour boundaries are questionable, that we donot live totally within the capsule of our skin. Itinforms us that we are fundamentally divine,not limited by a narrow definition of ourhumanity.

These three approaches, which we mightsum up in the words Treating, Meeting andLinking, need in my view to be much betterunderstood if we are to do justice to all thattherapy has to offer.

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CorrespondenceJohn Rowan70 King’s Head HillLondon E4 7LY.


At the initiative of the Local Implementation Teamfor the National Service Framework for MentalHealth, an assessment of current need for psycho-logical therapy was undertaken across all tiers ofprovision within the mental health services for thelocalities served by a specialist NHS Trust. Themethodology chosen involved collecting informationabout the current provision of psychological thera-pies in terms both of staff establishment and serviceusage (referral rates, throughput and waitingtimes). From this data it was possible to estimateshortfall in services to manage current referrals. Inaddition, the ‘hidden’ need – referrals which aresuppressed by this shortfall and would emerge withmore adequate provision – was estimated throughsurveys undertaken by members of the services witha sample of their major referrers. Results indicatedvery substantial shortfalls in provision, both forcurrent referrals and additionally for the ‘real’potential demand. This was true in differing degreesat each tier of the service. The required increases inprovision to meet identified shortfalls were calcu-lated. Required increases in Primary Care andSecondary Intermediate tiers approach 100 per cent,as did the Secondary Complex tier for one half of thearea. Increases in the Specialist Psychotherapyservices varied for the different types of provisionbut appeared to be similarly high. Methodology andresults are discussed in relation to their generalis-

ability to other services, their implications for work-force planning and current and future patterns ofservice provision.

The National Service Framework for MentalHealth [NSF] (Department of Health, 1999),proposes access to psychological therapies as aperformance assessment target for bothStandards 2 and 3 on common mental healthproblems and Standards 4 and 5 on severemental illness. This includes building capa-bility and capacity to ensure the goodmanagement of referrals to specialist services,including psychological services, from theprimary care sector. The present article gives anaccount of a project to assess needs for psycho-logical therapy across the area served by aspecialist mental health NHS Trust whichwould inform judgements about the degree towhich these standards were currently beingmet and what resources were required to do so.It was undertaken on behalf of the LocalImplementation Team for the NSF which hadset as targets the availability of counselling andpsychology services in surgeries and access to afull spectrum of psychological therapy inprimary and secondary care, proposing that‘delay and service shortfall’ be identified andtackled. This work is published in order to


Assessing needs forpsychological therapiesin the context of theNational ServiceFramework for MentalHealthRob Leiper, Head of PsychotherapyServices, West Kent NHS and Social CareTrust

inform colleagues of the methodologyemployed in such an exercise and so thatdetails of service provision and demand in onearea may be compared with those in others.

The population served covers two PrimaryCare Trusts (PCTs -A and -B) and one PrimaryCare Group (PCG -C). Both PCTs cover mediumsized towns and suburban-rural areas (A:173,000 people; B: 188,000 people) and the PCGa rural population of 74000 – a total populationof 435,000; social deprivation indices arearound the national average overall. Each PCTis served by two locality Community MentalHealth Teams (CMHTs) one of which alsoserves the rural PCG. Specialist services dealwith the whole area.

Work already undertaken locally in relationto the delivery of psychological therapiesincluded a report on implementing the NHSPsychotherapy Strategic Review (Department ofHealth, 1996; Leiper & Maltby, 2001) whichreviewed service provision and drew up adetailed development plan in relation to qualityand efficiency but addressed capacity only ingeneral terms. A local model of care developedfor adult mental health services proposed a pan-locality psychological therapies service with atiered model of provision in four levels: primarycare counselling and psychological therapy;time-limited psychotherapy in CMHTs;specialist psychological therapies; and psycho-logical interventions for those with severe andenduring mental health problems (cf. Paxton,2000). This assessment of need focuses onspecialist providers of therapy (i.e. formal andintegrative psychological therapies) across allfour tiers. It excludes certain areas of adultmental health provision particularly tertiaryeating disorders, general substance abuse orforensic psychiatry and the needs for developingthe capabilities of generalist providers of mentalhealth services in psychological care at all levelsof the system (Sainsbury Centre, 2000).

Assessing needsNeeds for any health service intervention canbe identified in a number of different ways. It issometimes possible on the basis of goodresearch evidence, population surveys ornationally agreed norms to identify appro-priate levels of provision for a community on a

socially adjusted per capita basis. No suchagreed norms or clear evidence of service needexists in relation to psychological therapies.Instead it is necessary to estimate on the basisof ‘marginal need’ from the usage of currentservice provision i.e. evidence that services arecurrently under provided. Shortfalls can beunderstood to exist at two different levels.Firstly, there is the failure of current services tomeet referred demand through the existence ofinappropriately lengthy waiting times to accesstreatment. However, it is generally recognisedand established by recent research (Shannon etal., 2001) that the existence of waiting lists is aself-adjusting mechanism which affects level ofreferrals within psychological therapy services.Thus there is a second level of shortfall whichcan be estimated as the demand for servicesrepresented by those who would have beenreferred if the necessary capacity was believedto exist.

It should be noted that a third level ofunmet need probably exists also. This is repre-sented by those patients who have healthcareneeds which could be addressed by psycholog-ical therapy but which are not currentlyrecognised as such by many referrers, togetherwith those problems which will, with develop-ment in psychological therapies, be seen to betreatable at some future date. The presentsurvey assesses only the first two levels. Sinceboth the skills and understanding of referringprofessionals and the scope and technique ofpsychological therapies have been developingrapidly over the past decade and are likely tocontinue to do so, the present assessment ofneed is only a snapshot of one moment in time.Assessment of need in this area, as in so manyareas of healthcare, is likely to be one whichchanges continually over future years.

Methodology Different types of information were collectedfrom a variety of sources in relation to relevantaspects of provision and shortfall with theassistance of many colleagues throughout themental health services:● Current provision of specialist

psychological therapies at each tier in theservice was assessed in terms of staffestablishment in relation to localities


(defined as Primary Care Trust areas) fromdiscussion with service leads anddocumentation on service resourcing.

● Current service usage was examined fromavailable utilisation data in relation toreferred clients, clients actually seen anddischarged, waiting times and averagecontact periods.

● Members of services conducted brief‘interviews’ with their primary referrers inthe service network to establish theirestimate of the probable increase (if any) intheir referral numbers if there was anappropriate rather than a limitedtherapeutic resource to refer to.From the service usage data, simple calcu-

lations were used to derive estimates ofrequired resources to meet current referral.Cross-locality comparisons and issues of equi-table provision were considered explicitly atthis stage of analysis. Estimates of likelyincrease in demand with the resultingimproved access were averaged across refer-rers and then factored into final estimates ofcurrent needed resources.

Needs assessment dataCurrent provision of psychological therapies ineach of the tiers is detailed in Table 1 (overleaf).All results of the needs analysis are thenpresented in relation to each of the four tiers ofservice provision.

Primary Care Tier:Detailed consideration of the equity of provi-sion across different localities is complex due tothe different combinations of psychology andcounselling in different localities and the provi-sion of counselling services by three differentproviders (the NHS Trust and a Consortium ofCounsellors together with input from a non-statutory agency) commissioned on differentbases (whole time equivalent staff establish-ment or clinical sessions).

For the NHS Trust’s service (providing brieftherapies, typically within surgeries), duringthe year 2000/2001 a total of 1690 clients werereferred and agreed to take up the service (85per cent of all those referred). These dividedaccording to geographical patch as follows:Area A, 817; Area C, 339; Area B, 534. Of these

referrals (averaging across the different locali-ties) a further 25 per cent did not take up anappointment when offered. Thus, about 60 percent of referred clients were actually seen, atotal of about 1260 ‘active’ cases with about fiveper cent of the total being seen only once. Over500 clients were on the active waiting list atAugust 2001. Waiting times ranged from one to12 months with the median being six months.Clearly this waiting period is inappropriate forthis tier of service provision and creates consid-erable strain within the service and distress forclients.

The Consortium of Counsellors providingservices to PCT-B received a total of 1441 refer-rals in 2000/2001, divided between LocalityBII(689) and Locality BI (752). Several differentsystems for managing referral flow have beenadopted in different surgeries (for example:referrals only to available places; or waitinglists closed if wait exceeds three to six weeks)which in some cases restrict waiting list sizes.As a result, waiting times are lower: One to 12weeks in BII and two to 20 weeks in BI.However, this further limits the reliability ofusing these figures to estimate the level ofreferral demand.

Undertaking a survey of 20 GPs served bythe Trust, estimates of potential increase inreferral if services were less restricted rangedfrom 0 to 100 per cent. The median estimatewas 40 per cent. Four GPs interviewed by thePCNC provided a similar spread of 0 to 100 percent. Acknowledging the unreliability of thismethod, it would appear that a 40 per centoverall increase is a reasonable and possiblyconservative estimate of ‘latent demand’.

The throughput of the Trust service and anestimate of its capacity can be made on thebasis of figures for yearly discharge from treat-ment (i.e. of those who were actually seen fortherapy). In 2000/2001 this was 843. This is ashortfall from referred demand of about 350cases. This represents about a 40 per cent gap inservice resources to meet currently referreddemand. If referred demand were to increaseby a further 40 per cent (i.e. to about 2360referred and 1770 seen at least once) this wouldrepresent an approximately 95 per centrequired increase in the resources of the Trustservice equivalent to 13.0 fte staff (not differen-



Primary Care Specialist Psychotherapies

PCT-A Psychodynamic/InterpersonalPsychology 4.5 fte Area A 2.6 fteCounselling – NHS Trust 2.4 fte Area B 0.5 fte

– Independent 25 clin. hoursCognitive-Behavioural

PCG-C Area A 2.0 ftePsychology 1.3 fte Area B 1.0 fteCounselling – NHS Trust 2.1 fte

– Independent 31 clin. hours Systemic/FamilyArea A 0.4 fte

PCT-B Area B 0.3 fteLocality BIPsychology 0.4 fte Personality Disorders UnitCounselling – NHS Trust 2.5 fte Both Areas 4.4 fte

– Independent 95 clin. hours[Eating Disorders

Locality BII Both Areas + + 1.9 fte]Psychology 2.5 fteCounselling – Independent 52 clin. hours

Secondary Care – Standard Secondary Care – Complex

Psychologists PsychologistsLocality BII + C CMHTs 1.0 fte Locality BII + C CMHTs 1.0 fte

Locality BI CMHTs 1.0 fte Locality BI CMHTs 1.0 fte

Locality AI CMHT 0.4 fte Area B + C – Acute inpatient 1.0 fte

Locality AII CMHT 0.4 fte Locality AI CMHT 0.4 fte

Locality AII CMHT 0.4 fte

Area A – Acute Inpatient 0.6 fte

Specialist TeamsPsychologists 0.4 fteNurse Specialist 0.5 fte

Table 1. Current Provision of Psychological Therapies

tiating psychologists and counsellors).Available data do not permit these samethroughput capacity calculations to be done forthe Consortium service. An equivalent propor-tional increase would be approximately 190clinical hours.

Intermediate Secondary Mental Health Tier:Within different Locality CMHTs somewhatdifferent policies on managing referral pres-sures and excess demand appeared to result indiffering levels of actual referrals being madefrom allocation meetings and differing propor-tions of patients seen by the psychologistwithin the community mental health team.Some allow waiting lists, others maintainpotential referrals within the team or requestassessment from the team psychologist andreferral to other services more frequently. Anunderstanding of the probable demanddepends on an interpretation of referralnumbers in the context of these differing proce-dures.

In the Teams serving localities BII and Cwithin the first six months of 2001, 24 referralsin one team and 35 in the other were made, ofwhich it was possible to see (assess andcommence treatment) only 23, i.e. slightly lessthan 40 per cent. In one team, with increasedresources there was an expectation of about an80 per cent increase in referrals and in the otheran extraordinary 160 per cent. On the basis ofthese figures, a 300 per cent increase inpsychologists, i.e. an additional 3.0 fte, mightbe estimated to be necessary to respond toperceived service needs.

In the Teams serving locality BI, 70 patientswere referred and attended initial appoint-ments in six months in 2001. Fewer of thesepatients were seen for treatment by thepsychologist and more referred elsewhere (andthere was a policy of restricting referrals toexclude primary behavioural/anxiety disor-ders which went directly to the BehaviouralTherapy Service although referral capacity herewas also deliberately restricted). There was lessexplicit demand in these teams for an addi-tional within team referral resource in thecontext of the culture and practice established.

In the two localities in Area A (in totalapproximately equivalent to the whole of the

preceding area) only a single psychology postwas established during the first six months of2001 – this is half the level of resourcing avail-able in Areas B and C. During this period,about 55 patients were referred and seen.Estimates by the team suggested approxi-mately an additional 135 referrals were heldback, i.e. an almost 250 per cent additionalresource requirement, equivalent to 2.5 ftepsychologists in these two teams.

Overall, averaging across the differinglevels of estimated team demand across thesecontexts (affected by both different policies bypsychologists to respond to team demand anddiffering referral practices established withinteams designed to manage within availableresources) a conservative estimate of assessedneed corresponds to approximately onepsychologist within this element of the CMHTfor each consultant psychiatrist at this level;this is equivalent to a 100 per cent increase incurrent provision or 4.0 fte psychologists acrossthe whole area.

Specialist Psychotherapies Tier:Numbers referred to the psychodynamicpsychotherapy service in 2000/2001 were 230. Ofthese 25 per cent opted not to respond to theoffer of assessment, a further 10 per cent didnot attend their assessment appointment and10 per cent were assessed not to be appropriatefor the service. Thus 55 per cent were offeredtherapy and a further 10 per cent (of the orig-inal referrals) chose not to take it up by startingtherapy when offered. Thus 45 per cent of 230,i.e. about 100 patients referred, would entertherapy in this year. The waiting list forpsychotherapy grew during this period:having been consistently kept under sixmonths, by August 2001 it was at least eightmonths after assessment (for which therewould have been about a three-month wait).

Throughput figures for this servicesuggests that 84 people started therapy in2000/2001 and 60 people finished. Thethroughput of 60 per annum is somewhatlower than the previous year when 75 peoplecompleted therapy. This may be due to varia-tions in staff turnover and the presence oftrainee and associate therapists within theservice. If the capacity of the service is a


maximum of 75, this is about 75 per cent ofwhat is currently needed on the basis of referralpatterns for 1999/2001. On the basis of thesefigures, the service appears to be under-provided by at least 1.0 fte staff. This service isseriously inequitably provided between AreasA and B by about 2 fte staff; as a result, referralsfrom Area A are twice those in Area B. Datawas not specifically collected on the potentialreferral rates if waiting lists were to be reducedand particularly if the service were to have amore accessible presence within the localitiesBI and BII. An additional 25 per cent referralincrease would seem to be a very conservativeestimate on the basis of the current pattern ofdemand. This suggests an increase of 2.0 ftestaff (as a minimum estimate) who should bedeployed primarily in Area B, bringing it toapproximate parity.

The small family therapy service was referred57 couples and families during 2000/2001.They have been capable of providing a servicewithout significant waiting for appointmentson the basis of their present establishment. Thishas been done chiefly through restrictivereferral criteria which focuses the service onthose with significant mental health problemsand excludes general relationship and psycho-sexual difficulties, however distressing, and bya rigorous discharge policy focusing on shorterterm contracts. This approach undoubtedlyleaves a significant area of unreferred needcurrently unaddressed or channelled into theindependent sector (particularly Relate andprivate therapists). A speculative estimate of0.5 fte more staff has been included in theservice plan.

Within the cognitive behaviouralpsychotherapy service, 314 clients were referredin the year 2000. Of these, about 40 per cent didnot opt to take up the offer of assessment orattend the assessment session or were deemedunsuitable for this therapy. A further 15 percent were offered therapy but did not start.Thus around 45 per cent, i.e. about 140 patients,should have started therapy within that year.The waiting list for behaviour therapy hadgrown substantially during the previous twoyears and in August 2001, a patient requiringindividual therapy might have to wait 15months. Eighty-four people started therapy

during 2000/2001 (and 104 in 1999/2000); 67(and 55) were discharged during these time-periods. This suggests that there may be a needon the basis of current referrals for a 100 percent increase in the provision of behaviourtherapy, i.e.3.0 fte. It is difficult to estimate thepotential increase in referrals if the waiting listswere to be more appropriate. It is likely to beaffected greatly by the amount and nature ofany increase in relevant provision within theprimary care and standard secondary caretiers. It is likely to be conservatively at least 25per cent. This suggests a further 2.0 fte staff.

The specialist personality disorders service, aday therapeutic community, received almost200 referrals during the first 18 months of thisoperation (30 re-referrals). Of these 30 per centdeclined or did not attend assessment and afurther 15 per cent were referred to out-patientpsychotherapy; less than 10 per cent wereassessed as unsuitable. Thus – almost 50 percent were offered treatment, initially atten-dance at an intake/preparation group; justunder 30 per cent (of the total group) refusedentry or dropped out at this stage, leavingabout 20 per cent to enter the full communityprogramme. Although this has limited capacity(18 people) it appears to be just about adequatefor an adequate throughput (including drop-outs from the programme). Waiting times forassessment and to enter the programme are notexcessive. However, it is apparent that thesmall staff team are somewhat over-stretchedand there are limits to the out-reach supportand consultation work which would otherwisebe undertaken. It is also clear that this serviceprovided from its Area A base under-servespatients in Area B (with just over 60 per cent ofpatients being referred from Area A). Ways ofimproving access require consideration.Improved access and outreach work are likelyto require a further 1.5 fte staff.

Complex Secondary Mental Health Tier:It should be noted in the figures provided inTable 1 that there is a significant inequity ingeneral provision at this tier between Areas Aand B, with A having less than half the provi-sion within the CMHTs. On this basis alone, afurther 1.0 fte post is urgently required. In theLocality AI and II CMHTs at the complex level,


between 35 and 40 referrals were received perannum for this service which is a level negoti-ated within the teams as one manageablewithin the present staff establishment at itsapparently inadequate level. Investigation ofpotential referrals currently held back by theteam suggested that there were approximately60 patients who had not received neededservices. This would suggest an increase ofestablishment of about 150 per cent (1.2 ftepsychologists). Figures for service throughputwere not available for the Area B teams due tothe disruption of the service over the past yearby overlapping maternity leaves but assumingequivalent levels of demand, the present staffestablishment should be adequate thoughfurther data may show this to be inaccurate.

In addition, developing provision in thistier is focusing on several emerging specialistteams which include rehabilitation, deliberateself-harm, assertive outreach, crisis resolution,psychosocial intervention for psychosis, earlyintervention for psychosis, dual diagnosis(substance abuse) and mother and infantmental health. This pattern of development isin line with the NSF and the NHS NationalPlan. Developments within the new specialistservices have begun without resourcing ofspecifically psychological provision. In reality,this has meant that the already thin Area Aprovision has become further stretched inorder to provide developmental consultancyand support to this new service. The needs forpsychological therapies specialists within thesenew targeted services have to be consideredseparately during the service developmentprocess.

DiscussionIt is apparent from the above account of theservice data that the differences between thevarious service tiers and formats and betweenestablished local patterns of managing demandresults in very complex problems in estimatingor comparing current or future need forpsychological therapy. These issues werehandled pragmatically in the above analysis bymaking best estimates and averaging across thediffering patterns of data: results can only beregarded as a general approximation for thisreason. Nonetheless, there was sufficient

consistency to afford some confidence to thisestimate within broad parameters.

It is also apparent from the data that theservice being analysed is already relativelywell developed: there are significant staffresources invested – about 36 fte (plus 200clinical hours) - in a quite highly differentiatedservice structure, compared with many otherareas. How this affects perceived need is amatter of speculation but it seems likely thatthis investment is both a consequence and agenerator of the significant level of demand forpsychological intervention within the profes-sional referral network. The response to needsfor psychological therapy within any networkof provision is extremely complex: inter-rela-tionships between different tiers are crucial;there is a sensitive responsive relationshipbetween referrers and therapists at each levelto manage demand. Alterations of the capacityand the format of psychological services willhave consequences for the level and pattern ofreferrals made to them. It is difficult to gener-alise to demand in other service contexts but itcan be reasonably assumed that as services inother areas approach this level of provisiondemand is likely to be similar.

It should be noted moreover that as special-ists in psychological therapies all of theseprofessionals at whichever tier of service provi-sion they are working are undertaking morethan direct clinical work with patients. Theyare in varying degrees also undertaking super-vision, consultancy and training roles withother generalist professionals to enhance thequality and increase the amount of psycholog-ical care provided. It is difficult to be preciseabout any changes in the proportions of theseactivities resulting from an increase inspecialist professional numbers and its impacton direct service throughput.

Even with all these reservations, the resultsunambiguously point to a very substantialshortfall in the current provision. It is highlylikely that such shortfalls would be replicatedin all but the very best resourced psychologicaltherapy services. A summary of these currentneeds derived from the above figures wouldappear to suggest the following increases inlevel of service according to tiers of psycholog-ical therapy provision.


● Primary Care Tier13.0 fte counsellors and psychologists inthe NHS Trust190 clinical hours of independent provision

● Secondary Intermediate Tier 4.0 fte psychologists

● Specialist Psychotherapies Tier2.0 fte psychodynamic psychotherapists5.0 fte cognitive behaviouralpsychotherapists0.5 ft family therapist1.5 fte therapists (Personality DisordersUnit)

● Secondary Complex Tier1.2 fte psychologistspecialist service proposals underdevelopmentOverall this represents at least a 75 per cent

increase; in those areas where provision anddemand was most clearly assessed it is higher:95 per cent in Primary care; 110 per cent inspecialist out-patient psychotherapies; 100 percent in secondary standard psychology. (Moreprecise funding estimates for these increases inservice would depend on more precise specifi-cation of profession and grading of posts.)

This very challenging figure for the esti-mated shortfall is unlikely to be accepted atface value by any commissioning body – andquite rightly. It should provoke reconsiderationof current service formats and new ways ofmeeting the demands; service efficiencies,staffing profile and therapeutic effectiveness ineach component must receive ongoingscrutiny. However, the shortfall is such that no‘efficiency savings’ will realistically make upthe deficit in service access. Indeed it is likelythat the strains on the service created by theinability to meet demand will cause a degree ofinefficient ‘turbulence’ in the system togetherwith the potential for staff burnout or disrup-tive turnover.

ConclusionThe report on mental health services by theHouse of Commons Select Committee onHealth (1999) found it ‘very disturbing thatthere is clearly such a shortage of psychologi-cally-based treatments in the NHS given thegeneral consensus as to their value for many

patients’. They proposed that the WorkforceAction Team investigate whether the rarity ofsuch treatments is due to shortage of skilledprofessionals, lack of awareness amongstcommissioners or cost. In their report(Department of Health, 2001) the WATacknowledge that in the face of growingdemand for both direct and indirect servicesthere has not been a matching increase instaffing by psychologists generally and toooften a lack of clear accountability structuresand adequate provision for continuing profes-sional development. They specifically note theneed to fund increased training numbers andtake a major step in proposing the provision ofsalaries for trainee Counselling Psychologistsintending to work in the NHS. It is clear thatpsychological therapies services now require amulti-professional staffing structure, both inorder to construct a suitable skills profile andsimply to meet demand for trained staff.Counselling Psychology will increasingly func-tion as a significant part of the wider ‘family ofpsychology’ which will in turn be only oneelement in a complex professional picture.

Assuming that recruitment and training ofthe relevant specialist professional resourceswill be possible in the medium term, thepreceding analysis suggests that substantialadditional financial resources within servicesare required in order to meet the needs of thelocal population for psychological therapy.Anticipated improvements in efficiency shouldnot obscure the degree to which these servicesare currently seriously under-resourced.Replication of this type of needs assessmentexercise in other local NHS mental healthservices would be extremely helpful in gradu-ally building up a bank of comparable datawhich would assist with service and workforceplanning on a national basis.

AcknowledgementsI would like to thank David Walker of OxleasNHS Trust for access to a needs assessmentexercise undertaken there; and staffthroughout the psychological services of thelocal Trust who assisted in data collection.


ReferencesDepartment of Health (1996). Psychological Services

in England: Review of Strategic Policy. London:DoH.

Department of Health (1999). National ServiceFramework for Mental Health: modern standardsand service models. London: DoH.

Department of Health (2001). Mental HealthNational Service Framework (and NHS Plan)Workforce Planning, Education and TrainingUnderpinning Programme: Adult MentalHealth Services: Final Report of the WorkforceAction Team. London: DoH.

Leiper, R. & Maltby, M. (2001). Implementing thepsychotherapy strategic review in the contextof clinical governance. Clinical PsychologyForum, 147, 22–25.

NHSE (2000). Psychological Therapies: Working inPartnership. London: DoH.

Paxton, R. (2000). Tiered approach – staff roles,community teams and out-patient services.Unpublished paper: Northumberland MentalHealth Trust.

Sainsbury Centre (2000). The Capable Practitioner:Report for the NSF Workforce Action Team.London: Sainsbury.

Select Committee on Health (1999). Report onMental Health Services. London: HMSO.

Shannon, H., Gillespie, N., McKenzie, K. &Murray, G. (2001). An evaluation of the impactof waiting list initiatives in clinical psychologyreferral rates and waiting times. ClinicalPsychology, 5, 19–22.

CorrespondenceRob LeiperThe Courtyard, Pudding LaneMaidstone, Kent ME14 1PA.E-mail: [email protected]


AbstractSecond to extra-therapeutic ‘client factors’, thequality of the therapeutic relationship, ‘being-in-relation’, is widely recognised as the mostsignificant factor in successful therapy. There is,nevertheless, an increasing tendency to emphasise‘technical expertise’ and pressure to package andmanualise ‘treatment’.

This paper argues that this tendency is bestunderstood in the context of a wider social-historicalprocess first described, and termed ‘rationalisation’,by Max Weber. It draws on the recent work of GeorgeRitzer who argues that the process of rationalisationhas continued to intensify. He has developed themetaphor of the fast-food restaurant, built on princi-ples of efficiency, calculability, predictability andcontrol and coined the term ‘McDonaldisation’ tocharacterise the tendency. Increasing areas of sociallife are subject to ‘McDonaldisation’ through, forexample, shopping malls, packaged holidays, hotelchains and digital television. Even areas such aseducation and medicine are subject to this process.The stress on grades and league tables in educationfocus attention on what is quantifiable in the endproduct, rather than the quality of the experience,and health care is increasingly impersonal and tech-nological. Both clients/consumers and workers aresystematically disempowered in this process. Thetendency to standardise, package and manualisetherapy is considered as another manifestation of‘McDonaldisation’.

IntroductionI believe that counselling psychology is at acrossroads. We have now an establishedpresence within The British PsychologicalSociety and clear pathways to qualification,Chartering and employment. Nevertheless,success has confronted us with a fundamentaldilemma. This can be expressed as a choicebetween two modes of being, encapsulated inMartin Buber’s distinction between the ‘I-it’and the ‘I-thou’ (1958). This translates into

seeing ourselves, as practitioners, as either‘technical experts’ or ‘persons-in-relation’.

There is, of course, a wealth of evidenceemphasising the therapeutic significance of thepractitioner-client relationship. Roth andFonagy (1996) clearly confirm this and Hubble,Duncan and Miller (1999), in their extensiveanalysis of outcome research, identify clientvariables and extra-therapeutic factors asaccounting for as much as 40 per cent ofimprovement in therapy and the therapeuticrelationship as accounting for 30 per cent.Placebo/expectancy effects and specific tech-niques each account for 15 per cent.Nevertheless, flying in the face of the evidence,the pressure, on us and other therapists, iscurrently very much in the direction of tech-nical expertise and an increasing reliance ontechnique. ‘Doing-to’ is substituted for a rela-tionship in which ‘being-with’ a person isparamount; ‘I-thou’ is ousted by ‘I-it’. Writingfrom a psychoanalytic perspective Peter Lomas(1999) has expressed similar concerns about theemphasis on technique over relationship andexplored some of the ways in which what heterms ‘the retreat from the ordinary’ damagesthe therapeutic process.

No doubt, as professions, in their verynature, make claim to expertise, this seeming‘ordinariness’ of ‘being-in-relation’ is part of theproblem. Nevertheless, Carl Rogers, who didmuch to establish the significance of relation-ship in therapeutic processes stressed thattherapeutic relationships are not different inkind from other relationships in everyday life.What can be over-looked is the intrinsic valueof meeting when depth of contact can be estab-lished in the relationship. Rogers emphasisedthe extraordinary therapeutic potential of thisordinary human capacity and we owe much tohis careful work in researching its nature andpotential and for identifying key therapeuticfactors as acceptance, empathy and congruence.


‘McDonaldisation’ or‘Fast-food therapy’Sheelagh Strawbridge

Differing therapeutic approaches nowdraw upon this understanding and one mightexpect this to lead to a focus on research intothe relationship and an exploration of theissues that arise when this is considered insome depth. For example, whilst there arestrong affinities between the approaches ofRogers and Buber there are also significantdifferences that have implications for practice(see, e.g. Kirschenbaum & Henderson, 1990,pp.41–63, and Friedman, 1992). Too often,however, the relationship is considered super-ficially and reduced to a pre-condition for theapplication of techniques; the ‘technical expert’over-shadows the ‘person-in-relation’.

The pressure on counselling psychology tomove in the direction of technical expertisecomes in part from its success. It has, I think,two related sources. The first can be thought ofas internal – linked to the development of thediscipline and its increasing sense of connec-tion with psychology, as distinct fromcounselling and psychotherapy. The espousalof the ‘scientist-practitioner’ identity is signifi-cant here. Despite developments in theory andresearch that challenge the more traditionalview of science, what Donald Schon (1987) andothers have termed the ‘technical-rationality’model still dominates and is favoured by thedemand for evidence-based practice. Researchtends to be constrained by notions of gooddesign often inappropriate to complex life situ-ations (Spinelli, 2001, p.5). There is an inbuiltbias towards the cognitive-behavioural tradi-tion which best fits the model and can,therefore, make the strongest claim for adistinctively psychological form of clinicalpractice (see, e.g. The British PsychologicalSociety, Division of Clinical Psychology, 2000).This is encouraged by the emphasis on efficacystudies, characterised by ‘randomised controltrials’, though, as Seligman (1995) argues, thesemay not be the best way to evaluate the effec-tiveness of therapy and, indeed, exaggeratedclaims may be made about the significance ofresults or the adequacy of the design (see, e.g.debates initiated by Bolsover, 2001, andHolmes, 2002).

The second source of pressure is moreexternal – linked to success in the increasingemployment of counselling psychologists in a

range of settings (most significantly the NHSand EAPs) where there is a heavy demand onresources coupled with a justifiable expectationof accountability. This favours the traditionaland limited view of evidence-based practice.There is also a strong tendency to promoteshort-term problem or solution focused workand standardised, manualised and evencomputerised treatments to the exclusion ofmore flexible and creative approaches (whichstress the specificity of each therapeutic rela-tionship) and longer term in-depth work. Thispressure is difficult to resist, but understandingit in the context of a wider social process mayboth underscore the importance of resistanceand provide it with a useful theoretical frame-work.

Rationalisation /McDonaldisationThis wider social process was first identifiedand termed ‘rationalisation’ by Max Weber inhis seminal analyses of ‘modernisation’ (see,e.g. Brubacker, 1984; Whimster & Lash, 1987).Rationalisation is characteristic of modernindustrial capitalist societies and involves theapplication of rational decision-making criteriain increasing areas of social life. The traditionalor ‘technical-rationality’ model of science islinked with the general form of reasoning‘zweckrationalitat’ or ‘instrumental rationality’central to rationalisation. Instrumental ratio-nality is concerned with calculableexpectations and, within the general sphere ofinstrumental rationality, the selection of themost adequate means to achieve a given endcan be assessed in terms of its ‘objective ratio-nality’ – that is scientifically. Instrumentalrationality is distinguished from ‘wertrational-itat’ or ‘value rationality’ which is oriented toconsciously upheld values. As instrumentalrationality comes to dominate, in the process of‘modernisation’, values and ends are effec-tively excluded from the framework ofrationality. Freed from the external constraintof values (historically the ‘protestant ethic’)productivity, the hallmark of industrial capi-talism, coupled with scientific andtechnological progress, becomes an end in itselfas opposed to a means whereby independentlyestablished human needs may be satisfied.


The overall effect is to construct a complex‘iron cage’ of bureaucratic rules and regula-tions geared to calculable economic efficiency.At the beginning of the 20th century(1904–1920), Weber wrote:

No one knows who will live in this cage in thefuture, whether new prophets will arise, or therewill be a great re-birth of old ideas and ideals, or,if neither, mechanised petrification, embellishedwith a sort of compulsive self-importance. For ofthe last stage of this cultural development, itmight well be truly said: Specialists withoutspirit, sensualists without heart; this nullityimagines that it has attained a level of civilisa-tion never before achieved. (1974, p.182)It seems that ‘mechanised petrification’

could well be on the cards. George Ritzer (1993)argues that the process of rationalisationcontinues to intensify. He coined the term‘McDonaldisation’ to characterise the highlycontrolled, bureaucratic and dehumanisednature of contemporary, particularly American,social life. The fast-food restaurant, built onprinciples of efficiency, calculability,predictability and control, where quantity andstandardisation replace quality and variety asthe indicators of value, serves as a metaphor forthe general mania for efficiency. Increasingareas of social life are subject to‘McDonaldisation’ through, for example, shop-ping malls, packaged holidays, hotel chains anddigital television. Perhaps more seriously, areassuch as education and medicine are subject tothis process. The stress on grades and leaguetables in education focus attention on what isquantifiable in the end product, rather than thequality of the experience, and health care isincreasingly impersonal and technological.

Ritzer (1998, pp.59–70) has also consideredthe organisation and experience of work andlinked his perspective to Harry Braverman’s(1974) analysis of the labour process. He recog-nises that the ‘deskilling’ and degradation oflabour is characteristic of rationalisation. Workhas been increasingly rationalised throughbureaucracies, scientific management ofassembly lines and so on. Now the process of‘McDonaldisation’ is leading to the creation ofmore and more ‘McJobs’ – jobs characterised bythe five dimensions of ‘McDonaldisation’.Work is highly routinised, thinking is reduced

to a minimum and even social interactions (e.g.with customers) are scripted (see Hochschild,1983). Higher-level skills (such as planning),creativity, critique and genuine human contact,are effectively excluded so both producers and,in the service industries, consumers aresystematically disempowered.

Dimensions of ‘McDonaldisation’● Efficiency – the discovery and

implementation of the best way to dovirtually everything: Fast food restaurantsprovide more efficient means of obtainingmeals than cooking at home from rawingredients. All the tasks performed byemployees are efficiently organised andthe same is true of the things done by theconsumers.

● Calculability – the emphasis on things thatcan be counted and quantified: The timeassociated with work tasks is carefullycalculated and quantity becomes themeasure of value – we have ‘Big Macs’ not‘Delicious Macs’.

● Predictability – the emphasis onstandardisation: The settings, the food andthe behaviour of the staff are much thesame in one situation as another.

● Control and use of non-humantechnologies – the careful control ofpeople, both workers and consumers,increasingly by the introduction of non-human technologies: Human skills aretaken away from people (deskilling) bothby detailed scripting of behaviour and bythe introduction of technologies (the fryingmachines ‘decide’ when the fries arecooked).

● Irrationality of rationality – rationalisedsystems, seemingly inevitably, bring withthem a series of irrationalities (what Webertermed unintended consequences?):‘McDonaldised’ systems tend to have anegative effect on the environment anddehumanise the world. It is this dimensionthat gives the thesis its critical force (afterRitzer, 1998 and 2002).

And counselling psychology?Even this brief outline suggests insights intothe labour market, dominated by medicine,


into which counselling psychology is increas-ingly drawn. The deskilling of work in generalhas broad political implications, to which Icannot here do justice, but it is of particularconcern to a profession that defines its practicein terms of human relationships. We mightlearn much from Michael Apple’s (1985)analysis of education from this perspective, butfor now it is only possible to note some of themeans whereby, in therapy, complexity isminimised, process routinised and thinkingand human contact reduced, e.g. by:● the strong emphasis on training in

techniques (despite the significance of thetherapeutic relationship);

● attempts to operationalise competences(e.g. through national occupationalstandards);

● the demand for quantification in efficacystudies (without due regard to theadequacy of the measures or the quality ofthe experience);

● the consequent stress on diagnosis andproblem specification (as opposed to thesubjective experience of distress);

● attempts to package delivery throughtherapy manuals; and,

● the use of computers to deliver some suchpackages.Of, course, in the food business as in other

areas of life, there is resistance to‘McDonaldisation’. This may take a number offorms. ‘Rib Joints’, for example, are difficult tofind (advertised by word of mouth), may seemshady or suspicious, are housed in seedypremises, have staff who may seem deviant andtheir ‘regulars’ can be disdainful of newcomers(Holley & Wright, 1998). Alternatively there arehigh-class exclusive restaurants with cordon-bleu chefs who use only fresh organic produce.I wonder how many of us have our origins inthe therapeutic equivalent of ‘Rib Joints’ andnow run expensive cordon-bleu outfits? I,personally, find this an uncomfortable analogy!But, to return to the crossroads, if we choose theroad of ‘being-in-relation’ as I hope we will, Ibelieve an important question for us, as aprofessional group, concerns the extent towhich we can resist ‘McDonaldisation’ withinthe mainstream of therapeutic services avail-able to the majority of clients.

I personally enjoy metaphors and I like bitsof theory that can be used playfully. It is in thisspirit that I offer this bit of theory and I hopethat others will take it up, play around with itand use it as a tool to reflect upon and inter-vene in the circumstances of their own practice.

Finally, in the spirit of McDonalds, nowthat you have finished the meal I offer you afreebie in the form of a joke.

The QM Goes to a Symphony ConcertA company president was given tickets forSchubert’s Unfinished Symphony but wasunable to attend. He gave the tickets to hisquality manager. Next morning the presidentasked the QM if he had enjoyed the concert andwas handed the following typed memo-randum:

For considerable periods of time the fouroboe players had nothing to do. The numbershould be reduced and their work spread overthe whole orchestra, thus eliminating peaks ofactivity. All 12 violinists were playing identicalnotes. This means unnecessary duplication andthe staffing of this section should be cut drasti-cally. No useful purpose was served byrepeating, with the horns, the passage that hadalready been played by the strings. If all suchredundant passages were eliminated the concertcould be reduced from two hours to 20 minutes.

If Schubert had attended to these matters inthe first place, he would probably have beenable to finish the symphony after all. (Sourceunknown)

ReferencesApple, M.W. (1985). Education and power. London:

Ark/Routledge and Kegan Paul.Bolsover, N. (2001). Correspondence with Peter

Kinderman. Clinical Psychology, 5 & 6. Leicester:The British Psychological Society.

Braverman, H. (1974). Labour and monopolycapitalism: The degradation of work in the 20thcentury. London: Monthly Review Press.

British Psychological Society, Division of ClinicalPsychology (2000). Recent advances inunderstanding mental illness and psychoticexperiences. Leicester: The British PsychologicalSociety.

Brubaker, R. (1984). The limits of rationality: An essayon the social and moral thought of Max Weber.London: Allen & Unwin.

Buber, M. (1958). I and Thou. (Trans: R.G. Smith.)Edinburgh: T. and T. Clark.


Friedman, M. (1992). Dialogue and the human image:Beyond humanistic psychology. London: Sage.

Hochschild, H.R. (1983). The managed heart:Commercialisation of human feeling. London:University of California Press.

Holley, P.D. & Wright, D.E. (1998) ‘A Sociology ofRib Joints’. Reprinted in Ritzer (2002).

Holmes, J. (2002). ‘All you need is cognitivebehaviour therapy? British Medical Journal,324 (7332, Feb.), 288–294.

Hubble, M.A., Duncan, B.L. & Miller, S.D. (1999).The heart and soul of change: What works intherapy. Washington: American PsychologicalAssociation.

Kirschenbaum, H. & Henderson, V.L. (Eds.) (1990).Carl Rogers Dialogues. London: Constable.

Lomas, P. (1999). Doing good: Psychotherapy out of itsdepth. Oxford: Oxford University Press.

Ritzer, G. (1993). The McDonaldisation of Society.London: Pine Forge/Sage.

Ritzer, G. (1998) .The McDonaldisation Thesis.London: Sage.

Ritzer, G. (2002). McDonaldisation: The reader.London: Pine Forge/Sage.

Roth, A. & Fonagy, P. (1996). What works for whom:A critical review of psychotherapy research.London: Guilford.

Schon, D.A. (1987). Educating the reflectivepractitioner. London: Jossey-Bass.

Seligman, M.E.P. (1995). ‘The effectiveness ofpsychotherapy.’ American Psychologist, 50(12),965–974.

Spinelli, E. (2001). ‘Counselling psychology: ahesitant hybrid or a tantalising innovation.’Counselling Psychology Review, 16(3), 3–12.

Weber, M. (1974). The protestant ethic and the spirit ofcapitalism (Trans: T. Parsons). London: UnwinUniversity Books.

Whimster, S. & Lash, S. (Eds.) (1987). Max Weber,rationality and modernity. London: Allen &Unwin.

AcknowledgementThis paper is a development of ideas firstoutlined in ‘Counselling Psychology inContext’ jointly authored with Ray Woolfeand forming Chapter One of the forthcomingsecond edition of the Handbook of CounsellingPsychology, London, Sage.

CorrespondenceSheelagh StrawbridgeSelf-employed Chartered CounsellingPsychologist.28, Victoria Avenue, Hull, HU5 3DR.Tel: 01482 446324E-mail: [email protected]


Correction

Neilson, J. & Hall, A. (2002). Referral patterns for psychology within a Community MentalHealth Team. Counselling Psychology Review, 17(2), 32–38.

We regret that a typographical error was made in the first paragraph of the conclusion tothe above paper. This should have begun thus: ‘The opt-in procedure as a way of gatekeeping was a useful process. It occludes the need for a waiting list…’

Also we should have made it clear that the second author completed the research whilston a training placement.

The Editor.

Becoming a Therapist: A manual forpersonal and professional developmentMalcolm C. Cross & Linda PapadopoulosHove: Brunner-Routledge, 2001. 108pp. Paperback £12.99.

The desirability and place of personal therapy inthe training of counsellors has been a matter of

debate for a number of years, but the generalconsensus, it seems to me, is coming round to theview that ongoing personal development is a vitalingredient in the process of becoming an effectivecounsellor. The personality of the counsellor affectsthe outcome of counselling probably more than theparticular techniques or competencies employed. It istherefore important that all trainees have the oppor-tunity to maximise their potential and to have accessto the means which will enable them to do this. Thebook by Cross and Papadopoulos provides a big stepin this direction. It offers a structured approach to selfexploration and awareness-raising and deserves tofind a place in any self-development programmeplanned by the training institutions.

It is a short book, consisting of an Introductionfollowed by six chapters devoted to specific aspectsof human experience: Family, Culture, Gender,Ethics, Personal Strengths, Change and Resistance tochange. The book ends with a concluding chapter onthe counsellor’s journey towards professional effec-tiveness, including a checklist of milestones whichmay or may not have been achieved along the way.

The format of the six main chapters followsroughly the same sequence: there is an ‘input’ sectionwhere the significance of the topic under considera-tion is spelt out together with its relevance to thework of the counsellor; this is followed by a numberof exercises designed to facilitate the students’ self-searching and appraisal of their system of personalvalues (and here space is provided within the text forstudents to record their responses, reflections orother observations) and interspersed between theexercises is a commentary on what the authors areseeking to achieve by setting these tasks. In some of

the chapters a case study is presented at this point towhich students are invited to contemplate how theywould react as a therapist under such circumstances.Casting oneself in the role of a counsellor is a recur-ring theme throughout the book. Each chapter endswith i) a concluding statement about the relationshipbetween the subject under consideration and theacquisition of greater counselling competency and ii)a useful reading list for further study of the topic.

The teaching elements of the book are consis-tently linked to recent research findings. These aresimply, though succinctly, stated without elabora-tion. The reader is free to pursue further lines ofenquiry by consulting a fairly comprehensive refer-ence section at the end of the book. The experientialexercises are certainly thought-provoking and somemay be experienced as painfully challenging. Theyunquestionably serve as a mirror in which the readermay take a good look at him - or herself. One may notlike what one sees sometimes.

Which brings me to the point of the use to whichthis book might be put. It is described as a ‘manual’and could, therefore, be used as a personal journal, ornotebook of inner thoughts and feelings. Maybe thiswas the purpose which the authors had in mind.Safeguards would need to be taken to prevent thebook and the reader’s recordings falling into thewrong hands. It did occur to me, however, thatworking in isolation was possibly not the best way ofgetting the most out of this book. I found that insharing my responses to some of the exercises withthose of a colleague, we bounced ideas off oneanother and consequently both of us gained consid-erably in insight and depth of feeling. Perhaps amore profitable way of using this book would be in agroup situation. I could envisage it being used veryconstructively as required reading for members of apersonal development group, either as a lead-in toindividual meetings (e.g. a chapter or section permeeting) or as ‘homework’ preparation in readinessfor group participation. Alternatively, it could beused as a resource-book for group facilitators,although copyright restrictions would require


BBooookkRReevviieewwss

publisher’s permission before material could bereproduced. Any way, it offers an exciting prospectfor trainers.

The authors have been very generous in sharingtheir ideas and the book deserves to be read by awide readership, not only be those in training forcounselling and psychotherapy, but even moreseasoned practitioners stand to gain from it as well.

Graham D. Davies

Time–Limited Psychotherapy inPracticeGaby SheflerBrunner-Routledge, 2001. 315pp. Paperback £16.99.

Time Limited Psychotherapy is associated with thework of James Mann (1973, 1991), whose

psychotherapeutic thinking is Freudian in origin. TLPis not merely a shortened form of classical, or inte-grated, psychoanalysis, however, undertaken becauseof lack of time or scarcity of resources. Mann, andShefler after him, describe an approach in which thefact that treatment is restricted to 12 sessions oftherapy and no more is fundamental to theory andpractice. The experience of loss as a result of thecurtailment of a close therapeutic alliance, is pivotalwithin TLP because it refers directly to experiences ofseparation which are universal within humanpsychological development and formative of theways in which we all, as persons, interpret and reactto whatever is happening to us. Losses of one kind oranother lie close to the surface of our self- awareness;in some cases they are simply waiting for a safe timeand place in which to reveal themselves. In Mann’swords, ‘Separation and loss are more global in theirimpact and more readily accessible in a brief treat-ment model than are Oedipal problems’ (p.4).

Mann’s approach, which is the one Sheflerfollows in this book, concentrates on the isolation ofa particular ‘central issue’ representing the heart of apatient’s feeling of distress about him or herself.Once this has been located, it is consistentlyaddressed during the whole of the time availablewithout any time-out for discussing other aspects ofthe patient’s distress which may be related to thiscentral issue (and would certainly be explored intraditional forms of analysis), but are not nowconsidered to be crucial to it. From this point of view,TLP is a paring down of extended dynamic therapywhich does not answer the needs of all clients.Shefler describes the situational requirements whichmake it the treatment of choice: ‘Focus, limited dura-tion, an active and directive therapist, strongmotivation for change, a high level of psychologicalmindedness, and the presence of a clear-cut constel-lation of conflict in the patient’ (p.20).

Two things stand out as structural features of theapproach: urgency (i.e. apart from an initial assess-ment and two follow-up sessions, 12 sessions ofactual therapy and no more), and clarity (a short

statement, preferably arrived at during the firstsession of therapy, in which the therapist formulatesthe central issue confronting the patient with regardto the way she or he is experiencing, and dealingwith, life). These two essential factors within thetherapeutic process are located within a particularcontext, that of empathy: ‘The therapist must possessabilities for attachment and expression coupled witha good ability for separation’ (p.33). The treatmentwill not work unless the patient feels understood andaccepted; which is why the ‘central issue’ ispresented to him or her before the rules about timelimitation are laid down. There is nothing cold-blooded or impersonal about this diagnosticassessment; it comes from the therapist’s own will-ingness to involve her or himself in the patient’s painand discover as accurately as possible what it feelslike from the inside. The quality of the therapist’sempathy is the principal factor in the patient’s will-ingness to accept the information that there is a firmand inflexible time limit set upon his or her therapy– and to benefit from the knowledge.

The relationship between therapeutic time,andtime imposed from outside therapy in order to limitit, is the most fascinating aspect of TLP theory. This iswhat makes time limitation a therapeutic experienceand not simply an economic and administrativeconvenience (which, of course, it is). Within theempathic relationship we become less aware of thepressure of time. In psychoanalytic terms, thisinvolves the formation of a special kind of awarenessin which ordinary time is suspended so that ‘Thetherapist transforms himself or herself into a mean-ingful, powerful and prestigious figure for thepatient,’ thus giving special importance to any sepa-ration occurring between them by taking on the roleof ‘significant object’ (p.58).

The focusing of attention upon the patient’sawareness of a particular kind of personal paincauses it to emerge in spite of psychological defenceserected against it; the relief of self-enforced privacyand the presence of understanding and acceptancesuspends ‘objective’ time for the patient; ‘The count-down toward the termination session and itsimminent approach places the experience of an ever-lasting bond with the therapist […] in directcontention with a concrete manifestation of the‘calendar’ nature […] of time’ (p.59). The contrastbetween these two kinds of time experience gives thetherapeutic relationship a particular quality becauseit relates directly to, and reactivates, the separationanxiety underlying our ordinary everydayexperience, now transferred onto a setting in which itcan be consciously addressed and integrated as oneof the factors in the way we have learned to adjust toliving within a changeable world, by adaptationrather than denial. In Shefler’s words, ‘The issues oftermination and separation arise in the initial stagesof treatment, causing an acceleration of the separa-tion process similar to the concluding stage oflong-term dynamic psychotherapy’ (p.178).


Eight of the chapters of this 12-chapter book arecase studies of patients who have passed through this‘separation processing laboratory’ (Mann, quoted onp.178), their ‘central issues’ ranging from ‘adolescence’to ‘borderline personality disorder’, taking in on theway ‘obsessive personality’, ‘transition and narcis-sistic personality’, ‘shame’, ‘depression’, ‘helplessness’and ‘low esteem.’ The final category, ‘borderlinepersonality’ is included as ‘The description of anunsuccessful therapy’, the patient concerned eventu-ally being referred for treatment which was non-timelimited and which lasted, in fact, for three more years.(To what extent it was eventually successful we are nottold – but what Shefler has to say about the reasonswhy, in this case, a 12-week course proved so unsatis-factory is perhaps even more thought-provoking thanhis descriptions of successful cases.)

The following chapter concerns research intoTLP, touching on problems familiar to many disci-plines. In the most important investigation cited, theoverall difference before and after TLP was statisti-

cally significant (F(8,8)=14.18), with an experimentalpopulation consisting of ‘neurotic disturbancesrather than severe psychiatric disorders’ (pp.230,237). As a dramatherapist, I am particularlyconcerned with the effectiveness of time-limitedapproaches, for few arts therapists are in a position tocarry out extensive courses of treatment. I personallyfound this book fascinating for another reason,however. Theatrical time, like the intense therapeuticrelationship described here, cuts incisively acrossevery other schedule; and it is within theatrical time,time-out-of-time, that dramatherapy constructs itsown ‘separation processing laboratory’, safelyexploring the quality of existential separateness-in-relation upon which personhood depends (i.e. thekind of ‘mirroring’ described on p.III). This may notbe precisely what Mann and Shefler are saying here;but I shall continue to hold these ideas in tension. I have very much enjoyed reading this well-writtenand persuasive book.

Roger Grainger


LETTER FROM THE CHAIRIn my last (and also my first) Letter from the Chair I stated that ‘this is a significant time for coun-selling psychology in Britain’. Issues confronting our discipline and profession currently include:

Keeping in touch, and in tune, with our philosophical roots/underpinnings whilstresponding to the contextual needs and demands of working in multi-disciplinary teams,for example, in NHS Departments (the main employer and a possible source of funding forfuture trainee counselling psychologists);Deployment of members’/Division Committee’s resources in relation to developing theprofession of counselling psychology (e.g. through exploring and negotiating funding forcounselling psychology trainees) versus involvement in wider government issues, suchcommenting on the Draft Mental Health Bill, National Suicide Prevention and HumanBodies, Human Choices;Understanding and responding to the issues and implications of Devolution. Currently weare involved in working towards a change in our constitution which would allow for, andencourage, the formation of National Branches which would have representation on theDivision Committee.These issues were reflected in the agenda of the main annual Residential Meeting of the

Division Committee. The Committee meets six times a year (usually from 10.30 am–4 pm), butonce a year a second day is allocated for discussion/decisions on wider issues. This year themeeting took place on 13–14 September and items on the agenda included:

Funding for trainingThe Draft Mental Health BillDevelopment of a Parliamentary StrategyThe Revised Syllabus for Training in Counselling PsychologyNational Occupational StandardsRegistration of Psychologists Specialising in PsychotherapyRepresentation on the division Committee from Devolved nations/areasDivision-led workshops for traineesPsychological Testing and Counselling Psychology Much of this, on the face of it, would seem to address the rather more pragmatic issues and

aspects of our profession and some of it may appear at odds with our traditional roots and basicphilosophy. But let us not forget that although different presentations/language can be indicativeof different underlying philosophies and theoretical orientations, the defining features ofCounselling Psychology are:

How we think (as psychologists) – employing psychological knowledge and psychologicalprocesses – (theoretical understanding, gathering information, formulating hypotheses,testing hypotheses, etc.);What we do (as therapists) – informed by psychological theory and clinical practice;How we are (as people) – our own personal development and subjective, intuitiveunderstanding, what we bring to and our understanding of therapeutic and professionalrelationships;How we relate to the outside world (as social beings) our understanding of difference, thecontribution we bring to wider social/cultural/ethical issues.

Jill Wilkinson, Chair, Division of Counselling Psychology.

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DIVISION OF COUNSELLING PSYCHOLOGYheld at the Grand Hotel, Torquay at 11.30 am on Friday May l7, 2002.

Each year we publish the minutes of the Division’s Annual General Meeting so that members whowere not able to be present can see what was discussed.

In the Chair: Pam James

1. WELCOMEPam James welcomed the members of the Division to the Ninth Annual General Meeting of theDivision.

2. APOLOGIESApologies were received from: Robert Bor, Lynn Marsden, Ian Cockerill.

3. MINUTESAcceptance of the minutes of the 2001 Annual General Meeting was proposed and passed as anaccurate record of the meeting by those who attended it. There were no matters arising.

4. ANNUAL REPORTSThe annual report was proposed as an accurate record of the work of the Division and itscommittees. Those present were invited to comment or ask questions of the committee members.The following questions and comments were taken:

4.1 Treasurer’s ReportThe much reduced cost of the conference last year was raised compared to former years. Thetreasurer explained that last year, as it was a joint conference, the BPS largely took over the costso expenses listed were only for Division of Counselling Psychology expenses.

4.2 Press Officer’s ReportThe outgoing press officer was invited to describe what the job involved. Mainly the task isabout writing press releases for the conferences and any other interesting event for the pressand media and then dealing with any responses that result.

4.3 Training Committee for Counselling Psychologists4.3.1 A comment was made about the statement in the report that training courses seem to behaving difficulty in defining their philosophy. It was suggested it might more accurately readthat there are some differences in how the term ‘course philosophy’ is understood between theTCCP and the course directors.The incoming chair responded by informing those present that the syllabus for training hadnow been taken over by the division and it was their intention not to dictate philosophy but toleave courses with the flexibility to develop their own philosophies within a wider remit.

4.3.2 Concern was expressed at the inclusion in the same report of accreditation outcomes forcourses which had not yet been through the necessary confirmations at TCCP and MQB levels.The process should be confidential until the full process was completed. It was agreed that thisconcern would be reported back to the next TCCP meeting.


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Errata — Jennie Rowden not Sowden is one of the Amicus delegates.

4.5 Tabled ReportsTrainee Independent Route Representative ReportSarah Bartlett reported that she had now come to the end of her term of office which she hadreally enjoyed. She found it stimulating and emphasised the importance of the liaison betweentrainees and the division. The Information Days were a particularly successful part of her termof office.

5. ELECTION OF OFFICERS AND COMMITTEE MEMBERSVacancies on the committee were advertised in the Counselling Psychology Review and in thePsychologist

5.1 Election of officers. Division members had not been balloted as all those standing for officewere unopposed:

(a) Stephen Munt was declared Chair-Elect.(b) Louise Turner-Young was declared Honorary Membership Secretary.(c) Betty Rudd was declared representative of the Conference Sub-committtee.(d) Antonea Reay was declared Press Officer (co-opted).

5.2 Election of committee members. There were two standing for election for three vacancies.There was therefore no postal vote.Sarah Bartlett and Barbara Alexander were declared elected unopposed.

5.3 Ex-Officio. Alan Frankland is now the Registrar and Alan Bellamy is the new editor ofCounselling Psychology Review.

6. RULE CHANGEThis item was prematurely included as any future rule changes are not yet ready for considerationby division members. The item was therefore deleted from the agenda

7. VOTE OF THANKSA special vote of thanks was made by the Chair to five members who have given sterling serviceto the Division. Bouquets of flowers and bottles of wine were presented to:a) Kasia Szymanska for her many years as the editor of the Counselling Psychology Review.b) Mary Drummond for her hard work over more than five years on the conference

sub-committee.c) Owen Hughes for his excellent contribution as Press Office and also for his work at the

conferences.d) Paul Hitchings for his time as Chair Elect, Chair and Past Chair, he will be very much missed

by the committee having been involved now for over 10 years.e) Ray Woolfe who has been involved with the committee and as Registrar since the beginning of

the BPS involvement in counselling psychology.

8. AOB8.1 CoachingStephen Palmer suggested that those interested in this developing area should meet during theconference. A time and place were arranged


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Alan Frankland reported that there were now a number of places available on Council andencouraged counselling psychologists to get involved.

9. AWARDSJenifer Elton-Wilson was awarded the Annual Counselling Psychology Award in recognition ofher outstanding contribution to counselling psychology in Britain. Unfortunately she was unableto attend the conference so the award will be formally given at the conference in 2003.

ATTENTION: CONSULTANT COUNSELLINGPSYCHOLOGISTS/NHS B GRADES

In light of the increasing number of counselling psychologists being employed as B Gradesin the NHS, it might be useful to develop a network of such post-holders and organise aforum to meet. This would allow B Grade Counselling Psychologists to come togetherand explore issues of interest (e.g. service delivery, career development, introduction of

counselling psychology more broadly, etc). This is usefully done in other divisions and mayoffer a forum to share information across Trusts and to develop another voice for

counselling psychology in the Health Service.

In order to ascertain whether there is any interest in this idea, would B GradeCounselling Psychologists contact Martin Milton at the address below. When makingcontact it would be useful to note, specialism and employing Trust as well as interest

in meeting.

Please contact: Dr Martin Milton, Consultant Psychologist in Psychotherapy,The Hedgecock Centre, Barking Hospital, Upney Lane, Barking, IG11 9LX.

Telephone: 020 8276 7888/9 E-mail: [email protected]

VACANCY FOR CONFERENCE CO-ORDINATORAND DEPUTY

The British Psychological Society Division of Counselling Psychology Conference Sub-Committee is seeking two new members whose duties will include being Co-ordinator and Deputy Co-ordinator, respectively, for Conference 2004.

There is a nominal fee for these duties.Please send your expressions of interest to: The Honorary Secretary, BPS Division of

Counselling Psychology, at the Society’s Leicester Office, by 14 December 2002.

If you would like more information before expressing an interest, please contact

MEMBERS OF DIVISION COMMITTEE 2002/2003The composition of the Division Committee for 2002/2003 is as follows:

Officers

ChairJill WilkinsonCheshunt Consultancy, Cheshunt, Blackhead, Guildford GU4 8QT.Also representative on BPS Council and Scientific Affairs Board

Chair ElectStephen MuntSchool of Psychology & Therapeutic Studies, University of Surrey Roehampton, Whitelands College, West Hill, London SWIS 35N.Tel: 0208 392 3626, E-mail: [email protected]

Past ChairPam James47 Westbourne Road, Southport, Merseyside PR8 2HY.Tel: 07949 502161 E-mail: [email protected] representative on Professional Affairs Board and Standing Committee of Psychologists inHealth and Social Care

Hon. SecretaryJill MyttonSchool of Psychology, University of East London, Romford Road, London E15 4LZ.Tel: 020 8223 4456Also representative on CPCDC

Hon. TreasurerGary TannerClinical & Counselling Psychology Services, Lanarkshire Primary Care NHS TrustLevel 2, Strathmore House, East Kilbride G74 1LF.Tel: 01355 249470

Hon. Membership SecretaryLouise Turner-YoungPsychology Department, Dykebar Hospital, Grahamston Road, PaisleyRenfrewshire & Inverclyde.E-mail: [email protected]

Chair of Conference Sub-CommitteeBetty Rudd73 Edward Road, Haywards Heath, West Sussex RH17 4QL.

Chair of Sub-Committee for Practice & ResearchSusan van ScoyocTWP Counselling Psychology, Suite 54, Dorset House, Chelmsford, Essex CM1 1TB.Tel: 01245 349072 Fax: 01245 283826E-mail (1): [email protected] E-mail (2): [email protected]

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Chair of CPD Sub-CommitteeAngela LawrenceKinta House, Helme Close, Kendal, Cumbria LA9 7HY.Tel: 07811 350211/732059E-mail: [email protected]

Press and Information OfficerAntonia Reay118 Hertford Road, London N1 4LP.

Ex Officio

Editor of CPRAlan BellamyPembrokeshire and Derwen NHS Trust, Brynmair Clinic, Goring Road, LlanelliCarmarthenshire SA15 3HF.Tel: 01554 772768 E-mail: [email protected]

RegistrarAlan M. Franklandc/o APSI, Melbourne House, 3 Villa Road, Nottingham NG3 4GG.Tel: 0115 969 3028 E-mail: [email protected]

Chief ExaminerPat Didsbury6 Little Bank Close, Bamber Bridge, Preston PR5 6BU.

Ordinary Members

Sarah BartlettDepartment of Clinical and Health Psychology, Gaskell House, Swinton GroveManchester M13 0EU.Tel: 0161 273 3271

Ruth JordanEIHMSDuke of Kent Building, University of Surrey, Guildford GU1 1XH.Tel: 01483 684642 E-mail: r. [email protected] NHS representative

Barbara AlexanderPsychotherapy Department, Wonford House Hospital, Dryden Road, Exeter, Devon EX2 SAF.Tel: 01392 403 433

Lynn MarsdenBeech Knoll, Poulner Hill, Ringwood, Hants BH24 3HR.

Margaret McLeanDepartment of Psychology, Block A, Clerk Seat Building, Royal Cornhill HospitalAberdeen AB25 2ZH.Also Scottish Officer

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Jennie RowdenColeford House CMHT, Gloucestershire Partnership NHS Trust, Boxbush Road, ColefordGloucestershire GL18 6DN.Tel: 01594 598200 E-mail: [email protected] Amicus/MSF Representative

Co-opted Members

Qulsoom InayatCourse Route Student Representative, University of Greenwich, School of Social Sciences, Avery Hill Road, London SE9 2UG. Tel: 020 8331 8907. E-mail: [email protected]

Sally GreenfieldIndependent Route Student Representative, The Oaks, 215 Rye Street, Bishop’s Stortford,Herts CM23 2HE.E-mail: [email protected].

Nicky HartTCCP Representative, Psychology Division, School of Health SciencesUniversity of Wolverhampton.

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DIVISION OF COUNSELLING PSYCHOLOGY2003 ANNUAL CONFERENCE

STRATFORD-UPON-AVON15–18 MAY

Pre-Conference Workshops

Prof. David Rennie: Research supporting the practice of experiential person-centredcounselling.

Dr Heinl: ‘Seeing’ the unconscious trauma. Exploration of early experiences throughintuition and the use of objects.

Kath Mannix: The use of cognitive therapy in palliative care.

Further details about workshops, facilitators and main conference are on the DCoP website.

Don’t forget about proposals for papers, symposia, workshops and posters.

If you have any queries then contact Isabelle Roney, 2003 Conference Organiser [email protected]


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DIVISION OF COUNSELLING PSYCHOLOGYSTATEMENT OF INTEREST IN VACANCIES ON COMMITTEESAND WORKING PARTIESFrom time to time, committees and working parties are looking for people to nominate for electionor to co-opt to membership. Some posts are representative of a particular group, some postsrequire particular expertise or interests. In order to promote openess, the widest possibleparticipation and equality of opportunity, the Divisional Committee invites expressions of interestfrom any Accredited, General, Affiliate or trainee members. (Trainees are needed from both courseand independent routes). Individuals may also nominate themselves directly for election to theDivisional Committee or for posts such as the Editor of Counselling Psychology Review, when thereare vacancies.

WHAT ARE THE DIVISION OF COUNSELLING PSYCHOLOGY (DCoP) COMMITTEESAND WORKING GROUPS?Division Committee (DC)Training Committee (TC)Board of Examiners (BoE)Sub-committee for Conference (5CC)Sub-committee for Practice and Research (SCPR)Public Relations (PR)Continuing Professional Development (C PD)

HOW TO APPLYPlease complete the section below and send to: The Honorary Secretary of the Division ofCounselling Psychology, The British Psychological Society, St Andrews House, 48 Princess RoadEast, Leicester LEl 7DR, together with a letter indicating your desire to serve, specifying in whatarea, whom you could represent and any special expertise or experience you have to offer. A willingness to learn, together with energy and enthusiasm, are particularly welcomed. CVs arenot required.

Name .................................................................................................................................................................

Address .............................................................................................................................................................

............................................................................................................................................................................

Tel. No: Home.......................................... Work.......................................... Fax...........................................

E-mail: ...............................................................................................................................................................

If you would like to discuss your application first please contact one of the committee memberslisted in Counselling Psychology Review.


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THE NATIONAL ASSESSORS LISTAs more Counselling Psychologists move toward a level of experience in the NHS that mayqualify them to apply for promoted posts, for example at Grade B level, it becomes increasinglyimportant that there are Senior Counselling Psychologists on the National Assessors List, for it isthe assessors who advise on such appointments. The following statement summarises therequirements to apply to be an assessor, the sections of the list, and the contact details for furtherinformation. Note the use of the term ‘Applied Psychologist’ in the statement. Although the Listis administered by the Division of Clinical Psychology, application for promotion to Grade B postsand entry to the List of Assessors is now open to all Applied Psychologists with the appropriateexperience, qualifications, and record of performance for the particular post or appointment.

APPOINTMENT OF APPLIED PSYCHOLOGISTS IN THE NHS(ENGLAND, WALES AND NORTHERN IRELAND)NATIONAL ASSESSORS LISTQuality assessment of applied psychologists at Grade B level is an important part of theprofession’s responsibilities under clinical governance. Therefore, the number of names on the listof assessors needs to be continually revised and so that it remains possible to find suitable peopleto take part in the appointments process. Any B Grade Applied Psychologist with a minimum offour years experience in the grade may apply to be an assessor. Annual workshops for assessorsare organised to help them in this work.

Appointment as a Grade B Consultant Applied Psychologist requires that ‘the experience,qualifications and performance of the individual under consideration are appropriately assessed’.It is the task of the assessor to carry Out this assessment.

In practice this means that the appointment process should include two external people fromthe list of National Assessors that is compiled by the BPS and issued by the NHS Executive to HRDepts. The Society’s electronic list is regularly updated with the NHS being informed of thechanges. It used to be the responsibility of the Consultant Adviser in Clinical Psychology to theChief Medical Officer of Health to update the list but this post no longer exists and the Division ofClinical Psychology has taken over the function.

The sections of the list are:● Management responsibilities;● Adult Mental Health Services (including assessors who in addition have expertise in the

specialist psychotherapies and services for people with long term psychiatric disability);● Services for people with learning disabilities;● General Medical Services (HIV/AIDS/Sexual Health, people with physical and sensory

disabilities and people with physical ill-health);● Substance misuse and addictive behaviour;● Teaching training and research responsibilities;● Neuropsychology and neurological rehabilitation;● Forensic services (including services for detained patients and mentally disordered offenders);● Services for older adults;● Primary Care Services (including General Practitioner-based posts);● Services for children and young people;● Social Services and community care settings.

An application form can be downloaded from www.bps.org.uk/sub-syst/dcp/index.cfm orrequested from Gwen Ward on 0116 252 9517 or e-mail: [email protected]

CORRESPONDENCE

Dear Editor,

I feel privileged and honoured to be appointed as the Honorary Chair for our Society’s Divisionof Counselling Psychology Sub-Committee for Conference. My aim is to build on the foundationsand hard work laid during the past years by Mary Drummond, Diane Hammersley and others, byconsolidating their input and continuing to put our vision of annual conferences into action. I takethis opportunity to thank Mary Drummond for passing on to me such a viable committee. Our division’s SCC is currently a strong team, and new pro-active members are welcome.

My future vision if not only for our conferences to continue but also for better PR, especially withthe media, for Counselling Psychology to gain a higher profile and to liaise with outside bodies inorder to ‘advertise’ the benefits that members of our Society’s Division can bring to their clientele.In my view, it is possible to do all this and more, via our conferences.

I look forward to our conferences leading further into the 21st century, which I am confident willbe achieved with our strong team as well as encouragement and input from you the members ofthe Division.

Hopefully, more people will attend conferences as our membership grows. I am happy to considerany suggestions you might have for conference venues and invited speakers. Please also contactme about any queries you may have about our conferences. Help me to help you get the most ofour conferences, by sending me your views, comments and suggestions c/o The BPS in Leicester.

Betty Rudd, Chair of the Sub-Committee for Conference

Dear Editor,

A notice appeared in the last issue of Counselling Psychology Review (Volume 17 Number 3) aboutthe Division of Counselling Psychology Interest Group in Coaching. Whilst recognising the valueof such groups, as yet the Division has no mechanism within its constitution for setting up interestgroups, or Special Interest Groups (SIGs), as they are generally called. At the last DivisionCommittee meeting, it was agreed that this should be rectified. We are accordingly working on aproposal to amend the constitution so that members with specific interests can put forwardproposals to form SIGs on which the membership of the Division will be able to vote. Whilst thismay appear somewhat bureaucratic, it is nevertheless necessary in order to preserve the integrityof the Division.

Jill Wilkinson, Chair, Division of Counselling Psychology.

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CONFERENCE DIARYFormat of events listed is:date: eventvenuecontact

NOVEMBER 2002

20–23: 3rd Ibero-american Congress onClinical and Health PsychologyCaracas, Venezuela.Contact: Zuleyma Perez; Alcabala a PuenteAnauco, Edificio Puente Anauco Piso # 2,Apartamento # 27, La Candelaria, CaracasTel/Fax: (+58) 212-5713060E-mail: [email protected];apicsa@attglobal. netWeb: www.apicsa.com/congreso_c

DECEMBER 2002

4–6: 4th Conference, European Academy ofOccupational Health PsychologyVienna, Austria.Web: www.ea-ohp.org/Vienna2002

JANUARY 2003

28: Health Education Journal Conference onPostgraduate Training in Health PromotionProfessor Anthony Blinkhorn, UniversityDental Hospital, Higher Cambridge Street,Manchester M15 6FH.Tel: 0161 275 6610 Fax: 0161 275 6299E-mail: [email protected]

FEBRUARY 2003

18–22: Biofeedback Foundation of Europe:7th Annual Meeting, Scientific Programmeand WorkshopsHospital Gervasutta, Udine, Italy.Mark Schwartz, Project ManagerTel: (1) 514 489 8251 Fax: (1) 514 489 8255E-mail: [email protected]: www.bfe.org

MARCH 2003

13–15: The British Psychological SocietyAnnual ConferenceBournemouth International Centre, Bournemouth.The British Psychological Society ConferenceOffice, St Andrews House, 48 Princess RoadEast, Leicester LEl 7DR.Tel: 0116 252 9555 Fax: 0116 255 7123E-mail: [email protected]: www.bps.org.uk

20–23: Work, stress and health: New challenges in a changing workplaceThe Fifth Interdisciplinary Conference onOccupational Stress & Health, convened byAPA, NIOSH and the School of Business ofQueen’s UniversitySheraton Hotel, Toronto, Ontario, Canada.Wesley Baker, Conference Co-ordinator,American Psychological Association, Women’sProgrammes Office, 750 First Street, NE,Washington, DC 20002-4242, USA.Tel: 202-336-6033 Fax: 202-336-6117E-mail: [email protected]: www.apa.org/pi/work/niosh5call.html

MAY 2003

16–18: The British Psychological SocietyDivision of Counselling Psychology AnnualConference 2003The Moat House Hotel, Stratford-on-Avon.The British Psychological Society ConferenceOffice, St Andrews House, 48 Princess RoadEast, Leicester LEl 7DR.Tel: 0116 252 9555 Fax: 0116 255 7123E-mail: [email protected]: www.counsellingpsychology.org.uk/conferences.htm

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16–17: British Association for Counsellingand Psychotherapy Annual ResearchConferenceLeicestershire.Angela Couchman, Research & DevelopmentOfficer, British Association for Counsellingand Psychotherapy, 1 Regent Place, Rugby,Warwickshire CV2 1 2PJ.Tel (general): 0870 443 5252Direct (Angela Couchman): 0870 443 4537Fax: 0870 443 5161E-mail: [email protected]: www.bacp.co.uk

22–23: Second International Conference ofthe Institute of Health Promotion andEducationSt. Catherine’s Hospice Training Centre, Crawley,Sussex.Helen Draper, University Dental Hospital,Higher Cambridge Street, Manchester M15 6FH.Tel: 0161 275 6610E-mail: (Professor Anthony Blinkhorn, Hon Sec): [email protected]: www.ihpe.org.uk

JULY 2003

6–11: 8th European Congress of PsychologyVienna, Austria.Berufsverband ÖsterreichischerPsychologinnen und PsychologenMöllwaldplatz 4/4/37, A-1040 Vienna,Austria.E-mail: [email protected]: www.psycongress.at

12–16: 6th European Regional Congress ofthe International Association for Cross-Cultural Psychology (IACCP)Budapest, Hungary.Dr Márta Fülöp, MTA PszichológiaiKutatóintézet, Budapest, Victor Hugo utca18–22, Hungary-1132.E-mail: [email protected]

[email protected]: www.psychology.hu/iaccp

22–25: VIII European Conference onTraumatic StressBerlin, Germany.Conference and Exhibition Office: VIII ECOTSBerlin 2003, CPO HANSER SERVICE GmbH,PO Box 33 03 16, D-14173 Berlin, Germany.Tel: +49-30-300 66 90 Fax: +49-30-305 73 91E-mail: [email protected] Society for Traumatic Stress Studiescontact details: ESTSS Secretariat Rijnzichtweg35, NL-2342 AX Oegstgeest.Tel: +31-71-519 15 16 Fax: +31-71-515 72 32E-mail: [email protected]: www.estss.org/form.htm

www.trauma-conference-berlin.de

Our policy for including events for this diaryis that the events should be broadly relevantto our readership and also bring together arange of speakers from different organisationsor backgrounds (as opposed to single-speakerworkshops, which we do not have the scopeto promote).

Please send details of all appropriateconferences to me:

By post: People in Progress Ltd, 5 Rochester Mansions, Hove, East Sussex BN3 2HA.

By fax: 01273 726180.

By e-mail: [email protected]

I look forward to hearing from you.

Jennifer Liston-Smith

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AN INTRODUCTION TO THE REGISTER OF PSYCHOLOGISTSSPECIALISING IN PSYCHOTHERAPY – PRINCIPLES ANDPROCEDURESby The Psychotherapy Implementation GroupThe registration of psychotherapists has become a ‘hot’ issue over the past few years. A bill for theregistration of psychotherapists was introduced in the House of Lords in the last session. It gainedconsiderable support both within the profession and beyond, suggesting that further attempts togo down the road of legal registration will continue.

In Britain different organisations (e.g. UKCP, BACP) have been established to recognise thosewho they deem to be suitably qualified as psychotherapists. Similar organisational developments(and battles) have been taking place in Europe, with varying attempts to include or exclude partic-ular professions.

Although different approaches to psychotherapy form significant parts of the training of manyprofessional psychologists (especially clinical and counselling psychologists), and many psycho-logists are experienced and influential psychotherapy practitioners, teachers and researchers,there has been no way for psychologists to be formally recognised as psychotherapists within theSociety.

The situation is now to be rectified with the introduction of the Register of PsychologistsSpecialising in Psychotherapy.

This registration process is a long awaited and significant development within the Society.Much work has been done by many people over the past 10 years to achieve this end. Differentapproaches to the registration process have been examined. The Proposals finally accepted by theCouncil of the Society (following detailed consideration and acceptance by both the Membershipand Qualifications Board (MQB) and the Professional Affairs Board (PAB)) are different from thosethat preceded them, but they have developed from, and stand on the shoulders of, earlier options.

In approaching the principles and procedures of the registration process, it is important torecognise that a distinctive stance is being taken for the recognition of psychologists specialisingin psychotherapy. At the beginning of a new millennium, and after 100 years of developmentswithin both psychotherapy and the Society, it seems appropriate to reflect on the relationshipbetween psychology and psychotherapy in new ways. The Society’s approach to the Register lookstowards the future of both psychology and psychotherapy and to the potential contributionswhich each discipline can make to the other.

Both psychology and psychotherapy involve professional engagement with psychologicalprocesses. The stance taken to registration acknowledges and elaborates the special responsibili-ties which psychologists have in relation to the development and practice of psychotherapy.

Many psychologists have been involved in psychotherapy practice, research and training forlong enough to have developed understanding, expertise and ideas about how the two disciplinesmay further elaborate their contributions to society. The registration process seeks to encourageinnovative developments within and between psychology and psychotherapy.

The notes which follow provide only a broad outline, and should be treated as a brief intro-duction to the Society’s document (BPS, 2002), The Register of Psychologists Specialising inPsychotherapy – principles and procedures (RPP).

A single Register is to be created, recognising basic competence in psychotherapy, though waysof recognising ‘advanced practitioner’ status will be implemented, in due course, for psychologistson the Register.

All applicants for the Register have to be chartered psychologists. All applications must bemade individually, but when courses accredited by the Society are developed the process willbecome much simpler.

The registration process aims to be as inclusive of different approaches as possible, while main-taining a carefully evaluative stance in relation to standards of practice and the credibility of thepsychological perspectives involved.

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The approach to psychotherapy practice and training which has been adopted emphasises thewider social world in which these psychological activities are undertaken. The importance isrecognised of developing ways and means whereby clients can make significant contributions tothe evaluation of the services offered. At the same time, national standards of achievements forpostgraduate training (QAA, 2000) are used as guidelines for making judgements in relation topsychotherapy training and practice.

The thinking behind RPP is primarily forward looking, charting a direction for the develop-ment of training and practice for psychologists specialising in psychotherapy. However, priority isgiven to the ‘grand parenting’ process by which foundation members of the Register will beassessed and included on the Register. All potential foundation members of the Register will besubject to the evaluation procedures, but with a more flexible use of criteria than will eventuallyapply. There will be a five-year period from the opening of the Register during which applicationfor foundation membership can be made.

The report sets an explicitly psychological framework for approaching the tasks involved inestablishing and maintaining the Register. Six principles are spelled out which indicate what isexpected of psychologists specialising in psychotherapy. These include:● active recognition of the necessary interplay between psychological and psychotherapeutic

theory, knowledge and practice; ● the fundamental importance of ongoing inquiry in psychology and psychotherapy; ● the need to develop understanding, knowledge, and practical competence in psychotherapy; ● the requirement for continuing personal development and supervision in relation to

psychotherapy practice; ● the importance of wider social, cultural and political knowledge and awareness in relation to

psychotherapy; ● the requirement for continuing professional development to meet the requirements of

periodic re-registration as psychologists specialising in psychotherapy. A psychological approach to training and practice is spelled out which values the range of

current approaches to psychotherapy, and which emphasises the importance of developingknowledge and understanding of a number of approaches to theory and practice. No singletheoretical approach has been shown to have all the answers, and understanding of differentperspectives and practices is recommended. Practical competence in at least one psychothera-peutic approach has to be developed and demonstrated.

After considering various ways of evaluating applicants for membership of the Register ofPsychologists Specialising in Psychotherapy, emphasis has been placed on the achievement ofcompetences in relation to knowledge, understanding and practice. This is a challenging basis forjudgement, but is increasingly recognised as important in the wider social contexts within whichpsychotherapists function.

Following from this, it becomes necessary for individuals and courses to articulate theirvarious Aims in relation to each of the Principles (mentioned earlier) and to work out in consid-erable detail what Competences have to be developed in order to achieve each Aim. Within theRPP document, two illustrative Aims are indicated for each of the six Principles, and examples ofCompetences relevant to a couple of Aims are indicated. A more fully worked out example (inordinary language) of how a network of Principles, Aims and Competences can be articulated isprovided in the Appendix. While these are presented as strong advice for individuals and courses,they are guidelines rather than rigid requirements. Individuals and courses are expected to givecareful and creative attention to the detailed task of spelling out aims and competences in relationto the six principles relevant to their psychotherapeutic approach.

The requirements for acceptance onto the Register are indicated in some detail for applicantsfor foundation membership and for those currently in training who will be accepted later asregular members. As already mentioned, applicants for foundation membership will be consid-ered in relation to the same broad requirements as those to be used for psychologists currently in

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training as psychotherapists, but a more flexible use of the criteria will be adopted to recognise thediversity of their psychotherapeutic experience and the less structured routes of training thatmany may have had available to them.

Administrative arrangements by which the process of registration will be established andmaintained are presented. The main committee involved in the registration process will be theRegistration Committee for Psychologists Specialising in Psychotherapy (RCPP). It will besupported in its work by the Assessors’ Sub Committee (ASC) and appropriate Working Groups,established for specific purposes. The RCPP will be responsible to MQB. Details are provided asto how the whole process will operate, and how it will be established.

Finally, detailed notes of guidance are provided for applicants, assessors and those involved inthe training of psychologists specialising in psychotherapy. It is hoped that these will be helpfulfor all who seek to understand and engage with the process of registration as psychologistsspecialising in psychotherapy.

Further information can be obtained from Ms Elizabeth Stanton-Buck, Acting Registrar, StAndrews House, 48-49 Princess Road East, Leicester LE1 7DR. Tel: 0116 252 9909. E-mail:[email protected]

ReferencesPsychotherapy Implementation Group (2002). The Register of Psychologists Specialising in

Psychotherapy – principles and procedures. Leicester: BPS.Quality Assurance Agency for Higher Education (2000). The framework for higher education

qualifications in England, Wales and Northern Ireland.Quality Assurance Agency for Higher Education (2000). The framework for qualifications of Higher

Education Institutions in Scotland.

The Members of the BPS Psychotherapy Implementation Group are: Dr Ralph Goldstein, Professor Miller Mair, Dr Adrian Newell and Professor Mary Watts (Chair).

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TALKING POINTThe first in a series of short pieces by invited Counselling Psychologists on subjects of topicalinterest and debate. Responses to the views expressed in Talking Point are welcomed: write to theEditor marking your letter ‘for correspondence’.

FREUD, PSYCHOLOGY AND PSYCHOTHERAPYAmong Sigmund Freud’s many radical contributions to our understanding of the human condi-tion, what is sometimes overlooked is his willingness to confront the medical establishment. Inparticular I want to point to the way he challenged the view that only doctors should be licensedto practise psychoanalysis. He pointed to the absurdity of the law as it existed which said that asonly doctors were allowed to treat patients and as psychoanalysis was a treatment for neuroticdisorder, it followed that only doctors could be allowed to practise it, irrespective of their personalsuitability or relevance of their medical training. He argued that what was important was what wenow call competence and that the necessary personal qualities and training could as equally beacquired by the ‘layman’ as by the doctor. Psychoanalysis he suggested is not a specialised branchof medicine but is a part of psychology.

I was reminded of this history when looking through the document produced by the BPS entitled The Register of Psychologists Specialising in Psychotherapy – principles and procedures. In partic-ular I was struck by the sentence on page 4 in which ‘it is assumed that psychologists specialisingin psychotherapy will be among the more knowledgeable practitioners in their area of work’. I wasstruck by the parallel between the seeming arrogance of this statement and the situation withwhich Freud was confronted as he developed his ideas and practice.

Some years ago I trained as a psychoanalytic psychotherapist and among my fellow traineeswho successfully passed the course were a psychiatrist, an occupational therapist, a communityworker, a psychiatric nurse, a music therapist, a counsellor and a teacher. We all did the sametraining, but it would appear that I am now being asked to believe that because I am a psycholo-gist, I am somehow a more knowledgeable practitioner than these colleagues. It may well be thatmy training as a psychologist provides me with expertise in a certain range of skills that they maylack, but could not this also be the case in reverse and that there is something in their training thatis not available to me? I now work in a clinical setting with a variety of people from different occu-pational backgrounds all offering psychodynamic therapy. Again, am I to assume that their workis less sophisticated than my own? While my personal orientation is psychoanalytical, I have noreason to believe that the same arguments are not also valid in the case of cognitive-behaviouralpsychotherapists.

Just as the medical establishment sought to colonise psychoanalysis, there is a tendency forpsychology to act likewise through an assumption that it alone has access to understanding thehuman condition. It is very likely that large numbers of clinical and counselling psychologists willclaim competence as psychotherapists. But as Freud wisely commented, ‘we have a right todemand that they (doctors) do not mistake their preliminary education for a complete training’.Perhaps we also need to acknowledge that psychology is not the only discipline which engageswith subjectivity, inter-subjectivity, values and feelings.

Ray Woolfe


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Editorial 2Kasia Szymanska

Letter from the Chair 3Pam James

The importance of developing a ‘culture of belief ’ 4amongst counselling psychologists working with asylum seekersKate Harris

Counselling psychology and the NHS: 16An individual perspectiveJacqueline Smallwood

Trainee expectations in counselling psychology 22as compared to the reality of training experiencesKasia Szymanska

Are counselling psychologists experiencing a 28‘clinical apartheid’ within the NHS?Jane Benanti

Book Reviews 34

Events Diary 36

News of Members 36

Volume 17 ● Number 2 ● May 2002


Letter from the Chair 3Pam James

Extended paper. 4The existential-phenomenological paradigm: The importance for psychotherapy integrationMartin Milton, Linda Charles, Dale Judd, Michael O’Brien, Annie Tipney & Amanda Turner


The role of the therapeutic relationship in promoting 23psychological change: A cognitive behavioural perspectiveSarah Corrie

Referral patterns for psychology within a 32Community Mental Health Team (CMHT)Jill Neilson & Anna Hall

Senior Examiner’s Report of the 2001 examinations for 40the Society’s Diploma in Counselling PsychologyPat Didsbury

Book Review 43

Correspondence 45

Conference Diary 46

Volume 17 ● Number 3 ● August 2002


Letter from the Chair 3Jill Wilkinson

Young people’s accounts of homelessness: 5A case study of psychological well-being and identityEsther H. Riggs & Adrian Coyle

Working with perfectionism: Towards identifying the 17needs of an emerging clientSarah Corrie

Suicide: The effect on the counselling psychologist 28Anopama Kapoor

Teaching and learning through client case studies: 36Counselling psychology in practiceJo Ploszajski, Malcolm M. Cross & Linda Popadopoulos

Book Reviews 45

Conference Diary 48

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Editorial 2Alan Bellamy

The three approaches to a therapeutic relationship: 3instrumental, authentic, transpersonalJohn Rowan

Accessing needs for psychological therapies in the context 11of the National Service Framework for Mental HealthRob Leiper

‘McDonaldisation’ or ‘Fast-food therapy’ 20Sheelagh Strawbridge

Book Reviews 27

Newsletter SectionLetter from the Chair 30Minutes of Division Annual General Meeting 31Divisional Committee 2002/2003 34Statement of Interest for Committees 37The National Assessors List 38Correspondence 39Conference Diary 40An introduction to The Register of Psychologists 42Specialising in Psychotherapy – principles and proceduresTalking Point: Freud, Psychology and Psychotherapy 45Ray Woolfe

Index to Volume 17 46

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Notes for Contributors toCounselling PsychologyReviewSubmissionsThe Editorial Board of Counselling Psychology Review invites contributions on any aspects of counselling psychology. Papersconcerned with professional issues, the training of counselling psychologists and the application and practice of counsellingpsychology are particularly welcome. The Editorial Board would also like to encourage the submission of letters and news offorthcoming events.

Manuscripts should be typewritten, double spaced with 1" margins on one side of A4 paper. Each manuscript should include aword count at the end of each page and overall. Sheets should be numbered. On a separate sheet include author’s name, anyrelevant qualifications, address, telephone number, current professional activity and a statement that the article is not underconsideration elsewhere and has only been submitted to Counselling Psychology Review. As articles are refereed, the rest of themanuscript should be free of information identifying the author. Authors should follow The Society Guidelines for the Use ofNon-Sexist Language contained in the booklet Code of Conduct, Ethical Principles and Guidelines. Four copies of the manuscriptshould be submitted with a large s.a.e. A copy should be retained by the author.

Bibliographic references in the text should quote the author’s name and the date of publication thus: Davidson (1999). All references should be listed at the end of the text and should be double spaced in APA style. A guide to the presentationof references using the APA style is given in The British Psychological Society Style Guide, available at £3.50 per copy from TheBritish Psychological Society, St Andrews House, 48 Princess Road East, Leicester LE1 7DR, UK.

Low-quality artwork will not be used. Graphs, diagrams, etc., should be supplied in camera-ready form. Each should have atitle. Written permission should be obtained by the author for the reproduction of tables, diagrams, etc., taken from othersources.

Submissions with abstracts onlyThe abstract should be no longer than 250 words (depending on the length of the paper). It needs to be double spaced, on aseparate sheet and headed ‘Abstract’. The British Psychological Society’s Style Guide provides the following information onwriting abstracts:

The purpose of the abstract is to allow the reader to assess the content of the article prior to reading the full text. In addition to appearing immediately below the author’s name, the abstract will be used for indexing and information retrievalby such services as Psychological Abstracts. It should, therefore, be written so that it can be understood independently of thebody of the paper (p.6).

Proofs of articles are sent to authors for the correction of typesetting errors only. The Editor needs the prompt return ofproofs.

Contributors should enclose a 3.5" disk (either DOS or Mac format) with the document saved bothin its original word-processing format and as an ASCII file. All diagrams and other illustrationsshould be saved in their original format and as a TIFF or an EPS.

Other submissionsBook reviews, letters, details about courses and notices of forthcoming events are not refereed but evaluated by the Editor.However, book reviews should conform to the general guidelines for academic articles. Contributors should enclose twohard copies.

Deadlines for notices of forthcoming events, letters and advertisements are listed below:For publication in Copy must be received byFebruary 5 NovemberMay 5 FebruaryAugust 5 MayNovember 5 August

All submissions should be sent to: Dr Alan Bellamy, Editor, Counselling Psychology Review, Brynmair Clinic, GoringRoad, Llanelli, Carmarthenshire, SA15 3HF.

counselling psychology reviewbps-dcop-uk.s3.amazonaws.com/cpr/cpr_2002_17_4.pdf · ken wilber...

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