THOUGH her soul requires seeing, the culture around her requires sightlessness. Though her soul wishes to speak its truth, she is pressured to be silent.
Clarissa Pinkola Estés
I would like to preface this book by saying that this is not a slamming indictment of therapy as a profession – far from it. I would not have come out of the other side of my experiences if it weren’t for a range of services and certain amazing counsellors and other professionals that supported me in some of my darkest times. Rather the purpose of this book is to serve as a warning - for potential counselling clients, counselling students and even practicing therapists; to be aware of the potential consequences of therapeutic negligence and the dangers of abusing a position of power, especially when you work with vulnerable people. Thankfully, the majority of those already working in the profession do not need this warning, they are all too aware of the impact their actions can have. But there are also those who are unaware or unaccepting of these dangers, or the potentially life-altering consequences they can have.
Often, those seeking counselling do not know what they are looking for - I certainly didn’t. I was unaware of the different modalities, approaches and specialities, how they worked and what each one brought to the table. Not to mention the range of counselling training providers and the fact that anyone can call themselves a counsellor without even the scent of a qualification; there is no government sanctioned register for counsellors in the UK and no way to regulate an individual’s private practices. A practicing counsellor can reel off a list of online only correspondence courses, a one-day seminar or seven years of hard training and development and the client would not know the difference between them unless they knew what they were looking for. And even then, without speaking directly to the awarding organisations there is no way to verify these claims because there isn’t a national register which monitors this information.
Shockingly the terms ‘counsellor’, ‘therapist’ and ‘psychotherapist’ are not protected terms – there are no penalties for calling yourself a counsellor without any counselling training, no one checking these qualifications or experiences and nothing to stop someone setting up shop and seeing paying clients without ever having set foot on a training course. Art Therapy, Music Therapy and Drama Therapy are all protected terms however, and members must belong to the Health Care and Professionals Council (HCPC), which have an online searchable register if you are looking to confirm the reputation and qualifications of your therapist in these disciplines. We will come to look at why the HCPC doesn’t also regulate counsellors and psychotherapists in this way in the coming chapters.
Although there are accrediting bodies such as the British Association for Counselling and Psychotherapy (BACP), the UK Council for Psychotherapy (UKCP), and the British Psychoanalytic Council (BCP), and many others, there is no requirement to belong to any of these bodies, they are entirely voluntary, and the bodies themselves are not regulated by an outside agency. They are self-governed, and while you might hope that any complaint or violation in procedure would lead to swift and permanent resolution, this is not always the case. As you will see, much of the anguish in my experience was instigated by a bad therapist, and then exacerbated by the body that protected them. All of which is allowed to happen within an industry which is accountable to no one.
Even in the rarest of cases in which a member of one of these bodies is removed from their register due to misconduct or negligence, that does not prevent them from continuing to work as a counsellor, they just lose membership privileges which often only amount to a shiny logo on their website and discounts in accessing courses and training events. The UKCP received 298 complaint enquiries in 2018, this resulted in 74 complaints being formally lodged – over double that of the previous year – with only 1 of these complaints resulting the removal of a therapist from their register. It can be argued that more complaints are due to clients being more aware of their rights, a better understanding of what is acceptable and what isn’t within the counselling relationship and feeling more supported in coming forward with their concerns. But it can also point to the huge increase in counselling trainees over the last 15 years. The Counselling and Psychotherapy Central Awarding Body (CPCAB), which is the leading training provider for person-centred counselling in the UK, receives over 15,000 new registrations every year. Combine this with undergraduate and post graduate courses up and down the country and alternative methods to qualifying and you can begin to see the enormity of the industry.
Belonging to an accrediting or regulatory body is not mandated for therapists, and even experienced and dedicated counsellors can choose not to do so because of the costs and additional expectations involved – there are often CPD requirements and a mandatory number of client hours which can significantly increase the expense of training and accreditation and so for individual practitioners, the upfront costs can outweigh the benefits. There are also the costs of supervision, which is a requirement for most of the membership organisations, and additional travel expenses. Especially when you are just beginning on your journey to become a counsellor, if you consider that one BACP survey found more than half of the respondents earned less than £10,000 a year from their counselling role and were working two jobs or more to make ends meet. All of these are important points to consider both if you are training to become a counsellor and if you are looking for a reputable therapist yourself.
I write this book from the point of view not only as a client, but now as a training counsellor, educator and mental health professional. I shouldn’t need to have a therapeutic or academic background to have my story heard, to be believed or listened to. It is all too easy to dismiss individuals – especially women – as hysterical, overreacting or as plain liars. There is already a considerable body of evidence that points towards female experiences of healthcare as less reliable and consistent compared to that of males. That female accounts of health complaints are not taken as seriously and that women are left without pain prescription for longer than men with the same condition are the tip of the healthcare disparity iceberg.
Historically, medications were only tested on Caucasian males so that differences in genetic makeup and variables of the menstrual cycle did not have to be taken into account. Additionally, so that if there were any unforeseen issues with the medication, women of reproductive age would not be harmed and there would not be any long-term consequences for unborn children. This disparity extends into mental healthcare with women more likely to be diagnosed with a personality disorder than any other mental health condition. That’s not to say that personality disorders do not exist, but they certainly do not account for the vast number of women who make up these numbers.
Women’s health, along with almost all other aspects of womanhood, has had a troubled history, with almost all mental health or mood disorders attributed to hysteria prior to the 1930’s, and the causes of this ranging from demonic possession to a wandering womb to sexual dissatisfaction. The word hysteria itself comes from the Greek word hysterika meaning ‘uterus’. Although cases of male hysteria have been documented, these were far less common and were linked to instances of traumatic shock and would have more in common with modern day post-traumatic stress disorder (PTSD) than a personality disorder. More than 100 years later and the first studies linking early traumatic experiences to the onset of Borderline Personality Disorder (BPD) are emerging. You don’t need to be an angry feminist to see the gender inequality here and recognise the outright apathy in furthering women’s mental health care. Though I do think that if you’re not angry then you’re not really paying attention.
In Freud’s time, hysteria (and occasionally ‘melancholy’) were most often treated with pharmaceutical stimulants like heroin, cocaine and methamphetamines, and physical stimulants like prescribed masturbation or forced ‘relief’, administered by a male physician. Freud gradually began to reclassify hysteria as ‘anxiety neuroses’ and was the first to use talking therapy – psychoanalysis- as a means of reducing internal conflict which in turn lessened hysterical symptoms and behaviour. Along with his unconscious uncovering and dream interpretation, Freud began to shift collective thinking away from women as inherent magnets for madness and towards them as victims of circumstance and trauma, most notably as incredibly persistent accounts of sexual abuse in almost all of his female patients.
Psychoanalytic theory has suffered many criticisms and attempts at discreditation since its emergence, because of its marked emphasis on sex and sexual maturation as the cause for almost all subsequent internal conflict and relationship development. Many have since argued against this, including Freud’s own prodigy, Carl Jung. As well as the inherent subjectivity of dream interpretation and the power imbalance created by the psychoanalytic relationship (the therapist as the guide rather than the companion), Freud’s original theories have undergone significant change to emerge into what we know of psychoanalysis today.
Mass media helps to perpetuate unhealthy stereotypes of female mental health by not only depicting women with mental health issues as unstable, untrustworthy and violent (to themselves and others), but also exaggerates the number of male counsellors and therapists while a significant proportion of mental health care workers at all levels are actually women. This helps to enforce the public rhetoric of the level-headed, well-educated male caring for unstable, unreliable females. Not only does this undermine women in their own right, but also perpetuates the mirage that men are inherently more trustworthy, their testimony more reliable and their judgement more impartial. A simple glance at modern politics should be enough to dissuade anyone from the idea of men as more emotionally stable, mature and reliable.
My favourite personal mantra is ‘not me first, but me too’. This is not a branch of the #MeToo movement, it is serendipitously separate from it, but in some ways still inextricably linked. The gap in mental health care, and healthcare as a whole, is becoming smaller, but it is still there. The attitude towards women’s mental health is also becoming more progressive, but there still seems to be a fight, especially in my experience, to be heard and treated with the same respect as a man in my position would be. As a woman I have had to meter my responses at every step so not to be seen as ‘too emotional’ or ‘hot headed’, rather than understandably angry and determined to call out injustice where I see and feel it.
Feminist manifesto aside (and there is a growing branch of feminist counselling to be explored, if you are so inclined), this book was originally intended just to tell my story, as a cathartic way to get this information out there and hopefully to foster some kind of conversation about the dangers of neglectful (and sometimes outright predatory) therapists. But in the writing and research I have spoken to some very brave and generous individuals who also want their story told and have allowed me to include them alongside my own, to further paint the picture of dangers of unregulated therapy. These have been reproduced from the client’s point of view with their full permission, and all names and places, as well as some other potentially identifying information have been changed to protect anonymity. You can read books and articles and forums and find many more accounts similar to these ones which helps to showcase the extent of the problem, and yet still it persists. There is even an infamous book written in the 1970s that espouses the benefits of ‘sexual intimacy with therapy clients’. I do not expect to be able to eradicate all bad therapists with my writing, but it would be nice to think that even when these situations arise, they are dealt with swiftly and with appropriate consequence.
But I did not want this is to become an anthology of misery, these stories are important, and they need to be heard, but there also needs to be some light at the end of this tunnel. As such, I have discussed this issue from a national perspective as well as a personal one and provided a kind of guide for those seeking therapy to help them avoid the same trap that I and the other people in this book have fallen into. As well as an examination of the therapeutic industry in our neighbouring countries who seem to have a better grasp of regulation and management than we do. As we will come to see, in many comparable countries, only those with medical training or postgraduate qualifications in psychiatry or psychology are legally allowed to deliver counselling and psychotherapy. There are considerable arguments against the regulation of counselling and psychotherapy too, but more on this later.
I want to highlight how important it is to know that no person is deserving of abuse or harassment, that it doesn’t matter the strength of your ‘connection’, if you consented or not – the inherent power imbalance that comes with a therapeutic relationship eliminates any genuine romantic feeling and any half-decent therapist will immediately address any physical or emotional attraction and bring it into the therapy room. If therapist or client are unable to work through this, then they should be referred on to someone else. Even if the client is the one who instigates the relationship, the therapist is the professional and they are taking advantage of vulnerability if they allow it to happen. There is no excuse for not doing this. It is never the client’s fault.
There are also many other behaviours which can fall under the category of negligence and even abuse, which will be explored in more detail throughout the following chapters. A relationship does not have to be physical to be inappropriate or to cause psychological harm. This book is not a condemnation of genuine feeling, a dismissal or rebuke of clients who fall for therapists, and vice versa. There is already significant discussion on that topic. Instead I am looking at the consequences of therapist abuse and neglect, the way power imbalances are taken advantage of and the impact this can have on already vulnerable individuals.
Many of the names and places in this book have been changed to protect the identity of those involved, even the ones not worthy of protection. But the content, the emotion, the damage, and the on-going effects are all real and painfully honest.
You will also notice that I use the terms counsellor and therapist interchangeably throughout the book, these terms amount to much the same thing and this can also extend to psychotherapist. These should not be confused with psychologist or psychiatrist, both of which are protected terms and have a minimum qualification stipulation and a national register in the UK (The British Psychological Society (BPS), and the Royal College of Psychiatrists (RCP) respectively).
The illustrations in this book are all my own, taken from my journals and sketchbooks immediately following my experiences, and well into the recovery period after it. I am not an artist or an illustrator, but I wanted to convey my meaning in the best way I know how – words and pictures. Neither of which seemed quite sufficient enough on their own.