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The Irish Journal of Counselling and Psychotherapy formerly • Volume 21 • Issue 4 • Winter 2021 Reflections • The Individual and Work: Politicised Psychotherapy • Let’s Talk about the F word! with purpose A reflection on fees • Dark and Light – What Our Psychotherapy Heroes Reveal About Ourselves and Our Profession • Shelter From The Pandemic: Notes On Nature • When the closing session is final A therapist’s journey with her client through terminal illness and death Irish Association for Counselling and Psychotherapy
IJCP Volume 21 • Issue 4 • Winter 2021 Contents From the Editor 3 Our Title In Autumn 2017, our title changed The Individual and Work: Politicised Psychotherapy 4 from “Éisteach” to “The Irish Journal By Alex Delogu of Counselling and Psychotherapy” or “IJCP” for short. Let’s Talk about the F word! A reflection on fees 9 By Brendan O’Shaughnessy Disclaimer: The views expressed in this Florescence 14 publication, save where otherwise Poetry by Members indicated, are the views of contributors and not necessarily the Dark and Light – What Our Psychotherapy Heroes Reveal 15 views of the Irish Association for About Ourselves and Our Profession Counselling and Psychotherapy. The By Emma Redfern appearance of an advertisement in this publication does not necessarily Shelter From The Pandemic: Notes On Nature 20 indicate approval by the Irish Association for Counselling and By Siobhan Maher Psychotherapy for the product or service advertised. When the closing session is final 24 A therapist’s journey with her client through terminal illness and death Next Issue: By Margaret Plunkett 1st March 2022 Noticeboard 27 Deadline for Advertising Submissions for Next Issue: 1st February 2022 Editorial Board: For more information about Mike Hackett (Chair), Hugh Morley, Kaylene Petersen, Annette Murphy, advertising please see Terry Naughton, Lynne Caffrey, Eve Menezes-Cunningham. www.iacp.ie/IJCP-back-editions. Editor: Assistant Editor: Scripts: Mike Hackett Lynne Caffrey Each issue of IJCP is planned well in Design and layout: advance of the publication date and GKD.ie some issues are themed. If you are interested in submitting an article ISSN: for consideration, responding to 2565-540X the Therapist’s Dilemma or wish to Advertising rates and deadlines: contribute a book or workshop review Contact the IACP for details. (Early booking essential) or Letter to the Editor, please see ‘Guidelines for Submitting Articles’ © Irish Association for Counselling and Psychotherapy – IACP on the IACP website, www.iacp.ie. All rights reserved. No part of this publication may be reproduced, stored in, or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), except for brief referenced extracts for the purpose Contacting IJCP: of review, without the prior written permission of the copyright owners. iacpjournal@iacp.ie Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP From the Editor: which our affected clients emerge. includes so that we can see them In this piece, Alex skilfully articulates as real people. We thus meet many of these tensions and outright ourselves in our own realness conflicts by illustrating the impact in along the way. selected client vignettes offering us Our fourth work offers us some an opportunity to explore our part in much needed respite from talk of maintaining potentially problematic Covid-19, and redirects us to the social pressures. topic of respite. Here, Siobhan Our second article addresses a Maher’s work, Shelter from the hot topic at present (as illustrated pandemic: Notes on nature explores by the number of motions on the the many ways we can be in nature Dear Colleagues, topic of protecting the value of and the many benefits this has We wish you a very warm welcome counselling and psychotherapy on our physical and psychological to the Winter 2021 edition of the at the recent IACP AGM). Here, wellbeing. Biophilia, fractals and Irish Journal of Counselling and Brendan O’Shaughnessy’s Let’s talk elemental natural forces are Psychotherapy. As I write, we have about the F word, explores the area described as important resources again reached that time of year of fee setting from his professional to offset the way we live today, when the clocks have fallen back, practise perspective. Brendan’s with our ever increasing reliance on the evenings stretch longer before approach is to explore the screens and indoor living. Siobhan us and we quiet somewhat and practicalities, ethics and business makes a strong case for a return to claim some space to restore and aspects of this often challenging nature as solace and shelter. reflect. Whilst not yet over the and overlooked aspect of our work. Our last prose work – When the effects of the Covid-19 pandemic, Overlooked in the sense of the closing session is final, Margaret and with it all of the upheaval need for careful, purposeful and Plunkett, in a remarkably human, and loss, we also have had data-driven decisions necessary courageous and compassionate enormous opportunity for careful, to inform us about what our work mode, reflects on her lived considered reflection on ourselves, is worth. Though money alone will experience of working with a client our practice, our clients and our likely never really represent the in the last stage of their life, from profession. In this context we are actual value of therapy for clients diagnosis of terminal illness to delighted to present five articles and for ourselves, it is an important their death. This is a piece which from professionals in our field who aspect of our financial wellbeing. is both moving and hopeful. With explore very different themes and Coincidental with the recent enormous grace, Margaret charts experiences. The thread which news of the passing of Aaron those final months with her client, binds them all together lies in V and shows us all what the soul of T. Beck (1921-2021), father of each author’s ability to weave their a therapist looks like when faced cognitive behavioural therapy, reflections on these themes into with such a terrible situation. I Emma Redfern turns her attention colourful tapestries of words and think this piece is a fitting end to to the topic Dark and light – what images which in turn prompts our our Winter Edition. The editorial our psychotherapy heroes reveal committee would like to express own reflections with purpose. about ourselves and our profession. our profound gratitude and support In our first article, Alex Delogu She does so in a thoroughly self- to Margaret for sharing such a explores the topic of Politicised reflective, descriptive and open sacred experience. Psychotherapy. As we are social way, illustrating the influences of And finally, as we continue our creatures, our wellbeing is tied veritable giants in our field. She formal poetry section of the journal, up with societal forces (including notes that though all of us likely we hope you enjoy the works from politics) which, in turn, shape our have our own therapy heroes (those five different poets on a range needs, expectations and place people whose work has been of topics and the theme of this enormous demands on us as formative and foundational in our quarter’s issue – Reflections with individuals. We cannot escape the identity as therapists), we need Purpose. impact of these forces. Therapists to remain vigilant for objectifying play a part in society because we are them as idealised others and land Mike Hackett, Editor members of the same society from with the shadow each necessarily and Lynne Caffrey, Co-editor Irish Association for Counselling and Psychotherapy 3
IJCP Volume 21 • Issue 4 • Winter 2021 Academic Article The Individual and Work: Politicised Psychotherapy By Alex Delogu individuals and work and the impact that these ideas have on physical and mental well-being. Identity and work are intertwined (Gertz, 2019, p. 127). Before looking at these two aspects, let’s explore the critique in more detail. The Critique I first encountered this critique through the work of philosopher Mark Fisher who wrote insightfully about the effects that culture and politics have on the psyche of individuals. As a biographical note, Fisher was open about his struggles with depression and sadly took his life in 2017 (Colquhoun, 2020, p.2; Fisher, 2021a). I mention this as sometimes philosophers can have a reputation of operating at a theoretical distance from their subject, but in this instance, we have a person thinking and philosophising through their lived experience. Fisher’s most influential book Capitalist Realism (2009) is concerned with how the political system at the time stunted our capacity to even imagine an Introduction adopting. This is not something alternative society beyond that of T here exists a rather worrying critique of psychotherapy in that it may exist in service of harmful interior to psychotherapy but rather a demand that is placed on it from the outside. How should the doctrines of capitalism, leading us down a bleak imaginative cul- de-sac that makes “it is easier to societal forces. To put it concretely, psychotherapy respond? The imagine the end of the world than it the risk is that psychotherapy aim of this paper is to show that is to imagine the end of capitalism” is used to rehabilitate people to this is a demand that must be (Fisher, 2009, p. 2). The focus here return to a societal system that resisted if one is to maintain the is that the social environment has itself harms and breaks them. This ideal of doing no harm seriously. a direct impact on our capacity to is not a criticism of psychotherapy The problem itself appears in imagine and on mental health more itself, but rather a particular the unusual conjunction of our generally, which will be returned to function that psychotherapy risks commonly held ideas about later. 4 Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP B From a mental health This is not an argument against perspective, Fisher’s main concern elief in the common personal improvement. Rather, was that this connection between idea that “you can the danger is that mental health our environment and mental health achieve anything” has difficulties come to be viewed was being undermined by the as a personal failing where in idea of the “atomistic individual” become more and more a fact it is often a reasonable (Fisher, 2009, p. 37). By over- reality today. and understandable reaction emphasising the individual, the to systemic demands that are political and social causes of detrimental to physical and mental mental illness are diminished. By (2021b, p. 119). I have argued well-being. The difficulty is in extension, the impetus to change similarly elsewhere (Delogu, 2020). identifying these connections. It things at a social and political level The detrimental effects of an is much the same as exploring are similarly diminished (Fisher, over-emphasis on individuality can someone’s developmental history 2009, p.37). If we become blind hardly be overstated, especially in and connecting past and present to the causes of our distress, how a society that glorifies individuality. difficulties, except in this situation, can we possibly change them? The pandemic has no doubt had the net is cast a little wider into the It is this disconnect that led an enormous impact of the focus cultural domain. psychologist David Smail to state on individuality. “Loneliness There is a discourse and that “psychotherapy does not work” hangs over our culture today like language that goes with this (Smail, 2001, p. viii), where he a thick smog” (Hari, 2009, p. 88). individualization, of which I am argued that a psychotherapy that Loneliness can occur because of sure many are quite familiar. aims to heal people but ignores the social isolation but exists even Belief in the common idea that societal causes of mental illness in the presence of others. As the “you can achieve anything” has will fail from the start. It would adage goes, the loneliest place is become more and more a reality simply end up treating a symptom, amongst a crowd. Hari points to a today. Smail calls this “magical something many therapists would key factor in reducing loneliness voluntarism” - “the belief that it is reject. This adds a nuanced danger and that is being together with within every individual’s power to to the popular idea that the only others who hold shared meaning or make themselves whatever they thing you can change is yourself. values (2019, p. 100): just being want to be” (Fisher, 2021a). This To counter this trend means together with people is insufficient. idea is clearly false. Obviously, it is that psychotherapy must become One might think the internet helps important to have belief in oneself, socially and politically aware in in this regard, and no doubt it but that “you can do anything” is its functioning (Fisher, 2009, does to a degree, but it is a paltry an unfulfillable expectation. Should p. 37; Totton, 2003, p. 49). substitute for real togetherness one not achieve these expectations Psychotherapy should not simply (Hari, 2019, p. 108). the outcome is regarded as a be a tool to adjust people to social These isolating social conditions personal failing. Believing in this norms but something that holds have an impact on how we see also entails its opposite: “It is the these norms into question. It is ourselves in the world. Nolen Gertz flipside of depression – whose important to note that this is not puts it well: underlying conviction is that we an excuse to ignore developmental are all uniquely responsible for and family contributors to distress. “So a system built on life, liberty, our own misery and therefore The political and social are simply and the pursuit of happiness deserve it” (Fisher, 2021a). This inherent dimensions of that very can induce nihilism by treating sort of view is unfortunately all process. lifelessness, oppression, and too common in positions which unhappiness as personal feelings, discriminate against people from Pathological Individualization as feelings that reveal a person’s lower socio-economic backgrounds: The idea of there being an pathological inability to be happy, “We have begun to think: I will look absolute individual exists only as the result of which is that we after myself, and everybody else an abstraction. The reality of our respond to our suffering with should look after themselves, as situation is that the social nature of the nihilistic desire to change individuals. Nobody can help you being human precedes any notion ourselves rather than with the but you” (Hari, p. 101). of individuality. “There’s no such political demand to change the Byung-Chul Han makes some thing as the individual” says Fisher system” (2019, p. 169). acute observations about the Irish Association for Counselling and Psychotherapy 5
IJCP Volume 21 • Issue 4 • Winter 2021 T direction this type of thinking our individuality and identity in his book The Burnout Society he thing that I found impact how we organise our (2015). Han sees burnout, challenging was that work lives. Work has a profound depression, ADHD, borderline effect on self-worth. The first he would nearly always personality disorder as question likely to be asked of exacerbated by modern living circle back to the idea that a stranger is “What do you do and this illusion of infinite it was down to his lack of for a living?” (Graeber, 2019, potential. “They are pathological p. 240). In his philosophy of conditions deriving from an will power or motivation existentialism, Sartre cautioned excess of positivity” (2015, p. 4). for not being able to move against rigidly identifying with We live in a society more inclined a distinct archetype, “there is towards individual achievement, past his anxiety and enjoy the dance of the grocer, of the driven by the ideals of “freedom, even basic things in his tailor, of the auctioneer, by which pleasure, and inclination”, where life. they endeavour to persuade their everyone “must be a self-starting clientele that they are nothing entrepreneur” (Han, 2015, p. but a grocer, and auctioneer, a 38). This is the downside to there I was working with a client, let’s tailor” (Sartre, 2004, p. 386). being less constraints on how we call him Bob, who was quite We collapse our potential into choose to live; we are confronted depressed. Bob had stopped easily digestible archetypes. This by choice paralysis. Echoing enjoying things pretty much goes for therapists as well. To Fisher, the implicit contemporary altogether. He did a lot of not simply become a therapist, to burden - the illusion of absolute exercise; a lot more than I do keep your being an open question freedom is exhausting, collapsing in fact. He was on medication (Bion, 2018, p. 30). into its depressed opposite, that for depression and had noticed Work leaves not solely an “Nothing is possible” (Han, p. no change. He came to therapy ideological mark. The toll which 11). It becomes an individual because of an upcoming job workplaces upon the body is failure for people who cannot interview which he aced but could often visible through strains, achieve their potential. There not face starting the job and injuries, or illnesses. The body is comes a weariness from too was subsequently dismissed. thus the site where work leaves much freedom, from having to He had no traumatic family its mark. The “body is political” constantly become something history, if anything they may have (Totton, 2003 p. 47). There are better. Leading society towards been distant, but it was hard to marks particular to the “labouring competitive performance between establish how much. How do you body” and the “consumerist individuals, “a space where quantify an absence? The thing body” (Totton, 2003, p. 49-50) solidarity and empathy are only that I found challenging was that and following Han let us coin dangerous distractions weakening he would nearly always circle back the modern “achievement body” the warrior that you are obliged to to the idea that it was down to his (2015, p. 8). As a subtlety, we be” (Berardi, 2019, p.46). lack of will power or motivation are called to see the damage It should be clear how insidious for not being able to move past from what anthropologist this type of thinking has become. his anxiety and enjoy even basic David Graeber calls “spiritual Obviously, people want to achieve things in his life. “It is ultimately violence” (2019, p. 67). That their potential, to be free. But my responsibility to change” he is, the detrimental impact of to demand it, expect it, and would say, as if everything hinged meaningless work, lack of values, make it the order of the day is a on him alone. His conviction and an increasingly uncertain form of violence that becomes on this point at times had me future (Hari, 2019; Graeber, internalized. It is oppression that struggling to think otherwise. My 2019; Gertz, 2019, p. 124-138). becomes internalized and invisible interventions never really evoked The proposed solution to the ills because who wouldn’t want more more thought around this core mentioned above is often more freedom? A paradoxical control conviction. The short-term therapy work. “Some have done better through the promise of infinite came to an end. than others because they’ve possibility. worked harder than others. If you Work want to do that well, you should Vignette 1 These profound ideas about work hard too” (Fisher, 2021, p. 6 Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP “I 122). All this even though “[m] Vignette 2 ore often than not, individual f we all woke up I had a client, let us call him Jeff. wealth owes more to luck, laws one morning and When Jeff was a child, he would and regulations, inheritance or be beaten for not helping in his discovered that not fortunate timing than to individual father’s business operated from brilliance” (Standing, 2017, p. 32). only nurses, garbage home. He would be paid little or There are thus many more factors collectors, and mechanics, nothing for his long day’s work. than individual motivation. Though This happened intermittently over likely preaching to the choir, many but for that matter, bus several years. Jeff now becomes who do not work don’t do this by drivers, grocery store retraumatised by the mere choice. Often, some relational mention of work and all that this difficulty or trauma gets in the workers, firefighters, or word symbolises. He would work way for those who want to work. I short-order chefs had in manual labour types of jobs feel like I am defending idleness been whisked away into (caring labour) and is extremely here. Let it be said that people sensitive to the disparity in pay shouldn’t need an excuse to be another dimension, the between himself and the people idle, there is nothing wrong, lazy results would be equally he would work for, that is, the or otherwise, about idleness and managers or coordinators would leisure (Standing, 2017, p. 117). catastrophic”. be making a lot more money than I think it is very important him. In therapy Jeff fluctuates however, to carefully interrogate done or assumed to be done by between wanting to work to make any inherited social assumptions women, e.g., cleaning, raising a better life for himself and not we carry about work because they children, teaching, nursing, etc. wanting to work because of the can carry into therapy. As Graeber Psychotherapy as a line of work stress it causes him. He receives points out, many think “that those can be similarly included. “The disability pay to sustain life’s who avoid work entirely should more your work helps and benefits basics. Jeff gets along somewhat probably drop dead” (2019, others, and the more social value better with his father. Work p. 242). Work is considered a you create, the less you are likely remains traumatising. fundamental human trait. To not to be paid for it” (Graeber, 2019, work is viewed as pestilent. Even p. 207). So, we have this societal Commentary within psychiatry “having a job devaluation of jobs that are of It was clear that there was a is considered one of the major enormous benefit to the social strong connection between Jeff’s characteristics of being a high- fabric of our lives. mistreatment by his father and functioning person” (Wang, p. 51). The hypocrisy of this position his ongoing difficulties with work. Again, this is political standpoint, was highlighted during the This developmental aspect was as “a capitalist society values pandemic. “Unskilled labourers” explored on many occasions productivity in its citizens above magically became “essential but is not the focus here. I was all else, and those with severe workers”. Graeber, writing pre- struck however by the fact that mental illness are much less pandemic, proposed a thought the things that were triggering him likely to be productive in ways experiment: “If we all woke up one revealed an injustice. Specifically, considered valuable: by adding to morning and discovered that not management earning much the cycle of production and profit” only nurses, garbage collectors, more money for the same or (Wang, p. 51). and mechanics, but for that fewer hours. A classic capitalist There is a connection between matter, bus drivers, grocery store arrangement. This seems to be how work is also valued in workers, firefighters, or short-order something that others take for monetary terms. There is a chefs had been whisked away into granted but because of Jeff’s long history of the devaluation another dimension, the results heightened sensitivity, it could not of women’s labour (Federici, would be equally catastrophic” be ignored. 2014, p. 92-96) or what today (2019, p.208). Many of these jobs It seemed to be that rather can be called “caring labour” tend to be the ones that generate than his father being the source (Graeber, p. 236; Block, Croft, the most scorn during strike action of his future difficulties that he Schmader, 2018). In other words, taken to secure better pay or was a conduit for these social work that has traditionally been working conditions. forces of workaholism. Culture Irish Association for Counselling and Psychotherapy 7
IJCP Volume 21 • Issue 4 • Winter 2021 I is not something outside of interest in embodiment and the family, but the family is our often felt compelled, teaches Tai Chi and Qi Gong first encounter with culture. especially early in the in Dublin. He has been playing “The family is permeable to music semi-professionally for over therapy to intervene with environmental forces and exterior 15 years. influences” (Guattari, 2009, p. anxiety management 201-202). In Jeff’s case, his to help Jeff to cope Alex can be found at father had embodied this work www.alexdelogu.com ethic to an authoritarian degree, and continue to work. and can be contacted at and he was encountering a However, I resisted this alexdelogu@gmail.com variation of this same theme in his adult work life. To say that his compulsion. difficulties with work are solely to be resolved through exploring his the therapy as rehabilitation for past would be the sort of nihilism work would have fallen into the REFERENCES inducing interpretation mentioned trap mentioned at the outset, Berardi, F. B. (2019). Futurability: The age of impotence and the horizon of possibility. Verso. earlier. facilitating my client’s exploitation Bion, W. R. (1980). Bion in New York and Sao and his inner self-exploitation. Paulo: And three Tavistock seminars. The Harris “If the symbolic father is often Meltzer Trust. lurking behind the boss– Conclusion Block, K., Croft, A., & Schmader, T. (2018). which is why one speaks of The purpose of this work is to Worth Less?: Why Men (and Women) Devalue Care-Oriented Careers. Frontier Psychology. “paternalism” in various kinds show how society and politics https://doi.org/10.3389/fpsyg.2018.01353 of enterprises–there also often shapes our ideas of individuality Colquhoun, M. (2020). Egress: On mourning, is, in a most concrete fashion, and our attitudes to work. We are melancholy and Mark Fisher. Repeater. a boss or hierarchic superior permeable in our most intimate Delogu, A. (2020). One and many: Reflections behind the real father. In the mental functioning; we are not from Bion. The Irish journal of counselling and psychotherapy, 20:1, 4-7. unconscious, paternal functions closed off. These attitudes affect Federici, S. (2014). Caliban and the Witch: are inseparable from the everyone, both therapists and Women, the body and primitive accumulation. socio-professional and cultural clients. For therapists, we have Autonomedia. involvements which sustain a responsibility to not simply Fisher, M. (2009). Capitalist realism: Is there them” (Guattari, 2009, p. 201). reiterate and reinforce this no alternative? Zero Books. social and political structure Fisher, M. (2021a, September 12). Good for nothing. The Occupied Times. https:// I often felt compelled, especially but to create a space for radical theoccupiedtimes.org/?p=12841 early in the therapy to intervene reassessment of all assumptions. F isher, M. & In Colquhoun, M. (2021b). with anxiety management to What has been in question here Postcapitalist desire: Mark Fisher the final lectures. Repeater. help Jeff to cope and continue are ideas of individuality and how Gertz, N. (2019). Nihilism. The MIT Press. to work. However, I resisted these may become pathological Graeber, D. (2019). Bullshit jobs: The rise of this compulsion. On reflection, coupled with scrutiny of the pointless work and what we can do about it. it would have been a mistake. many social contradictions and Penguin Books. Further, it was not Jeff’s goal. attitudes to work. Guattari, F. (2009). Chaosophy: Texts and Had I pursued this intervention, interviews 1972-1977. Semiotext(e). it would have been based on Han, B.-C. (2015). The burnout society. Stanford Briefs. my assumption that helping Jeff Alex Delogu Hari, J. (2019). Lost connections: Why you’re to endure work was the correct depressed and how to find hope. Bloomsbury. course of action. Though he Marino, G. (2004). Basic writings of existentialism. wanted to work, I wondered Alex is a pre-accredited The Modern Library. whether this desire was socially psychotherapist with a private Smail, D. (2001). Why therapy doesn’t work. Constable & Robinson. conditioned, or was it something practice in South Dublin. Standing, G. (2017). Basic Income: And how we he wanted. His father valued work He received his Masters in can make it happen. Pelican. above all else. I tried to proceed Philosophy from UCD in 2012 and Totton, N. (2003). Body psychotherapy. Open in a way that kept the possibilities went on to get his BA (Hons) in University Press. of these questions open, at Counselling and Psychotherapy Wang, E. W. (2019). The collected least in my mind. To simply treat from DBS. He has a strong schizophrenias: Essays. Graywolf Press. 8 Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP Practitioner Perspective Let’s Talk about the F word! A reflection on fees By Brendan O’Shaughnessy Finally in my work as a supervisor with students I have become aware that their expectations regarding making a living may be too optimistic. I share a financial model with them that may provide a more realistic view of private practice. More on this later. My own Background My attitude to fees is strongly influenced by my life experiences. For most of my 40-year working life, I held senior management positions in several multinational electronic companies. This experience encouraged data analysis as a prerequisite to developing strategies. For 28 of those years, I also worked as a part- time counsellor with a charitable organisation that offered low-cost Introduction article is part of my reflection and professional counselling to people I n researching and writing this article I have become more aware of the therapeutic, personal, an examination of my reasoning. It is my hope that this will be useful in your fee determination. who may not otherwise have access to therapy. In 2019, the charity was dissolved and I set up my own ethical, and business issues Coincidently, I was reading some private therapy and supervision involved with fee setting. I hope comments on the Irish Association practice. I also retired early from my it will be a source of interest and for Counselling & Psychotherapy position in the electronics industry. reflection for you, but first let’s look (IACP) Facebook page (Irish I am in the lucky position to be able at what prompted me to explore Association for Counselling and to work at therapy and supervision this issue. Psychotherapy, 2021) about the for two days a week and not be Prior to an initial meeting commoditisation of therapy in reliant on it as my main source of with a prospective experienced Ireland. Therapy and Employee income. I realise that this is not the supervisee, I sent a draft contract Assistance Programmes (EAP) case for everyone and I recognise and my fee scale for supervision. providers are advertising low this influences my attitude to fee Subsequently, we had a phone rates and then paying therapists a setting. conversation where she expressed portion of this. The comments were We will explore the topic of fee her shock at my concept of a highlighting the conflict between setting then in four sections; the fee scale. We had a very open making therapy more accessible therapeutic bit; the ethical bit; the discussion about this, and I to more people and a race to the research bit and the business bit. I committed to reflect on how I came bottom in terms of fees that may will then conclude with my thoughts to this method of fee setting. This follow. and observations on the topic. Irish Association for Counselling and Psychotherapy 9
IJCP Volume 21 • Issue 4 • Winter 2021 The Therapeutic bit From a personal perspective my communicate “any benefits, costs From a client’s perspective fees can earliest experience with fees was and commitments that clients be viewed positively and negatively. when the charity I worked with began may reasonably expect” (British In writing about fees and the asking for donations. Most clients Association for Counselling and therapeutic relationship McLeod were happy to donate between Psychotherapy, 2018). notes: €5 and €10 and I became used The American Counselling to making this clear at the initial Association (ACA) notes that Freud and other psychoanalysts meeting with a client/clients. One have argued for the ‘sacrificial’ client whom I remember well was an In establishing fees for nature of the fee. The assumption older woman who suggested a €1 professional counseling services, here is that, as a means of donation. As I came to learn later counselors consider the financial maximising the motivation of this was not easy as she was in status of clients and locality. If the patient for therapy, and difficult financial circumstances. At a counselor’s usual fees create signalling the importance of their the end of one of our sessions she undue hardship for the client, the commitment to therapy, a fee was searching in her handbag for the counselor may adjust fees, when should be set that is the maximum €1. I assumed she was not able to legally permissible, or assist the affordable by the patient. This afford it that week and I made the client in locating comparable, implies that sliding fees should be terrible mistake of telling her it was affordable services (American operated: a fee that represented OK not to pay for that session. She Counselling Association, 2014). a major personal commitment for fished out the €1 and let me know in one client might be insignificant no uncertain terms that this was her Due to the scant advice for another, more affluent client. counselling, and she was paying for above, I wonder if this reflects a (McLeod, 2019, p. 43) it. I came to treasure that €1 more professional sense of “fee guilt” than any I have received since for mentioned by McLeod above? This would seem to support the what the experience taught me. notion of a fee scale. The Business Bit The Ethical bit When setting up in private practice, On the other hand, payment may So, what advice as we get from a personal challenge involved also have a negative impact on the codes of ethics on the topic of challenging my own attitude toward therapeutic relationship, as clients fee setting? The IACP Code of fees. Having spent the previous 28 may feel the therapist is ;only in Ethics briefly mentioned fees in years in a counselling organisation it for the money; “he/she is only section 2.3 where it mandates that pretending to value me because they therapists that transitioned from no fees, to are being paid” (Wills, 1982, p. 56). asking for donations to setting a From a therapist’s perspective a) Take responsibility for the minimum negotiable fee, I had little fees can be also have different setting and monitoring of experience with how to ask clients meanings. On the one hand fees appropriate, boundaries for money. As I tend to be more may be a tangible measure of how within the practitioner/client instinctive in my counselling life, I the client and the therapist values relationship, making these did not make any detailed analysis the service provided. However, as explicit to the client. of fee setting but did start out with McLeod noted “Some therapists a scale based on an evaluation of experience ‘fee guilt’ arising from b) Take responsibility for making client’s income levels. the conflict between being wanted a clear contract with the client Had I adopted my prior business to be perceived as a ‘helper’ and to include issues such as approach (data analysis), I would being involved in a business that availability, fees, and cancelled have completed several steps involves making a living and a appointments… (Irish before setting up my own practice. profit” (McLeod, 2019, p. 152). Association for Counselling and So, for the purposes of this On a more sinister note, “If a Pyschotherapy, 2018) reflection, I now present the steps therapist’s income is contingent which now guide my fee setting. on a client remaining in therapy, The British Association for he or she might subtly find ways to Counselling & Psychotherapy 1. Budgeting: Prepare a budget prolong treatment” (Kottler, 1988, (BACP) makes no mention of fees, for practice running costs and p. 154). but does suggest that therapists identify my income goals. 10 Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP 2. Competition Comparison: Budgeting Model: Discover what other therapists charge. Daily Weekly Annual 5 46 230 3. Market Analysis: Investigate Start Time 09:00 what can clients afford. Finish Time 18:00 9.00 Hours per Client 1.50 What do in need to charge 6 (Budgeting) Clients per day For illustration, I present a sample Plan 6 budgeting model based on several Can't Fill/No Show/Cancellation etc % 30% goals and assumptions. Particularly, Actual 4.2 with respect to income, the goal of Rounded 4 20 920 earning the average Industrial wage Average Fee per Client €69.08 as measured by the Central Statistics Office (Central Statistics Office, Income €276 €1,382 €63,556 2021). Note: Microsoft Excel has a Expenditure Per Session function called Goal Seek, where, Room Rental €12 €11,040 based on your goal (in this case the Professional Fees (IACP Membership) €410 average Industrial wage), you can Training & CPD Sessions @ 30:1 Ratio Per Session €500 calculate the fee you need to charge. Supervision 31 € 70.00 €2,147 You will see this number highlighted Office Supplies €500 in the yellow cell in Figure 1. Website and Advertising €1,000 If anyone wants to adapt and use Professional Indemnity Insurance €105 the budgeting model for their own Bank Charges and Payment Processing fees €1,274 circumstances, please email me Heat, Light Power €200 and I would be happy to share it. Travel €600 Phone and Internet €600 Competition Analysis: What do Miscellaneous €500 other therapists charge? Total Expenditure €18,876 The following analysis (Figures 2 to 4) is based on IACP website “Find a Therapist” Section (Irish Net Income Avg Industrial Wage €44,680 Association for Counselling and Pyschotherapy, 2021) as of Tax, PRSI. USC etc €13,404 July 11th, 2021. Of the 2,762 therapists listed 2,566 mentioned Net Income €120 €601 €31,276 a fee. Many fees are negotiable, but I assume this is interpreted as Assumptions in the model negotiable downwards rather than 1. 5 Day working week from 09:00 to 18:00. upwards by most clients. 490 IACP 2. 6 Weeks allowed for holidays, Christmas, Easter, Training, and self-care. members did not state a fee, but 3. 55 Minute sessions and 35 minutes between each client to allow time for notes and said fees were negotiable. preparation. How many IACP Therapists work 4. 30% allowed for not being able to fill each slot each day or cancellations/no shows. fulltime? 5. Supervision is based on 30:1 ratio and at €70 per session Based on the above analysis, it would 6. Room Rental is based on paying €12 per hour on sessional basis. Some people may seem that most IACP therapists do opt to work from a home office saving this cost, but work/life balance and safety issues not earn the industrial average. So ought to be considered in this case. how do they survive? According to 7. So, if I want to earn my desired income, I need to charge €67.58 on average per the IACP member survey (conducted session. during the Covid 19 pandemic) Figure 5, only 9% of members work more Figure 1: Budgeting Irish Association for Counselling and Psychotherapy 11
IJCP Volume 21 • Issue 4 • Winter 2021 Individuals – All Fees Reported than 26 hours per week (no change from a prior survey). The majority of respondents, 63%, worked less than 15 hours per week before the Covid 19 member survey and 67% since (Behaviour & Attitudes Limited, 2020). This is consistent with the 2013 survey which noted “7 in 10 work in counselling/psychotherapy on a part time basis but fewer than a half (44%) have another occupation” (Irish Association for Counselling and Pyschotherapy, 2013) It appears then that the majority of therapists are Figure 2: Fees for Individual Therapy opting for the average industrial wage area of €60 to €69 per hour and work part time. It would appear that counselling is not therapists’ primary source of income. Couples – Excluding Negotiable Market Analysis. What Can Clients afford? One of the things I have learned is that clients with higher incomes can usually claim a set number of session fees from their health insurance provider (Voluntary Health Insurance (VHI), Laya etc). Further, excess fees may be claimed as tax relief at 20%. It is worth acknowledging though that clients on lower incomes are unlikely to have Health Insurance or pay tax. Figure 6 illustrates two extreme examples for the net cost to two couples. Example A is of a couple with Figure 3: Fees for Couples Therapy a joint income of €100,000, good VHI plan and able to claim tax refund. Example B is of a couple with a Supervision – Excluding Negotiable joint income of €30,000, no health insurance and not paying any tax. This brings up some interesting questions about social equity and the redistribution of wealth in Ireland. Example A Example B Annual Income € 100,000 € 30,000 Weekly Income € 1,923 € 577 Cost per Session € 105 € 60 VHI Refund @ 80% -€ 84 € - Figure 4: Fees for Supervision where specifically mentioned Tax refund @ 20% -€ 4 € - Net Cost € 17 € 60 As % of Income 1% 10% Figure 6: Affordability for clients € Per Session ItIncome has Levels also encouraged me to appreciate toIndividuals the real Couples cost to clients on Income over €101k per year lower incomes. By using a fee85scale 105 based on clients’ incomes, it could be argued that €51k to €100k per year 70 80 clients on higher incomes are thus subsidising those €31k to €50k per year 60 70 on lower incomes. That seems fair to me. Less than €31k or on Social Welfare 50 60 Following discussion on this topic with my supervisor, All Negotiable depending on family financial circumstances another interesting aspect arose. How do my fees reflect how I value what I offer to clients? By setting too low a fee am I saying my service is only worth x amount? By setting too high a fixed fee am I overestimating my value and excluding people who Figure 5: Extract from IACP members survey on Covid 19 can’t afford my fees? 12 Irish Association for Counselling and Psychotherapy
Tax refund @ 20% -€ 4 € - Net Cost € 17 € 60 Volume 21 • Issue 4 • Winter 2021 As % of Income 1% 10% IJCP Finally, part of the why I do € Per Session counselling is to assuage my sense of social responsibility. Income Levels Individuals Couples I am lucky to be in a position Income over €101k per year 85 105 where fees are not my only €51k to €100k per year 70 80 source of income. I learned the hard way to value what €31k to €50k per year 60 70 clients can pay and to be able Less than €31k or on Social Welfare 50 60 to structure my fees to make it All Negotiable depending on family financial circumstances more affordable for more people. The table in Figure 7 then, provides an illustration of a Some observations on the above structure: scaled fee structure. GDPR: You are not collecting client income data. e.g., it is possible for someone on €40,000 income per year to have huge mortgage and only pay €50. To ensure you comply with General Data Protection Regulation (GDPR) regulations you should only keep a record of the agreed amount Conclusion and not how it was calculated and as with all client data only use it for the purpose of the therapy. So, what have I learned from Practical Billing: I use payment platform to process payments from clients. Initially, I used a this? debit/credit card reader for payment at the end of each session, but when I moved to online Broadly, our profession appears was able to use a billing feature of my payment platform to create an invoice which is emailed primarily part time one and to the client with a link so that they can pay online. On resuming in-person work, I continued this practice as it is easier for me to keep track of payments and saves time at the end of each the range of fees offered vary session. It more secure than dealing with cash and less covid risky. I also believe this is a more considerably. My own experience professional way of issuing receipts. Summary information can be extracted for accounting and with supervisees would lead me taxation purposes. The cost of this service is currently 1.69% of each transaction. to believe that few are fully aware Figure 7: Illustration of a scaled fee structure if starting a private practice that can be financially sustainable, while also expressing a desire to Whether we use fee scales or Brendan O’Shaughnessy work full time in counselling. fixed fees seem less important At the same time, it appears than how this reflects the cost Brendan is an IACP accredited there are and will be more of the service we offer, both for Counsellor/Therapist/Supervisor in companies setting up commercial ourselves and our clients. To private practice. He worked part time counselling/psychotherapy provide a sustainable service to with the Cork Marriage Counselling services which also impact on the Centre for 28 years and has a Higher clients, whether this be free, low earning potential of therapists. Diploma in Counselling from UCC. cost or fee based, I think we have Fees are a far more complicated Brendan has been on the board a responsibility to consider the topic that I had originally of directors of various charities considered. One that cannot costs involved so we can continue including the National Domestic be ignored from a therapeutic to serve our clients. Violence Agency. relationship or private practice I hope you have gained some Contact details: perspective. Also found myself insight from this, and it has considering social justice issues provided you with some food for brendanoshaughnessy@hotmail.com and the concept of fee guilt. thought. www.brendanoshaughnessy.org REFERENCES American Counselling Association. (2014). Code of Psychotherapy. (2021, April 1). Retrieved therapists?co=&cat= Ethics. Retrieved from www.counseling.org. from https://www.facebook.com/IACPdot. Kottler, J. A. (1988). On being a Therapist. Jossey- Behaviour & Attitudes Limited. (2020). COVID-19 ie/?ref=page_internal: https://www.facebook.com/ Bass. Membership Survey. B&A Research and Insight. groups/241219326763908 Mallon, T. M. [Tracy]. (2021, April 1). Corporate British Association for Counselling and Irish Association for Counselling and health Ireland is a private business so no doubt Psychotherapy. (2018). Ethical Framework for the Pyschotherapy. (2013). IACP Membership Survey their service provider will be asked to work for less Counselling Professions. Retrieved from BACP: 2013. Retrieved from IACP: https://iacp.ie/files/ [Online forum post]. Facebook. https://www. https://www.bacp.co.uk/events-and-resources/ UserFiles/IACP-Members-Survey-Report-2013-1.pdf facebook.com/groups/iacpmembersgroup/ ethics-and-standards/ethical-framework-for-the- Irish Association for Counselling and counselling-professions posts/738648113687691 Pyschotherapy. (2018). IACP Code of Ethics. Central Statistics Office. (2021, 07 11). Retrieved from IACP: https://www.iacp.ie/iacp- McLeod, J. (2019). An Introduction to Counselling Earnings. Retrieved from Central Statisics Office: code-of-ethics and Psychotherapy: Theory, Researc H and Practice https://www.cso.ie/en/statistics/earnings/ Irish Association for Counselling and (6th ed.). Open University Press. earningsandlabourcosts/ Pyschotherapy. (2021, 07 11). “Find a Therapist”. Wills, R. (1982). Insight-oriented marital therapy Irish Association for Counselling and Retrieved from IACP.ie: https://www.iacp.ie/page/ [Treatment manual]. Detroit: Wayne State University. 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IJCP Volume 21 • Issue 4 • Winter 2021 FLORESCENCE* Winter You and I The Work of Group By Sian Williams By John Edward Basil By Eileen M Higgins Keenaghan Seeing my life laid out on the floor The land laid bare as winter crept in, Cleansing away the seasons of hurt and sin. Seeing the things Gifted with these lands of beauty and I sit, listen and observe I had never seen before wonder, To all you say and do Reaching deep from inside But her expansive resources we chose to I take it all in Trusting all will coincide plunder. To try and understand you Transported by time Whilst sharing the smiles Raping her of all she possessed I try not to judge or doubt Burdens there too Striving to make mankind tower above the To empathise if I can Veiled in our eyes rest. I sit with you in hope Taken to pieces We robbed for the lands, the plants, and To try to lend a hand And reassembled again seas, Here to be found Listen now for the reaper is coming to You talk and tell your story Sorrow, joy, hope and pain collect his fee. To express how you feel There in that space You cry laugh and gaze In every face Consumerism grew as a vague distraction To see what is revealed We’re putting the pieces together again Now the separation of real soul connection Wholly rewarding an endeavour is holding traction. You then may pause awhile For now, I know ‘me’ that little bit better. Vast unsupported media truths are causing To let it all sink in desolation, You reflect, repeat and relive Watch the rivers run red as fighting kin fall in To question, lose or win all great nations. We then meet together The Word The wise Lakota spoke of a common Without a word being said tongue, By Margaret Walsh To wander through this journey Where all who walked the land would be For a while we are wed one. Lost in thorns and brambles left with Instead, we pushed against the free flow of deep wounds invisible to all, a moment of We gently come to realise change the words that captured me, “you the tide. That ease has just begun are strong” thorns shifted in form, resulting Blinded by ego mankind is drowning in greed and pride. It may take a little longer in soft moss. I could sit stop and think. Until your song is sung. “Strong”, strength not weakness. But Too late, to late the wise one cried, But you are singing now new thoughts. I felt the cushioning And sadly, the earth she softly sighed. of the moss the warmth of its comfort I Because she trusts that seasons change, could stand again, not fully steady but I and the land will grow could balance, and I knew I knew that took But mankind this wisdom will never know. strength. The Bridge on Glendermackin By Paul Hewer Flowers know the way Blencathra was his grandmother Standing by the forever stone Always finding the best path home Only he knew her by another name* With a lantern’s brightness Growing through earth's fractured spaces. And I never really knew him. I sing you back to your bones. Three brothers came to the village He knew every well and wall in the parish Over the mountain with Glendermackin And every country with a port Come back from where you’re lost Pit gear on a donkey. But somehow he was lost. And grow whole again Like the sunflower. This is father's landscape not mine Always on the outside waiting He was the bridge to these ancestors Sitting on the front step But that has gone now. To come in, to come home. *Saddleback 14 Irish Association for Counselling and Psychotherapy
Volume 21 • Issue 4 • Winter 2021 IJCP Reflective Article Dark and Light – What Our Psychotherapy Heroes Reveal About Ourselves and Our Profession By Emma Redfern Developmental Transformations (DvT); and Robin Shohet founder of the seven-eyed model of supervision. Living and working through the pandemic I count myself fortunate that when the UK went into lockdown in March 2020, I was already working online with both clients and supervisees, and I continued to be able to do so. Add editorial work and the usual CPD and I had plenty to keep me feeling productive, focused, and safe enough. This article is a product of that time. I imagine I am not alone in having been bombarded since the beginning of Covid-19 with emails offering countless opportunities to learn new therapy skills, gain extra and specialist qualifications, while saving money on discounted deals. Without already having developed a sense of the people whose thoughts, skills and experience I value, I would Introduction professional working in the field probably have been ‘at sea’, I n this article I introduce the concept of the psychotherapy hero. I touch on why we might of psychotherapy. Three of them are American, one British; one is a woman and three are men, feeling the pressure of grasping as many opportunities as possible, or feeling like a failure have psychotherapy heroes and all are white. They are: Byron for letting countless opportunities how having them can be helpful. Katie, developer of The Work; pass me by. Thankfully, when it I encourage the reader to reflect Richard Schwartz, founder of came to booking core CPD for on who theirs might be and Internal Family Systems Therapy 2021, I already knew what I value what those choices say about (IFS); David Read Johnson, learning about and from whom, the chooser. I introduce four of trauma specialist, dramatherapist partly because I was already my own current psychotherapy and founder of an embodied aware of my psychotherapy heroes, each of whom is a leading psychotherapy known as heroes. Irish Association for Counselling and Psychotherapy 15
IJCP Volume 21 • Issue 4 • Winter 2021 B Each of the four psychotherapy idealised. heroes I introduce has probably yron Katie is passed the standard UK not a trained What a psychotherapy hero is not retirement age. Even without the psychotherapist. Yet, My gratitude to these individuals threat of Covid-19, they are not is not that of a victim saved by a going to last forever (and neither since hitting rock bottom superhero such as SpiderMan or am I). I want to expose myself and then experiencing Wonder Woman in comic books or to more of their wisdom while her own ‘awakening’ in films. The individuals I introduce I can and while some of them are not saints or saviours, each take advantage of online delivery February of 1986, she is a regular Joe, or Joanna. White (due to physical challenges, I devised a powerfully and privileged, yes, yet also don’t travel as well as I did). therapeutic practice she knowing shame, trauma, healing, Also, through this article, I want and transformation from the to acknowledge to myself and calls The Work. inside and having faced trials and to others my gratitude to, and tribulations of their own. Each has appreciation for them. feet of clay, and a shadow side reflect how much society and I just like the rest of us. Who I am influences my choice of need healing. psychotherapy hero Someone who is pioneering I have had different psychotherapy What is a psychotherapy hero? Richard Schwartz has shown heroes at different points in my As a psychotherapist, I believe courage in embracing the journey. My top ten would include that psychotherapy has great unwelcome failure of a family Maya Angelou, Brené Brown, and potential to benefit individuals therapy trial with young people Alice Miller - all of whom have had and society. Perhaps every with eating disorders which was a huge impact, from a distance, therapist who has kept working not giving the results he hoped on my personal growth and/ throughout the stresses and for (Schwartz & Sweezy, 2020). or professional development. strains of the global pandemic Instead, Dick became curious (Note, my psychotherapy heroes is worthy of being considered a about his clients’ inner worlds are not all psychotherapists psychotherapy hero. However, I which was largely verboten in his themselves.) However, my current am thinking on the scale of those field at the time and, in response psychotherapy heroes have all worthy of receiving a lifetime to what he learned, he rigorously had a closer impact, not least in achievement award because their and scientifically ‘followed the that I have completed in-person professional careers in therapy data’ to devise Internal Family training with all bar Byron Katie have conferred great benefit to Systems therapy. IFS is currently (though I did get to see her do humanity. one of the most rapidly expanding The Work at a large event in Over decades, these four and countercultural therapy London once). professionals have made long- trainings in the world. Due to my history and personal term, impactful contributions to David Read Johnson was demographics (white, cisgender mental health through therapeutic a pioneer of dramatherapy female, Western, educated, work with people; training of with adults before the title English speaking and privileged), therapists; supervisors and dramatherapist even existed. it makes sense to me that my ordinary people; writing of articles Like Schwartz, this meant current psychotherapy heroes are and books; and direct contact having the courage to go all white, Western professionals. with the public in person, through against prevailing cultural tides In addition, I position myself as their websites, recordings, and in society and the healthcare a ‘wounded healer’, having had a so on. Imagine, if you will, this community. This is demonstrated significant trauma history, and in article is my nomination, using by an experience earlier in his my understanding, each of these my own criteria, for each of these career as a dramatherapist people recognise, understand, people. These are my criteria: when he found that the nursing welcome, and work with suffering, a pioneering spirit, outstanding home expected him and his trauma, and the shadow within achievements, admirable dramatherapy group to share a us. While my choice makes professional and personal room with a deceased resident personal sense, it may also qualities, and being real not being stored there temporarily 16 Irish Association for Counselling and Psychotherapy
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