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

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If the author disagrees, but we are satisfied that the work has been published elsewhere, is in the public domain and the complainant can fully prove it is their work, we will publish a clarification in the next available issue or as soon as possible. If the complainant can't provide this evidence, we will take no further action. The final decision will rest with BACP. Online posting by authors after publication 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 know from my own private practice that these issues come up on a regular basis, and responding to them is not always straightforward. But it’s not an issue we can sidestep, given that, since the pandemic, a reported ‘record number’ of six million people have received antidepressant medication, 2 on top of an increase in antidepressant prescribing of 23.3% in 2019/20. 3 Dr Moncrieff argues that therapists have a key role to play in both educating clients about how antidepressants work and supporting those experiencing the effects of withdrawal. As a follow-up, I would highly recommend the comprehensive, easy-to-read guide, ‘Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs: Guidance for psychological therapists’, 4 produced by the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG for PDD) with funding from BACP, to which Dr Moncrieff has contributed.

Berrol C. Neuroscience meets dance/movement therapy: mirror neurons, the therapeutic process and empathy. The Arts in Psychotherapy 2006; 33: 302–315. But people don’t notice psychological ambiguous loss; we know about deaths, we generally know what to say, and we have the rituals to mark those losses and give comfort to the griever. They all involve community, people offering comfort to the bereaved. With ambiguous loss, because it is unclear, it is unnoticed, which means the person is suffering alone, in isolation.’ It can be painful when you have trained in an approach and someone comes along and says “actually, the evidence challenges that”,’ Cooper agrees. ‘It may not feel great. But I don’t think the evidence says “abandon person-centred practices”. It is saying some clients maybe would benefit from more of something else. Of course, we can only offer what we are trained in, but having the skills and willingness to refer on may be an important element of a therapist’s work.’ Says psychotherapist Juliet Rosenfeld: ‘Freud is so clear about the difference – depression is when you don’t know what is lost; with death, the person you loved most in the world has gone. In the work with depression, you are trying to work out what got lost; with bereavement, you know what is gone, but the work still takes a long time because it is so hard to believe it at the level that is necessary to accept it. The person has to relentlessly reality test.’ I’ve been deeply moved by the fact that so many of our members have taken the time to write to us and call us to commend our response to this crisis.But they also take pains to stress that treatment method is important: ‘It remains a matter of judgment and methodology on how much each contributes, but there is virtual unanimity that both the relationship and the method (in so far as we can separate them) “work”. Looking at either treatment interventions or therapy relationships alone is incomplete. We encourage practitioners and researchers to look at multiple determinants of outcome, [and] particularly client contributions.’

Other key factors included restrictions on funeral and memorialisation practices that meant people were unable to support one another and mourn collectively, which in turn made it difficult to find closure and begin to grieve, she says: ‘These grief difficulties are consistent with the findings of the US pandemic study, 6,7 that disrupted meaning contributed to worse grief outcomes, and that higher levels of functional impairment occurred for all deaths during COVID-19 compared with pre-pandemic times.’ The researchers are still analysing results that will show if the degrees of distress would be enough to flag up risk of PGD. Brooker D. Person-centered dementia care: making services better. London: Jessica Kingsley Publishers; 2007. Please include up to 50 words of biographical information including, for example, your current job title, relevant qualifications or research interests. This will be published with your article. My mum was suffering from dementia. She was diagnosed in 2017 and we had to move her into residential care in December 2019. Then COVID came and I couldn’t visit daily, as I’d been doing. Then I got a call saying they’d got COVID in the home, and I knew it was a matter of when not if Mum got it. They called me on Friday 10 April to say she’d got a cough and they’d called 111 and been advised to treat it as COVID. We can’t ignore the fact that – in the words of my daughter – mental health is ‘massive’ on TikTok, and it’s where ‘everyone gets their information now"To sum up: ‘... a pluralistic perspective of good practice that is inclusive of all modalities is essential. The therapeutic relationship is key to effective therapy, and a focus on ingredients such as collaboration, empathy, and responding to client preferences is vital to ensuring ethical and effective therapeutic practice. The recognition that different clients need different things promotes a more pluralistic provision of therapy services.’ And if there’s an uncomfortable silence? ‘I’ll explore that with them. I’m interested in why. But I carry some cards with me, and I’ll sometimes bring them out and we’ll just play a game if a young person is feeling particularly anxious or uncomfortable. It’s all part of building the relationship.’ 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.