SCoPEd and poverty

We write as long-standing members of BACP who, with other counsellors, run a charity offering low-cost counselling. We are a group of nine counsellors providing about 40 sessions weekly. For eight years, we have successfully offered counselling to financially disadvantaged adults for a nominal fee, thus fulfilling the ethical principle of justice. Some of our clients meet the specific criteria for ‘Level C’ therapists under SCoPEd – that is, clients with chronic and enduring mental health conditions.

We wish to raise the issue of poverty, as all our clients would be unable to pay the usual counselling fees and referral would usually be impossible because private therapy would be unaffordable. The recession caused by the pandemic is increasing demand for low-cost counselling but the SCoPEd framework appears to require a cessation of our service for complex clients without the possibility of an alternative provision. This is very worrying.

Many of our clients are passed on from Health in Mind as too complex for them. Many others arrive at our service having found that the CBT provided by the NHS has not met their needs. In our unequal society there are many potential clients without sufficient income for private therapy.

We feel sure that readers are aware of the usual fees for therapy. Please consider these in the context of, for example, the £409.89 per month paid to single claimants aged 25 or over. It is our view that the SCoPEd framework, if adopted, would further increase the usual private fees charged by therapists, since there will be pressure to complete longer training, with associated higher costs.

We believe we are not alone as an organisation in voicing these significant concerns. Other similar organisations will be facing the same situation. We would like some clear responses to this very specific issue. An essential part of counselling provision for very vulnerable clients is in danger of being lost if this is not addressed.

Colin Hartland, Geraldine Pass, Ruth Sheen and Liz Woodhead, Trustees, Low Cost Counselling Service, Lewes

The overuse of the term ‘mental health issues’

We all know, or should know, how important it is to be aware of mental health issues and how crucial it is to address them whenever and wherever possible. It is true that the issue has been sidelined for far too long, but of late it has become prominent in discussions in the media and elsewhere.

Undoubtedly, mental health should be given the same amount of attention (and financial support) as physical health. However, there is a danger of overstressing the issue without offering adequate explanation. Several public figures and celebrities have helped immensely to shed light on mental health and decrease the stigma – a desperately needed change. And of course, there is a lot more to be done in this area. Yet, it has to be done competently and carefully.

Pre-lockdown, I had a young client who claimed they suffered from schizophrenia, which they self-diagnosed, having watched a television programme. After that they searched online and came up with this diagnosis.

There is a danger in over-popularising the phenomenon of mental health. We run the risk of exaggerating the presence of mental health issues among the general population. It is crucially important to point out that experiencing various emotions, be it sadness, fear, happiness or enthusiasm, for instance, and many more, is a healthy human reaction. My impression is that now, at the time of the COVID-19 pandemic, mental health is being mentioned far too often as a possible and expected consequence. Aren’t the unease and fear only to be expected at the time when daily reports of the number of deaths inevitably trigger our inherent fear of death? Doesn’t insisting on mental health consequences risk a self-fulfilling prophecy? It is not to say that there will be no mental health consequences, but anxiety, fear, panic, or lethargy, apathy and sense of helplessness are very understandable and could even be a sign of healthy reaction under the circumstances. The question is not what one feels but how overwhelming the feeling is and how one processes it. Only if the feeling is long-lasting and affecting daily functioning should we talk of mental health issues.

Dr Jasna Levinger-Goy MBACP, psychotherapist

Why I don’t have a niche

Since I began in private practice 18 months ago, I have heard a lot about the need to ‘have a niche’. Having a niche is a ‘good marketing strategy’ and will draw in ‘your ideal client’. The thing is, I don’t have an ideal client. The idea of having an ideal client is, to me, like the idea of having an ideal family. Who has one of those?

The particular issue the person presents with is part of a narrative – a story the person is telling themselves. Clients often feel trapped in a particular story. This is often what drives them to therapy. If we view clients in terms of a niche, we could be reinforcing their story and excluding a fuller exploration of other, silenced parts of them.

In specialising in a niche, we may be unconsciously contributing to the sense that a group identity (be it class, race, sexuality or type of issue) is the only identity that a person can have. In reality, we are all complex, multifaceted and messy in both our identities and our needs.

Maybe it is helpful to have some idea of the issues that person presents with. Conversely, the idea that we may ‘know’ something of their experience before they have the chance to talk about it may buy into the idea that the whole of that person is that narrowly proscribed narrative. Bion1 spoke of going into a session with a client ‘without memory or desire’. I think he was trying to encourage a sense of not knowing and allowing understanding to develop. I believe we should allow our clients to educate us on their own unique circumstances and difficulties rather than allocating them to a ‘niche’.

Nina Bradshaw MBACP

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1. Bion, W. Notes on memory and desire. The Psychoanalytic Forum 1967; 2: 272–73, 279–80