Have you ever thought about whether you would cross a picket line to get to work? Do you know what you would do if you had a session booked with a client who was out on strike? If you’re a supervisor with a supervisee whose clients are striking, have you considered what your supervisee and his/her clients might need? I admit that in almost 20 years as a workplace therapist in the public sector, I’d never given these questions any thought until I met with colleagues who had. Being a therapist in a climate of growing industrial action was the topic we discussed at the BACP Workplace Executive Committee, held in October last year, prompted by the tens of thousands of workers in 2022 who went out on strike as the cost of living outstrips wage rises.1
Strikes look increasingly likely this year, and professionally speaking we find ourselves, once again, having emerged from the pandemic, navigating some uncharted waters. I hope this article helps frame the conversation about how industrial action might impact on the workplace therapist, the therapeutic relationship, the service manager, EAPs and supervisors. As a profession, we need to be able to explore how we respond individually, organisationally and collectively to the issue of strikes, their consequences and the underlying despair that is driving workers to strike.
The strike in the room
While not all counselling services will face striking workers, therapists tell me that they are already seeing clients who are using their sessions as a safe space to work out how they respond to the strike. Workplace counsellors therefore need to be attuned to the ways in which strikes might impact their clients. Andy Price is an independent therapist and member of the BACP Workplace Executive Committee, a former fire fighter and a trade unionist who, as a firefighter, went on strike twice and knows the toll it can take: ‘Striking isn’t easy – it’s costly, personally, professionally and financially.’
A tipping point
While writing this article, the Royal College of Nursing (RCN) announced that, following a ballot, nurses had voted to go on strike for the first time in the RCN’s 106-year history. Pat Cullen, General Secretary and Chief Executive of the RCN, called it ‘a defining moment’, while the current Health Secretary, Steve Barclay, called it ‘disappointing’.2 The latest workforce figures reveal that, in England, nurse vacancies have now reached a record high of 47,000, and the World Health Organisation3 recently described the UK as facing a ticking time bomb and a disastrous shortage of nurses and healthcare staff unless it acts now to train, recruit and retain the next generation of health workers.
Against this backdrop, it’s no surprise that the strike action by RCN members is being defined as being both about nurses’ pay and about patient safety. According to YouGov, public support is very much with the nurses taking strike action4 – as the crisis in the NHS is hitting people personally, with lengthy waiting times in A&E and a record 7.1 million people waiting for treatment.5
Given the perilous state of our NHS and other public services, due to chronic underfunding, it’s worth pausing to reflect on the actions taken by psychologists, therapists, social workers and counsellors in the US last year against their employer, Kaiser Permanente. Despite reporting record profits, the company had just one mental health clinician for every 2,600 patients, and the vote to strike by the National Union of Healthcare Workers was because patients were not receiving a service that was fit for purpose.6 Workers were vocal that their strike action was over the poor quality of the service that they were being expected to deliver, which prevented them from providing ethical care.6
Here in the UK, junior doctors in England, represented by the British Medical Association, are planning to ballot this month on industrial action, and more than 10,000 ambulance workers belonging to GMB voted to strike in December, with further strike announcements likely. More than 70,000 members of the Universities and College Union (UCU) at 150 universities voted in favour of strike action in two separate disputes on pay and pensions, secondary teachers in Scotland voted to strike in December, the National Education Union’s teacher members in sixth forms have voted to strike and two teaching unions are balloting more than 400,000 teachers and support staff in England and Wales.1
Perhaps even more surprisingly, Amazon’s workers have been staging walkouts and protests after a 50p per hour pay rise was offered last summer,7 and workers are now joining unions for support in their fight to be paid and treated fairly. In Coventry, the GMB Union held a historic first-ever ballot for strikes at a UK Amazon warehouse, which only narrowly missed the legal threshold for industrial action last October.8
Striking in solidarity
With so much unrest, therapists may be considering what action to take, if any, in support of their clients who are employees. While it’s not an issue with his current portfolio of work, Price says that if he worked in the NHS as an in-house therapist, and nurses were striking, it would become his issue: ‘I would say to my manager: “I am uncomfortable with not supporting the strikers.” I’d discuss how to manage both my client appointments and support for my colleagues. The RCN offers some helpful guidance on how to balance patient safety during industrial action, which I’d bring to my discussion.’9
Questioned whether it is ethical to cancel clients to take strike action, Price says: ‘When staff are underpaid, undervalued, burnt-out, using foodbanks and experiencing a crisis in both recruitment and staff retention, I think it’s my ethical duty to my clients, the patients and my own self-care as a therapist, to find ways to support the industrial action.’ Other therapists don’t agree and, off the record, voiced the opinion that if therapists take strike action in support of their client employees, it’s not only unethical and unprofessional, it’s also being too overtly political. Price is quick to refute this: ‘How can I possibly separate politics from the NHS? How the NHS is funded is a political decision, made by the Government. But take a step back and look at all the reforms that have helped to bring decency to people’s lives – whether it be education, pensions, voting or housing, they have come about because of the collective actions of others. As a working-class person, I’ve benefitted from this and I have a debt of gratitude to those who made that possible.’
Crossing the picket line
Elsewhere, Nicola Neath, a therapist at the counselling and psychological support service at the University of Leeds, has already had to navigate a path across the picket line: ‘Strikes have been held, and I believe that my ethical priority is to the clients who I am seeing that day, for whatever reasons they may need to attend. I support those taking action, and any of my clients may or may not be in unions or protesting. If I need to cross a picket line, I will say “hello”, if possible.’
If this sounds simple, it isn’t. Articulating the complexities of managing the tripartite relationship, which is inherent in the workplace counsellor’s role, Neath says: ‘I am a caregiver to the organisation and they are my employer, I feel and witness the organisational pain and conflict when a strike occurs and the inner conflict that clients can also experience.’
In addition, Price stresses that it’s worth being prepared for what might happen after the strike: ‘As a therapist, it’s important to be aware that strained relations can remain among workers long after the strike has ended. For example, if some workers have gone on strike without pay and others have gone to work, it can last long in the organisation’s memory.’
While strikes are meant to disrupt the organisation, they can also disrupt the smooth running of an in-house staff counselling service. At the University of Leeds, Neath explains what happens when a strike day is scheduled: ‘Legally, we cannot ask clients if they will be attending the session or, if they are late, phone to ask if they are coming, as this could give the impression that we are trying to find out who is in a union and, of course, employees have the right to privacy.’ There is also a risk that when industrial action is planned, the actions or inactions on the part of the in-house therapists – for example, crossing a picket line – could be perceived as the therapist being ‘on the side of the management’, with potentially uneasy consequences for both the therapeutic relationship and for whether employees view the service to be one that they can trust.
Next in this issue
The role of supervision
It is usual for strikes to divide opinion, and according to Sarah Prince, an independent workplace counselling consultant and supervisor, this means that supervisors and supervisees need to consider how they manage their approach when working with clients who are for or against the strikes. She says: ‘The impact of strikes on clients, as yet unknown, has the potential to generate an interweave of thoughts, feelings and emotions, exacerbated by competing ideals.’
Highlighting that it’s also part and parcel of supervision that strong feelings and opinions are managed ethically and professionally, Prince reminds us: ‘The role of a supervisor is to facilitate a healthy and open discussion in supervision. It’s in the Ethical Framework that supervisors are responsible for providing opportunities for their supervisees to discuss any of their practice-related difficulties, without blame or unjustified criticism.’10
While it’s not always easy to be neutral about the issue of strikes, this makes the need for safety in supervision all the more essential, to allow the supervisee the opportunity to say all that needs to be said before focusing on the client. Reminding us of why it’s so important, Prince states: ‘What clients want and can rightly expect is that their counsellor is holding the therapeutic space for them, absolutely, without a counsellor’s personal beliefs intruding. Keeping one’s own counsel when it comes to contentious political and social issues recognises the potential for a power imbalance in the counselling relationship, and is undertaken in service of the client to facilitate their explorations.’
What about EAPs?
It’s worth pausing to consider what happens if a counselling service is a hybrid, employing both in-house salaried therapists and affiliates via an EAP contract. One of the many benefits of offering a hybrid service is that it allows the service to be able to respond to a surge in demand for counselling without the client needing to be aware of any distinction between the in-house therapists and the affiliates. In this scenario, if workers took strike action in the organisation, the affiliate therapist would also need to work through what course of action to take.
Julie Hughes is the former Chair of BACP Workplace and Co-Director of Mind Matters Counselling, a national EAP engaging over 650 therapists, and has this issue on her radar: ‘The contract is always at the forefront of any decision making in our organisation. So, if, for example, affiliates chose to strike in solidarity with striking workers, we would find ourselves defaulting on contracts, which would have implications for the business and the affiliates who we work so closely with. Realistically, if an organisation contracts a service with Mind Matters Counselling and we default on a contract, the organisation will simply move to another provider. This leaves the door wide open to the influx of international companies that are looking to snap up EAP work to secure their footing in the UK market. In these circumstances, would striking in solidarity really help bring about the desired outcome?’
It’s one of a number of questions for therapists to consider as we balance supporting both our clients and organisations throughout a time of unrest, organisationally and nationally. And it’s worth remembering that our role doesn’t always involve working directly with the client, as we will often work across the organisation, building relationships, supporting managers, teams and leaders, which means that we often know the very people who can be viewed as being in opposition to striking workers. It’s an organisational factor for Neath: ‘My general sense is that there’s a lot of pain in many organisations, and as humans we have an understandable need for a scapegoat. But I don’t think there is any one individual in any organisation who is responsible for what’s happening when it comes to strike action.’
Age of austerity
Taking a broader view, workplace therapists have witnessed how the cuts in public sector pay have been used as a tool of austerity over the past 12 years and increased adversities for our clients, including pay freezes, low pay, poor morale and high burnout rates, particularly in healthcare, education and social care. Juliet Lyons is the former General Secretary of the Psychotherapy and Counselling Union (PCU) and was a school counsellor during the early days of the coalition Government’s austerity agenda: ‘It was impossible not to notice that cutting vital support like Sure Start had a devastating impact on the emotional and financial lives of the families I worked with.’
The climate led Juliet to become a founding member of the PCU, which supports its 800 therapist members and helps to provide a voice for the profession, legally distinct from professional bodies, such as BACP. She says: ‘We are a small union, and members join seeking a sense of solidarity and support. We can help them with complaints, workplace issues and working for fairer pay. The therapy world can be a split and divided one, which makes it hard for therapists to work collaboratively. What we need is to have a voice and a sense of being valued as a workforce, because our profession is both desperately undervalued and underpaid.’
Is striking therapeutic?
Of course, it’s feeling both undervalued and underpaid that drives workers to strike, to fight for better pay or conditions, and recent outcomes have reminded us how effective industrial action can be. While it seems highly unlikely that therapists in the UK will be striking any day soon, disputes resolved last year have seen some workers being awarded pay rises of 10% or more.1 In October, criminal barristers in England and Wales accepted a 15% pay rise, 2,000 bus drivers in North London won an 11% pay deal after threatening a strike, and BA staff at Heathrow accepted a pay deal worth 13% after threatening to strike.1
Reflecting on the strike action being taken by university staff across the UK, Neath says: ‘The decision to strike often comes when people are at their lowest point, feeling disempowered and in despair. And I have also seen how striking can become a powerful and potentially empowering act.’ It’s a view shared by Price, and one he’s experienced first-hand: ‘There’s a perception that industrial action is largely negative, but my experience is that being a part of a dispute can build self-esteem, and the psychological effect of people working together is incredibly therapeutic.’
The potency of collective action is integral to the story of a strike, and central to the plot of Made in Dagenham, a film set in the 1960s about women’s fight for equal pay; and Pride, about the 1984
miners’ strike, when many more workers belonged to a union. Since its peak in 1979 at 13.2 million, union membership has been dropping across the UK, and according to Government statistics, 6.4 million people were members in 2021.1 Of those, 50% of public sector workers were in a union, compared with 13% of private sector employees.1 Interestingly, the likelihood of joining a union increases with age, and employees over 50 are most likely to be members, something that could become increasingly significant with our ageing workforce.
Writing this article, I’ve reflected on my work over the last 20 years as a self-employed counsellor working with teachers, heads, social workers, firefighters, carers and other local authority workers. It’s long enough for me to remember a time before the financial crash in 2008, before I’d really met the word ‘austerity’ in my work, when conditions were different for both clients and counsellors. While no one was profligate, budgets existed for the professional development of staff, and I’d deliver training on stress awareness, promoting positive working environments and developing self-help skills for health and happiness.
Today, I struggle to believe this quaint-sounding world ever existed, given the current depleted state of our public services and those who work in them. I’m pained to remember that trainers, like me, would offer staff and managers psychoeducation on coping with stress at work, assured that we now lived in an enlightened age, and that the modern threats facing workers were largely psychological rather than the primitive task of surviving.
Not anymore. Too many workers are striking because their most basic needs for physiological survival and safety are not being met. Too many are cold, hungry and tired. Too many can’t afford to pay their rent or mortgage, and some working people are left with no option but to live in their car or van.11,12 And it’s why the slogan ‘enough is enough’ is resonating so deeply with workers across the country. And, workplace practitioners like me know this more than most, having been alongside, bearing witness too often to what has quite simply become unbearable.
This article was written in early December.
1 https://www.bbc.co.uk/news/business-62134314 (accessed November 2022).
2 https://www.rcn.org.uk/news-and-events/news/uk-nhs-nursing-strikes-2022-rcn-strike-ballot-results-released-091122 (accessed November 2022).
3 https://www.nursingtimes.net/news/workforce/who-warns-of-nursing-workforce-ticking-timebomb-in-uk-and-europe-15-09-2022/ (accessed November 2022).
4 https://www.nursingtimes.net/news/workforce/increasing-public-support-for-nurse-strike-action-poll-reveals-02-09-2022/ (accessed November 2022).
5 https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis (accessed November 2022).
6 https://www.theguardian.com/us-news/2022/aug/15/mental-health-workers-strike-kaiser-permanente-californiaCMP=Share_AndroidApp_Other (accessed November 2022).
7 https://www.theguardian.com/technology/2022/oct/11/amazon-coventry-workers-strike-ballot-uk-first?CMP=Share_AndroidApp_Other (accessed November 2022).
8 https://www.bbc.co.uk/news/uk-england-coventry-warwickshire-63326717 (accessed November 2022).
11 https://metro.co.uk/2022/11/03/norfolk-health-worker-set-to-move-into-his-car-to-ease-cost-of-living-17693875/ (accessed November 2022).
12 https://www.bristolpost.co.uk/news/bristol-news/greenbank-view-van-dwellers-bristol-6988982 (accessed November 2022).