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Introduction

Naomi Moller

Andreas Vossler

David W. Jones

David Kaposi

Contents

 Introduction to understanding mental health and counselling 5Core aims of this book 5A word on terminology 6Book themes 7Book structure 8Activities, reflections, readings and images 10

 References 11

Introduction to understanding mental health and counselling

The Earth and a birds-eye street view. Both are factually accurate but distance changes how things are seen and understood.

Welcome to Understanding mental health and counselling. We hope you will enjoy reading this book and come to understand more about the key debates in mental health and counselling and the core approaches taken to working with mental health problems.

This opening chapter introduces the core aims of Understanding mental health and counselling, the three themes that are interwoven through the chapters, and the structure of the book. There is also a section on the terms used to describe people with mental health difficulties.

Core aims of this book

Existing resources on the broad topic of mental health often explore how it is currently, and has historically been, understood and how this understanding has impacted the evolution of mental health care, policy and law. Many such resources largely ignore what this might mean in practice for how to work ethically and effectively with a person who is in mental distress. Equally, many books about counselling theory and practice engage seriously with building knowledge around the topics necessary for ethical and effective practice, yet they pay scant consideration to broader understandings of mental health and ill-health and how these have shaped the field of counselling and psychotherapy.

The result of a failure to consider mental health and counselling holistically is, in the worst cases, that counselling theory is taught as if it were a cult, where criticality is discouraged and fervent support encouraged, while mental health is taught in a way that creates disdain for anyone trying to engage with a system so demonstrably flawed.

This book aims to do something both ambitious and radical: to create a resource that allows readers to consider the field of mental health from the practical to the conceptual and from the individual to society. The hope is to offer a perspective that combines a strong commitment to criticality (asking: But how do you know that?) with an acknowledgement that therapeutic practice often involves a deliberate stance of ‘not-knowing’ (Bion, 1967) in order to foster deep and empathic listening to the client. The stance is that it is important to hold on to two opposing ways of understanding. On the one hand, mental health is an area that is shifting and highly complex, full of seriously troubling experiences and practices and plagued by a lack of knowledge and arguments about the ‘right’ kind of knowledge. On the other hand, it is an area in which decisions must be made and actions taken, often quickly.

A word on terminology

Before going any further, it is important to say something about the terminology used in this book to refer to people with mental health concerns. Words are important because they shape how people are perceived and understood, and how they experience themselves. There are lots of words – slang, medical and everyday words – that have been used to describe people with mental health problems.

Pause for reflection

Briefly consider a few words that are used to describe people experiencing mental health problems. Then consider how you might think or feel about a person who was described by each word.

Language can perpetuate stigma and thus there is a commitment in this book to trying to use non-discriminatory language (alongside the recognition that there is debate about which terms are/are not discriminatory). For example, we avoid any language that suggests that a particular difficulty defines the person – such as ‘depressive’. We also discuss the considerable and important debate about the use of medical language for mental health difficulties. The Time to Change campaign, which was set up to reduce the discrimination faced by people with mental health problems, provides guidelines on appropriate and inappropriate terminology (e.g. Time to Change, 2020). In line with this, we will be using the following terms in this book:

 person with mental health problems or difficulties

 service user

 client.

These terms all have slightly different meanings; for example, ‘client’ tends to mean someone who is having counselling, whereas ‘service user’ is often used to describe someone who has a broader engagement with mental health services. All these terms will therefore be used, depending on the topic being discussed.

As an additional point, it is worth saying something here about how we are using the terms ‘counselling’ and ‘psychotherapy’. The distinction/overlap between these terms is hotly debated in some areas. In practice, the difference often (but not always) has something to do with the types of training people have. Psychotherapists typically undertake longer postgraduate training, while counsellors complete shorter, undergraduate/diploma training. For the sake of convenience we have decided to use both terms interchangeably. So when you read about ‘counselling’ and ‘counsellors’ this generally also includes ‘psychotherapy’ and ‘psychotherapists’ (and vice versa), unless stated otherwise.

Book themes

The aims of the book outlined above are reflected in the three principles that have informed the content:

 Service-user and client voices: Acknowledging that service users and clients are the most important people to consider, and that they may have been harmed by mental health and counselling services, a key focus of the book is on the critical importance of listening to the perceptions, understandings and experiences of mental health service users and counselling and psychotherapy clients.

 Diverse experiences: Understandings of mental health and assumptions about ‘best’ treatments have historically often disadvantaged, ignored or excluded minority groups. A second key theme of this book is thus around how diversity (e.g. in terms of ethnicity, sexuality and gender) impacts the understandings, expression and ‘treatment’ of mental health difficulties.

 Research/methodology: A key concern of the book is how ‘knowledge’ about mental health and counselling is established. The book critically examines the strengths and weaknesses of underlying research approaches/paradigms and the limitations and caveats around the knowledge they produce.

Book structure

Understanding mental health and counselling is organised into five parts.

Part 1 Understanding mental health: the emergence of the talking cure

This part introduces the fundamental debates about the contested nature of mental ‘illness’ and the institutions that have developed to provide ‘treatment’.

 Chapter 1 outlines the historical development of psychiatry and psychological treatments.

 Chapter 2 introduces the service-user movement and outlines the concerted efforts of the people who have engaged with mental health systems to change them for the better.

 Chapter 3 examines the evolution of psychological treatments and ‘talking cures’.

 Chapter 4 focuses on the debates about systems of classification and diagnosis.

Part 2 Presenting problems

This part focuses on the issues that cause people to seek therapy.

 Chapter 5 focuses on depression and anxiety.

 Chapter 6 considers how trauma and crisis are understood and worked with.

 Chapter 7 examines how our relationships influence our mental health and vice versa.

 Chapter 8 presents an overview of formulation, presented as an alternative to diagnosis, and provides a prelude to models of counselling, which are covered in Part 3.

Part 3 Models of working

This part introduces some of the main approaches used in counselling and psychotherapy.

 Chapter 9 introduces psychodynamic approaches.

 Chapter 10 focuses on cognitive behavioural therapy approaches.

 Chapter 11 introduces humanistic approaches.

 Chapter 12 considers pluralistic/integrative approaches.

Part 4 Counselling in practice

This part examines issues central to how counselling and psychotherapy are practised and how mental health problems are treated in different practice settings.

 Chapter 13 focuses on the therapeutic relationship in counselling and psychotherapy.

 Chapter 14 introduces counselling approaches that go ‘beyond’ the individual.

 Chapter 15 examines the rapidly developing field of technology-based counselling.

 Chapter 16 explores professional and ethical concerns in practice.

Part 5 Contemporary issues: mental health and society

In this part, the focus returns to social understandings of mental health and how social, political and economic forces inform contemporary practice.

 Chapter 17 examines how mental health and counselling research agendas and practices are often shaped by external forces.

 Chapter 18 considers the important links between ideas about mental disorder and criminal justice.

 Chapter 19 explores whether it can be helpful to think about mental health difficulties as societal versus individual problems.

 Chapter 20 reviews the debates about the idea that we now live in a ‘therapeutic culture’.

The book ends with a conclusion drawing together these themes.

Activities, reflections, readings and images

We have included activities and ‘pause for reflections’ in each chapter. One aim of this is to help you reflect on your own understanding and opinion about the topics covered in the chapters. Another aim is to help you connect the material to your own experiences. Additionally, reflection – the ability to think about your thinking (and feelings) – is a key skill for counsellors, and so it is apposite to practise reflection in a book where the focus is mental health and counselling. We have also included suggestions for further readings at the end of each chapter.

Finally, we hope that you will enjoy the artwork in this book. The cover image was created by Fatma Durmush, an artist represented by the Bethlem Gallery. This gallery is based within the grounds of the Bethlem Royal Hospital, which supports artists who are current or former patients of the South London and Maudsley NHS Foundation Trust. Lucy Owen, the Interim Director of the gallery, explains: ‘Our mission is to make an equitable space for our artists, leading change within arts, health and society.’ Artist Fatma Durmush offers some personal background: ‘I started painting when I was 37 years old. I wanted to bring colour into my world. I became ill and received art therapy but then went on to study painting and printmaking at the University of East London at undergraduate and masters level. At University I received encouragement and support and most of the students there were adults. Now I paint at home with passion.’

The images within this book were created by Open University students. Andreas Vossler, co-editor of this book, organised this crowdsourcing initiative. As he explains: ‘We were overwhelmed by how many students submitted images for us to consider including in the book, with many submitting numerous photographs, paintings and drawings. It was difficult to select an image for each chapter, but we think they are amazing and we really hope you enjoy them.’

– Naomi, Andreas, David and David

References

Bion, W.R. (1967) ‘Notes on memory and desire’, in Langs, R. (ed.) Classics in psychoanalytic technique. New York, US and Oxford, UK: Jason Aronson, Inc., pp. 259–260.

Time to Change (2020) Mind your language! Available at: https://www.time-to-change.org.uk/media-centre/responsible-reporting/mind-your-language (Accessed date: 21 April 2020).