Camila Batmanghelidjh: Not a member of UKCP, or any other professional body

Camila-BatmanghelidjhPsychotherapist Camila Batmanghelidjh, the founder of troubled charity Kids Company, revealed this week that she is not a member of any professional body, despite having thirty years experience working in the field. If one her of psychotherapy clients wanted to make a complaint against her they would quickly find nobody to make that complaint to. She explained that when she trained “it wasn’t an absolute requirement that you became a member” but that, in all the years she has been practising: “I just haven’t organised my membership”.

Batmanghelidjh was appearing before the House of Commons public administration and constitutional affairs committee (video) along with Alan Yentob chair of the trustees to explain to MPs the governance of the failed charity. The exchange where she revealed her lack of professional memberships came early on when the chair, Bernard Jenkin, was probing the credentials she held to be able to diagnose children with psychosis:

Chair: You’re a psychotherapist yourself?

CB: I’m a psychotherapist myself.

Chair: What were your qualifications?

CB: My qualifications are I have a four year psychotherapy training, I’ve had eighteen years of psychoanalysis, I did one year of arts psychotherapy at Goldsmiths and I’ve had..I’ve now got some thirty years of work experience behind me. Kids Company wasn’t the first thing. I founded Place2be, prior to that I worked in women’s aid…

Chair: …and what professional bodies are you a member of?

CB: I am accountable to UKCP, but I just haven’t organised my membership.

Chair: you’re accountable to?

CB: …to UKCP . United Kingdom Psychotherapy Association (sic)

Chair: But you’re not a member

CB Not I’m not a member (shakes head)

Chair So you’re not a member of any professional body?

CB I’m not a member of any professional body because when I trained it wasn’t an absolute requirement that you became a member, but I have been speaking to UKCP before all this happened about them organising a membership.

Listening as a professional counsellor with fifteen years of experience, my jaw dropped during this exchange. I know that many of my peers have been similarly shocked. In my time I have met a number of individuals who refuse to join any professional body and when I ask where a client should go if they are unhappy, or wants to make a complaint, they usually say that they abide by the UKCP or BACP code of ethics. A client would be very disappointed if they approached either of these bodies to be told that sorry, your counsellor is not a member – there is nothing we can do.

Please Ms Batmanghelidjh and others, join something, for the sake of your clients and the protection of the public. Thirty years is long enough to sort out your membership.

Update: Thanks also to Phil Dore at Unsafe Spaces for picking this up and adding very interesting information about her qualifications.

Can neuroscience explain the causes of mental illness? Erm, maybe not.

counsellor in exeterResearchers from Monash University have discovered that patients with depression may have different sorts of brains to the rest of the population. Jerome Maller and others looked through thousands of brain scans and found that it was more likely that a patient with depression had occipital lobes which were wrapped around each other. The occipital lobes sit at the rear of the brain and are responsible for processing visual information. It seems that people with depression may have different kinds of brains.

Does this help to explain depression and, if it does, will it help people get better?

In a wide-ranging article for Therapy Today in July, Kenneth J Gergen questions the faith that practitioners have in neuroscience to help explain the causes of mental illness. One of the things he argues is that if we say that a particular brain state is the cause of a given problem, then any work on alleviating that problem should be focused on altering that particular brain state.

He uses the analogy of a faulty engine in a car. “If one’s automobile fails to function properly, engine repair may be required.” It doesn’t seem unreasonable that if you take your car to the garage that the mechanic should look under the bonnet and identify the broken piston and replace it. The fact that you’ve been in ten times that month with the same problem, and that when you drive off you are bumping along the same potholed, poorly surfaced roads has not featured in the mechanic’s diagnosis or remedy.

Gergen would argue that the cause of broken down car is the state of the roads and manner in which it had been driven over them. The piston is a symptom rather than a cause of the distress. Is the funny brain scan the cause of a person’s depression, or a symptom? Is the real cause of distress the society or system in which you find yourself?

How you answer these questions probably influence which side of the neuroscience debate you are on and how you see the nature of mental illness.

Are humans like aeroplanes? The problem with solution focused therapy.

counselling exeterSolution focused brief therapy (SFBT) is an extremely popular type of counselling which helps thousands of people everyday. Its success for clients lies in that, instead of being asked to dwell on the past, or to wallow in their problems, they are directed by the therapist to think about solutions for their difficulties. It has some very clear ways of doing this.

It is ultra-pragmatic and interested in only what works for the client. One of its foundational beliefs is “do what works and do more of it; if it does not work, do something different.”

Criticisms of SFBT are hard to find. Usually, difficulties are couched in the same terms that SFBT uses – does it really work? Is there empirical data for it? Does it ignore problems by focusing on solutions? These are different ways of asking: is SFBT effective?

I agree that it is effective and does help people. My issue with SFBT goes deeper. I would like to look at two simple philosophical problems that SFBT raises which explain why I don’t offer this type of therapy as a practitioner. The problems relate to the assumptions behind SFBT.

The first assumption is that: solving problems is good.
If I were a business person, an airplane pilot or a structural engineer, I would definitely think that solving problems is good. Is there a fire in engine number one? Bridge looks like it’s about the fall over? No profits for the third quarter in a row? These are all well defined problems that are perfect for a solution focused approach because it is clear that airplanes should try to stay in the sky, or land safely; bridges should stay up and business should make profits.

Humans are not like bridges, airplanes or businesses though. The function of all these things is well defined. What is the function of a human being? What should they optimally do? There are plenty of different answers if we look at the last 3000 years of literature, poetry and philosophy. I would doubt that the best and clearest answer to what human beings should do though is: solve problems all the time.

The second assumption is that: solving problems makes life go better.
Some people, who apparently don’t have very many day to day problems (the super rich, royalty) still suffer. See Diana, Princess of Wales for a good example. Many with intractable, unsolvable problems appear pretty happy. Few of us would want early-onset Parkinson’s disease but Michael J Fox has embraced his illness as a gift.

If we go along with the idea that human beings are rather like bridges or airplanes then life probably would go better if we managed our lives like pilots or engineers. I’m not convinced human existence can be simplified like this though

What is Psychobabble?

counsellor exeterAll of us, at some time, may have read something in a self help book, listened to a TV psychologist or laughed off an advertising slogan as “psychobabble”. Ever described yourself as “OCD” because you like a neat fridge? Or said you’re “addicted” to chocolate? You’re probably doing it yourself. But what is psychobabble? And is it always misplaced?

The term psychobabble is actually not that old. It originated in a 1975 book by journalist RD Rosen who noticed language being used to describe psychological ideas was not describing effectively what was going on. He argued that psychobabble was the use of jargon or cliché that “kills off the very spontaneity, candour, and understanding it pretends to promote”.

The term quickly spread to be used as a term of abuse in over-complicated psychological descriptions and also as a general overuse of psychological jargon in ordinary life.

Craig B Hallenstein developed this thread in 1978 by arguing that the overuse of psychological jargon, amongst other things, fostered the development of an elitist class of psychological workers who were privileged in various insights into the human condition.

The overuse of jargon probably does not promote understanding of ourselves and probably does contribute to an unhelpful divide between the people who access psychological help and those who dispense it. My own counselling approach seeks to dissolve, as much as possible, the line between the well and the unwell, since in a sense we all need to find our way and orientate ourselves between the givens of life, as psychotherapist Irvin Yalom talks about – death, meaninglessness and responsibility.

I’m also very interested in the way we do and don’t communicate with each other. Related to psychobabble is “business speak”. We all know and laugh about “blue sky thinking”, even if we don’t really know what it means – and technobabble – which, if something is described as “quantum”, we are probably being technobabbled.

In all these cases, hierarchies are cemented between those that know and those that don’t – and little actual communication is taking place. The use of psychobabble in counselling and psychotherapy does not seem all that different to me – perhaps we just need to be thinking outside the box?

Bereaved? Expect it to be more complicated than 2 years, one month, four days

counselling in exeterThe charity Sue Ryder gained a moderate amount of publicity this month for a survey it commissioned into how long people take to feel better following a bereavement. Some of the major British newspapers picked it up, including The Mail, and the Daily Telegraph as well as a few locals. The survey’s headline figure was that people, on average start to feel better in 2 years, one month and four days. Men take slightly quicker to feel better than women.

There has been little research before this about timescales for recovery after bereavement. The Royal College of Psychiatrists talk vaguely that “Most recover from a major bereavement within one or two years” and that problems can arise for some people who get “stuck” – “Years may pass and still the sufferer finds it hard to believe that the person they loved is dead” the RCP say. People are very interested in the question of how long things are going to feel like this.

So, can we trust this new piece of research from Sue Ryder? Let’s have a look at the people who carried out the survey, an organisation called Census Wide, who describe themselves as “Specialists in robust, quick turnaround surveys for the PR industry.” Ah, I see, so it was a public relations company who completed this “research”? According to their methodology page, it was probably a self-selecting sample of people via an online survey.

I’m already going a bit cold on the accuracy of the headline figure now, and you are too probably, especially if you ever read anything scientist/journalist Ben Goldacre has written about fake PR surveys. Ben’s attempts to extract the background data to one survey about the mental health of teenagers was met with silence.

How long should you expect to take to feel better? Perhaps this isn’t even the right question and that we need to acknowledge that everyone is different. As J William Worden explains in a piece by Karen Carney at Psychcentral, “The loss of a significant loved one is something that is not gotten “over.”. Carney paraphrases him like this: “According to Worden, there may be a sense that you are never finished with grief, but realistic goals of grief work include regaining an interest in life and feeling hopeful again.” That’s a whole lot more complicated than 2 years, one month and four days.

CBT is less effective – and nobody knows why.

CBT - now you need to have hope and trust that it works.

CBT – now you need to have hope and trust that it works.

A new meta-analysis of 70 studies of the effectiveness of cognitive behavioural therapy or CBT has concluded that over time it works less well.

Tom Johnsen and Oddgeir Friborg(pdf) looked at research involving 2426 patients with depression and compared the scores of their pre- and post-therapy questionnaires on two well known scales; the Beck Depression Inventory and the Hamilton Depression Rating Scale. When they looked at results from a period from 1977 to 2015, they found CBT does not help to reduce symptoms of depression as much as it used to.

The results of this study of course flashed around the world from the Huffington Post to the Guardian with journalists hungrily trying to explain the data. Oliver Burkeman speculated on the role of the placebo effect in therapy, others wondered if the clinical landscape had been flooded with rookie therapists who were basically doing it wrong. One interesting idea put forward was that all treatments, over time, gradually show worsening results.

The thing to note, as the BPS did, is that actually the authors of the original study were not able to answer the question of why, but were only able to offer speculations. Perhaps patients belief in the efficacy of CBT have decreased they said: “it is not inconceivable that patients’ hope and faith in the efficacy of CBT has decreased somewhat” The paper they had just written, they noted, might also help to erode patient’s faith in CBT.

The real news from this study appears to be the idea that a patient who receives CBT has to also believe it will work for it to be effective. This is surely a strange belief to have if you are a CBT therapist.

If you practice CBT, your working assumption is that thoughts cause feelings, and by changing one’s thoughts you can change how you feel. How many CBT therapists will now also inform their patients that, by the way, if you want to get better, you’ll need to have hope and faith that this will work?

CBT is presented as the “gold standard” for many mental health issues because it “works”. When was the last time your GP told you, when handing over a prescription for antibiotics, that you also need “hope and faith” that they will be effective? Could there be more to therapy than CBT has room for?