Editorial 23.4

‘Th’ whole worl’s in a terrible state of chassis’ says Captain Jack Boyle in Sean O’Casey’s play ‘Juno and the Paycock’ (1969). The play is part of a trilogy about The Troubles in early twentieth century Dublin but O’Casey’s words could easily be written about chassis (chaos) and uncertainty in the early twenty-first century. Indeed, the phrase came to mind when I was reading some of the papers in this issue. More than once I was made to consider how current world chassis is impacting on therapeutic practice. 9/11 was a political turning point. Sixteen years on we are seeing the impact of the external, global world on the internal psyche. None of us remains emotionally unaffected by politics. We find it hard to be objective about Brexit or Trump. If our clients express fears about travelling on the underground or going to a concert in the aftermath of a terror attack, we can no longer primarily understand this in terms of their persecutory anxiety. We may feel it ourselves as well. Alongside this, racial prejudice is being given a louder and more open voice, nationally and globally. This insidious and irrational hatred of the other isn’t just out there. We all have moments when we wonder who might or might not be a terrorist. In a recent supervision session, my supervisee and I found ourselves seriously wondering whether a very troubled young man might have been radicalised after spending the summer with his family in Pakistan. Our evidence for this was that he’d grown a rather long beard and spent a long time each day at his mosque. It took a while to refocus our thoughts and understand that this young man was far more of a danger to himself than to others. He had returned to counselling for help to manage his violent and self-destructive feelings but the nature of prejudice and terrorism is such that it feeds on the persecutory anxiety in all of us. This can make it difficult to distinguish between external and internal reality when we know the world is in a ‘terrible state of chassis’.

In the first of the papers in this issue, Rosemary Rizq touches directly on the subject of terrorism prevention and its impact on the therapeutic space. In ‘“Pre-crime”, PREVENT and practices of exceptionalism: psychotherapy and the new norm in the NHS’ Rizq describes the duty of care required of NHS therapists and other mental health professionals to help prevent people from being drawn into terrorism. Rizq, herself an NHS psychotherapist, describes the compulsory training they undergo. She argues that ‘Governmentality’ has found its way into the NHS consulting room and the therapeutic space has been ‘colonised’ by the government’s anti-terrorist agenda, PREVENT. Rizq considers how and why fears and persecutory anxieties from the external world have entered the therapy room in such a concrete way. What surprises her most is that NHS workers, unlike some of their colleagues in the public sector, have not protested, allowing a culture of conformity and compliance to prevail. She points out that Safeguarding has been used as the vehicle for implementing PREVENT. In this very thoughtful and thought-provoking paper, Rizq meticulously argues her case and draws some of her theoretical base from the Italian philosopher, Georgio Agamben and his theory of Exceptionalism in which a state of exception can be established and normalised, hence conformity to the PREVENT agenda. She talks about the danger of the therapy room being used as a pre-crime space in which the potential terrorist is seen as a vulnerable child or adult in need of Safeguarding and clinical play or exploration is inhibited by the need for surveillance. In conclusion, she asks ‘How can psychotherapists continue to function thoughtfully in such ethically compromised spaces?’

Setting ethical standards for counsellors was something the late Ellen Noonan worked hard to achieve in the 1970s and early 80s. She was one of the first student counsellors in the UK. With others, she worked hard within the British Association of Counselling (BAC) and the Association for Student Counselling (ASC) to create an ethical framework and standards for counselling. Her paper, ‘The responsible counsellor and the ethics of the counselling relationship’, published posthumously, forms part of the collection of her writings to which her brother, Frederick Noonan, generously gave the Journal access. We believe it was presented at an ASC conference but cannot verify this. In the paper, Noonan says that ethics is a matter of trying to decide rationally what is right or good; what ought to be done and what ought not to be done, particularly pertinent in the light of Rizq’s paper. As a former student and colleague of Ellen Noonan, I found it a real gem. I can hear her voice explaining important concepts in a way that make them seem obvious. To make her point about the importance of getting to know our clients as unique individuals, she uses the here and now of the conference hall. She points out that we only really care about the delegates we already know. The unknown names on a list don’t matter to us and we don’t care what happens to them. Similarly, we can only genuinely care about our clients if we get to know them properly. Again, she uses a wonderful analogy asking how a mother sheep and her new born lamb distinguish each other from all the other woolly creatures around them.

‘Failing to try to perceive a client’s uniqueness is unforgiveable’, she says. Throughout the paper Noonan brings the idea of ethics to life, acknowledging that although we’d all like a set of hard and fast rules, it would be impossible to agree on what these should be. She opts for three aspects of the counselling relationship to hang her thinking around, Attachment, Respect and Accountability. In concluding her paper, she leaves us with a couple of typical Noonan phrases: ‘The counsellor is a specialist in helping people bring out what they know’ and ‘the responsibility for change lies with the client’.

‘Building Seven Bridges with Young Asylum seekers in the UK (Part 2)’ is based on the other half of a lecture presented to the Birkbeck Counselling Association by Sheila Melzak in November 2016. Part 1 was published in the previous issue of Psychodynamic Practice. Melzak is a child and adolescent psychotherapist and founder of the Baobab Centre, a non-residential therapeutic community for young refugees. Both papers are about the work of the Centre and Part 2 focuses mainly on her work with a young African asylum seeker she calls Johann. At the time of writing, Johann is still waiting for a decision to be made about whether he can stay in the UK. He has been here for 12 years and Melzak has been working with him for the last five. Her account of the therapeutic work with him is very moving but her desperation with the system is palpable. These young people ‘have to wait a longer time for a decision than a child can bear’, she says. Despite this, Melzak’s paper demonstrates what can be achieved therapeutically with seriously traumatised young refugees. Through slowly building a relationship with Johann and gradually getting to know him, she is able to help him with his intrusive thoughts, horrific flashbacks and the unbearable uncertainty of whether he can stay in the UK. At times this pushes both of them to the boundaries of what is or isn’t acceptable in a therapeutic relationship. At one point, he asks her to adopt him and she seriously looks into the legal possibilities. When Johann has a breakdown in his final year at university, Melzak and the Baobab Centre, are there to support him. Eventually he passes his exams, completes his degree. It is at this point that the idea of adoption is raised and subsequently rejected by both of them. Melzak’s work with Johann shows how important it is for young asylum seekers to be properly known, in the way Noonan talks about it. Johann has suffered multiple losses and witnessed horrific acts. He is an orphan with no family to hold his history. When Melzak started working with him, he couldn’t bear to be alone with his thoughts and memories. ‘Through psychotherapy he can bear being alone’, says Melzak. He also has a job and is in a steady relationship.

Melzak shows how important it is for young asylum seekers to be properly known. This parallels Noonan’s ethical requirement for counsellors to recognise the uniqueness of each of their clients. Ironically, Nini Fang’s Open Space paper, ‘No Wonder – the Problem of Depression in Psychodynamic Practice’ raises the issue of people who may not to want to be known. Her fascinating paper is based on her doctoral research into depression. She talks about the medicalisation of depression and says a medical diagnosis seems to be increasingly acceptable to people. With this diagnosis comes the seductive possibility of a quick-fix drug that will make the depression go away. However, medicalisation alone closes the door to a therapeutic exploration of the causes of a depression and the opportunity of being properly known by a therapist. As a student counsellor, I am aware that isolation and not feeling held in mind by anyone may be warning signs of high suicidal risk. Equally, I know some students who are relieved when a doctor gives them diagnoses of Depression. They no longer feel it’s their fault they feel so bad about themselves. This is what Fang means by ‘No wonder’. If someone has a diagnosis of depression, it is no wonder they feel as they do. Depression feels as if it inhabits them. A medical diagnosis makes it seem as if it comes from outside the self, like an infection or a virus. Fang suggests the No Wonder narrative allies itself with what was repressed in the first place. What Fang is saying is controversial. It may not be popular with some doctors but I don’t think she is talking about clinical depression which needs treating with drugs. Neither is she denying the importance some medication for depression. What I think she is saying is the medicalisation of depression can be used as a defence and the No Wonder narrative ‘masks our understanding of the underlying unique story beneath and behind depression’. It also sanitises the messiness of psychological experience.

The second Open Space paper ‘International Women’s Day’ takes us on a totally different journey. This time we are taken on a tour of art galleries in Florence by psychotherapist Linda Cundy. Cundy starts the paper as she starts her day, ‘I woke up this morning and checked for emails on my mobile phone. A message arrived in my inbox urging me to sign a petition, ‘Rise up for women!’ I rose. It is 8 March, International Women’s Day. I am in Florence’. Immediately the reader is transported into Cundy’s world. She tells us about the traditional sprig of Mimosa, the free Prosecco and free entry for women into art galleries in Florence on International Women’s Day. Cundy is highly knowledgeable about Italian art and delights us with her knowledge. One can almost picture her with her symbolic umbrella guiding us through the Renaissance art and Architecture of Florence. At the same time, she is looking through her psychotherapist lens to give us insight into the art and sculpture she is viewing. She walks us past the Uffizi Museum and the Palazzo Vecchio on her way to the Bargello Gallery, where she takes us to see the Madonna della Misericordia, the Lady of Mercy. This Gothic figure becomes the centre piece of her paper in which she shares her thoughts about the power of becoming a useful and helpful member of society as a way of mourning unbearable loss and managing grief. The sculpture depicts the Madonna sheltering many figures inside her cloak. Her son died a cruel and public death, says Cundy but her capacity for compassion survived. She found meaning in her life by sheltering others. Cundy links her thoughts about this fifteenth century sculpture with the plight of the mothers of Aberfan who tragically lost so many of their children in the coal slurry that covered the primary school in 1966. Like the Madonna these women ‘became useful members of society with valuable but tragic life experience, rather than victims to be pitied’ says Cundy. She is also reminded of the women she has worked with who have suffered tragic losses. At the end of her day of art and reflection, Cundy goes to a restaurant, where she is given a free glass of Prosecco and a sprig of Mimosa. A fitting ending to an inspiring day and a delightful read.

Finally, to the book reviews in this rich issue of Psychodynamic Practice. These are always a fascinating part of the Journal. This time I was very interested to read Christine English’s Book Review Essay on a collection of papers put together by R. Gill, ‘Essays of Addictions from an Attachment perspective: Do broken bonds and early trauma lead to addictive behaviour?’. The papers were presented at the twentieth John Bowlby Memorial lecture and they set out to address the ‘relational roots of using’. English herself has done research on addiction and interviewed 34 addicted adults for her doctorate, so she has her own views on the subject. As we might expect, most of the chapters in the book come from an Attachment Theory basis, so it is interesting to read English’s reference to Kleinian analyst John Steiner’s idea of addiction as a psychic retreat; a way cutting off from others as well as one’s personal desires, needs and passions. The second Book Review Essay by Aziz Quzel, ‘The Paradox of Statistics: Uncovering the logic of avoidance in medical framework’ is about the book ‘Diagnosis and the DSM: A critical review’ by S. Vanheule. Other books reviewed in this issue include: Creative Listening and the Psychoanalytic Process by Fred Griffin; A New Therapy for Politics by Andrew Samuels; A Different Path, an emotional autobiography by Neville Symington; Identities in Transition, The Growth and Development of the Multicultural Therapist by Monisha Nayar-Akhtar; Maximizing Effectiveness in Dynamic Psychotherapy by Patricia Coughlin and Incandescent Alphabets: Psychosis and the Enigma of Language by Annie G. Roger.

Ann Heyno
Commissioning Editor
[email protected]