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

Tuesday, 18 December 2012

David Rennie's Approach: Meta-Communication in Person Centred Counselling - Screencast 2/3

Second of my screencasts highlighting the work of David Rennie. In this presentation I briefly describe the use of meta-communication in person centred counselling.

Thursday, 13 December 2012

David Rennie's Approach - Process Identification in Person Centred Counselling - Screencast 1/3

This Screencast is a presentation I have created about David Rennie's work on process identification. Students at the University Centre at Blackburn College studying for the foundation degree in Counselling with Brief Interventions are exploring the work of Rennie as a way of deepening the level of exploration happening in their sessions.

Thursday, 22 November 2012


Last Sunday my friend, counselling colleague and peer supervisor, Mrs Jean Clements of Burnley, drove down the motorway, Google's directions in hand, for a Mindfulness workshop in South Manchester. 

It was a lovely day, cold and crisp and sunny. We arrived at Aileen's Mindfulness training to be greeted by the most beautiful, golden-coloured cocker spaniel by the name of Ruby. Each time the training session began and it was time for Ruby to be put in a separate room she would come and sit by me for protection - clearly a good judge of character, you cannot fool our canine friends! It did no good - she was still shut in her room. 

A nice surprise was to see one of my students there - Fleur - who had alerted me to the training and who fell in love with Ruby as we all did and later in the day took her for a walk.

The Mindfulness workshop began with eight students and two facilitators choosing a sultana. We were then given our first lesson in Mindfulness. Obviously my initial thought had I not been in a Mindfulness workshop would have been to throw the sultana into my mouth and swallow it down. In fact I cannot remember putting a single sultana in my mouth - why would you when a handful can be eaten instead? We were encouraged to roll the sultana around the palm of our hands, smell it, place it on the lips and to put it in the mouth to taste it, then bite it and after a long time swallow it down. We did all of this whilst paying attention to our senses and the sensation of having the sultana in our hands and mouth. Memories of my mother's baking, Christmas and vineyards in Italy were unlocked for the group. We went on to learn meditations that focused on the external and internal world and meditations during which we focused on our breathing; finally we all laid on the floor and experienced a mediation called the 'body scan'. I left the workshop feeling very relaxed and promising myself that I would incorporate mindfulness into my daily routine (and I downloaded the app).

So what is Mindfulness then? Well, my understanding is that it is an antidote to the society we have created  in which we are always busy and where we spend a great deal of time distracting ourselves from our feelings. Mindfulness is about focusing 'in the moment' on our experience and on our selves. That was my experience on Sunday, for once the world stop spinning and I could literally catch my breath.

Monday, 29 October 2012

Fine Words from Ed Miliband

It seems as though the British establishment is under a great deal of scrutiny at the moment. Whether it's bankers, the media or BBC celebrities, they're all under the spotlight. Indeed, Nick Cohen in yesterday's Observer penned an excellent article suggesting that the British are engaged in a 'strange rebellion' ... 'turning on their failed elite and scourging their institutions'. There certainly needed to be, post-Suez, a reduction in the deference we paid to politicians; but  I suspect the amount of cynicism around at the moment is a double edged sword. Too much cynicism destroys the trust we have in our institutions and each other. Maybe it's already happened, with the BBC the last institution standing about to topple into the mire. 

Our politicians are often in the firing line, but there is one area of policy where I'd hoped they might redeem themselves just a little - mental health. This year we had an excellent mental health debate in the House of Commons with several MPs speaking about their own experience of mental illness. Today the leader of the Labour Party will  speak about the need to stop making light of mental illness: Ed Miliband: time to stop caricatures of mentally ill He will commit himself to changing the NHS constitution so that individuals living with mental illness have the same rights as those diagnosed with a physical illness. This is good news. Mr Milliband is calling for a change in our culture and a change in policy. 

But there is a problem. Whilst the Government has announced extra spending on young people's mental health services, dementia research and just last week an extra £50 million for dementia care, the overall picture for mental health services is of cuts to budgets and serviceswith only one quarter of people living with mental illness getting the help they need. So whilst our politicians talk about support for mental health provision we might be excused for being a little sceptical, even cynical, if that talk is not accompanied (finally) by adequate funding. Fine gestures from our politicians are welcome but in the words of Walter Mondale,'Where's the beef?'

Tuesday, 23 October 2012

Jimmy Savile and Child Abuse

I've just watched the BBC's Panorama. It investigated the decision by the editor of Newsnight to shelve an investigation into sexual abuse allegations surrounding the late Jimmy Savile. It seems the decision to pull the report was made to protect Savile's name ahead of several tribute shows the BBC had planned to broadcast.

Over the years numerous BBC people had heard the rumours that Savile was a child molester, and some had witnessed Savile's inappropriate behaviour towards children, but few thought to say anything and Savile's abuse of children continued for decades.

The amount of distress Savile caused can never be calculated. The victims are to be measured by the hundred. They included children in hospital, patients in Broadmoor, children in care, and BBC visitors, invited by Savile to join the audience of Clunk ClickTop of the Pops or Jim'll Fix It.

Good God! The man was a legend, part of my childhood, Mr BBC, a children's TV presenter, and all the time he was using his celebrity, wealth, influence, charity work and contacts to groom and abuse children, silence his victims, and avoid detection and prosecution. Watching Savile now I see what commentators mean when they say he was 'hiding out in the open'. How did he get away with it? 

We now live in a society where safeguarding children is a high priority, yet still there are cases, like Rochdale, where social services fail to intervene and where a blind eye is turned to the sexual abuse of children. But in the 1970s and '80s, when Savile was at the height of his fame and at the depth of his depravity, our society was not at all sensitive to the problem of childhood sexual abuse. Repeatedly interviewees on Panorama said that whilst they disapproved of his behaviour it never occurred to them to report Savile for molesting teenage girls. 

I imagine that many rock stars and celebrities in the 1970s saw the sexual exploitation of young fans as an entitlement rather than a crime. Society as a whole gave no thought to what Savile was doing, preferring to see his heavily sexualised behaviour on TV as playful and harmless. That's why it's shocking to watch: because we now see what was always there but what we did not see before.

And now the inquiries and investigations begin, and as former Conservative Cabinet Minister, David Mellor said on the radio tonight, 'blood will have blood'. Let us see how this unfolds.

Monday, 15 October 2012

Book Review: In the Freud Archives by Janet Malcolm

Last week I wrote a short review of Psychoanalysis: the Impossible Profession by Janet Malcolm. This week I finished reading another of Malcolm's books, In the Freud Archives. An enjoyable read,  finished in a couple of sittings, though I appreciate the book may not have broad appeal. It's about two Freud researchers, Jeffrey Masson and Peter Swales, and their encounter with the psychoanalytic establishment in the USA. It's a fascinating tale and high-class gossip!

The first researcher we meet is Jeffrey Masson, a professor of Sanskrit and unsuccessful therapist, who seduces the eminent psychoanalyst and long-time secretary of the Freud Archive at the Library of Congress, Dr K. R. Eissler. Very quickly Masson is appointed as Eissler's replacement and tasked with editing a complete edition of Freud's letters to his friend Wilhelm Fleiss. An excellent job Masson does too! 

But whilst working in the archive Masson looks for evidence supporting his view that Freud's initial understanding of the etiology of hysteria was correct, that his patients had indeed been sexually abused. He argues that Freud abandoned this 'seduction theory' because of the hostility of his fellow medical professionals. Wow! The whole basis of psychoanalysis, the Oedipus Complex and Freud's theory of childhood sexuality, questioned by the new keeper of Freud's archive. Masson published his views in a national newspaper and was subsequently removed from his post as secretary of the Freud archive. Masson promptly sued Eissler for $13 million, settling for $150,000. 

Of course it's not the sequence of events that's interesting but rather the personalities involved. Masson comes across as confident and charming, but above all - due to his frankness during interviews - narcissistic. And for that unwanted portrait Masson sued the author of the book - an unsuccessful court case that lasted ten years. Eissler comes across as totally devoted to his beloved Freud, but naive and easily duped. I'm reminded of the priest played by Richard Burton in the 1978 film Absolution: a pious man whose rigid beliefs are no defence against the wickedness of a murderous boy he teaches.

Masson went on to write two incendiary books: a hatchet job called The Assault on Truth about Freud's abandonment of the seduction theory; and Against Therapy which is an attack on the unethical practice and power crazed therapists Masson finds in every field of psychotherapy.

Another researcher graces the pages of this book. Peter Swales is a complex man with an encyclopaedic knowledge of Freud and the origins of psychoanalysis. He calls himself a 'guerilla historian of psychoanalysis'. He too won the confidence of Eissler, who arranged for the Freud archive to gift him $4000 to enable him to continue his research. What Swales comes up with is the closely argued theory that Freud had an affair with his sister-in-law, Minna Bernays, that she became pregnant and that Freud arranged for a termination. So here we are again, Dr Eissler using the Archive's money to fund research intended to harm the reputation of Freud and psychoanalysis.

So for those Freud anoraks out there I can highly recommend Janet Malcolm's book. Beautifully written, full of wry humour and a nice partner to her other volume, Psychoanalysis: The Impossible Profession..

Sunday, 7 October 2012

Book Review: Psychoanalysis: The Impossible Profession by Janet Malcolm

I recently spotted a tweet from my Twitter pal @RuthNinaWelsh saying she'd just bought Janet Malcolm's book, Psychoanalysis: The Impossible Profession. Before I knew it the very same book was in my Amazon basket, along with another by Malcolm, In the Freud Archives, my next big read. I've a weakness for pretty dust jackets and books about psychotherapy and with the help of Amazon I've been able to fill two rooms at my house and office. The Marsden Therapy library! It will certainly fill a large skip when I'm dead and gone.

Janet Malcolm's book fooled me a little. This latest edition was published in 2012, but the book was first published in 1981. Very dated then. It started as an article in The New Yorker, where Malcolm has been a contributor since 1963, and it's been expanded to 168 pages with detours into Freudian theory and practice. 

At the heart of the book is an extended interview with psychoanalyst "Aaron Green", a 'forty-six-year-old psychoanalyst who practices in Manhattan in the East Nineties' (3). The book is fascinating when it describes the views and experiences of Green, this 'slight man, with a vivid, impatient, unsmiling face' (3). 

To increase the word count (I suspect) the opinions of Green become departure points for fairly esoteric discussions of Freudian theory and technique (transference, analyzability) and the competing revisions of post-Freudians. In the face of all these revisions Green remains completely loyal to Freud's original conception of psychoanalysis, articulated for Green by his contemporary, Charles Brenner. 

The first chapter of the book is something of a potted history of Freud's discoveries, but after that the book becomes much more interesting. The interview with Green casts light on the politics of the New York Psychoanalytic Institute, the eccentricities of the New York Psychoanalytic Society, the manoeuvres and bids for power and status of America's leading analysts in the '70s and '80s. There are insights too - on therapy, on Freud and on human nature - so I'm looking forward to reading my other Malcolm purchase, In the Freud Archive, about Jeffrey Masson, who did us all a great service as the editor of the Freud-Fliess letters and then did a hatchet job on Freudian studies and the field of psychotherapy with his two books, The Assault on Truth and  Against Therapy

Janet Malcolm, Psychoanalysis: The Impossible Profession, London, Granta. Available from Amazon

Monday, 1 October 2012

Gay Cures and Red Hair

Yesterday the Guardian published an article on the passing of laws in California to outlaw gay conversion therapy: California banishes controversial 'gay cure' therapies to 'dustbin of quackery' Democrat Governor Jerry Brown signed the Bill making California the first state in the Union to outlaw the use of gay conversion practises on children and young people. A victory then for humanity and common sense!

Meanwhile a letter from the British Association for Counselling and Psychotherapy (BACP) drops through the letter box at Marsden Towers. The first 'Statement of Ethical Practice' and one in which the BACP echo the views of the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO) stating that 'practices such as conversion or reparative therapies "have no medical indication and represent a severe threat to the health and human rights of the affected persons".' It goes on to say that 'the diversity of human sexualities is compatible with normal mental health and social adjustment' and concludes, 'BACP believes that socially inclusive, non-judgemental attitudes to people who identify across the diverse range of human sexualities will have positive consequences for those individuals, as well as for the wider society in which they live'.

These two developments are to be hugely welcomed - victories against the homophobia espoused by the religious right in the UK and America. Unable to accept that God might have created gay people along with everyone else, the religious right push the idea that being gay is a 'lifestyle choice' and inherently sinful or pathological. In my view being gay is as much a choice as being left handed or having red hair. You may know that left handed people were once also persecuted by the Church whilst people with red hair are in a minority and subject to insults from a society with thatches of plain black and mousy brown.

Can we extend the metaphor and liken gay conversion therapy to hair dye for people ashamed of their red hair? Keep applying the dye if you must, but deep down your hair is still red and will emerge and be  restored to its former glory when you're more comfortable with yourself and your natural hair colour. It's so you!

Saturday, 22 September 2012

All You Need is Love

Did you read Oliver James in the Guardian this morning? His article, All you need is love bombing, contains advice to parents on how to help their unhappy and defiant children. What James calls  'love bombing' involves two things: devoting time exclusively to your child and letting the child control what happens in that time. As a result the child experiences what all children need if they are to flourish: love and security. It seems such a simple idea, maybe too simple.

So my first reaction was favourable: many children in the UK are growing up in families that simply do not meet a child's basic physical, social, psychological, emotional and spiritual needs.This has a huge negative impact on the child's development and on their ability to function well (as children, adolescents and adults) in our fairly unforgiving society. But the remedy is to hand, love and security, and if it isn't ever-present then it needs to be scheduled. Scheduled? Has it come to this? Could it be that James' solution is actually symptomatic of the problem? Have we really created a society where we have to 'find a window' to 'love bomb' our children?

Monday, 17 September 2012

Trauma in Northern Ireland

My copy of Therapy Today, the magazine of the British Association for Counselling and Psychotherapy (BACP), arrived at the weekend. Inside there was an interview with Helena Stuart, a psychotherapist at The Wave Trauma Centre in Belfast.

In her interview Helena says that despite the fragile peace in Northern Ireland there is still a big need for trauma counselling. It is, after-all, in the aftermath of conflict, during times of peace, when we are often most vulnerable to the affects of trauma; when we cease coping with the crisis around us and begin processing, experiencing and reliving the traumatic events we have survived. 

One recent study found that the suicide rate amongst middle-aged men in Northern Ireland has doubled since the Good Friday agreement, further evidence of the difficulties many have coping with the transition to peace. These men grew up when violence in Northern Ireland was at its height and its made them susceptible to mental health problems in later life.

Helena says that as life in Northern Ireland returns to something like normality the symptoms of trauma begin to appear but not just in those directly affected. She says the effects of trauma are 'reverberating down the generations', affecting adolescents and children aware of but unable to talk about the unspeakable trauma their families have experienced. 

Reading the interview I was reminded of a visit I made in 1992 to Belfast's Museum and Art Gallery on the edge of the Botanical Gardens. I was a philosophy and politics student at Queen's University at the time. There was an exhibition of children's paintings. Those painted by the youngest children, only four or five years old, featured big yellow suns and bright red tractors; but as the children aged the colours became darker, the scenes increasingly bleak. Teenagers painted scenes of violence with military helicopters overhead.

Helena works creatively with her clients, they paint and use sand play to help symbolise the horror they have experienced. She says, "The symbols of healing appear in the sandbox even when the person themselves hasn't found healing yet. The potential is there and we always grow towards potential'.

Sunday, 19 August 2012

Gore Vidal Obituary

The American writer Gore Vidal died on 31 July 2012 at the age of 86. And finally I have a Sunday free so I can reflect on his life and pay tribute to the great man of American letters. Gore Vidal was a hero of mine. I admired his intellect and wit, his brilliant essays, interviews and liberal politics. He was urbane but with an acerbic edge. Vidal had the courage of his convictions and over a long life relished his battle with the American right in all its political, social and religious manifestations.

Gore Vidal's literary output was prodigious: essays, novels, novellas, plays, screenplays and memoirs. His novels varied in quality. The historical novels Burr, Lincoln, Creation and Julian are excellent because Vidal is an expert at combining history with characterisation to produce a compelling narrative.

His satirical novellas Duluth and Myra Breckinridge are wonderfully shocking and funny; but for me Live from Golgotha and The Smithsonian Institution, like some of his other novels (The Judgment of Paris and Messiah) fall flat. But even so there is something very touching in The Smithsonian Institution. Vidal's main character is a young physics genius working on the neutron bomb and time travel. He uses his time travelling discoveries to visit the battlefield of Iwo Jima and rescue his friend, a young marine killed there.  A moving piece of wish fulfilment this: Vidal's friend, an eighteen year old marine called Jimmy Trimble died at Iwo Jima in 1945 and Vidal grieved his loss for the rest of his life.

Jimmy Trimble also features in The City and the Pillar (1948), an unflinching account of a young gay man's life and his ultimately destructive attachment to his best friend. It's a remarkably frank account now but in 1948 the book caused a storm. Vidal says he was faced with a difficult choice contemplating its publication: he could pursue the political career he wanted, Vidal's grandfather was a United States Senator, or he could publish the book and be damned. He chose the latter course and was subsequently shunned by the establishment and the right-wing press in particular - the battlelines were drawn! Vidal went on to run for high office on the Democratic Party ticket but was unsuccessful. 

Gore Vidal was a good novelist; but, as Martin Amis has said, it's as an essayist that Vidal approaches greatness. He was a master of the wicked turn of phrase, the put-down, the metaphor that sums up an enemy in the most unflattering terms possible. He drew on a vast knowledge of history, politics and literature. Vidal was a voracious reader, a habit that began when he was six, reading to his blind grandfather, Senator Gore of Oklahoma. In his scathing attacks on American foreign policy Vidal drew particularly on classical history, likening the post-war 'security-state' and it's interventions abroad to the late Roman Empire. Vidal mourned the passing of the republic, arguing that the Founding Fathers would not recognise the America of Nixon and Bush. 

In recent years I enjoyed watching videos of Vidal on YouTube and on Websites run by public service television stations in the United States. His legendary row with the sneering William F. Buckley is there and a near punch up too with Norman Mailer. I shall be watching them again, but this time with some sadness rather than relish. As The Economist says, the passing of Vidal really is the passing of an era. I'm now going to visit Amazon to plug the gaps in my Gore Vidal library and I've added some links below for those who would like to read more about Gore Vidal.

Gore Vidal Obituaries

Friday, 17 August 2012

Taming the Black Dog

A friend and counselling colleague gave me a copy of Taming the Black Dog. I'm often on the look out for self-help books I can recommend to my clients. Something to replace the classic by Susan Jeffers: Feel the Fear and Do it Anyway. Published in 2004 and written by Patrick Ellverton, Taming the Black Dog is a guide to beating depression, the Black Dog of the title.

Ellverton's book does contain a lot of good advice about healthier eating, exercise and the benefits of keeping a daily log. Ellverton recommends finding a mentor and writes admiringly  about his own source of  inspiration, Winston Churchill. There's advice on creating a daily regime of walking and prayer (or meditation) to 'restore the balance' and keep the black dog at bay. There's also advice on alcohol misuse whilst another section contains a twenty minute exercise routine. The guidance I personally found most useful was the recommendation to spend time in the evening planning the next day's tasks.

Ellverton's advice is rooted in a lifetime of coping with depression. Ellverton was an army officer and this too is reflected in his book. You can see from the description I've given that the book has a 'pull yourself up by the bootstraps' quality. He eschews counselling as tending to do more harm than good, though he offers a counselling service on his website.

I suspect Ellverton sees counselling as backward looking - a fruitless examination of unhappy past experiences likely to make depression worse. It's certainly true that rumination is a big part of depression and in my work as a counsellor I don't encourage clients to constantly dwell on their misery. I seek to acknowledge distressing memories and current unhappiness but recognise too the client's heroic side and the possibility of change.

Ellverton sees medication as a way of managing the symptoms of depression in the short-term whilst the depressed person makes changes to his or her thinking, behaviour and lifestyle. I have sympathy with that view and the need for lifestyle changes.

So Ellverton advocates a set of new habits: walking, exercise, playing a musical instrument, prayer, healthy eating and sobriety 'to keep the black dog in its kennel'. Anyone who likes this approach and can follow his prescription will find Ellverton's book helpful - replacing the behaviours that maintain depression with new behaviours that promote good mental health. The only problem is that depression tends to take away the motivation and will power needed to  make these changes. If that's the case for you then maybe some kind of therapy might be helpful.

Taming the Black Dog is available on Amazon here 

Friday, 10 August 2012

NLP In Blackburn

I facilitated three days training in Neuro Linguistic Programming (NLP) last weekend. I was with my friend and fellow NLPer Cath Birtwistle at the University Centre at Blackburn College. We got some great feedback from our trainees in what turned out to be a fantastic training experience on a hot and sunny weekend. Coming home in the evenings to see our Olympians win multiple gold medals was surely the icing on the cake! In this post I want to publish some links to my favourite NLP resources on the Web.

NLP Links

Andy Bradbury has provided a collection of insightful NLP book reviews at Honest Abe's NLP Emporium

The Anglo-American Book Company is a good place to go for NLP books including those by Crown House Publishing

The Association of NLP is one of the UK's leading organisations for the promotion and regulation of NLP

INLPTA is the International NLP Trainers Association and certify training around the world

I learnt most about modelling from David Gordon, his website is here: Expanding Your World

One of the wonderful out-growths of NLP is Symbolic Modelling and Clean Language, modelled on the work of the late David Grove by Penny Tompkins and James Lawley.

For NLP training in Lancashire - Diploma, Practitioner and Master Practitioner courses - you can check out Chris and Glenda Grimsley at: The Insit2te for NLP for Public Services

Robert Dilts the NLP developer has published lots of resources at his NLP University website.

My friend Fran Burgess, author of The NLP Cookbook has a website called The NLP Kitchen

Another friend, Chris Mitchell has successfully used NLP with disaffected young people and you can see how by reading her book The Behaviour Management Toolkit

Another of NLP's developers is Steve Andreas, you can see some of his videos at his YouTube site: NLPComprehensive

Friday, 27 July 2012

Jon Richardson and OCD

Just some thoughts on Jon Richardson's excellent Channel Four programme on Obsessive Compulsive Disorder this week. Jon did a great job investigating the problem of OCD; coming at it from the perspective of someone living with mild obsessions and compulsions himself. Diagnostic tests towards the end of the documentary suggested his difficulties were not sufficiently severe or distressing to attract a clinical diagnosis of OCD. But his experience of what he called 'quirks' gave him a great deal of empathy for those who did live with the disorder in its severe and debiliating forms.

Jon interviewed three individuals living with the disorder and it was distressing to see the torment these individuals were experiencing. First of all Jon met a young man, aged fifteen, whose life was becoming increasingly populated with obsessions and compulsions, expressing themselves as rituals about where and how he placed his feet and how many times he touched things. He perfectly expressed the bind at the heart of his OCD: 'If I don't perform the rituals then I experience distress that leads to more rituals and more OCD'.

Another person living with OCD was unable to let Jon into her home. Her OCD showed itself as a fear of contamination and to ward off the fear of inhaling dust and being 'permanently contaminated' she cleaned and cleaned. One of her rooms was sealed and dust free. Her partner was on the point of leaving, unable to cope with her relentless pursuit of safety through cleanliness.

A third visit was to a women who lived with OCD, ordering her life to prevent dirt and dust entering her home. When she or her husband entered the house they each showered and changed their clothes. This preserved the inside of the house from contaminants and allowed her some peace of mind. Further tragedy was revealed when she began to tell the story of her son. A truly gifted engineering student so tormented by obsessions and compulsions that he poisoned himself to death by blending twigs and leaves from a Yew tree and drinking the result. It was a sobering thing to see obsessive compulsive disorder on the death certificate. Sad to see the grief as she carefully removed her son's suicide note and other documents from its dust free folder. She regarded OCD as a blight on the family.

There is evidence of OCD being inherited, with early onset at age seven and late onset in the early twenties. Jon talked about his perfectionism, and his mother commented on the delight Jon experienced when book shelves were orderly. Perfectionism certainly seems a character trait associated with OCD. But Jon and the people he visited sometimes linked OCD with stressful, even traumatic experiences.

So it seems some individuals are susceptible to OCD. Risk factors including genetics, personality traits, and environmental factors, such as whether or not other family members have OCD. Then there are triggers - stress and distress. OCD's positive intention is to manage the resulting anxiety, setting in train a self-maintaining system of obsessions and compulsions with the potential to take over an individual's whole life and being.

Jon Richardson's programme left one feeling a bit hopeless. Each visit ended with Jon more aware of how debilitating the disorder can be. The hospital he visited used medication and exposure and response prevention to treat very severe cases with an 80% recovery rate. That was more hopeful; another programme showing how people recover from OCD would be most welcome.

Tuesday, 17 July 2012

Thank You Lenny!

Every now and again I need a break, even from the things about which I'm passionate. So last week I stopped reading about psychotherapy and mental health and took 'time out' to read Humphrey Burton's biography of the American composer, concert pianist and conductor, Leonard Bernstein. What a great man! What a great life! Wikipedia provides a summary of Bernstein's achievements here and you can see and hear him conducting some of the symphonies of Mahler at my page here

Burton's biography is a fairly satisfying read that catalogues Bernstein's conducting and composing; his  friendships and sexual relationships, with men and women; his political activities, fund raising, teaching and broadcasting. Bernstein was so talented that he risked dissipating his powers on numerous different  projects. His mentors, including the composer Aaron Copland and the conductor Dimitri Mitropoulos, pushed him towards conducting and indeed he was a fabulous conductor, one of the greats. His interpretations of Mahler are wonderful, possibly because he identified so closely with the man, another conductor/composer. But at the end of his life Bernstein wished he had spent more time composing. Bernstein's works include several Broadway hits, including West Side Story; a couple of operas, three symphonies and, a favourite of mine, the delightful operetta, Candide.

Bernstein's father reluctantly paid for Lenny's piano lessons and reluctantly paid also for Lenny to study music at Harvard. When quizzed about this later in life he would say, "How did I know my son was going to become Leonard Bernstein?" Leonard Bernstein was a handsome young man and had numerous relationships with men and women before eventually marrying the Chilean actress Felicia Cohn Montealegre. In 1976 and feeling he could no longer suppress his sexuality Bernstein left his wife and committed himself to a gay relationship. He was returning to his marriage when Felicia was diagnosed with cancer, she died in 1978. When she died Bernstein was heartbroken and never recovered from his loss. He was, however, able to live more openly as a gay man. He enjoyed the company of young men, surrounding himself with young students and musicians in thrall to the maestro.

Burton suggests that Bernstein became more rebellious, maybe even coarse after his wife's death. It did his reputation no harm and may have added to the Bernstein mythology. Bernstein was a compulsive smoker - at rehearsals he would on occasion conduct the orchestra with a cigarette! It killed him in the end, in 1990, aged 72. I was saddened then overwhelmed by emotion as I turned the page and saw the picture there of Bernstein on a New York street waving at the camera, a smile on his handsome face. A complex man who left behind so much wonderful music. Thank you Lenny!

Wednesday, 13 June 2012

The Courage to Create

In a break from marking essays I have just finished reading The Courage to Create, a short and delightful book by the existential psychotherapist Rollo May. I was motivated to read more of Rollo May by the video I watched and reviewed here. This deeply humane and thoughtful book was a nice antidote to the last book I finished, by the much more combative Thomas Szasz.

Rollo May's book is about the creative process. A painter himself, he draws many of his illustrations from the visual arts as well as science and psychotherapy. The title comes from May's belief that creativity is a courageous act: the discovery of 'new forms, new symbols, new patterns' challenges conformity within society, and the creative genius is often punished for it.

May writes a lovely chapter on creativity and the unconscious, exploring the experience we have all had in which we apply ourselves to a problem for days only to have the answer come out of our unconscious when we finally put our pen down, have a rest or go for a walk. My old teacher used to say 'leave it to the night shift' and he meant just this, let your unconscious mind work on the problem and it will come up with the answer. May argues that the mind needs the 'relaxation of inner controls for the unaccustomed idea to emerge' (63).

My favourite chapter though is May's meditation on 'creativity and the encounter' in Chapter Four. He argues that great art comes out of the encounter between subject and object, between, for example, the painter and the landscape. He argues that the intensity of that encounter, the passion or commitment involved, determines how great that art will be. It also brings with it anxiety (92).I love this idea of the encounter and I immediately applied it to my work as a psychotherapist. Out of the encounter between therapist and client - or out of the client's encounter with self - out of the intensity of that - come new perceptions, realisations, insights and profound change. And yes, it certainly requires courage!

Thursday, 7 June 2012

Walking with Power and Grace

There was a flutter in the chicken coop this week as research published in the British Medical Journal strongly suggested that exercise does not help with depression (see the Guardian report here). 

The claim seemed counter-intuitive, but the evidence was pretty conclusive. People with experience of depression protested (see here and here), whilst Clare Slaney saw a hidden agenda at play - the dread hand of austerity around the throat of the prescription gym membership.

There has been evidence that exercise helps with depression (see, for example, the BBC News website here and here) and what about all those endorphins that exercise releases? On Twitter Professor Cary Cooper said the study focused on severe depression only. I'd like to read the BMJ to see for myself, but it's by subscription only and times are tough.As compensation there was a pretty well balanced report, reminding us that this study tested prescribed exercise only, in the Daily Telegraph here.

If the study did involve only those living with severe depression then I can well imagine how exercise came out as ineffectual. Might as well whistle down a storm. But thinking of the guys I have helped - people with moderate levels of depression - life style changes have often been beneficial. Sometimes it's difficult to work out whether people become more active as their depression lifts; or is it that the depression lifts and enables them to become more active?

I'm reminded of a story about Milton Erickson, the psychiatrist and hypnotherapist. He told a man living with depression to count the chimney pots on his way home from Erickson's house. The man did this, mainly to humour the old fellow; but by the time he had arrived at his own home he did feel quite a bit better. Erickson's intervention changed the man's thoughts, feelings and behaviours. Instead of looking down he was looking up, instead of ruminating he was counting chimney pots, instead of sitting at home on his own, he was walking down the street meeting people - you get the picture. The man had a strategy for maintaining his depression and Erickson flipped it round.

On some of the NLP training I've done I've been encouraged to walk with 'power and grace' and if you can behave differently then you will tend to think differently and feel differently. Like Gregory Bateson I think we're built that way - we are cybernetic.

Will walking with power and grace lift our mood? Possibly. Will it shift clinical depression? Probably not. It'll be the same with exercise (maybe).

Wednesday, 30 May 2012

Book Review: Psychiatry The Science of Lies

Reading this short book by Thomas Szasz is a real challenge. Each chapter contains half-a-dozen spring-loaded boxing gloves, which punch you on the nose as you read. That's what it felt like to have my assumptions and settled ideas about psychiatry and mental health challenged by Szasz. I had expected the attack on psychiatry, but was unprepared for his attack on patients as malingerers or the neo-liberalism that drives his approach to social reform.

The Szasz argument goes something like this: psychiatry is fake and has nothing to do with medicine. Mental illness does not exist, it is conjured into existence when a psychiatrist makes a diagnosis. So in psychiatry disease is the same thing as diagnosis. He suggests there is an unholy alliance between the state and psychiatry. The state has delegated to psychiatry the power to incarcerate individuals guilty of no crime. 

Here is Szasz in his introductory chapter, a passage that sums up his argument:
Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the "mental patient's' inability to prove his 'psychiatric innocence' makes psychiatry one of the dangers to liberty and responsibility in the modern world (3).
Later Szasz makes clear why psychiatric diagnoses are so damaging: 'Attributing a medical diagnosis to a healthy person does not transform him into a bodily-medically ill person, whereas attributing a psychiatric diagnosis to him does indeed transform him into a mentally-psychiatrically ill person' (15). 

If mental illness does not exist then Szasz must find a reason why so many individuals claim to be mentally ill. Szasz argues that individuals who claim to be mentally ill are in fact malingering. Szasz winds the clock back and shows us the Victorian consulting room. He says the patient arrives believing he or she is ill. The doctor must conclude that the patient is malingering or that he, the doctor, can find no disease. In the face of this unpalatable dilemma a third option emerges: the patient is mentally ill or, in the language of the time, suffering from hysteria: 'Thus arose the modern idea of mental illness, the product of the conflation of having a disease and occupying the sick role (voluntary or involuntary)' (23).

Szasz doesn't explore the 'role' of the patient much more than this. His book tends to get lost in the history of psychiatry and the wickedness of Sigmund Freud. It wages war on a number of unlikely subjects: Kay Redfield Jamison's bi-polar disorder is described as 'an alleged illness'; whilst the author, Lauren Slater, belongs on a 'list of "mad persons" using their madness to build successful careers as celebrity experts on madness' (100). Particular ire is reserved for the psychologist David Rosenhan who tricked the psychiatry establishment into admitting him and his colleagues into a dozen psychiatric hospitals despite having no symptoms of psychosis apart from a pretend 'auditory hallucination' - they told doctors that they repeatedly heard the word 'thud'. Szasz condemns Rosenhan's use of the word pseudo-patient arguing that Rosenhan was actually a real patient with a pseudo mental illness. Szazs thinks that Rosenhan had unwittingly supported the coercive system of mental health care rather than exposing it as prone to error..

If mental illness is a myth then I'm left wondering how Szasz understands the real fear and distress that people experience. There's no indication in this particular book. I see the feelings of distress that individuals experience as an understandable and legitimate reaction to stressful events.I don't see people experiencing psychosis as malingering, but as coping best they can with the circumstances of their lives. I imagine Szasz would say, 'fine' but let's not call it mental illness, and if an individual requires help let it be a be a private arrangement between the client and their chosen mental health professional, which has nothing to do with the state and it's coercive power.

This New American article, Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses, deploys the Szasz arguments against modern psychiatry and its revision of DSM-V. So Szasz is current and worth reading for his radical and alternative viewpoint, but I'm going to turn to his classic works rather than rely on this collection of essays.

Thursday, 24 May 2012

Moral Compass Shifts as Roles Change

As I was going through my favourite blogs today and avoiding work, I came across this report in Psych Central News: Moral Compass Shifts as Roles Change. It describes research with individuals working  in a dual role; like army medics, for example, who perform the role of soldier and doctor. The subjects were tested to see if their moral decisions were influenced by their social roles. The results were affirmative: ask a guy about the sanctity of human life and he'll give different answer depending on whether he is thinking as a soldier or as a medic.

So the traditional belief, that moral integrity is a fixed character trait, seems rather inaccurate; actually our ethical thinking (and the decisions that follow) is influenced or even mediated by the social roles we are performing at the time. This reminds me of the famous Stanford Prison Experiment where mild mannered undergraduate students became brutal prison guards or recalcitrant prisoners within days of having those roles randomly assigned to them. By the way, there was a good article in the Stanford Magazine last year, celebrating the 40th anniversary of Zimbardo's famous experiment available here

So these two pieces of research answer the question I asked myself last month as I followed the Judge Rotenberg Center trial and blogged about it here. I had wondered if the staff at the Center, using aversive therapy, had left their morality at the door when they arrived for work. These two articles remind me that morality is not a fixed thing to be taken on and off like a coat, rather it shifts and changes with the roles we play and the environments in which we operate. Would a member of staff working at the Rotenberg Center apply electric shocks to the skin of their own defiant children? Probably not. But in the 'clinic', where aversion therapy is given legitimacy and moral authority, where it forms part of the individual's work role, then aversive therapy becomes an acceptable form of 'treatment'.

There must be thousands of similar institutions that have become detached and isolated from the norms of society - like that Scottish island in the 1973 film, The Wicker Man. As social norms change, as the tide of liberalism and tolerance advances, islands of traditional belief are left behind as craggy old outcrops - very much like Lesley Pilkington. It's why we need regulation, accountability, professional standards, openness, public scrutiny and democratic controls - because the culture within an institution and the role an individual performs, has such a powerful influence on the identity, morality and behaviour of the staff who work there.

Monday, 21 May 2012

Women Offenders and the Talking Therapies

In my nine years working for the National Probation Service I didn't have the opportunity to work with women offenders. I worked in a residential setting with high-risk male offenders; there were never any female residents staying with us. The other Approved Premises in Lancashire had four female beds at one time but they were rarely used and before I was employed that hostel also became male only. Just recently, a couple of years after I took voluntary redundancy, a regional facility opened in Preston: a female only residential unit for women offenders from across the North West. They employ women workers only, some of them are friends of mine. I don't know how the place is running but I can imagine it's challenging work.

According to the Centre for Mental Health (2011) and their briefing, Mental Health Care and the Criminal Justice System, as of August 2011 there are 4289 women in custody (out of a total prison population of 86,821). Women in prison are five times more likely to suffer from a mental health problem compared to the general female population. Women tend to serve short sentences, which do little to address their criminogenic needs, but often result in their children being taken into care, loss of employment and housing, and increased risk of further offending and worsening mental health. As a result of these poor outcomes, policy makers have asked for alternatives to prison for women. Maybe that has resulted in the opening of the residential unit for women offenders in Preston I mentioned earlier. Usually probation hostels take high-risk offenders on conditional release from prison. I'd be interested to know whether or not the facility in Preston performs a similar function or is it in fact a community based alternative to custody.

I'm writing about women offenders today because I've just read an article by Toby Chelms in CBT Today the magazine of the British Association for Behavioural and Cognitive Psychotherapies (BABCP). Chelms writes about his own experience at Leeds Counselling, where he says it's very difficult to reach women offenders with cognitive therapy. Let me provide a summary of the interesting things he says.

Chelms says that talking therapies for female offenders in Leeds have traditionally focused on counselling, an approach suited to the kind of 'wellbeing' issues that affect women offenders: domestic violence, sexual abuse and childhood abuse. In addition to these issues Chelms says women may also develop mental health problems whilst in prison or have pre-existing conditions made worse. He cites depression, panic disorder, obsessive compulsive disorder and agoraphobia. Chelms points to the high rates of depression and anxiety amongst the female prison population. It's easy to see why these conditions might be a response to the chronic stress of prison life; but it's worth mentioning that for some women prison may meet the basic physical and psychological needs more than the outside world.

Evidence based practice suggests and the National Institute for Clinical Excellence (NICE) recommend cognitive behavioural therapy for depression and anxiety. It would make sense, therefore, for female offenders to be referred (or to self-refer) to the Leeds IAPT service for free CBT for their depression and anxiety problems. 

Chelms makes the point that whilst CBT is advertised in local GP surgeries there is little done to promote the intervention in probation offices. This is a problem because on release from prison few women offenders are in touch with primary health services whilst most of them are in touch with the National Probation Service. In fact the problem is a little more deeply rooted than this. Reading Psychological Therapies in Prisons and Other Secure Settings (reviewed here) it's clear that problems exist with the way that mental health services in prison communicate with mental health services in the community and that referrals, joined up work and hand-overs just aren't happening. That female offenders are not accessing primary care services is a systemic failure that points to their marginalised status and contributes to their social exclusion.

To Chelm's credit he has tackled this particular issue in a number of ways. First of all by promoting his IAPT service (and other mental health services) within and outside prisons, distributing a 'directory of mental health services' to the probation service. Secondly, he has recognised the importance of female friendly spaces when promoting mental health services to women. He refers to the Corston Report (2007) which recommends female-only environments, arguing that: 

'By encouraging women to feel physically and emotionally safe, less marginalised, and therefore more able to feel confident and express themselves in a way which is needed for progress, female-only environments would in turn lead to higher attendance and engagement levels, while increasing access to support and rehabilitation'.

In my own area there are two very good Women's Centres in Accrington and Blackburn, which offer a range of interventions, including low intensity and high intensity IAPT work; as well as counselling, support groups, employment advice and family interventions. It seems like a good model, 'women friendly' and a range of services under one roof so that a package of support can be tailor made for each woman. Now GPs and the Probation Service are referring clients directly and these two Women's Centres, under the leadership of my friend, Sarah Swindley, have become important service providers for women and families in East Lancashire.

Chelm's third intervention to broaden participation amongst women offenders was to set up a pilot project at the Together Women's Project in Leeds. Promoting the service to the probation service generated nine referrals. Of those nine referrals, all attended and were assessed as suitable for talking therapies. But of those only one went on to attend CBT sessions. Clearly it's not enough for women offenders to be aware of services, those services must be accessible; but even then other priorities take over and motivation shifts to basic needs and coping.

Thursday, 17 May 2012

DVD Review: Rollo May and Existential Psychotherapy

This is a busy time of year for me. The courses I'm teaching come to an end, the assignments flood in and the marking begins. It's great to be able to give feedback and reward my students' hard work, learning and development with medals and missions; but marking is a time consuming business and results in numerous late nights and early mornings ... well, late nights mainly.

The last book I finished was Yalom's latest, but that was several weeks ago and I haven't started another yet. When I've a lot of work on I can't concentrate sufficiently to read and enjoy a book. Instead I tend to spend a lot of time flitting round the Internet: from Twitter to Facebook, to email and back to Twitter again. I learnt yesterday, from an article published by Science Daily, that this is indicative of depression. I'm not depressed, just suffering from a little bit of stress. In fact the research described in the Science Daily article makes a bit of a leap when it says flitting around the Web indicates an inability to concentrate and that indicates depression - I go with the first conclusion but hesitate at the second. 

So, unable or unwilling to dedicate time to reading I have hit upon a clever alternative. Several months ago I noticed that DVDs were available for purchase on Amazon. I've bought them before, from the USA, and been slugged with a £28 import tax, so seeing them on Amazon and available in the UK was a pleasant discovery and flicked the 'buy me' switch in my mind - at this point imagine a railway line, a clanging bell and a locomotive carrying hard-earned cash towards Amazon INC's company HQ.

Despite the expense, watching DVDs of expert therapists working with actor/clients is great learning and very satisfying. I've recently watched Gestalt Therapy with a difficult to engage client and brief psychodynamic therapy with an elderly depressed client. My latest is an interview about existential psychotherapy with Yalom's own therapist, the existential psychotherapist and author, Rollo May. 

The sound and picture quality on the Rollo May DVD is pretty poor. It was made in the '80s on VHS - or possibly a machine that has a revolving foil drum. There is one camera, which pans around the participants when it might have more fruitfully remained exclusively on Rollo May. The participants are dressed for the1980s, early 1980s, when the moustache enjoyed a final blaze of popularity before its final death rattle and demise everywhere but Northern Ireland. 

The video has the flavour of the '80s for other reasons too. May constantly repeats his opinion that other therapies are 'gimmicks' - gimmicks in comparison to the therapy he practices, the therapy of Freud and Jung. Indeed he doesn't recognise short-term problem-focused therapy as psychotherapy at all. 

Remember that this is the time when managed care became popular and funding shifted from long-term psychoanalysis to short-term interventions and in particular Cognitive Behaviour Therapy (CBT). On reflection Rollo May seems rather zealous and intolerant of other therapies. We have come to accept the existence of a multitude of brief, outcome orientated or problem focused approaches.  For May they are quick fixes (gimmicks) whilst true therapy is a philosophical and mythological endeavour, an exploration of how to live the good life. I can sympathise with this, it treats seriously our existential concerns, but I see nothing wrong with helping clients to solve problems or reduce the symptoms of trauma and distress. May believes, with some justification, that these remedies are short-term and that symptoms return. Indeed symptoms tell us that all is not well, that we need to attend to the existential roots of our distress. 

There is no way to settle this dispute except to say that watching the DVD crystallised the problem for me at a time when I wasn't able to concentrate on reading any of the Rollo May books I have just bought for Summer reading ... from Amazon INC.

Thursday, 3 May 2012

Book Review: The Spinoza Problem by Irvin Yalom

I've already blogged about my admiration for the psychotherapist and author Irvin Yalom. I've also mentioned how much I've been looking forward to reading his latest novel, The Spinoza Problem. So I was delighted when it dropped on to the doormat in its Amazon package and I set aside three days over Easter, dedicated to reading the book.

Yalom always writes a fascinating book. In When Nietschze Wept he imagined a curious scenario where the German existentialist philosopher Friedrich Nietschze seeks help from the father of psychoanalysis, Sigmund Freud. In the Schopenhauer Cure a follower of the pessimistic philosopher, Arthur Schopenhauer, attends a therapy group. Philosophy in novel situations is a Yalom speciality.

In his latest book it's the thought and attitude of Baruch Spinoza that provides Yalom with the philosophical tool bag he requires to meditate on such issues as religious belief, community, belonging and the nature of evil. On a more personal level Yalom also reflects on what it means to be Jewish and what it means to stand outside the religious beliefs of one's culture and community.

The book is a double narrative. We read about the life and thought of free-thinking philosopher Baruch  Spinoza and his excommunication from the Dutch Jewish community in the late Seventeenth Century;. This alternates with the life and thought of Nazi philosopher Alfred Rosenberg in 1930s Germany. 

So the Spinoza Problem exists on a number of levels. For Jewish leaders in Seventeenth Century Holland the problem is Spinoza's heresy, his critique of Jewish dogma. For Spinoza the problem is a personal dilemma: to accept the religious dogma of ones community and continue enjoying the benefits of fellowship or follow ones conscience and pursue knowledge and truth wherever it leads. For Rosenberg the Spinoza Problem is a problem for a Nazi bigot: how to reconcile the fact that the greatest of German writers, Goethe, admired the Jewish philosopher Spinoza.

Spinoza lived the life of a thinker - grinding lenses and writing philosophy. Rosenberg was an anti-Semitic  idealogue, besotted with Hitler and totally committed to the Nazi Party. They have nothing in common, but Yalom's alternating double narrative means that each is seen in the light of the other. So, for example, Rosenberg's pathological need to be well-regarded by Hitler and the Nazi leadership is contrasted with the heroic truth-seeking of Spinoza: his stoical acceptance of excommunication and internal exile. In Yalom's book Rosenberg sees a psychotherapist, so we are treated to the fantasy of Irvin Yalom treating the Nazi philosopher for depression! The book ends rather randomly and an epilogue completes the two narratives. I don't think this book is as satisfying as Yalom's previous novels, but it is nonetheless a thoughtful and thought provoking read.

Tuesday, 24 April 2012

Crumpled Paper

Tuesday is one of my teaching days at the University Centre, Blackburn College. Mainly on a Tuesday I teach modules on the Positive Practice with Children and Young People Foundation Degree. I enjoy teaching and have been teaching in Further and Higher Education since 1998. At that time I was a PGCE student at Bolton Institute. Returning to Blackburn College to do my teaching practise was a lovely experience, tinged with a sense of homecoming.

When I think of teaching I think of Irvin Yalom's concept of the 'ripple effect' - teaching ideas and skills that learners can use to improve their practice as care professionals out there in my local community. So I love hearing stories from my students, about how they are changing the lives of children and young people as a result of learning achieved in the classroom. Teaching is very much a two way process though and I reckon I learn as much from my students as they do from me.

Today I was working on an assignment with a group of students; a module about mediation, advocacy and counselling. We were talking about bullying and how we can help children understand the effects, including the long term effects, of being bullied. One student told me about a simple but powerful approach used at her school.

The teacher crumples up a piece of paper to symbolise what it's like to be bullied. She then asks the pupils to smooth out the paper and get rid of the wrinkles. Of course nobody can get rid of the wrinkes: you can smooth out the paper but the creases remain. And this is what happens when a child is abused, neglected or bullied. Recovery may take place but the harm inflicted on the child leaves its mark, on the individual and the choices they make throughout their life. It's a powerful metaphor and one I will use in my counselling and teaching.

Thursday, 19 April 2012

Personifying Obsessive Compulsive Disorder (OCD)

In a recent blog post on Psych Central, Janet Singer wrote about her son Dan and his Obsessive Compulsive Disorder (OCD), which became so severe at one point that he was unable to eat. Distressed and confused Janet turned to a psychologist friend for help. He told her that Dan and his OCD were in a 'battle'. On good days Dan had the resources he needed to win the battle, on bad days the OCD over-powered him. This made a lot of sense to Janet and she began to refer to her son's OCD as 'the enemy'. She says it's a common approach to the treatment of OCD and enables the individual living with the condition to separate himself or herself from the 'disorder'. Janet says OCD is an 'insidious disorder' and that some 'battles' in the 'war' will be won and some lost, the important thing is that 'those suffering from OCD keep fighting'.

Over the years I've worked with many individuals living with obsessions, compulsions, and with OCD. I've been mostly successful in my helping, using a pluralistic approach, creating an individual therapy for each of my clients, using counselling, Cognitive Behavioural Therapy (CBT) and Neuro Linguistic Programming (NLP) .

Sometimes though I am unable to help. Often this is because the client has something else stressful happening in his or her life that constantly activates intense episodes of obsessive-compulsive behaviour. It's incredibly difficult to control OCD when the storm is raging. In those circumstances I offer support and I work with the client to resolve these 'external' sources of stress. If stressful life events happen whilst the client is having counselling then it's likely that he or she will have learnt strategies (1) to deal with this 'incoming' stress and (2) to manage their OCD. This usually prevents the OCD from escalating out of control.

In many ways I agree with everything that Janet Singer has said. One of my aims when working with clients living with OCD is to help them recognise and label OCD thinking; and it can be difficult to identify obsessive thinking when one is in the middle of it, the most irrational of intrusive thoughts can seem real when they are accompanied by intense feelings. But recognising and labelling OCD thinking requires the individual to stand outside of the OCD ; it is, I think, the first step towards mastery. It introduces the possibility of choice - 'This is my OCD wanting me to check the doors and windows of my house. Do I comply or do I not?' The next step may be to learn to tolerate the agony of not complying or not seeking re-assurance. There are many more rounds to go in this boxing match, but at this stage, and possibly for the first time, the OCD is on the ropes!

As you can see, it's very tempting to use a martial metaphor when talking about OCD. I've likened OCD to a boxing match, and Janet Singer uses words such as 'battle' and 'war'. Clients often use this kind of language when describing their experience of OCD and the process of recovery. When this happens I will often follow suit, working to create 'critical distance' between the client and their obsessions and compulsions, for the good reasons Janet Singer identifies in her blog post. I do have a reservation though about labelling OCD as the 'enemy'.

I worry that labelling OCD as the 'enemy' in effect creates a state of perpetual war within the individual, or possibly, periods of peace interrupted by fresh outbreaks of conflict.

These concerns come from my belief in the NLP pre-supposition 'all behaviour has a positive intention' and my training in the 'parts work' of family therapist Virginia Satir. In my view OCD is a 'part' of the individual and it has a positive intention. Like all anxiety disorders it is working incredibly hard at keeping the individual safe from harm. For example, when a person obsessively checks to see if their front door is locked there is a positive intention behind their behaviour, it is to keep his or her property and family safe and secure. In this context OCD isn't the enemy, it's the fire service, police force and National Guard all rolled into one. But of course whilst OCD behaviours might have a positive intention they nonetheless create havoc in the life of the individual living with OCD - this is a 'part' that needs retraining and re-assigning.

So, whilst I do help clients to personify their OCD - and use martial metaphors to 'defeat' the disorder - I may also look to re-assign or re-integrate a 'part' that is out of control by re-directing an individual's obsessive and perfectionist tendencies towards the perfection of a skill or hobby - I sometimes refer to the healthy obsession of the concert pianist. This means that time previously spent 'doing' OCD is spent having some fun and creatively filling the space that OCD used to occupy.