From the Editor

Sally Brown

When I was training, I spent two years as a Samaritans volunteer (in addition to a clinical placement). On the night shift, we’d frequently get calls from young men – often still in their teens – held on remand at the local prison. The recurrent themes in their stories made for a veritable full house of adverse events in childhood – time spent in care, family violence, bereavement, parental drug or alcohol dependence, extreme poverty. Yet they were often expected to withstand hours alone in segregation (for punishment or their own protection), with no means of passing the time – something that even those with robust mental health would find difficult.

Meanwhile, we heard the staff were overstretched and struggling to maintain control in a Victorian building overrun with rats – and that incidences of assaults on staff were among the highest in the country. So I held in awe a counsellor I met during my placement who also had a role as a prison counsellor. Retired from a successful medical career, she had retrained as a therapist and seemed undaunted by the prison environment. ‘They always treat me with respect,’ she once told me, ‘I think I remind them of their nana.’ She radiated calm compassion – I can only imagine what it must have felt like to spend time in her presence, being listened to without judgment.

But like many of the counsellors working in our prisons, she was unpaid. The prison governor valued the counsellors’ work, she told me, but budget cuts meant there was no longer any money for ‘extras’. My colleague was qualified and experienced, although many of the volunteers providing counselling in prisons are trainees. Whether this situation is appropriate or sustainable is one of the questions asked in our ‘Big issue’ report this month into the mental health crisis in the UK’s prisons. Don’t miss it.

If there is a theme running through this issue, it’s making a difference in the community, and I am honoured to be able to showcase some of the ways members are doing that, from counselling men at risk of suicide to supporting parents caring for children with disabilities. And if you need uplifting, read Daniel Hand’s joyous account of using tabletop role-playing games (think ‘Dungeons and Dragons’) as a therapeutic intervention with young clients.

Elsewhere in the issue, Duncan Barford unpicks the much-used term ‘narcissism’ in our ‘Clinical concepts’ section, and in ‘Best practice’, Roxy Birdsall invites us to consider the impact of class dynamics in the therapy room.

As ever, I hope there is something here that supports you and your practice, and I would welcome your feedback on this and any other issue.

Sally Brown, Editor


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Deputy Chair Michael Golding on Milestones

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Dr Philippa Kaye writes our client column

Talking point

Learning from endings: What have endings in your practice and life taught you?


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Analyse me

Maria Albertsen speaks for herself