Counselling, Supervision, Training, Research, Teaching, Writing. Providing therapeutic services to the people of East Lancashire and beyond.

Wednesday, 31 August 2011

Punk Education - Learning with Twitter!

I have been using computers since the 1980s, when I bought my first (and last) Amstrad. It was a portable, which meant it had it's own room in the house. How I marvelled at the green screen and dot matrix printer! Now I'm marvelling again, at the way I'm able to access and manage so much useful information flooding over the Internet. Google Chrome has taken my browsing into another realm: all my favourite sites are on the tool bar, snazzy extensions give me instant access to news feeds and the Evernote clipper. I can write a blog from there and shorten a long url before posting to Twitter.

I have been using Twitter as a research tool, checking out the articles posted by the Tweeters I follow, those interested in counselling and mental health. When I find a good article I return the favour and in this way a community of learning - a professional network - is built across the Web. My colleagues, Craig and Phil, at University Centre, Blackburn College, refer to this as "punk" education - learning that is informal and democratic, technology that takes knowledge out of elite universities and into the homes of citizens.

Just today I (finally) learnt how to use Google Reader and I have now subscribed to dozens of blogs, websites and podcasts. I can now dip into a stream of information about mental health as it travels down my computer screen. Anything interesting and I send it to Evernote, where I'm building a collection of interesting articles and opinion pieces. OK this is not a methodical approach to research, and I'm happy spending time in the library conducting detailed and systematic literature searches, but Google Reader is giving me an overview of what professionals in my field are writing, talking about and reading and it's great to be part of the conversation!

Monday, 29 August 2011

Book Review: Person-Centred Counselling by David Rennie

This slim volume is an account of David Rennie’s approach to person centred counselling. The book started as a set of training materials, its ideas tested in the training room, but the book is also informed by Rennie’s own practitioner-research and by the suggestions of peers such as Mearns and Thorne. We are left with a short, lucid and well written account of Rennie’s ideas for developing the person centred approach and one that will undoubtedly improve the therapeutic skills of every reader.

At the heart of Rennie’s understanding is the client as reflexive agent. In other words the client’s job in therapy is to reflect on their experience and from that reflection arrive at a deeper understanding of the issues that confront them and the choices they can make. Rennie believes that greater understanding can lead to greater agency.

The therapists job is to keep the client on track with their reflections and to use empathic and process orientated interventions to deepen the client’s exploration. Empathic communication includes paraphrasing and reflecting, the interventions one would expect from a person centred therapist. But Rennie also advocates presenting the client with visual imagery and metaphors, symbolic representations that can emerge out of the clients experience as reported to the counsellor, or from the counsellor’s unconscious, in tune with the client’s experience.

There is an excellent chapter on transparency with sound advice on when counsellor’s ought to express congruency; but Rennie’s greatest contributions to person centred therapy are in his chapters on process identification, process direction and meta-communication. Rennie argues that therapists are able to deepen the clients exploration of their experience and the felt-sense associated with it by encouraging reflexivity, and this can be promoted if the therapist appropriately comments on the client’s process issues. At its simplest this involves pointing out what the client is doing: “As you said that you raised your eyebrows”. This brings into the client’s awareness thoughts and behaviours that were out of awareness and as a result the client becomes more self-aware. Rennie’s discussion of metacommunication invites therapists to deepen their relationships with clients by commenting on the meaning behind their own or their client’s communication.

There are some things I disagree with in Rennie’s book. I do not think, as Rennie does, for example, that it’s OK for the contracting process to become a “five minute routine”. I see the contract as part of the therapy and an opportunity to explore with the client their anxieties about therapy and issues such as confidentiality. But this small book has a great deal to offer therapists looking to deepen their contact with clients and I will be urging my students to read it.

Rennie, D.L. (1998). Person-Centred Counselling: an Experiential Approach, London: Sage

Friday, 26 August 2011

Living with Autism

A stop motion short film by Jonny Lawrence, about an autistic boy called Kevin

Thursday, 25 August 2011

John's Top Android Apps

I love studying so I have set up my phone to support my learning. Thanks to the number of programs that sync across devices I can organise information, process and share documents like never before.


Enables you to organise notes, projects and cuttings from the Web. It syncs with your laptop and PC and saves all your work onto the cloud. I keep a daily journal, take notes on the books I'm reading and work on my writing projects, all accessible from any device. I can even take a photo or make voice memos. My favourite app.


Fantastic envelope budgeting software to manage a household budget. You can create up to 10 envelopes with cash in. Record what you spend and it deducts the amount from your envelopes and tells you if your budget is on track or if you have over spent.


The best to-do list app for Android- and I've tried lots of them. It lets me create and name multiple task lists, enables me to set the priority and due date. I have it as a widget on my HTC Sensation. It also syncs with Google Tasks but I haven't been successful as yet.


A great music player if you can't get used to playlists. Keep your mp3s in folders as God intended. Drag them from your PC into your phone's music folder and Folder Play will play the contents of each folder or any individual tracks therein. Simplicity!


The notebook app for me. Easy to use: type up notes, lists and memos then share them with other apps including Evernote. Think I paid a couple of quid, but I appreciate it's uncluttered and simple to use interface.


Superb program that enables you to share large files across several devices. If you are working on a report put the document in Dropbox and you have it available on your laptop, phone and PC. Work on the report, put it back in Dropbox and it updates the document on all your other devices automatically, so you are always working on the latest version. I can also put a document in Dropbox and then send my students a web link so they can go and download it to their desktops


Allows you take pictures of a document or book page by page, it then assembles all your pages in order and creates a PDF out of them just like a mini photocopier. Great to have on your phone when in the library


This dictionary costs a few quid but is an excellent tool. Download the database so you can look up words and synonyms without a connection to the Web. I access it all the time and its detailed definitions are a great help.


Sets off an alarm at a time and date of your choosing so you don't forget important stuff.


Free to install and has a wider choice of books than the pre-installed reader on my HTC phone.


Allows me to count down the days until the next assignment deadline.

Wednesday, 24 August 2011

Some Reflections on Self-esteem and Confidence

I've been co-facilitating group work sessions on self-esteem and confidence for a good few years now and each year another penny drops and I develop my understanding.

First of all - like fish and chips - self-esteem and confidence are related but quite different concepts. Self-esteem involves some kind of measurement, from the Latin aestimare meaning ‘estimate’. It involves a self-assessment - the measurement of our own self-worth.

Confidence also involves a measurement, it's an assessment of how well we (or someone else) can be relied upon to behave in a particular way or perform a certain task. So, I'm fairly confident that I can finish writing this blog, but I'm not confident that anyone will read it!

So what is the relationship between self-esteem and confidence? I can't answer this question fully. You would think that people with high self-esteem would also have high levels of self-confidence; but there are many people, some pop stars for example, who have very low self-esteem but are confident enough to get on stage and entertain thousands of people. Maybe this kind of incongruence is unsustainable, so eventually the whole façade comes crashing down. It seems to me that self-esteem is the foundation on which self-confidence is built and without firm foundations confidence can be pretty shaky. In contrast, if someone is confident about performing well at some task and they perform badly, then that can be generalised to, “I didn’t perform well, I am a loser”. It's an interesting interaction.

I think it is completely rational to have low self-esteem, especially in an unsafe environment like an abusive relationship or family. Low self-esteem has to be maintained just as much as high self-esteem, it's just that the maintenance of low self-esteem has become so automatic and effortless that we do it without thinking. Low self-esteem makes sense because it keeps us safe and prevents us from taking risks. Feeling we are not good enough to go for a new job justifies not applying and saves all the anxiety of going for the interview or the possible rejection of missing out. Low self-esteem keeps us safe, but at a huge cost because people with low self-esteem can miss out on the good stuff and on reaching their full potential.

Feed Your Self-esteem

On the groups I co-facilitate I try to help group members uncover the strategies they have for maintaining low self-esteem. For example, individuals develop ingenious ways of discounting compliments from others. Once that is exposed, an individual can choose healthier ways to handle positive feedback. I invite group members to list some ways they can "feed" their self-esteem, treats that cost nothing but make them feel good: having a hot bath, going for a walk, feeding the birds or writing a blog entry! It's our attitude that's important. Having a luxurious bath with candles and aromatherapy oils feeds our self-esteem much more than "a quick bath then we don't stink in the morning".

The final thing I ask group members to do to improve their self-esteem is to keep a diary for one week. I ask them to write in their diary each night three positive things that have happened to them during that day. At the next session they can read out their diary entries and re-live the positive things that have happened. Everyone who takes part in this experiment begins to feel a little more positive because instead of filtering for bad stuff, they are filtering for good stuff. They begin to notice what has been there all along, the small but significant events that feel good and contribute to our improved self-esteem.

Tuesday, 23 August 2011

Book Review: Freud and Cocaine: the Freudian Fallacy by E.M. Thornton

My beliefs about Sigmund Freud have been severely challenged by reading E. M. Thornton’s blistering attack on the founder of psychoanalysis. I’d considered Freud one of the greatest thinkers of the Twentieth Century. If anything, I imagined him to be a victim of his own success - so many of his ideas are a part of mainstream culture that Freud has become associated only with the eccentric and unacceptable leftovers.

I think Freud represents a paradigm shift in how we think about the mind and human motivation. We accept the notion that individuals are driven by unconscious wishes and the idea that the mind can cause physical illness. But for E.M. Thornton, these are just two examples of the false beliefs that underpin psychoanalysis. Her argument is that Freud’s theories are a product of his cocaine addiction. She also argues that Freud’s case studies, on which the whole edifice is built, are more likely to be suffering from temporal lobe epilepsy than hysteria. She argues that a great deal of time has been wasted by physicians who could have been working on physical medicine and neurology rather than the drug induced fantasies of Freud.  Towards the end of her book she goes so far as to describe Freud as 'a man of pathological preoccupations' (291).

The early chapters of Thornton’s book are a disappointment, focused too much on medical history and hardly at all on Freud. She writes about Freud's early encounter with cocaine following its recent discovery and importation into Europe from South America as a new cure-all. Freud took it, recommended it to friends, prescribed it to patients, supplied his fiancé and published an article on its medicinal qualities, recommending it as a cure for opiate addiction. In his affection for coca Freud was joined by a great many others, particularly in America. Thornton calls this the great cocaine epidemic and provides an interesting account of cocaine use in the late Nineteenth Century, before cocaine was eventually outlawed in the United States in 1902. Initially it was seen as a wonder-drug and widely prescribed, even introduced into soft drinks; but over time the case against cocaine and its dangers emerged. Individuals, especially doctors, became addicted and developed an insatiable need for the drug. Side effects included paranoia, violence, hallucinations, egomania and physical effects such as heart problems and impotence. Addicts described obsessions with sex and had sexually explicit hallucinations, they believed they were in possession of a great truth and simply had to share it with others. Later on of course Thornton will argue that Freud suffered from these symptoms of prolonged cocaine use and that cocaine produced not just a runny nose but the Standard Edition of the Complete Works.

Thornton is claiming that just at the time Freud developed his most contentious theories, such as the Oedipus Complex, he was misusing and suffering the symptoms of cocaine addiction. How else, she argues can we explain Freud's belief in the sexual origins of the neuroses. My understanding is that Freud had come to the seduction theory because that is what his patients had been telling him and that Freud's reading and research in the late 1880s at La Salpetriere, which pointed to high levels of sexual abuse in French society, had made more believable the disclosures made by his patients.

Thornton reminds us that the patients treated at La Salpetrier by Freud’s mentor, Charcot, were more likely suffering from temporal lobe epilepsy than hysteria. She certainly paints a grim picture of the Salpetrier and its mainly female patients, performing for doctors and medical students from around the world, all attending to hear Charcot’s lectures and see demonstrations of hypnosis. She goes on to argue that because of their epilepsy these patients were susceptible to hypnosis, indeed that hypnosis is actually only possible with patients suffering from this pathology because hypnosis is a form of temporal lobe seizure. She scorns Bernheim of the Nancy School of hypnotism for believing that most people are hypnotisable and claims that most of Bernheim’s patients were pretending to be hypnotised out of fear of upsetting him. As someone who has experienced and practised hypnosis and studied the work of Milton Erickson I have to disagree with Thornton's narrow definition of what constitutes hypnosis and the hypnotic state. In the end her critique of hypnosis serves one purpose, it is in furtherance of her attack on Freud, who learnt and briefly practiced hypnosis but decided he wasn't proficient enough and abandoned the technique. For Thornton all the trees in the forest must be cut down so she can swing her axe at the mighty oak.

Thornton's analysis of the Anna O case is an excellent read. She argues that Anna O was not hysterical but suffering from meningitis contracted whilst nursing her father who had died of tuberculosis. She charts the changes in Anna O's presentation and makes the case for an organic cause, principally brain lesions, where Breuer had ascribed a psychological cause. She makes use of research by Ellenberger (1972) who had discovered what happened to Anna O after her treatment ended. It turned out to be an orderly handover to other physicians rather than the story put about by Freud in which Anna O developed a hysterical pregnancy that caused Breuer and his wife to flee the country. Ellenberger discovered that Anna O had not been cured by Breuer and that the account of her treatment in Studies of Hysteria differed from the contemporaneous case notes made by Breuer and found with Anna O's medical file in the asylum at Bellevue. Thornton also suggests that another case of Freud’s, "Frau Emmy", was not suffering from hysteria but almost certainty a variant of Tourette's disease. She suggests that Freud was mistaken when he took mild tonic seizures to be evidence of the effectiveness of the cathartic method.
Thornton also writes about Freud’s “pathological” treatment of 'Dora', another of his cases with epilepsy rather than hysteria. Freud analysed Dora and her dreams, and with an imaginative use of symbolism discovered a sexual cause to 'Dora's' neuroses but after three months 'Dora' discontinued her therapy.

After her chapter on Anna O, Thornton begins looking for evidence of cocaine use in Freud's letters to Fleiss. She argues that Freud’s heart condition, messianic traits, 'monotony of interpretation', headaches, nasal problems, depression, death anxiety and dysphasia all point to cocaine misuse and appeared after April 1894. The idea that Freud experimented with cocaine in the late 1880s and then stopped is disproved by the Fleiss letters. Later on she suggests that Freud’s preoccupation with 'irregular modes of sexual gratification' (241) is a result of his cocaine addiction. She also thinks that Freud's relationship with Fleiss had a 'homosexual element' and this too 'would be consistent with the other symptoms of cocaine usage' (242).

Thornton attacks Freud for criticising Charcot: "Such brash interpolations by a then little known neurologist in the work of a man of Charcot's eminence were undoubtedly the result of a cocaine effect" (209). At that point I wondered if Thornton might also be making “brash interpolations” and just as Freud everywhere saw sex as a cause of mental distress so Thornton sees cocaine use as the cause of psychoanalysis. Thornton (254) correctly states that Freud's self-analysis (1897 - 1900) was responsible for some of the most basic ideas in psychoanalysis. She criticises the subjective nature of this process and argues that it is particularly untrustworthy as a method because Freud's cocaine use was distorting his memories and creating vivid dreams. Freud's first full analysis of a dream was his 'Irma dream' on 24 July 1895. Thornton makes an interesting point when she suggests that vivid dreaming is a mark of cocaine misuse and that Freud’s patients were also having vivid cocaine sponsored dreams. So it was that dreams came to occupy a major place in the practice of psychoanalysis.

A final attack on psychoanalysis comes at the end of the book when Thornton makes the point that psychoanalysis has had a negative impact on research into brain disorders - organic brain disorders being the true cause of neurosis/psychosis for Thornton.  She argues that patients who could have had cures were instead given ‘hopeless psychoanalytical diagnoses’, including the catch all diagnosis of hysteria. Freud’s nemesis puts her pen down at the end of her book, arguing that as Freud’s later work rests on unsupported theories he developed during his cocaine years there is little point discussing them. Her assessment is damning: 'As we have seen, the foundations of this edifice were presented in a series of papers characterised by inconsistencies and circular arguments, with a total lack of evidence for the postulates they contained' (290).
Thornton, E.M., (1983). Freud and Cocaine: the Freudian Fallacy, London: Bond and Briggs

The Pro-active Carer Programme

I had some good news today from my friend and counselling colleague Adam Gibson. For several years Adam and I have co-facilitated a personal development course for people who care for others. We call it the 'Pro-active Carer Programme'. Today Adam told me we have funding from Blackburn Carers Service to run the programme again, our fifth time! This is wonderful news because we enjoy working together; but more importantly it's wonderful because we know from feedback and from a one-year follow up study that it really WORKS. Thank you Blackburn with Darwen Carers Service

People who care for others often experience significant problems as a result. Caring is likely to affect their employment, income, physical and mental health and overall quality of life. In a caring relationship a state known as 'co-dependency' can develop. In a co-dependent relationship the carer ceases to enjoy a separate life and identity of their own and become bound up in the life of the person they care for. This can lead to anger and resentment, closely followed by guilt. This kind of relationship often harms the person in need of care, because the tendency is for the carer to 'manage' the relationship by becoming more and more responsible for the person they care for. This further dis-empowers the cared for person and deepens the co-dependency.

The Pro-active Carer Programme addresses the problem of co-dependency. The Programme comprises seventeen two-hour sessions split into modules and covering communication skills, increasing self-esteem and confidence, managing change and assertiveness skills. It uses lots of techniques and approaches from Neuro Linguistic Programming (NLP) to help participants develop resources and make changes in their lives.

The greatest resource is the group itself. A lot of time is spent forming and reforming the group each week. The group becomes safe, cohesive and supportive. Time spent forming the group creates a sense of belonging, raises self-esteem and leads to accelerated learning.

So, come November Adam and I will begin again with another group, helping participants to make positive and sustainable changes to benefit them and the people they care for.

Sunday, 21 August 2011

A Class Divided

Here is a snippet of a Class Divided. My good friend Ian sent me a link to the 55 minute Google video here. It is an amazing documentary about Jane Elliot’s action research. Children are taught about discrimination by being assigned “top dog” and “under dog” roles according to the colour of their eyes. It's a piece of experiential learning that radically changes the attitudes of the children involved. Not sure it would be passed by the ethics committee these days!

The children developed their prejudices quickly, causing a great deal of distress for their peers in the process. It transpired that the status of the children had a great impact on their academic performance. By the end of the experiment the children had increased empathy for people experiencing discrimination and had bonded as a group. In this documentary Elliot  takes her message to a prison and the prison staff are shown attending a workshop none of them will ever forget!

Brene Brown: The Power of Vulnerability

In this video Brene Brown gives a TED talk on what I think is an eternal verity: as humans we need connection to give our lives meaning. What gets in the way of connection is shame, the belief that if people really knew who we were then they would reject us. Those who enjoy connection in their lives have the courage to be vulnerable, to be authentic and to be truly their selves. When that happens connections are established and we find meaning and  nourishment. This is the challenge for me and for counsellors and psychotherapists: to live a wholehearted life, to risk feeling vulnerable and to have the courage and the compassion to really connect.

Book Review: Trauma by Gordon Turnbull

This book will be a very pleasant surprise for readers anticipating a dry textbook on psychological trauma. Instead Turnbull has written a wonderfully engaging account of his career as a psychiatrist in the Royal Air Force and private practice as an acknowledged expert on post-traumatic stress disorder (PTSD). The reader is alongside Turnbull as he uncovers the ways exceptionally traumatic events affect individuals and how PTSD develops as a means of coping in the midst of overwhelming terror.
For Turnbull PTSD is a natural response to events outside normal human experience and the symptoms of PTSD are often part of the recovery process. But his pioneering work is treated with suspicion by senior officers in the military who prefer to blame the individual for a ‘lack of moral fibre’ rather than accept PTSD as a natural outcome of military conflict.
Turnbull pioneered his technique of psychological debriefing with members of RAF mountain rescue teams attending the Lockerbie disaster. He worked also with released British POWs after the first Gulf War and the hostages John McCarthy and Terry Waite. He argues convincingly that service men and women need time for decompression before returning to civilian life, so soldiers returning from Afghanistan stop off in Cyprus to recuperate before returning home. Turnbull advocates a group approach to recovery and recommends cognitive therapy, but he also embraces hypnosis and EMDR as methods for transforming right-brain sensory material into left-brain narrative and meaning.
Turnbull illustrates his book with fascinating case material. He learns as much about trauma from his clients as he does from research and colleagues. Indeed the high regard Turnbull has for his clients and his view that trauma can lead to emotional growth makes his book an optimistic account of psychological trauma. Counsellors and psychotherapists of all persuasions will be entertained and educated by its insights.

Book Review: RD Laing by John Clay

The structure and approach of John Clay’s biography is conservative: a well organised and fairly friendly account of R. D. Laing’s life and work. The chapters on Laing’s childhood give a stark account of the emotional abuse Laing suffered from his parents, and in particular his mother. Laing’s drinking, drug taking, hostility to women, aggression and distress; but also his quest for meaning, love and security; and his deep empathy and understanding are illuminated by these early chapters. He found an escape in sport, literature, and above all music. Laing’s work on families and the binds they sometimes inflict on children has its origins here.
Laing qualified as a doctor and chose psychiatry as his specialism. Clay provides a good account of Laing’s work as an army doctor and hospital psychiatrist. In hospitals Laing began to introduce more humane ways of working with patients: seeking to build relationships with individuals living with psychosis rather than inflicting ECT and Insulin Therapy upon them. In 1965 Laing founded the Philadelphia Association, which still provides homes for individuals experiencing emotional crises. Laing’s aim was to provide a safe place, an asylum, where the mentally unwell could live with and “work through” their mental illness free of psychiatric treatment.
After his time as a hospital psychiatrist Laing enrolled at the Tavistock Clinic to begin his training as a psychoanalyst. Here the book features all the big names in British psychoanalysis. Many of them saw brilliance in Laing, but he was too rebellious to be a trusted colleague. Over his career Laing moved towards a more humanistic and existential understanding of the human condition and mental distress , but he described himself as a psychoanalyst throughout his career.
Laing achieved international fame with a series of books on mental illness, understood from a phenomenological and existential perspective. Mental illness, he argued, must be understood as a reaction to the context in which we live. If society depersonalises then Laing’s response is a humanistic and existential one. In fighting his own neuroses Laing used LSD and cannabis on a regular basis and became a heavy drinker. His moods were changeable and he could be very aggressive. Later in life he suffered from depression, from cancer and from heart failure. He drove many of his friends away with his violent outbursts and hurtful comments. When Laing began his psychotherapy practice he had on the wall a print of Icarus falling into the sea, a picture that prefigures Laing’s raise and fall as a star of the 1960s and ’70s.
After reading Clay’s biography and Laing’s own work, and especially after watching the brilliant ninety minute documentary, “Did you used to be R.D. Laing?” available here, I was left with an impression that stays with me. A man who had many flaws, who treated his wives and children thoughtlessly, but who met the facts of our existence head on, who had great empathy and understanding for deeply distressed patients and communicated this in his work, his talks and books. Watching Laing work with clients is a moving experience, he was fully present and wholly himself. His approach is fascinating to anyone who knows NLP. In Laing we see aspects of Perls, Satir and Erickson: solution focused, telling stories and reframing experiences. But above all there is rapport, and Ronnie Laing, “Hanging on to every word”.

The Pain of OCD

The Dorset Echo provides an insight into the terrible distress of severe OCD
Mr Shaun Nutman, a thirty-three year old family man, was driven to stab himself in the chest because of depression, anxiety and Obsessive Compulsive Disorder. His wife said disturbing thoughts attacked her husband’s mind “like a machine gun”. According to the Dorset Echo, the coronor, Mr Michael Johnston, said he needed evidence that Mr Nutman intended to kill himself to record a verdict of suicide and gave a narrative verdict instead as he believed Mr Nutman was in “such distress from his obsessive compulsive behaviour that he probably really hardly knew what he was doing.” The coronor was critical of the care Mr Nutman received.