Editorial

Julie Lloyd and Rachel Pollard, 2013. Editorial. Reformulation, Summer, p.3,4.


In continuity with the ACAT conference in March, the theme of this 40th issue of Reformulation is Ethics and CAT. We are very grateful to those of you who responded so thoughtfully and in varied ways to our request for contributions on this topic. Whilst adherence to ethical codes of practice is a requirement for membership of all professional bodies, in the fi eld of psychotherapy ethics is so inextricably bound up with theory and technique, it is impossible to consider it as a subject apart. It is hard to conceive of writing about psychotherapy that was not informed by ethical values, even if these are implicit and not overtly referred to. We hope that, through an explicit focus on ethics, the articles in this issue will illuminate some ethical concerns that we may not have thought about recently or perhaps taken for granted and will encourage us to think critically and creatively about the assumptions that underpin them.

Helen Jellicoe’s article is a penetrating and challenging critique of our own code of ethics that she suggests is an ‘off the peg’ version that does not fi t well with the ethos and practice of CAT in varied settings. She questions assumptions about individual autonomy, therapist impartiality and therapeutic boundaries and suggests some alternative ways in which these ethical concerns could be addressed. We have printed some brief responses to this article from the ACAT Ethics committee that suggest that the ACAT code of ethics is due for an overhaul, but it is up to us, as ACAT members whose work is governed by this code, to formulate and express our own views as Helen Jellicoe has done so vividly.

As Helen Jellicoe’s article suggests, ethical issues in our work are often highly complex and sometimes fraught, because of the contexts in which we work and also because competing values or different views about the welfare or best interests of clients come into play. This is the case particularly for CAT therapists working with vulnerable adults in learning disability services and older adult services as well as those working with children. In these services, the boundaries of the one-to-one therapy relationship are insuffi cient and the therapeutic space is contained within and includes the team. Two articles by trainee clinical psychologists, Oliver O’Mara and Harriet Winstanley explore and tussle with the complex ethical issues of the client’s right to know the truth about themselves and the people close to them when working with vulnerable adults. Both concern the death of a relative and, taking into account the client’s different circumstances in these two situations, reach different conclusions as to what the client’s best interests are. ‘Off the peg’ codes of ethics are of limited use to us in situations such as these that require a dialogic, collaborative approach so that different points of view can be considered in the process of reaching a decision, a decision that may not seem clear or obvious at the outset. From a Bakhtinian perspective, this invokes the ethics of a ‘non- categorical imperative’1 that takes into account the unique aspects of each individual and their social situation.

The therapist’s legal obligations and the involvement of the courts and social services can add yet further complexity to the process of reaching ethical decisions. Marie- Anne Bernardy–Arbuz, the fi rst and, so far, the only qualifi ed CAT practitioner in France, describes how as a psychotherapist in children’s services, she has to make some diffi cult decisions in consultation with her team when the therapist’s view of the best interests of a child and the views or interests of the child’s parents are in confl ict. She describes how CAT theory can help to fi nd a way through this ethical minefi eld by mapping the reciprocal roles involved. Her article also draws our attention to uncertainty and how ethical dilemmas often present themselves with no certainty as to the outcome whichever decision is made. This is when clear moral and, sometimes, legal guidelines become paramount.

Beth Greenhill, Amanda Roberts and Rebecca Swarbrick, in response to the horrifi c treatment of people in Winterbourne View, one of many examples of the human rights of people with learning disabilities and older people in institutional care being abused, present their research about how CAT can contribute to the provision of relationally informed services in which the ethical importance of the human rights of both clients and staff are recognized and respected. If staff do not feel valued and respected by their organizations and managers then the ‘emotional labour’ involved in their work becomes more demanding leading to stress and burnout. The authors suggest how relationally informed training and a relational approach to risk can help to facilitate a change in the culture of organizations to one in which the human rights of all are respected. As the authors highlight, the fi ndings of their research are relevant across a range of organizational/institutional settings and particularly to those where the work of front line staff involves caring for other people.

Maryanne Steele, in the fi rst of two articles, invites us to consider what we mean by collaboration in CAT and to refl ect on how collaborative we really are in our own practice. She considers the ethical implications of collaborative as opposed to other modes of practice and how easy it is to stray from the ideal of collaboration if we fail to maintain our ‘selves’ and our awareness of our own vulnerabilities. She enriches the CAT understandings of collaboration by bringing in the perspectives of other modalities and ways of working.

CAT originated from Anthony Ryle’s recognition that the NHS provision of psychotherapy was failing to meet the mental health needs of the majority of the population. Ryle threw down the gauntlet to, what he perceived as, the elitist and complacent psychoanalytic establishment and its outdated assumptions about who could participate in psychotherapy as a client or a practitioner. In common with other radical movements, CAT has drifted towards the centre ground as it has, itself, become established in the NHS and its associated professions in mental health. So just as we need to be continually updating and maintaining our ‘selves’ in order to be truly collaborative therapists, as an organization we need to be continually, collectively rethinking the ethos of CAT and how that is refl ected both in our own individual practice and how we engage individually and collectively with the social and political world we are part of. Alongside others who have written recently in Reformulation about the political dimensions of psychotherapy as they affect the lives of our clients, Lucy Howe’s article discusses the, now rarely acknowledged, issue of social class, the class differences between many therapists and their clients and the disadvantages that working class people experience in mental health services. Drawing on her own experience as a therapist, she exposes the myth that we now live in a classless society and highlights how the economic and social deprivation that more often affects the lives of working class people also has a considerable adverse impact on mental health. She criticizes training courses for failing to take account of class differences alongside the failure of employers to recognise class as an aspect of people’s lives that can be a source of oppression and discrimination.

Philippa Gardner’s article moves beyond the UK and Europe to describe her experiences visiting her daughter who works as a volunteer teacher in Ghana. She also invites readers of Reformulation to contribute to the charity her family has set up to support the families and children in the village where her daughter works. Her article invites us to refl ect and act on our ethical responsibilities beyond national borders and on our interdependency with other people throughout the world.

As CAT has evolved it has been used creatively by therapists using media other than words. Rose Hughes presents a very moving and powerful account of her work with a client who had been sexually abused in childhood, using art as a medium of expressions and communication as part of CAT therapy. There are times when ‘words cannot be found’ and a ‘language other than words’ is needed.

Continuing the theme of CAT and the arts, Amanda Lapping and Julie Lloyd review a book on ‘Forensic Music Therapy’ whilst Jonathan Strauss reviews a contemporary novel from a CAT perspective.

The deadline for submissions for the next issue of Reformulation is 30th September 2013. We would particularly welcome responses to the articles in this issue in the form of letters or articles. We have also negotiated for Reformulation readers to review books from Karnac publishers. A list of books can be found on their website http://www. karnacbooks.com/ - Please let us know if there are any books you would like to read and review.

Full Reference

Julie Lloyd and Rachel Pollard, 2013. Editorial. Reformulation, Summer, p.3,4.

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