6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

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As a CBT practitioner, he uses exposure to challenge the avoidance: ‘What is striking in research is that a strong predictor of complex grief is the fear people have of the intensity of their pain – they endorse statements saying the pain would be unbearable, too intense. Such catastrophic misinterpretations or phobia-like predictions are strong predictors of complex or prolonged grief. CBT is about targeting that avoidance and gradually confronting the loss, the irreversibility, the pain, the implications, but very gently, at the pace of the client, which is central to the approach. CBT asks the client to test these fears. We don’t aim to take away the pain; we try to turn the unhealthy grief into healthy grief that people can live with. So the grief doesn’t necessarily decrease but people learn how to build their activities around it and are less preoccupied with their loss.’ Start with a clear idea of the concepts and information you want to convey. Think about your audience - you need to capture their interest and be relevant to a range of practitioners. Read other articles from the specific journal to get a feel for the tone and style. She says coaching is frequently misunderstood as highly directive and technique based. ‘Yes, coaches often have a toolbag of frameworks to use, but we also need to have the discipline to be focused on the person in the room and give them space to think – not reach for this or that tool and think this will fix them. That’s not our job. The tools are a way of helping them to explore things further for themselves. And you are always listening for their strengths and for the resources within them as well as the pain and suffering.’ Meantime, the July issue offers rich reading, not least Phil Hills’ and Rachel Lawley’s description of how they, as newly qualified counsellors, set up and are now taking a specialist counselling service into schools to offer support to the teachers. It’s a story of head, heart and sheer business-mindedness that, as they say, has meant they can work to the values and principles that brought them into the profession.

We can support those living with dementia to learn to move themselves into life after loss. As Marina reminds us, perhaps as witnesses ‘we are not looking, feeling or listening hard enough’. Embodied interventions suggest that movement, emotions, cognitions and the body are not separate – they are entangled. A kinaesthetic awareness when engaging with a person living with dementia can allow for a relational intimacy – however fleeting (to borrow Marina’s words) such moments of connection, companionship, seeing and bearing (the pain) together may be. Biologist Ann Fausto-Sterling 13 points out that our bodily self-perception is formed on the basis of past information, which by definition is always out of date with our current physical body. So, embodied attention during the psychotherapeutic relationship with people who live with dementia offers a crucial possibility to activate the mirror neuron system in the brain, thus linking bodily awareness, empathy and intersubjective processes. 14 We can invite the person with dementia to re-member through the body. In my role as both clinician and educator I have observed over the years how the materiality of movement exchange between self and other can allow for an experience of finding self in other. For the dementia family this can mean re-connecting and building new kinds of relational intimacies with a loved one; for professional carers it can mean re-learning about a relational intimacy. Summoned If you've included information or discussion about any member or members of your family, please confirm that what you've included is made in good faith and is true and accurate to the best of your knowledge; that you’ve considered any potential impact on them and on other family members if they read the article; and that, having done so, you wish to go ahead with publishing. Stroebe M, Schut H. Bereavement in times of COVID-19: a review and theoretical framework. OMEGA–Journal of Death and Dying 2021; 82(3): 500–522. Freud originally conceptualised mourning as something that passes as the person ‘tests the reality’ and confirms the person no longer exists and so gradually detaches themselves emotionally from the dead loved one, and finds a new object for their love. But, says Rosenfeld, he changed his mind after his daughter Sophie and then his much-loved grandson Heinele died. We don’t ‘move on’, Rosenfeld says; we find a way to live with the loss, even if we do find a new ‘love object’. ‘Some losses you can never replace,’ she says, and perhaps especially the deaths of children, which can defy all attempts to make meaning of them.

In this issue

This short multi-layered film speaks, sings and dances the lived experience of dementia. If, as witnesses, we become baffled in trying to solve the puzzle of the, at times, peculiar and other-worldly narrative (and imagery) of I Can’t Find Myself, it is because we are not looking, feeling or listening hard enough. Because dementia is peculiar, other-worldly and alienating. Most importantly, the film highlights that dementia is unavoidably an embodied, relational and affective experience. As two of the letters in the ‘Reactions’ section of this issue remind us, language matters. Jennifer Deacon’s letter explains the problems with describing therapy that takes place outdoors as ‘walk and talk’, while Lois Peachey expresses her frustration at the increasing use of ‘mental health’ as a euphemism for ‘mental distress’. You must provide evidence that you have permission to use any written or visual material from a third party, such as extracts, pictures or diagrams.

Breen LJ et al. Risk factors for dysfunctional grief and functional impairment for all causes of death during the COVID-19 pandemic: The mediating role of meaning. Death Studies 2022; 46(1): 43-52. Another highlight of this issue for me is our ‘Experience’ piece, in which Max Marnau, a BACP senior accredited counsellor, shares the dilemma of whether to ‘come out’ to clients about her late diagnosis of autism. She also questions why therapy for autists still focuses on helping them conform to a neurotypical world. There are a lifetime of stories that need to be told and heard, and there’s depression and righteous anger about the here-and-now too – at ageism and the loss of visibility, community, mobility, health, respect and independence. Intrigued? Turn to our feature on counselling older people. Our cover theme, the ‘Big issue’ report ‘Riding the waves’, assesses the impact of the predicted post-COVID mental health tsunami and confirms what many of us know from our own practice – that it’s the most vulnerable in our society who have been most impacted. In this article, we ask what needs to happen now to minimise the effects. I am aware that Therapy Today’s readers work in a wide range of settings and with a variety of modalities, but if we are BACP registered or accredited, one thing we all have in common is monthly supervision. Given that this is mandatory and a regular expense, it makes sense to get the most out of it, so this month we launch a new column to answer a common supervision question each issue. The first looks at the benefits of pre- and post-supervision reflection.However, not every therapist has had a negative experience. BACP registered therapist Katie Rose, who has set up a Facebook group for UK therapists working for BetterHelp to share tips, says you can make it work for you: ‘Yes, clients can message you at any time of day, but you don’t need to respond at any time of day. I respond during my normal working hours. The system does pester you if you don’t respond within 24 hours but you’re not expected to respond immediately or at the weekends,’ she says. ‘Plus, you do get paid for messaging so for me, there is an incentive to respond.’ Many others struggled with relationships and compulsive sex. It seemed drugs were omnipresent on the gay scene. At Attitude, I noticed a pattern of staff taking Mondays off. I found one asleep on his desk. Then the gay brother of our advertising manager, someone who worked with us for a while, who had struggled with drink and drugs, took his own life. Specifically, our aim for the film is to create a wider understanding of people living with dementia and to highlight how engagement with the entangled relationship between dance and music can enhance affective and kinaesthetic responses – not only for those who live with dementia but also, crucially, for their network of carers. We cannot escape embodied entanglements in life or in psychotherapy. Changes in physicality or gesture influence affective state, and the implications for this are profound. As people move together they learn different ways of relating; they develop shared networks of meaning making and communication that are important to intersubjective relating, neurologically and psychodynamically. 6 Both dance movement psychotherapy and neuroscientific research highlight how our ability to feel with others is intimately connected with our capacity to move with others, and for our bodies in turn to move in response to such feelings. 7,8 Moving with others, as Julia says, touches.

Berrol C. Neuroscience meets dance/movement therapy: mirror neurons, the therapeutic process and empathy. The Arts in Psychotherapy 2006; 33: 302–315. Allegranti B, Wyatt J. Witnessing loss: a feminist material-discursive account. Qualitative Inquiry 2014; 20(4): 533–543.

From the Editor

If you include material about individuals (clients, colleagues or participants in any research or study), please provide written confirmation that you have their permission to publish the material in a print and online journal and that you have anonymised all identifying details. Depending on the nature and detail of the material, we may also ask you to confirm that they've read the article. Conversations and correspondence This issue also sees the introduction of two new columns. ‘My practice’ is a chance for you to share how you work. In the first column, Sarah Edge describes her work with postnatal clients. I am also delighted to introduce a new column from Therapy Today’s Editorial Advisory Board – the team of talented practitioners who are on hand to ensure the content of your magazine stays relevant and inclusive. I’d like to thank John Barton for agreeing to go first with a thought-provoking piece on ‘getting over ourselves’. You’ll hear from a different Editorial Board member each issue. Allegranti B, Silas J. Embodied signatures: a neurofeminist investigation of kinaesthetic intersubjectivity in capoeira. The Arts in Psychotherapy (forthcoming). I spoke to a number of people about their experience with therapists. Some reported positive experiences, and that they sometimes found it helpful talking to heterosexual therapists who might bring a fresh perspective. But this was not the case for everyone. Says Emily Harrop, one of the lead researchers, ‘People described the distress and guilt caused by being unable to say goodbye and provide comfort to their dying relative; parents also described the added confusion and upset caused to their children by being separated from grandparents before the death. Having unanswered questions, regrets and doubts made it harder to process and reconcile their feelings surrounding the death, and these difficulties were reflected in the numbers of participants – some 60% – reporting high or fairly high needs for help dealing with their feelings about the way their loved one died.’