‘Littered under Mercury’ is a book aimed at those just starting out in the counselling profession. It offers a relational view of counselling, which has much to offer anyone, however trained.
It contains chapters on ‘Practicalities”, “The nuts and bolts of relationship’, ‘How the past influences us,’ ‘How parents influence us’, ‘Attention: relationship at work!’, “What heals in counselling and therapy’, “Boundaries’, ‘Defences’, and ‘Counselling and Psychotherapy in the modern world context.
The book is suitable for college and university trainees whether aiming at becoming clinical psychologists or counsellors or psychotherapists, and those in the early days of the work.
Littered Under Mercury
Counselling begins
Prologue
Counselling and psychotherapy are confusing professions to join. For a start, are they two professions or one? A glance at their literatures would suggest that they inhabit two different cultural streams, and therefore see themselves as different. They don’t tend to read each others’ books and papers. Yet they are both alike and different. Some people call themselves psychotherapists who seem to have followed what is basically a counselling training, while some people call themselves counsellors who seem to do similar work to psychotherapists.
It is their trainings which inhabit two largely different worlds. Here the split begins. Counselling is a mainly undergraduate-trained profession, while psychotherapy is a mainly post-graduate-trained profession. Yet many counsellors seek supervision with qualified psychotherapists, who, on, the one hand, may deny any relationship with the other profession, but on the other hand, do not see counselling
supervision as irrelevant to their work. And counsellors do not see psychotherapeutic supervision as irrelevant to their work.
Professional battle lines are sharply drawn in the light of these understandings - or lack of them.
The nomenclature is different, too. ‘Counsellor’ is derived from Latin ‘consilium’ meaning ‘consultation or advice.’ Yet many counsellors are eager to assure us that they do not give advice. Psychotherapy on the other hand is formally defined in the OED as ‘the treatment of mental disorders by psychological means.’ Yet some psychotherapists do not regard themselves as being engaged in ‘treatment’ or even recognise the existence of mental disorders! But if this distinction of function is meaningful, and it is for many, does this imply that psychotherapy is a serous business in a way that counselling is not?
And if this distinction is meaningful, how does it impact on prospective clients? Do those clients who know they need treatment of their mental disorder go to a psychotherapist, while those who just need somebody to consult
- to talk to, in effect - go to a counsellor? It would appear not. There is no such referral mechanism, which would ensure that some cases go one way and some another. The NHS has tended to run psychotherapy departments rather than counselling departments, which might give us a clue as to how they view things. But many GP surgeries now provide counselling opportunities, albeit short term in nature, for patients who seem to them to need something of a more psychological nature that modern medicine alone - which seems to suggest a link in their minds between treatment and counselling. And, anyway, a great deal of psychotherapy and counselling operates outside of the NHS medical model, and therefore defines itself pretty much as it wishes. Many qualified psychotherapists are in private practice and may have little to do with the NHS anyway, and this is an ongoing trend, with the reduction of many psychotherapy services in the NHS because of cuts in budgets in recent years.
Much counselling and some psychotherapy is offered on a voluntary agency basis, or through employee health programmes of various kind. Again, links with the NHS may be tenuous.
This is before I mention such questions as who, then, are clinical psychologists? And where do psychiatrists fit into the picture? It may surprise some readers to know that clinical psychologists, who do a great deal, if not most, of the therapeutic work in the NHS, are not obliged to qualify as psychotherapists, though they may have a great deal of theoretical knowledge of research in psychology, and indeed have had extensive supervised clinical experience. However, they may have had no personal therapy at all. Psychotherapy as such, however, is not predominantly a theoretical discipline, and most trainings of substance are based on the study of clinically-derived (rather than research-derived) aspects of theory, plus lengthy personal therapy and lengthy, supervised clinical experience. The balance, in short, is different from that of a clinical psychology training.
Psychiatrists are qualified doctors, with additional specialist training in mental health, and are similarly very knowledgeable about medicine and research psychology. But they are not required to train as psychotherapists, and again may have had no personal therapy at all. I sometimes think that this deficit can be expressed as a
case of having to know everything about everybody else, and nothing about oneself! The founders of psychoanalysis, Freud and Jung, were both qualified doctors, and Jung was a qualified psychiatrist, but both eventually decided, on the strength of massive clinical experience, that there was not much point in requiring you to be a doctor, if you wanted to practice psychotherapy, because the links with medicine are indeed tenuous.
If the illness seems to be organic, it is easy enough to refer the patient to a qualified doctor. It is interesting that, with the development of all kinds of body-based and energy-based therapies, this straightforward split is being challenged afresh, from new perspectives which increasingly recognise the psychological basis of much physiological illness. Nevertheless, if every practitioner were required to become expert in medicine as well as psychology/psychotherapy, trainings would be so long as to deter all but the most hardy and well-endowed financially.
It is often hard, in fact, to get the point over to psychologists, that clinical experience plus persona
therapy are big chunks of the cake of being a psychotherapist or counsellor. The study of theory is important, but not more important than these components of training. I remember once saying to a group of advanced academics that Freud practised ten hours a day six days a week for most of his professional life, and finding that they did not see this as amounting to a hill of beans, compared with having read all the available research into Alzheimer's disease, or the educational difficulties of young children in Salford. But in the consulting room, as a counsellor or psychotherapist, which of these streams of knowledge do you think you are most likely to draw on?
How does the beginning counsellor or psychotherapist find their way through this dark wood of unclarity?
Elizabeth Simpson
April 2014