A Common Conversation

He said: I want to be normal again

I said: What’s normal?

He said: Like I was before

I said: What would that have been?

He said: Happy

I said: What makes you think you should be happy?

He said: Because I was.

I said: And now?

He said: I’m not happy.

I said: That’s tough then.

He said: Yeah. It is.

I said: And it shouldn’t be tough?

He said: No. Not this tough.

I said: And it is this tough.

He said: Yes. It is.

I said: Are you sure?

He said: Yes. I am.

I said: Good. Now we know where to start

Your MENTAL Health? Really?

MENTAL Health. 

The Oxford Dictionary definition of Mental


relating to the mind
 mental phenomena
mental faculties 




done by or occurring in the mind:a quick mental calculation, she made a mental note to ring him later



of or relating to disorders of the mind: a mental hospital

[predic.] 

informal mad; insane:I think he was a little worried that I might be mental


Origin: late Middle English: from late Latin mentalis, from Latin mens, ment-'mind'


The use of mental in compounds such as mental hospital andmental patient was the normal accepted term in the first half of the 20th century. It is now, however, regarded as old-fashioned, sometimes even offensive, and has been largely replaced by the term psychiatric in both general and official use.



How often have you heard  - "well, we all have mental health issues", "I'm worried about my mental health"? What do we really mean when we say this? What are we really trying to identify?

It has become a term so ubiquitous it is now very much part of the zeitgeist. We talk about 'mental health' as if we all understand what that means; a term swallowed whole without being chewed over, digested or appreciated, and this lack of awareness is having serious repercussions for those identified as having a 'mental health' problem or 'disorder'.

In my practice I frequently meet people who have either identified themselves, or been identified, perhaps by a GP, psychiatrist, or indeed a friend, as having a mental health disorder, problem or issue; they have 'depression', 'anxiety', 'bipolar disorder',  'social anxiety disorder', 'obsessive compulsive disorder'. These labels strike fear into most of us because they are de-contextualised from our individual lives and perspectives, identify us as a member of a sub-group and thus incomprehensible. "How come I've got this (illness)?" The subtext will often be - "I am (mentally) ill" or simply "I am mental", "there must be something wrong with my brain", "I'm mad"etc.

No doubt you will have noticed my italicised emphasis - mental. As you read these words, notice how you react, how the word locates the field of the problem; in the head and probably more specifically in the brain or the mind. The Oxford Dictionary definition above clearly locates this as the field.

My gripe with this is not semantic, far from it, for quite clearly we need our mental faculties; we need our intellect, cognition, and our abilities to conceptualise, perceive, theorise, think etc. However, this is to seriously overlook and ignore the complexities of our lived experience. To locate the problem in the mental field alone is to ignore the significance and impact of our felt world; e.g I feel depressed or I am depressed, I feel anxious or I am anxious, I feel scared or I am scared,  - in short, I feel or I am. We don't say, I think scared, I think anxious, I think depressed; it is a felt experience.

Those I have worked with who have been in the 'mental health system', have all experienced a focus on their problem or disorder and not on them as individuals, an experience which can be very invalidating and dismissive, as if the journey they made to the point where they sought help is both irrelevant and unimportant; i.e. the problem is 'the mental health problem/disorder', nothing to do with how they found themself at this point in their life.

Each of us has a unique story. How can we expect our clients to feel they are being taken seriously if we ignore their story and their experience of that story.

The Value of Failure

Some years ago my supervisor and mentor wanted to refer me a client whose very successful life was seemingly collapsing around him - his marriage was in tatters and he was in danger of losing his high profile post.

My supervisor, himself a trained psychotherapist, was accustomed to working with high profile and high achieving clients; e.g. politicians, CEOs and those known from the media.
Now, at that time my client base, while being diverse, did not attract this demographic so I said (with some anxiety) to my supervisor - "I'm really not sure that these are the right client's for me".

His immediate riposte? - "Rubbish, you'll be perfect; you know a lot about failure!"

Most of us can handle success; failure is a different kettle of fish.

"We must protect ourselves! We can measure - we will be safe!"

"what measures/procedures there are out there for therapists to get solid feedback from clients on how therapy is going / has gone for them. Efficacy! Can any of you recommend one?"

The above quote is from a request posted on a network site to which I am connected; this is my response. -

Much thanks to Ben James for his broad view on the sad and fearful regulatory corrals that now surround and invade the real work of therapy.

I am not able to be so rigorous in my examination of this state of affairs as Ben; suffice it to say that if I want to know whether I am being helpful, I ask my clients. To use a universal examination is to insult and infantilise each individual. 

And... as Ben so appropriately points out, I only see my client for 1/168th of a week; to assume that I might be responsible for someones' depression lifting, someones' anxiety diminishing is both arrogant and ignorant. If we, as therapists, cannot bear to live with the uncertainty and ultimate immeasurability of being here then we are in the wrong game.

What is it exactly that we seek to measure? Whose story/context/content/culture would you have me use as the measuring stick? This whole issue of regulation is riddled with fear. Who do you trust?

My first therapist gave me a book to read some thirty years ago - "The Wisdom of Insecurity" - (Allan Watts). I am ever grateful.

The slogan of regulation - "We must protect ourselves! We can measure - we will be safe!"

Why do I offer post-graduate training?

 Why do I offer post-graduate training?

My experience running Personal Development groups for trainee counsellors and therapists finds me questioning the depth and rigour of many current training courses. I believe this is not so much due to the tutorship or personal agendas, persuasions and skills of tutors, but rather the burgeoning requirement on training courses to prove ('evidence') that all bases have been covered; politically and correctly learned and assimilated, therefore nullifying any possibility of the training being flawed or inadequate - all boxes ticked!
This obsession with training courses evidencing they have ticked all the boxes, covered all bases, means tutors are constantly preoccupied with 'looking over their shoulders' lest they omit or contravene an edict from their respective governing body or authority. This evokes a level of hyper-vigilance severely limiting the potential to explore, experiment, experience and learn; now the 'evidence' becomes the overarching priority. We thus, in giving diplomas for the ability to evidence all the 'right' boxes are ticked, might say that we give 'diplomatic immunity' to our graduates. Would we want to set this precedent for our clients? Indeed, would we like a CCTV camera in the corner of our consulting room? What part(s) of ourselves must we leave outside the consulting room lest it is spotted by 'big brother'?

What do I think I'm doing?

I have to acknowledge that sometimes I simply don't know. Of course, the medical (or medicinal) models used to help those with psychological and/or emotional struggles might likely see this as heresy; you have to know. Be right.


I have just listened to two gladiatorial psychiatrists tussling over their respective positions and opinions on the symptoms, diagnosis and treatment of ADHD.  Womens' Hour presenter - "What would you say to anyone listening who may have a very real concern about their children's ADHD diagnosis and subsequent treatment, when they hear two 'experts' unable to agree?" Their response was to completely ignore the question and to continue to battle their respective stations. 'I'm right' - 'No, I'm right!'. Quite clearly their own positions being paramount; completely ignoring the concern of their 'patient'.


I remember recently being at a seminar/workshop where an experienced and respected colleague described much of his work as 'fumbling around in the dark'. Aware as I am that this description might evoke doubt, uncertainty, hopelessness and fear in those seeking help and comfort, this, indeed, can be my experience, I cannot run, shy away, from these feelings and experiences; they are the constituents of darkness; a world we all deal with on any given day, and most certainly the central nature of therapeutic work; we are constantly fumbling around in the dark.


Daring to do this we sometimes stumble into or trip over some enlightening insight. Things can become clear through darkness.

Idiotic Assessments of Peoples' Troubles (IAPT)

'IAPT' is the acronym for 'Improving Access to Psychological Therapies'; a recent government initiative engineered by an economist whose father was a Psychoanalyst trained by one of the founding fathers of therapy, Carl Jung.
I've always had a playful, cynical response to acronyms and my outraged response to a recent talk/discussion on 'Happiness' with Lord Professor Richard Layard (said economist) at the 'How the Light Gets In' festival at Hay-on-Wye, and these recent developments with which he is inexorably connected, tempted the following from me:

Idiotic Assessments of Peoples' Troubles
Institute of Acting Profoundly Thoughtlessly
Inappropriate Analysis of Psychological Therapy
Inexcusable Acts of Projection and Transference
Initiatives Advanced from Paternal Transference
Inappropriate Acts of Philanthropic Transference

IAPT is part of Layard's Orwellian plan for a happy society; he is now running round the country promoting his book and another initiative - 'Action for Happiness'. A noble enough intent I think, though for a man of some seventy something years, alarmingly naive. In Hay, his viewpoints in discussion with Simon May, philosopher, and Jess Norman, Conservative MP, left me and many others open-mouthed. While of course, I hope his promotional and proselytising journey evokes happiness for others, and indeed himself, his belief that happiness is a measurable state, and one which can be engineered (via IAPT e.g.) all in the name of economic sense tempts me to call NAIVE!

And finally......., while I don't have the exact quote to hand, one phrase rang out from his talk at Hay; it goes something like this: "We can always resort to medication"!!! This man is the advisor to the government on our psychological therapy! Oh dear!


First Noble Truth:
birth is suffering, aging is suffering, illness is suffering, death is suffering; sorrow, lamentation, pain, grief and despair are suffering; union with what is displeasing is suffering; separation from what is pleasing is suffering; not to get what one wants is suffering; in brief, the five aggregates subject to clinging are suffering

This is what a therapist deals with! Happiness is a fleeting bonus. May you be happy.