Perspectives on suicidal ideation and self-harm: the impact on therapists and psychotherapeutic approaches to helping people at risk

Transcription

1 Perspectives on suicidal ideation and self-harm: the impact on therapists and psychotherapeutic approaches to helping people at risk Psychotherapy & Counselling Psychology Reflections Research Centre 5th Annual One-Day Conference Saturday 9 June :00 to 16:30 Registration from 08:00 Regent s University London Inner Circle, Regent s Park, London NW1 4NS Who should attend? Psychotherapists, counsellors, and psychologists Students of psychotherapy and psychology Academics and researchers Universities and FE colleges Education authorities Social services Community safety teams Community support officers Criminal justice practitioners Equality and diversity practitioners Anti-social behaviour coordinators Family justice centres Family protection units Health service professionals Outreach and support teams Community and voluntary organisations Book early! Regent s staff, students, alumni and RSPP professional members: 105 ( 85 if received by 31 March 2018) Public: 150 ( 120 if received by 31 March 2018) Non-Regent s students: 120 ( 95 if received by 31 March 2018) For more information: regents.ac.uk/pcprconference Please book online at store.regents.ac.uk

2 Keynote Speakers Dr Andrew Reeves Relational exploration: the missing link in working with suicide? Andrew Reeves is a suicide researcher and has published widely in this area for many years, including Counselling Suicidal Clients (Sage, 2010), and Working with Risk is Counselling and Psychotherapy (Sage, 2015), amongst other papers and chapters. He is a registered social worker and BACP accredited senior counsellor/psychotherapist. He additionally works as a senior lecturer on a doctoral programme in counselling, psychotherapy and psychological trauma. He was previously editor of the Counselling and Psychotherapy Research journal and acts as an adviser for The Listening Place in London. With suicide rates on the rise and an increased urgency in the public health agenda around suicide prevention, the dominance of science in understanding risk is prevalent in many mental health and therapy services. In conjunction with this, the risk assessment industry continues to produce tools, questionnaires and protocols in the hope of discovering a definitive indication of another s intent to end their own life. While such tools have something to offer, this paper asserts that, amongst the reduction targets, evidence-based practice and statistically significant assessment tools, a potentially more meaningful gateway to understanding another s pull towards death is becoming increasingly sidelined: that of a relational exploration of the suicide place. This paper will further argue that while we can probably never fully accurately predict the eventuality of suicide, we can come much closer by being willing, as helpers, to enter into the suicidal phenomenological space of the other. This demands much of the helper, and the need for self-care and harm mitigation is critical. The paper considers how we might achieve greater relational depth in working with suicide, and how we ensure we do not lose ourselves in an abyss. Professor David Winter Self-harm and reconstruction: a personal construct theory perspective David Winter is Professor Emeritus of Clinical Psychology at the University of Hertfordshire. He was previously programme director of the university s doctorate in clinical psychology, and spent most of his working life practising as a clinical psychologist and personal construct psychotherapist in the National Health Service. He has held visiting positions at various universities, including visiting professor at the University of Padua, Brotherton Fellow at the University of Melbourne and visiting scholar at the University of Wollongong. He is a Fellow of the British Psychological Society, and has over 170 publications, primarily on personal construct psychology and psychotherapy research. His recent research includes work with individuals at the limits of human experience, including both suicidal and homicidal people, those who have been radicalised, and survivors of civil war and of the Ebola epidemic in Sierra Leone. This paper will consider the paradox of behaviour which is apparently self-destructive by drawing upon personal construct theory. A personal construct taxonomy of deliberate self-harm and suicide will be presented, illustrated by interviews with people attending accident and emergency departments following self-harm. This theoretical perspective, and associated research findings, led to the development of a personal construct psychotherapeutic approach for people who self-harm, and the findings of a study evaluating this approach will be reported. Implications for the therapeutic relationship with people who self-harm and/or are at risk of suicide will be discussed, as will broader implications for international relations.

3 Keynote Speakers Dr Terence Nice I bleed therefore I am: pain, restoration and repair in self-cutting Terence Nice is Lecturer in Psychological Therapies at the Centre for Professional Practice at the University of Kent in Canterbury. He is a visiting lecturer at Regent s University London where he teaches and supervises students undertaking the MA Psychotherapy & Counselling. Dr Nice was appointed as associate specialist lecturer at the University of Kent after having graduated as a psychoanalytic psychotherapist in His training inspired him to attend the Tavistock Centre in London and complete a three-year MA in infant and young child observations. He has always been fascinated by a developmental trajectory with regard to child, adolescent and adult mental health. He has worked clinically as a specialist psychotherapist in a child and young person s mental health service for many years. His specialist interest is self-harm and attempted suicide in young people and he is an active researcher in the NHS and within the wider community. Dr Nice is a member of the UKCP Research Faculty Committee and a reviewer for the British Journal of Psychotherapy and the Journal of Social Work Practice. He has presented workshops and papers in London and Dublin and has conducted many regional radio broadcasts on the topic of self-harm and suicide. Adolescent self-harm is a national and global public health phenomenon that involves young people physically damaging or injuring their bodies. Historically, it has been understood as a coping mechanism and a form of escape from chronic levels of stress and distress in the context of unbearable states of mind. Prevalence has been hard to establish given the high levels of under-reporting, but some reports suggest that it may be as high as 25% of young people who have self-harmed on at least one occasion (Wright et al, 2013). Specific typologies of self-harm include self-cutting, burning, picking, bruising, medication overdoses and inserting foreign objects into the body. The focus of this article is upon the phenomenon of self-cutting and the physical and psychological wounds that are carved and stamped into the young person s body. It explores self-cutting through the theoretical constructs of attachment, adhesive identification and the twin processes of introjection and projection moving towards the purpose, function and symbolic meaning of self-cutting. The principal thrust of the paper reasons that in states of acute dissociation self-cutting is employed by young people to repair chronic levels of splitting, emotional surges and rapid cognitive recycling (over-thinking) and depressed cognitive cycles (underthinking). Paradoxically, self-cutting can be understood as an act of self-destructiveness fused with a desire to acquire control, equilibrium and relief from psychic pain. The body becomes the last beacon of orientation as the young person seeks to ward off feelings of fracture and breakdown. Consequently, the adolescent shuts down and disengages with others, engaging in a primitive form of self-holding. Two case studies support and ground the theoretical arguments. In each case, pseudonyms have been used and permission has been sought before including their clinical material. Jessie Emilion Selfish or a selfless act: suicide from an intercultural perspective Jessie Emilion is a BACP accredited counsellor and UKCP registered cognitive analytic psychotherapist and supervisor. She has been working in the NHS for 20 years in various capacities as a senior clinician, trainer and manager. She has a particular interest in bilingualism, culture, language and race and the impact of these factors on mental health, development of self and therapeutic alliance. As a trained interpreter she has extensive experience of working with refugee communities, asylum seekers and voluntary sector organisations both as a clinician and an interpreter. Her other areas of interest are maternal mental health, including psychological issues related to fetal abnormalities, post-natal depression, and repeated miscarriages. Jessie Emilion teaches on the CAT programs in the UK, India and in Qatar. She is central to the introduction of CAT in India and has developed the model further by incorporating religious, cultural and societal values, making it adaptive, appropriate and relevant to Indian society and the Indian psyche. She is currently employed by South London and Maudsley NHS Foundation Trust as a CAT psychotherapy lead at the Munro Centre, Guys Hospital and by CRUSE Bereavement Support as consultant psychotherapist and supervisor. In her former role as the diversity lead she developed the diversity strategy to improve access to psychological therapies within black and minority ethnic groups. She developed culturally appropriate interventions, including group programmes that focused on issues of race, language and culture. In 2014, Jessie contributed to the development of programmes for the Addictions Training & Rehabilitation Centre in Qatar as an associate of Maudsley International. Jessie is interested in using her experience to support Maudsley International s broader aims of improving global mental health. Suicide, suicidal ideations and suicide preventions are currently a hot topic in mental health. Having a patient who is actively suicidal is one of the worst fears for most professionals. Most of us will have come across suicide either directly as clinicians, or indirectly as supervisors at some point in our career as mental-health professionals. The presentation will discuss the different role positions one can take in relation to suicide, with a particular emphasis on an intercultural perspective. It will highlight some of the challenges and internal struggles that are faced by clinicians both on an individual level and within a wider professional context. Confronting the act of suicide itself challenges one s own narcissistic aspect of self. This will be further discussed and conceptualised within a cognitive analytic therapy framework.

4 Presentations Michael R. Montgomery Suicide is painless the experience of psychotherapists working with clients suicidal ideation Michael R. Montgomery is an independent psychotherapist and psychiatric social worker. He has worked in a range of mental-health settings, including during his time living in South East Asia, the NHS and Mind. He was in private practice in Hamburg, Germany before recently moving to Chicago, Illinois. Michael spent many years studying and practising Dzogchen meditation and lived and worked in a meditative retreat centre for several years. His current research focus is on how the therapist conceptualises and employs silence in practice. Michael will offer a personal and challenging presentation on suicide and suicidal ideation. He will draw from research that he conducted with senior therapists that explored how they resolved responsibility when faced with risk. The study indicated that the increased sense of persecution and surveillance, as a result of audit culture and regulation, is resulting in therapists being less prepared to take clinical risk, favouring safeguarding policy over clinical engagement. It is argued that this is potentially to the detriment of both the client and the therapist, and that it needs to be addressed at a training level. Ben Scanlan Therapist experience of losing a client to suicide Ben Scanlan is completing the MA Psychotherapy & Counselling at Regent s University London and is currently reading for the Advanced Diploma in Existential Psychotherapy at Regent s. He has a long-standing interest in suicide after his father killed himself, and after several suicide attempts himself. He previously worked at Maytree, working in a residential setting with people in suicidal crisis and has spoken in several arenas including conferences, online and on the TV documentary Professor Green: Suicide and Me. Ben currently works as an honorary counsellor in an IAPT service within the NHS and in private practice. The potential loss of a client to suicide is present for most therapists, and given the ever-increasing suicide rate, presumably happens to a number of our profession, yet it is rarely talked about or acknowledged. For his MA, Ben used interpretative phenomenological analysis to explore the research question of how therapists experience client suicide and deal with the after-effects of that experience. He will examine different experiences of losing a current client to suicide, as well as recommendations for the profession at large and for individuals, to give additional confidence in working with suicidal clients and ideas for adequate support to mitigate the after-effects of losing a client to suicide.

5 Conveners and Panel Members Dr Maria Luca Conference Organiser/Convener/Panel Member Dr Maria Luca is a Senior Research Fellow. Reader in Psychotherapy & Counselling Psychology, Head of the Regent s Reflections Research Centre and the PhD programme and Editor of the Journal of Psychotherapy & Counselling Psychology Reflections at the School of Psychotherapy and Counselling Psychology. Previous roles include Head of the School of Psychotherapy & Counselling Psychology. Maria worked in the National Health Service for 12 years and currently has a small private practice in London. Her current research projects include: sexual attraction and the erotic in therapy; sexual bullying among university students; the lived experience of migrants; medically unexplained symptoms and grounded theory. She made a television appearance on Sky News discussing sexual bullying among young people. She has published widely, including (2014) Sexual Attraction in Therapy: Clinical Perspectives on Moving Beyond the Taboo - A Guide for Training and Practice, London: Wiley; (2004) The Therapeutic Frame in the Clinical Context Integrative Perspectives, London: Brunner-Routledge; (2002) Professor John Nuttall Convener/Panel Member John Nuttall is Head of the School of Psychotherapy & Psychology and Professor of Integrative Psychotherapy at Regent s University London. He teaches theory, skills and research methods in the field. He is a professional psychotherapist in private practice. Professor Nuttall has had an extensive career in senior management in multi-national industry and commerce, and is a Certified Management Consultant and Chartered Marketer. He has written widely on management and psychotherapy and his special interests include psychotherapy integration, organisation theory, and the provision of counselling and psychotherapy in the community. He is also honorary psychotherapist and Chair of the charity, West London Centre for Counselling, a major provider of therapeutic counselling in primary care. Please note that this programme may be subject to change without notice