Clare Slaney Counselling Home

18/8/2021

Rishi Sunack cares so deeply for younger people that he’s advised them in particular to get back to the office.

"I doubt I would have had those strong relationships if I was doing my summer internship or my first bit of my career over Teams and Zoom."
"That's why I think for young people in particular, being able to physically be in an office is valuable," he added.

Almost before the words had left his mouth people of all ages were talking about how, in the last 18 months, they’d finished their professional studies, got a promotion (or two) had been working from home with responsibilities for teams over vast areas of the UK for the past 20 years, or quietly pointing out that the internet has been around for some time.

Many people moved home on the understanding that if they can work from home for a year they can work from home for much longer. Small fortunes, days worth of time and unknown levels of sanity have been saved by not having to commute for the last 18 months. And while lockdown has been genuinely upsetting for people who thrive in the busy environment of the chatty, social office for many others it’s been a relief to be able to work without interruption and not be considered weird or antisocial if they don’t want to go out for drinks afterwards. JOMO – the joy of missing out – is real. People who are disabled have been telling the rest of the world that it’s possible to be very productive while working from home with good IT for decades. That’s undeniable now.

For some people with children and/or a small home it’s been dismal and most of them will be very pleased indeed to get back to the office. And of course, huge numbers of people of all ages have been working face to face throughout the pandemic in low paid essential jobs, from deliveries to health care, in supermarkets and schools, and as volunteers. The idea that promotions and developing in ones career are dependent on “strong relationships” has more to do with nepotism than with talent. It’s also got a great deal to do with age.

People younger than Mr Sunak are completely used to being online one way or another all day long, being able to see who else is in the virtual office, pinging each other in the same way as you or I might have wandered over to a colleague’s desk to ask a question.

For centuries, clerks would spend all day copying one contract out with a quill on parchment in silence: no one suggests that should continue but computerphobia was genuine in the 80’s

“In the early days of the telephone, people wondered if the machines might be used to communicate with the dead. Today, it is the smartphone that has people jittery,” she wrote. “Humans often converge around massive technological shifts—around any change, really—with a flurry of anxieties.”

McKinsey, along with other forward thinking organisations, have been discussing this latest change in culture for months and whilst nothing is currently certain most office-based employers recognise the benefits as well as the challenges that these changes have brought. Those that don’t, who, in a world of productivity measures, 360 reviews and keyloggers, still prefer the panopticon may find their sickness and turnover rates increasing.

Mr Sunak’s concern for the working person, especially younger ones, is touching. He will also be feeling concern for people who’ve heavily invested in commercial properties. Understanding that an unregulated Market is the best way forward, he’ll be able to reassure them that everything will work out fine.

In the meantime, if your company is pressuring you to get back into the office and you’re finding that burdensome now is the moment to seek a more future-focussed, agile employer. There’s going to be a flurry of anxiety in September when furlough is due to end which will shake up the employment market and our economy is showing signs of (inevitable) recovery. Prepare yourself, your CV and your ‘strong relationships’ for the opportunities you want to make the best of.

Office based work traditionally slows down in August, it’s no bad time to sit back, review how the last year has been and what you might want for the next couple of years. If your employer has valued you, given you what you need to balance productivity, remuneration, rest and a life beyond work then rejoice and consider how you'd like to develop. But if your employer puts greater weight on being able to control you than focusing on your actual productivity, it’s time to leave them where they’re most comfortable: in the past.

8/7/2021

England's hopes to go through to the ‘96 Euro semi finals ended when Gareth Southgate missed a penalty. He was consoled by some of his teammates but guilt and humiliation were an obvious consequence of his failure in front of thousands of people in the stadium, millions of people watching on tv, hundreds of millions of people talking about it in the days afterwards.

After England got through to this years’ semifinals someone (if you know who it is let me know so I can credit them) created this image of that younger, devastated Southgate being met and reassured by Southgate as he is now: 25 years older, steady, the universally respected, inspirational manager of the England team.

I've spent a long time looking at this image, it encapsulates a vital piece of the work of therapy: reaching back in time to meet with the parts of us that were harmed - and harm is part of being alive - to see them, pay careful attention to them, listen to what they have to say and help them feel less beaten. That young Southgate is never going to skip off the pitch singing “Oh it doesn’t matter!” but the impact it had on him wasn’t met and so it affected his life for far longer than it needed to: “I just couldn’t face anyone but my family. It was a bleak time. I felt anxious and nervous, as I didn’t know how others would react to me.”

He’s since said he could have done with therapy, which is now a standard part of professional footballers care. Instead, he got a Pizza Hut advert.

This kind of banter can be healing for some men who already have high status but it’s a risky tactic to embrace the identity of a dolt in the hope that you can diffuse it.

Therapy offers the space to risk a return to the pain, to relive some of it with someone who isn’t going to sneer at you or tell you to get over it or punish you. If you need to make it better by laughing at yourself and telling yourself to toughen up, that’ll be respected and the opportunity to reach further will be offered.

You’ll find the internal resources to be the person you needed at that time, to tell yourself that it really is terrible right now but this isn’t going to last forever. To let you know that yes, it’s humiliating, crushing, and maybe even dangerous but that this will pass. The confidence and pride that was demolished remains available to you. Therapy offers the chance to rediscover it and to move on with greater knowledge and understanding.

26/5/2021

Where Therapy Happens

Freud's therapy room.

More than a year on from lockdown and with Covid restrictions being reduced, where are therapists as a profession and what are my plans?

Some therapists working in highly specialised agencies caring for extremely vulnerable clients have moved backwards and forwards between virtual and face to face work throughout the year. A few therapists in private practice have done the same but this hasn’t been the choice for most of us for obvious safety reasons. Perhaps less obvious are the theoretical bases for this decision.

The boundaries of regular, stable, predictable meetings come a very close second to clients’ safety. Knowing where and when you’re going to meet, what’s going to happen when you get there, how things begin and end, allows a trustworthy, reliable relationship to form. The unconscious mind needs cues to feel secure and predictability of sessions allow the client to enter quickly into a therapeutic mindset, to move from the mundane to the intensely personal and make the most of the session. This doesn’t mean that the content of the session will always be the same, not at all, it means that the client is free to attend to what's on their mind without the distraction of change, of having to reorientate themselves or wonder about and become distracted by what changes the therapist might be going through. It's vital that the client remains the focus of attention, not the therapist.

Therapy develops a kind of ritual flavour: just as we behave one way when we’re at home, another way in the pub and another in the office, so knowing how to be during therapy comes much easier with regularity. It’s why therapists prefer seeing you at this time on this day: a dedicated, stable place and time for this delicate process supports clients getting the best from it.

Professional Advice
The British Association for Counselling and Psychotherapy have useful guidance on deciding whether or not to return to face to face work which includes:

consider your clients on a case by case basis – is the risk to the client of working remotely greater than the risk of working face to face?
consider whether the space you plan to work from allows for social distancing of two metres or at least one metre with mitigation – this includes any areas such as entrances, exits, corridors and waiting areas
decide whether you need protective equipment such as masks or visors
conduct and publish a risk assessment of your premises and create a procedure checklist to mitigate the risk of contamination before, between and after seeing clients. This is a legal requirement.

As I've said before, risk assessments around a virus that remains a bit of a mystery to epidemiologists is not possible for therapists. Infection control is a specialist discipline and one that therapists have absolutely zero teaching or experience in.

If I begin seeing one client but not another that will set up all kinds of reasonable, entirely avoidable and potentially very unhelpful dynamics between us. "I'm more or less important to you" "Do you think my life is less or more valuable?" "Do you not want to see me?" "Do you not trust me?" and so on. This can be valuable, informative material. And it's something that can be addressed without implementing policies based on a pretence of expertise.

Covid
The UK hasn’t done very well in managing the pandemic. The numbers of deaths here are relative to population. It’s worth isolating, say, India from this chart and then the UK to see the graphic difference in numbers of deaths over the year. The new variant which has developed in India has been spreading quickly so that areas of the UK are back under more restrictions. It will soon predominate in London.

While both vaccines cover the new variant they are about a fifth less effective against it than against older variants. It looks fairly certain that the new variant is going to result in us moving back into some kind of national lockdown. This is enough of a risk for me to hold off moving back to face to face work. For me, the therapeutic importance of regularity outweighs my own need to be physically in a room with a client.

Costs
Office rental fees anywhere, let alone in London, were becoming ludicrous before Covid; right now the market is labile and looks to become stupid in the coming year as landlords try to make up lost earnings. These increased costs must be covered and that means increasing fees, something that I very much want to avoid. Many Employee Assistance Programmes (EAP’s) having maintained the same payments for, on average, 15 years, have used the pandemic as an excuse to reduce them. The hourly cost of an office can be the same as many EAP's hourly payments.

The positives of video conferencing
I’ve had the pleasure of working with people from all over the country in the last year and we’ve been able to continue to work wherever the client is, whether that’s at home under lockdown, in a side office at work or from their hotel room. Privacy has been an issue for some people some of the time, particularly over winter, but not yet a reason to end therapy. People with disabilities, with children or other dependents have been able to come to therapy, the flexibility of not having to come to an office has seen therapy open up to a greater range of people.

Overwhelmingly, VC gives clients far greater control over their time. Rather than therapy being another box that must be ticked, often running to and from the office during a precious lunch break, therapy has become much more relaxed, often more profound. People now take at least 10 minutes before and after our work, often a lot more, to prepare for and process it. Their focus can be on therapy rather than on whether the tube is running or when they might squeeze some food in to their day. It’s notable that a large majority of clients have been able to set a day and time to meet and have been able to maintain that rhythm, something that was previously all but impossible. As restrictions ease this is likely to change, but with the extra time that VC makes available it’ll be interested to see just how much.

In time, when this pandemic genuinely comes under long term control and the office rental market stabilises I’ll look again at returning to face to face work but I find myself thinking about where our profession started, with the patient coming to analysis 3 times a week for 5 or so years, reclining on a chaise lounge and free associating while the analyst sat silently out of sight. 20 years ago when the internet was a novelty VC was a strange new world, now grandparents speak to their grandchildren via it, it’s very ordinary, especially for people in their 40’s and younger.

The limitations of returning to face to face work currently outweigh the benefits. I never say never and in this case I’m saying ‘not now’.

26/7/2020

Who Dare Speak For SCoPEd?

Katherine Streeter

In 1998 I was involved in lobbying for the protection of an ancient timber circle that had emerged from the sand and peat of a Norfolk beach. Seahenge provoked strong feelings and I got a number of phone calls from people objecting to my opinions. Some calls were silent and constant, some were loud and abusive and a few of them were death threats. I was confused to begin with, then shocked and when my then 6 year old daughter picked up the phone to a couple of these calls I got hold of a very loud whistle.

In 1990 I did a two minute piece on Channel 4 about the Poll Tax Riots and twice my phone calls were played back to me over my own phone. That was frightening.

It’s a given that anyone who stands up with something to say will attract negative attention and a minority of that negativity is likely to be extreme. Although it’s important to challenge this behaviour it’s never going to be wiped out, it’s an ugly part of human nature observable across history.

Less clear cut but just as inevitable is more subtle abuse. It’s less Flashman using his superior strength to torture someone, more Jane Eyre’s female cousins running to mamma to tell on Jane for retaliating after their brother physically abuses her. This “Take Her, Not Me!” reaction is often used by people anxious about their own status, backing the powerful against the less powerful.

In recent years there have been accusations of bullying from people who work for BACP, most notably Andrew Reeves who gave an account of receiving a letter which accused him of smelling of fish. Having been in the same room as Mr Reeves I can confirm that he does not smell of fish and that this attempt at insult is as powerful as Monty Python’s “Your Mother Smells Of Elderberries.” Of course, no one deserves abusive correspondence, Mr Reeves is absolutely entitled to any feelings this correspondence elicited in him and to write anything he wants about that experience. What happened, however, was that this article was interpreted as a man being viciously attacked by people who were critical of SCoPEd.

The narrative of anti-SCoPEd therapists being bullies, and BACP-affiliated people being frightened of that abuse while bravely standing up for the truth has taken root. This weekend, The Legend Of The Bullying Of Andrew Reeves was referenced yet again by an institutionally powerful person as the reason they were so anxious about publishing an article encouraging BACP members to stand for election to the BACP board. It had, apparently, taken them "ages" to summon up the nerve.

Every time I hear this story I think of a person on Twitter who became a contributor to the SCoPEd debate: they were diagnosed with a rare metabolic condition colloquially known as ‘Fish Odour Syndrome' which means that that sufferers actually smell of fish. This problem caused their life to collapse. A bitter irony is that they met a BACP registered therapist in a high status role who dismissed their medical condition and made a psychiatric diagnosis that he was not qualified to, which resulted in a cascade of life-changing harm.

Therapists are not separate from society and we’re all living through a period of history where polarisation and conspiracy theories have become mainstream responses to profound anxiety, confusion and a powerful desire for certainty. We’re at a place where if I don’t say “no one deserves abusive correspondence, Mr Reeves is absolutely entitled to any feelings this correspondence elicited in him and to write anything he wants about that experience,” some people will assume that I think Mr Reeves deserved abuse, wasn’t entitled to his feelings and shouldn’t have written about them.

I’m referencing Mr Reeves not because I think he’s a terrible person or because I want to bully him, this has very little to do with Mr Reeves as a private individual and is everything to do with illustrating the dynamics of power playing out in groups. His article was a pivotal moment in the SCoPEd debate when the myth of anti-SCoPEd therapists being bullies was firmly set and when polarisation occurred almost instantly: who wants to be on the side of abusers?

Mr Reeves later clarified that there was no proof at all that therapists who opposed SCoPEd had anything to do with the abuse sent to him, but that was like the Sun apologising for a bogus story 3 weeks after publishing it, at the bottom of page 18. A small number of prominent people were assumed to be behind targeted abuse and a simplistic fiction of frightened but determined goodies standing bravely against insolent, malicious baddies leaped, fully formed, into being. Appealing to emotion is an old political manoeuvre, kissing babies, telling people that you can make their interests great again, that they’re victims surrounded by wicked enemies, “shining like the sun in the dark.” (Yes, really.)

Dan Olweus, considered a pioneer in bullying research, defines bullying as “repeated negative behavior, both verbal and physical, that occurs within an asymmetric power relationship.” (My emphasis.)

The narrative is of therapists with institutional power feeling bullied by an unspecified group of therapists who have no institutional power. A sub-narrative has emerged, of therapists with no institutional power feeling bullied too. As all therapists know, feelings are vital information but not always the best guide to objective truth.

Who are these bullies? What are their methods of bullying? Are they calling people at home to offer them preferential treatment if they shut up or to tell them to stop complaining? Are they sharing personal information with each other about the people they’re attacking? Are they using Twitter to contact a therapists’ professional body, to publicly name and accuse them of egregious behaviour? Have they openly diagnosed anti-SCoPEd people with mental illnesses? Do they accuse people of wanting to harm clients? All this and a great deal more has happened to the 5 or so people - all women, none with any institutional power or personal elevated status beyond being White - who’ve most publicly opposed SCoPEd. DARVO anyone?

BACP, UKCP and BPC have a huge membership and ruling authority over therapy. BACP alone has 50,000 members and pays its executives, some of whom have backgrounds in the corporate world corporate salaries. That’s real, undeniable power and status. Each individual person working for BACP, paid or unpaid, may not feel personally powerful but whether they want it or not (and if they don’t want it why have they asked for and accepted it?) they have power, authority and massive influence.

Therapists Connect’s event on Monday discussing SCoPEd has not been able to find one person who wants to speak in support of it, despite BACP, UKCP and BPC having paid staff dedicated to it. Hanging in the air, inflamed by those tweets about having to “summon up the nerve” to write in defiance of fictional bullies is the unspoken, “We’ll only be abused.”

Disagreement is not abuse. Asking legitimate questions is not bullying. Illuminating inconsistencies is not an attack. SCoPEd will have a seismic impact on the therapy landscape, on therapists’ already pitifully limited opportunities to move beyond unpaid work: are therapists really expected just to sit back and let their betters get on with it? If it’s such a brilliant project it should be a cinch to explain and defend it. There may be circumstances that we’re not aware of which mean that not one single person feels able to advocate for SCoPEd, but bullying is categorically not one of them.

Olweus, Dan. Bullying at School: What We Know and What We Can Do. Blackwell, 1993.

6/7/2020

Decision Making And Face To Face Work

Updated 11/9/20

Image: Financial Times New Confirmed Cases of Covid 19

There’s an understanding that lockdown is over but the science doesn’t seem to have changed. This is from my previous blog, 27/5/20

"People can carry the virus without having symptoms but still be highly infectious.

The viral load – how many viruses are in the air – seems to become critical at around 15 minutes in a closed space, even if the 2m exclusion zone is maintained.

"Given how little is known about the production and airborne behavior of infectious respiratory droplets, it is difficult to define a safe distance for social distancing. Assuming SARS-CoV-2 virions are contained in submicron aerosols, as is the case for influenza virus, a good comparison is exhaled cigarette smoke, which also contains submicron particles and will likely follow comparable flows and dilution patterns. The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols. In an enclosed room with asymptomatic individuals, infectious aerosol concentrations can increase over time. Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart."

The therapy world is, like every other profession, in a state of flux because of C19, we’re having to think about how to respond to changes that sit at the heart of our work and this has hardly begun. Here are some of the things we’re talking about.

People cry in therapy and it’s seldom a matter of ladylike sniffles and a lace hanky: how do we manage tissues? Do we ask clients to bring their own so that they don’t touch and therefore potentially contaminate the box that everyone uses? Do we ask clients to take their own used tissues with them? Is it OK to sit in a room with a bin with virally loaded tissues in it? Is the therapist responsible for emptying a bin with a viral load? Why should a minimum wage cleaner have to do it instead? How is emptying the bin done to minimise contamination?

Do we wipe down every surface a client comes into contact with after every session? What with? How do we dispose of whatever we wipe things down with? Will these chemicals smell? Will the therapy room become more like a hospital?

Should the therapist and client wear masks, even if they’re two metres apart and the window is open? We spend 50 minutes together talking, sometimes talking loudly. Wearing masks or visors has implications for the viral load but particularly for the therapeutic relationship, the alpha and omega of therapy.

What does it mean when the other person in the room is a potential source of illness and possibly death, not just for ourselves but for our families and society? What’s it like to know that when you leave, the therapist will attempt to remove every trace of you from every single thing you’ve come into contact with, and will be watching to see what you touch? It’s normal for people to explore boundaries, to accidentally leave personal items – an umbrella, a water bottle, gloves - that will now take on entirely new meaning: normally the therapist would keep the item safely until the client returns but what do we do during a pandemic? Double bag in it sealed plastic bags? Where do we store it? If we have bagged it how do we return it to the client?

What’s it like to be with someone when you can only see half their face, particularly if you knew them pre-C19?Visors, being wide open at the bottom, don’t seem to stop the wearer from spreading the virus at all, just from having particles blown into their face while intubating or extubating a very ill patient, while medical staff wear masks under visors. What happens if the client begins crying? Do they take the mask off? Do they put it on again? If they accidentally leave a mask as they might leave a water bottle, what do we do with it? Where do they put the mask when they take it off in the room? Should they never take it off? Both masks and visors are uncomfortable to wear for long: how will the therapist manage the discomfort of wearing one for protracted periods of time? How will that discomfort impact the therapeutic relationship? Why should a client trust that the therapist has effectively sterilised the chair, door handles and anything else they might touch?

How does all this work in a shared office where it’s impossible to keep any distance at all from other people in corridors and stairs and where pushing and pulling fire doors is impossible to avoid?

What happens in autumn and winter when cycling or walking to work becomes less attractive or even possible and windows must be shut? We can be utterly content to be sealed into PPE in a HEPA filtered room but travelling on public transport to get to and from therapy holds a very real risk of cross infection. Do we increase our fees to take taxis, car hire or ownership into account? Do we contract to only work face to face when certain meteorological conditions are met, or to work one way when R is at a certain level and another way when R reaches a different one? Whose data do we agree to work with?

Consistency is a foundation of therapy, a dependable routine and environment that allows the client to swiftly and safely relax without worrying about what might change without them knowing. It’s why therapists give clients as much notice as possible about holidays and so on, and why holidays, room changes, any changes at all, can be so ripe with material. Therapists should be content to talk about money, sex, erotic transference, fear and hatred: the feelings that masks, any yearning to return to face to face work or fear of it might engender are all very worth talking about.

Insurers are giving varying advice but all mention risk assessments. Hospitals have infection control teams, it’s a clinical speciality. Therapists aren’t health care workers let alone infection control experts, we cannot make realistic risk assessments about working face to face with multiple people during a pandemic caused by a very new, virulent virus whose long term effects can be appalling.

One of the main sources of information that I’m attending to is the Financial Times Corona Virus Tracker which currently shows that new cases of the virus in the UK have only just dipped below new cases throughout the entirety of the EU. Public Health England stats are dependent on a pretty meaningless testing regimen and it seems that at the time of writing the R for London has crept up to 1.1

So I’ve decided that for the next few months I’m going to continue working online. Long term clients tell me that while the work was different to begin with they have settled into the new routine. New clients haven't had to contend with those changes but for both groups the main issue is privacy and so far everyone has been able to find some. Clients tell me that, not having to do therapy in their lunch hours, to rush to my office and then rush back to work, they now have more time after a therapy session to transition back into the flow of life. Even those with children who remain at home find that they can take some of the time that they’d otherwise spend getting to and from therapy for themselves. It’s not perfect, but neither was having to keep it all in because they didn’t want to leave the office looking upset, or being anxious about getting back to work or home on time, or all the other pressures of living in a culture where time is more precious than money.

Working face to face in a therapy room seems to be a pretty perfect way to transmit and receive C19, never mind the other important ramifications for a psychotherapeutic relationship the majority of which remain unknown. We can’t control or know everything and all our choices have implications. While some other therapists are anxious to return to pre-C19 ways of working, my understanding is that it's not going to be possible to do that safely until a reliable vaccine is in use, and I'm not willing to use my clients or myself as guinea pigs to soothe a yearning for a return to something that was once straightforward but now is not. Loss, nostalgia, mourning for the past, the simple need for human presence are all valid, all real, and all necessary to talk about in therapy. In the meantime we will all have to get used to living with the uncertainty caused by C19, but my aim is to adapt to swiftly changing realities and to offer as much stability, consistency and safety as I can to people who put their trust in me.

27/5/2020

Returning To Face To Face Work

In writing this policy I’ve tried to keep as up to date with research as possible, bearing in mind that C19 is a new virus and new knowledge is emerging all the time.

At the time of writing the UK has the largest number of C19 deaths per million people in the world.

London seems to have lower rates of transmission than some other cities though the virus is still very active. In other pandemics a second increase in infections and deaths has occurred when a population returns to normal life.

The impact of C19 can range from no symptoms at all, aches and pains, long term respiratory problems, stokes, heart attacks and other blood clotting problems, to multi organ failure and death. Being ventilated entails being put into an artificial coma and having a 23cm tube inserted into the trachea. Families of people who are terminally ill, or dying from C19 are not allowed to visit their loved ones and those people will die with a very kind stranger by their bed. Recovery from C19 is by no means straightforward and, being a new disease, not well understood.

People can carry the virus without having symptoms but still be highly infectious.

The viral load – how many viruses are in the air – seems to become critical at around 15 minutes in a closed space, even if the 2m exclusion zone is maintained.

"Given how little is known about the production and airborne behavior of infectious respiratory droplets, it is difficult to define a safe distance for social distancing. Assuming SARS-CoV-2 virions are contained in submicron aerosols, as is the case for influenza virus, a good comparison is exhaled cigarette smoke, which also contains submicron particles and will likely follow comparable flows and dilution patterns. The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols. In an enclosed room with asymptomatic individuals, infectious aerosol concentrations can increase over time. Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart."

For me, wearing a mask while being with a client complicates matters more than working online without masks. If a client begins crying how do they manage that while wearing a mask? Using a mask to to protect against C19 is complex. And this is before any psychological considerations.

If I am asymptomatic, have the virus and come into work I am highly likely to transmit it to a client. Both of us, using public transport, will be at very serious risk both of infecting others and being infected.

Hairdressers, pubs and restaurants have been told not to open before July 4th "at the earliest" and I'll review my decision to remain working on line then.

Worldwide, the huge majority of therapy clients have transitioned to either phone or video work and have continued to find it useful. Many clients are saying that they appreciate the time saved in not having to travel to and from therapy, some say that they can feel and say more because they don’t have to immediately adapt to the world outside of the therapy room, and feel less embarrassed about crying in their own home rather than in their therapists office.

For me, face to face therapy is the gold standard and video therapy the silver gilt. Nothing is worth risking your, my own or public health when it can be easily protected.

25/5/2020

Life On The Other Side Of Normal.

Increasing numbers of us are becoming restless to get back to normal. What 'normal' means in this context is a return to life that was exactly the same as before, which is reasonable when that means being able to embrace family and friends, to treat other people as people rather than potential vectors of infection and to go on holiday. But the reason we're being told to get back to work is to service the economy.

Like all other nations Britain has been up to its neck in debt since national debt was invented. We began paying off our WW1 debts in 2014 and still haven’t paid off those incurred by the Napoleonic wars. The equivalent of £17bn was paid to 46,000 UK slave owners in 1833 as compensation for the loss of their human 'property' which was only paid off in 2015. Running a national and international economy is not like home budgeting, economics is entirely based in ideology, not maths. At the end of WW2 Britain's debt exceeded 200% of GDP the country was in ruins and we created the NHS, a decent welfare system and built nearly a million council homes. That was profoundly abnormal. Our current debt is 85.2% of GDP

So while we do need to speed our economy up there’s no natural law - like the sun coming up or the inevitability of death - that says that nothing must change. C19 has illuminated just what a choice “normal” is. For years, disabled people have been saying that they can work and study effectively from home and have been told that it would be too difficult to organise. They’re also unwilling experts in the effects of social and cultural isolation yet within the space of two weeks museums, theatres, galleries, opera houses and other institutions became accessible to everyone. Instant experts on screen fatigue are being consulted by business keen to reduce their liability, while disabled people have been managing it for over two decades.

Two women a week are routinely murdered by a current or ex-partner and under C19 those numbers have more than doubled: are we content to return to normal?

Of course children trapped in abusive households must be rescued, but hasn’t that always been the case? We didn’t seem to care as much about education being a respite for them pre-pandemic.

Children must be educated but we’ve clearly seen that education’s current foundational purpose is childcare so that both parents can work. A child’s need for loving, caring touch and attention can be provided by family if all members of the family don’t have to work all the time, and if the family is more than units of isolated couples or single parents. Extended families were normal before the 1980’s, then we were told to 'get on your bike' to seek employment as a means to avoid being identified as a scrounger, and atomisation became the new normal.

What is not being talked about is the very positive impact lockdown is having on mental and physical health for a great many people.

Commuting is an expensive, dismal stress and gaining two hours a day to do with as you please is very welcome. Workplace bullying has been an epidemic from before the Industrial Revolution and working from home offers some respite from it: physical spite is reduced to zero, gossip is limited. While some research shows that some people find the social aspects of working life great fun, more research shows that when fewer leading questions are asked and more time is given for respondents to answer fully, working culture thrives on purposefully constructed competition. For most of us work is a burdensome toil that’s performed for a sense of identity rather than income, more panopticon than anything else.

Quieter voices are daring to say that lockdown has offered them time, peace, pleasure, privacy, opportunity. Never before have parents been expected both to work and to educate their children and many, realising how unreasonable this is, have prioritised domestic harmony over competitive productivity. Educating their children has less to do with comparison emerging as a period of mutual curiosity, pleasure in time spent together and new conversations – nothing heavy, just having the time to talk with each other about anything at all, agenda-free.

Children are relaxing, resting, playing more, discovering boredom and absolutely relishing being with their family.

For these people walking through deserted streets is delightful not unsettling. As a middle aged woman, I can tell you that a 2m-exclusion zone, even if seldom respected, is a joy. I can walk in a straight line rather than having to constantly calculate whether someone has seen me or if they’re going to barge into me. The cessation of construction, traffic and other human noise allows birdsong, the sound of the wind or rain or even – rare as hens teeth – silence; not boring or disconcerting but a balm. These quieter voices are saying that they greatly appreciate the time to think, to observe - not to fulfil a quota of ‘mindfulness’ but because they would like to spend 5 uninterrupted minutes looking at, listening to, being with something. For them, the routine of waking, working, eating, sleeping and the organisation that supports it all, has fallen softly and naturally into place without the noisy demands of an extravert, neurotic society warping the authentic shape of their lives. Their stress levels are way down.

And many say that that they won’t share their contentment too widely because they’ve been accused of not caring about people dying from C19.

We live in a world driven by other people’s anxiety and inability to be still, to endure or even to be aware of the noise in their head. Therapists are noticing that some patients who, pre-C19, were anxious or depressed are now much less so. What was making them anxious and depressed was the manner in which they were forced to live, utterly against their nature. These are not dreamy poets, they’re ordinary people who are unable to warp their nature sufficiently to feel comfortable in the world. Neither are they particularly privileged: I’ve spoken informally with middle managers, bus drivers, horticultural, restaurant, retail and local authority workers and precarious freelancers from a great many sectors.

Perhaps most interestingly people on benefits are suddenly able to relax. Freed from the bitter enmity of the DWP they have the space to recover and to seek opportunities in a very different world. This is a world where 1.8 million people suddenly had to apply for Universal Credit and where everyone is forced to have a small taste of the very curtailed life that claimants must endure full time. Bear in mind that almost overnight the DWP was able to increase the standard rate of UC and local housing allowance, issue 700,000 advance payments, make statutory sick payment available from day 1 of illness and be generally agile and helpful, so that new claimants really are not experiencing the shock and cold fear of being subjected to a sadistic sausage factory of poverty and contempt. But every little helps.

The world that benefit claimants, the disabled, the working poor live in is now somewhat shared by all and it’s not a ‘lifestyle choice’ for any. Growing numbers of ordinary people are discovering that there might be a choice in the way we move forward, that there is life beyond commute/perform/repeat; that family life can be rich and rewarding; that the majority of children and parents thrive most of the time when they're allowed that time; that boredom can be amazingly creative. How brutally abnormal life has become when we have to be reminded that sleep is necessary, not an inconvenience or luxury but as imperative as water.

As pressure mounts for a return to normal, have the bravery to listen to the voice that resists it, not through fear but through determination to make a life that’s better for you, the you that is more than a cog in a machine or an economic unit. You’ve seen what happens to cogs and units that are considered worn out or unproductive: you’re worthy of better than that. Everyone is.

9/5/2020

Returning To Reality.

An article about the neglect that BAME people experience in my borough was posted to a Facebook page for locals a couple of days ago: “Kensington and Chelsea's unemployment rate is 6.7%, which is within the lowest performing third of all the London local authorities. Additionally, for bad/very bad health and limiting long term illnesses Kensington and Chelsea's poorest wards find themselves in the worst 20%.”

The first reply to it began with “Absolute bollocks!” and went on to detail how wonderful it was in the good old days.

North Kensington was a slum until about 35 years ago. When the piggeries and potteries of the 1820’s where people “were found to be living at a density of about 130 to the acre, and the number of pigs was 'upwards of 3000'..” were finally demolished the only way money came into households was from women taking in laundry . Rachman and other slum landlords made a fortune here on the back of brutal racism, men ruled the bombed out streets and local murderer John Cristie was able to hide bodies in the walls of his home.

What the poster was remembering is fiction. Perhaps his family and neighbours were great fun and helped each other out as most very poor families and neighbours do, because not to means absolute destitution, terrible isolation and scapegoating. You all stick together because otherwise you all fall apart.

Communities remain tight here, there are fewer postcode gangs than street- or building gangs. Under stress, identity bases itself more on who you are against rather than who you support. All communities are built on exclusion, often much more so than inclusion.

The divergence between reality and belief is nothing new, we all do it all the time and it’s so powerful that we often don’t know that we’re doing it at all. It’s how advertising works: advertisers tell us what they want us to believe via actors pretending to be people who are fictional, aspirational versions of ourselves. So it is with Covid 19 deaths. We have only a vague idea how many people have died from Covid 19 because either C19 has to be mentioned on the death certificate or the deceased has to have been tested for C19.

What we do know is that we have the highest death toll from C19 in Europe. Immediately that was announced, rebuttals emerged about population densities and evidence bases but there’s a very stark contrast between the soberness and shock with which the UK observed Italy’s motorcades of corpses and the ways in which we’re responding to a near doubling of that in our own numbers.

Therapy is at heart an opportunity to examine from all angles what you believe to be true. Distress emerges when beliefs become intolerably strained and one remedy for that is a doubling down into those beliefs. People who continue to retreat in that way are much less likely to seek therapy than those who are instinctively more curious. A 30 second internet search disproves the Facebook poster’s beliefs but he’s not interested in reality, his need is to hold on to his identity because that identity is spun glass fragile and he fears losing everything – friends, respect, social life, support, perhaps even family and personal safety if he changes his mind. He depends on the contempt of people he considers enemies because it strengthens his identity and so he invites harsh judgments. Without them, and without the support of people who hold similar, easily disproved opinions, he would naturally begin to question his beliefs and his identity.

Mr Johnson is going to tell us how his government will begin lifting C19 restrictions tomorrow. Whatever is announced, we know that until a safe vaccine is in widespread use, increases in deaths and permanent disability from C19 will be linked to a reduction in restrictions. That’s the way it’s been with plagues throughout history. It’s worth being reminded by the Director of the London School of Hygiene & Tropical Medicine, who contracted C19 in mid-March, wasn’t ventilated and is still barely able to climb a flight of stairs, about the impact of C19:

“Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives.”

There is no simple way to live with C19, any relaxation of restrictions is a balance between managing restless people, increasing GDP and exposing people to the virus in numbers that the NHS can cope with.

A useful question - a question about the value of your own and others lives - is how much does your identity depend on being a positive thinking, hard working tax payer?

Since March huge numbers of people have had the choice between contagion and eviction, many have had to continue working at minimum wage in supermarkets, pharmacies, cafes and other businesses that refused to shut down or were told to remain open. Most people who are unable to work from home are low paid key workers. It’s notable that most people who have been able to work from home are not low paid, and many have already been told not to expect to return to the office until September at the earliest. It's going to be people who need money to keep a roof over their heads, who will go bankrupt if their business fails, or whose bosses interpret 'stay alert' as an excuse to end furloughing who will be forced by circumstances beyond their control to risk their health and their lives.

In some small areas of the world there’s been a frisson of hope that society will emerge into the daylight of a post C19 dawn with a fresh awareness of what’s valuable and worthwhile, but as a nation we are showing zero desire for anything but a return to life as it ever was. C19 illuminated the cracks and strains that have existed in society for decades, from just-in-time supply lines to the highly precarious lives of low paid workers and the elderly and a few weeks spent more or less indoors isn’t going to change decades, perhaps centuries, of culture.

Nevertheless, this is an opportunity for individual people – for you - to reconsider how much you are willing to sacrifice yourself and your family, perhaps literally, so that you can maintain your identity as a passionate, committed, respectable working person. We’ve been doing this for years: both parents going to work so that they can afford to pay someone to bring up the children; despising cheap, secure social housing because only the mad, bad or dangerous to know live like that; getting into debt because only the stupid don’t go to university and ‘A man who, beyond the age of 26, finds himself on a bus can count himself as a failure.’

The ugly paradox is that the more able you are to make that choice the less likely you are to have to. But even the most prosperous can feel trapped by the expectations of their family and social circles, their employers and colleagues, other mothers at the school gates. Competition at that level can be febrile, destructive, very nearly insane and it’s based on the same premise as the belief that life in a slum was decent: “I am living this life, therefore it must fundamentally be good.”

When your life is considered or you consider someone else’s life to be less important than The Economy ™ that is not a good life. The more you argue with that the closer you move towards someone who thinks that living in a slum was wonderful.

28/3/2020

Memento Mori

When I was 9 years old my father died. My mother, having had two heart attacks, was considered fragile, we lived with the unspoken knowledge that she was likely to die sooner rather than later, my father was the strong, capable parent. One day he went to bed with chest pains, my mother and I propped him up with pillows and I played at being a nurse, fussing about with sheets not really understanding what was going on. Two days later I kissed him goodbye as I went to school and that was the last time I saw him.

The hospital rule was that anyone under 13 wasn’t allowed on the ward and so while my mother visited I would wait outside. He died there and I remember emptying the hospital property bag, his false teeth falling onto the kitchen table, which was shocking proof that he was, in fact dead.

Many of us are going to repeat some of that experience very soon. We know that a four thousand bed hospital is being kitted out in London; a 5,000 bed hospital in Birmingham; a 1000 bed hospital in Manchester, with similar hospitals in Glasgow, Cardiff and possibly Belfast. We know that temporary morgues are being set up across the country.

We know it and we cannot bear to know it. The streets are quiet, the weather has been good and many of us are distracted by a sudden, unexpected and catastrophic collapse of income. But we all know that there is something much more fundamental coming.

Mothers Day was a hint for some families. Therapists tend to focus on the adult children of parents who couldn’t or didn’t care for them properly, but the pain of the many more adult children who didn’t experience neglect or abuse, and their mothers on Mothers Day was equally real. Some people stood at the end of a path and sang songs or held a little party that the grandchildren came along to while their mother stood in the doorway. Some mothers were in care homes and not even that was possible. Fathers day is on June 21st, around a month after the peak of deaths from C19 has been calculated to fall.

Now, when a person gets put in an ambulance to go to hospital they may as well be taken to Mars. Most hospitals will not allow any visitors unless there are truly exceptional circumstances, such as a relative having dementia, and then one designated person may visit at the discretion of whomever is in charge. This is necessary to preserve life and it has a terrible human cost. Wherever C19 has spread people have died alone. They have already died alone in the UK, even in hospices.

Why am I telling you this?

Not to frighten you, although of course you’re frightened. I’m frightened. I’m telling you this in the hope that you will now do and say the things you need to do and say because for too many of us, a point will come when it is too late, and that point is around two weeks away.

Life is not a soap opera. If you spend any time working with people who are dying that becomes crystal clear very quickly. Now, right now, is the time to think about what you want to say to the people you love, even people you like. Make care and love your guide, even though there are things about everyone that are annoying.

You are thinking about what you want to say to them on their deathbed, what you want them to know when you are on yours.

The only reason you might want to spend a long time thinking about what you want to say is if you need to get past anger and resentment. Otherwise, write it down this weekend. If it’s on your computer, print it out. If everyone you know is well, you can come back to it over time and edit it but it doesn’t matter that it’s not Shakespeare. Phone people or Skype them on Sunday evening, let them know you have something important to say, and read it out to them.

It doesn’t matter if you get choked up, say what you need to say. If they can’t bear to hear you say it, it’s OK, at some point they may be ready, and if they’re not ready by next week send them a letter.

Write letters for your children. Decide who you want to be their legal guardians, talk to that person or persons about it and put it in writing. I’m not a lawyer so I can’t advise you on the legal ins and outs of it but there’s lots of information on the net. In the UK on average every 30 minutes a child under 16 loses a parent. This average is going to change next week.

Make a secret collection of things for them that will remind them of you and keep it secret, the very last thing a child needs is to know that their parents are preparing to leave them. But if they want to talk with you about you dying think now about how you might respond. “Oh don’t worry about it, I’m never going to die” is not good enough.

Whether or not you have children it’s important to attend to the legal stuff too, like writing a will if you haven’t already, which will be a demonstration of how love fits in to your life. Too many people use wills to act out, never thinking that they will actually die. Sometimes this behaviour is a kind of fantasy, a dramatic and immature playing out of a dream in which the person writing the will gets the final upper hand. Sometimes this is abuse, continued even after death. If you’re the first kind of person, now is the time to grow up. If you’re the second kind of person, there’s nothing that will change your mind and your death will be as your life was.

C19 is a scourge but in taking us to the edge of the precipice and holding us there it is helping all of us discern what is more or less important. And still there are many people - including a great many therapists, we’re far from immune from this - who are in denial and distorting reality because it’s far too terrifying to endure. The odds are against you dying. If you're hospitalised, even ventilated, you may well come out again. But thousands of people are going to die, many of them will be in the prime of their lives. Even some of the very rich with all the access to private, high tech, constant, highly skilled medical care have already died. Ventilators just give the body a chance to fight back, they don't do the fighting.

Please do not wait until you or someone you love is being put into an ambulance before you try to find the words.

Think now. Talk now. Act now.

But if you find that you’ve waited too long and that moment is reached, “I love you, thank you” will be enough.

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