Careers: Opening up possibilities

'One of the appeals of counselling psychology is that you can integrate it with other approaches. NICE increasingly stress CBT, which is fine, but in counselling psychology, you can experiment, use what works, open up possibilities rather than close them down,' says Don Rawson. 'Counselling psychology is under pressure from NHS cuts and from a more outcome-driven and measured culture. There are growing tensions between counselling and clinical practitioners – there are fundamental differences, but we should celebrate them.'Don said that he liked talking about counselling psychology, among many other things, when I interviewed him at his home near Rickmansworth. He quickly gave evidence that he thinks deeply about what he does. I'd recently been on a monastic retreat: Don was interested in this. 'I sometimes take a day off to do nothing but walk, sit in cafés and think. Working with troubled clients is draining; any psychologist needs this sort of thinking time.'

It had been an interesting journey through John Betjeman's Metro Land on the Chiltern Railways, a drive to a (for me) unexpectedly beautiful part of the world, then walking into a house with piles of gold discs ('my wife has managed a number of well-known rock bands').

I tried (occasionally unsuccessfully) to avoid asking Don which famous rock stars he'd met and we got on with the interview.

We strive not to label people

'Counselling psychology has at its core three things. Estate agents say "location, location, location": our mantra is "relationships, relationships, relationships" and the plural form is deliberate. There are three core relationships we are attentive to: between the client and the social world; within the room, between the client and the counsellor; and between clients and themselves.

'The second key nexus of ideas is to do with complexity and holism. We strive not to label people based on a symptom complex. We tend to ask "How are you today?" not "Is your anxiety getting worse?". It's been suggested that all symptom names should be changed from nouns to verbs. Instead of "X is a narcissist" you could say "X is narcissising". A person does something not is something. I think that's a really useful idea even if it sometimes leads to barbaric language!

'If you want to summarise – rather simplistically – how clinical and counselling psychologists differ, you could say clinical psychologists are really strong in assessment and formulation, counselling psychologists focus on process. I believe counselling psychology implies empowerment and liberation. And, while we're at it, many people see counselling and psychotherapy as pretty indistinguishable, but, again very simply, psychotherapy reconstructs longstanding issues, counselling puts people on the right road.'

Don's third point is about reflexivity. 'To some extent, the psychological scientist takes him or herself out of the situation; it's implicit in the model of psychology as a science. Counselling psychologists, however, say "I'm not neutral; I must understand the effect I have".' These 'Careers' interviews have often included sections that should have been headed: 'Psychology: Art or science? Discuss'. Don comments: 'Counselling psychology is based on the science of psychology with the art of counselling: the trick is to combine the two. You learn the knowledge, you practise, then a lot of what you do is intuitive, but informed by what you know. You get your ego out of the way. It's similar to a creative process. Intuitions form the basis of questioning. But I want to stress that none of this is irresponsible – it's informed creativity.'

The word tenderness features on Don's site (www.counsellingpsychologist.com), which offers a more extended account of Don's approach to the area . It seems an unusual concept in psychology. I asked him about this. 'No, it's central. Clients are often not kind to themselves – a big part of therapy is subverting the Judge Jeffries inside everyone. If we can be tender and kind to clients, they may be able offer the same qualities to themselves and other people.'You have to be agnostic about what you talk about
What was Don's route to counselling psychology?

'I left school hardly able to read and write but escaped through drawing and painting. In the 1960s it was fashionable to encourage such skills, and I ended up at an art school in Chelsea . A tutor – Alan Beattie – encouraged me to read and write. I did my A-levels and had already decided I wanted to do psychology.' Why? Don grins: 'Honestly? I've never understood what really makes people tick. If I ever did find a definitive answer I'd probably have to change careers.

I went to LSE and felt like I'd come home; I finally "got" education. There was no such thing as counselling psychology at the time so I did a BSc and then a doctorate in social psychology. I worked for a while in areas of health promotion, working on cancer prevention and the role of health promotion officers. Looking at health issues and addressing the mind–body gap is a way of understanding people.'

In 1994 the Counselling Psychology Division appeared and Don retrained but 'carried the insights from social psychology with me'. Don makes it clear he's anonymising client details in any cases he mentions.' I worked with a client who had an extremely dangerous condition and was told – wrongly – that he/she would die quickly. He/she developed a profound stammer and was effectively struck dumb and so given speech therapy. Attribution theory in social psychology suggested that instead of treating the mutism, I should address the shock. If the client concentrated on the mutism he/she would get into a vicious reinforcement cycle. As I worked with the client, the mutism disappeared. As has been said, there's nothing so practical as a good theory.'

Don's practice has been divided between teaching, supervision, counselling and research. 'This variety is important. Too much of anything can wear you out. I trained in counselling at City University and I stayed on as a lecturer. My research experience was useful. I was course director for a while then left to follow my own ideas for independent work. But seeing 35 patients a week made me near-reclusive. I couldn't cope with social situations and so when the university asked me back I agreed.'

Don now splits his time between three places. 'I work at the Belmore Centre which is dedicated to complementary health, a research interest of mine. I like this as an environment for counselling. People are motivated and want to go to such a centre so they start with an open mind. The professions cooperate rather than compete. And, whatever you think about complementary medicine, I like the fact that it addresses the mind–body problem seriously. Medics – and, to some extent, therapists – tend to polarise too many things, and this sells people's own feelings and experiences short.' This is an example of drawing from other disciplines and knowledge areas. 'I also practise as a medical herbalist. It's been fascinating to learn a new skill set.' Don additionally works with cancer patients and their families in Harley Street one day a week. 'It's exhausting and demanding and puts any problems I might have into perspective. I'm also establishing a training clinic at the university with a reduced fee if the client sees a trainee, obviously supervised. It allows students experience of being co-therapists.'

Don is involved in couples therapy. 'I'm writing a book about it. Sometimes when I'm in a session with an individual it becomes clear that the person who should be there is missing – the client's partner. In a multicultural society, couples therapy gets more complicated and sometimes misnamed. Working with a husband who has two wives, for example, is a big challenge.'

The conversation returns to counselling psychology's accepting approach to clients and the need for psychologists to be aware of their own effect. 'I'm interested in the connections between mind, body and spirit. Spirit might not be spirit but its definitely there for some people. You have to be agnostic about issues people raise and to concentrate on whatever works for them. For instance, working with a terminally ill husband who was an atheist and his devout wife, who was angry that he was dying and denied that they would meet "on the other side" requires you to take two very conflicting beliefs seriously. "Moral reactions" also have to be managed. Couples come into your room and tell you things about their private life which could have you gasping! That's why supervision – which is something I get involved in – is particularly important for counselling psychologists. It replicates client relationships and helps keep us on track.'

A subject with a long past and a short historyDon argues strongly that psychologists, and especially counselling psychologists, need to know and remember their own history. 'It helps you understand what you're doing and the discipline's trajectory. Counselling psychology is  a pretty peculiar phrase. It was invented at a conference in Boulder, Colorado after the Second World War and originally incorporated the idea of career counselling. There was a subsequent split between occupational and counselling applications and here we are – not at the end of something but facing major new developments. Just look at demographics. By 2033, 45 per cent of the population will be over 60. Helping people grow old well is a huge challenge for counselling psychologists in particular. Other challenges include social disruption, the influence of multiculturalism and the heavier challenges of work. Psychology is a subject with a long past but a short history. We've hardly started on the issues we can help with.'

After our formal interview, Don and I have lunch and mull over the themes of the interview but the conversation also moves into discussion of too many books and films to mention, a rock star (who shall remain nameless) who lost a multi-million dollar royalty cheque when he sent it off in his jeans pocket to a dry cleaners, and Don's interest in restoring vintage vehicles, which he occasionally exhibits at enthusiasts' events.

Something strikes me as I travel home. One way psychology is advancing and changing is through, for want of a better phrase, scientific discovery. But as with all disciplines, there's another method: looking at other established ideas, practices and theoretical models and seeing how they fit with psychological method. You could call it the 'syncretic method'. Counselling psychology is one of the laboratories  for this and people like Don are deeply involved in this effort, while, through teaching and supervision, ensuring psychology retains its professional and intellectual standards. Another, maybe obvious, point is that every counselling psychologist I've interviewed has been friendly, honest and open and turned the event into more of a conversation than an interview. And that's an invaluable skill.

From social work to risk management

Ian Florance spoke to Yvonne Gailey

I first interviewed Yvonne Gailey, Chief Executive of the Risk Management Authority (RMA), when the organisation advertised for a Psychologist/ Psychiatrist Member of the RMA board. I suspected she would have fascinating views of psychologists' work from the outside, as someone who employs and has worked alongside psychologists during a career in social work and public policy.

Gripped by the research revolution
'I started in social work, a new profession at that time, in its heyday. That era was important to me personally, but more importantly established or reinforced a "welfare" culture in Scottish criminal justice policy and practice – the responsibility for the supervision of offenders in the community was placed with social work.

The early 1990s marked another milestone for me, Scottish policy and the wider field of criminal justice research. I moved into criminal justice social work when it was recognised that criminal justice services were not being afforded enough priority. There was a move to ring-fence funding and set national standards and objectives. This transition also coincided with the early publication of largely psychologically driven research that changed the face of rehabilitation; the "what works" research that continues to provide the outcome data essential to evidence-based practice. I was gripped by this research revolution, and unashamedly still am.'

Yvonne proceeded to undertake an MSc in Criminal Justice Studies that gave her further access to this research base, she completed a dissertation on women offenders, the basis of an Isobel Schwarz travel award in 2000. 'So actually, psychological research literature strongly influenced the course of my career.' In 2001 Yvonne left social work services and provided training and consultancy in such evidence-based practice with the Cognitive Centre. 'Those years of study and work were fantastic, and one highlight was the opportunity to interact with leading international psychologist researchers, who were happy to engage with those endeavouring to promote evidence-based practice.'

In 2006 she joined the Risk Management Authority and two years ago became Chief Executive. Yvonne is transparently proud of what the RMA does. It started setting standards and providing guidance on the assessment and management of risk posed by the most serious offenders, particularly those subject to an Order for Lifelong Restriction (OLR). It has increasingly concentrated on creating consistent shared risk practice across all agencies.

Multi-agency working
RMA is a multidisciplinary team and influences a multidisciplinary audience, an issue which featured strongly during our conversation.

'I started working in residential child care and became intrigued by the people who held positions of influence and decision-making power in the lives of those children cared for in residential settings.

'Once I qualified as a social worker and moved out into
the field, I quickly learned that effective social work involves dialogue with other agencies. Multi-agency work in all areas – from child protection to criminal justice – since the 1990s has developed phenomenally. It was never about everybody doing the same job or becoming amateur theorists in each other's fields. We can't all end up doing the same thing but must aim to share objectives while offering mutual respect for different contributions.

'Psychologists have a key role in any multi-agency team – after all, understanding and responding to human behaviour is central to what we all are doing. Psychologists bring an expertise in this respect, but equally social workers and the police bring particular, though again different, experience. So, in Scotland we're building – in fact by the time this article comes out we will have published – shared standards, principles and guidelines for risk practice across agencies. Each discipline has a different contribution: for example, social workers seek to care, empower and protect; the police to detect and prevent crime; health services are involved in the care and treatment of individuals; the prison service aims for safe, legal and secure custody; but we must work together on managing risk. 'Of course, I could give many examples of existing good practice in risk management and multi-agency working. For instance, in Edinburgh a consultancy service provided by a clinical and a consultant forensic psychologist assists other agencies in the assessment and management planning in very complex cases. The ethos of this service is one of respectful support and appreciation of the frontline agencies, and as such really fosters multi-agency working  as well as good practice.'

The psychological contribution
Yvonne emphasises the central importance of psychologists' and psychological approaches to the work of the RMA on several levels. 'They're central to the provision of accredited assessors for the High Court. This whole area of risk assessment naturally lends itself to forensic psychology though assessors may come from any discipline, provided they evidence the necessary competency levels. At present the majority of the accredited assessors are chartered forensic psychologists with several years' experience. This role is not for junior psychologists but for those who have several years of more senior practice to draw upon.

'Psychologists also contribute hugely to the risk management of OLR offenders – at present all the offenders subject to the OLR are in the custody of the Scottish Prison Service (SPS), where forensic psychologists act as case managers and undertake the task of developing risk-management plans that must be approved by the RMA.'

What is it about psychological knowledge that makes psychologists so useful? 'Their training equips them to appraise and assess, to respond to individuals in a variety of contexts, within the discipline of an ethical code. I'm impressed by the way the SPS psychologists apply this approach to their work; drawing up a risk management plan for each OLR case, submitting it for approval, implementing it with an eye to the dynamic nature of risk, and reviewing it formally every year is a huge task; but the plan and its delivery must draw on detailed evidence, individual assessments and the research literature.'

What other skills do you value in psychologists? 'I'd go back to the research contribution in the '80s and '90s that so influenced my and my peers' approach to issues such as crime reduction rehabilitation and public protection. Most of the research that gripped us and changed our approach was psychologically based. Psychologists are trained to do sound research and, equally importantly, apply their findings. In the past few years RMA has been able to employ MSc forensic psychologists as research assistants for that very reason. A couple have gone on to secure positions as trainee forensic psychologists. One has opted to remain with the RMA as a caseworker in the OLR process and relishes the learning that she can achieve through interacting with professionals from many disciplines.'

But Yvonne does raise an issue for psychologists, one which has been discussed in other interviews over the past few years and which I wrote about in an article last year.

'I've stressed the importance of multidisciplinary working and the strides we've made. There are still occasional issues to resolve, however. For example, every now and then disputes can arise between forensic and clinical psychologists about the remit of their roles. Obviously these can represent important dialogue and challenge within the profession about respective responsibilities and competencies; respecting and appreciating the different knowledge and experience all allied psychologists bring, should ensure that such disputes do not detract from the important contribution psychologists make to public protection.'

Yvonne's seems to have made a huge transition from practitioner to a high-profile role in policy 'but my real interests are just the same, whether it is delivering, managing or advocating the kind of practice that engages individuals in a process of change, but this role gives me the opportunity to support and influence policy, provide resources for frontline practitioners, and so promote the delivery of evidence-based practice.'

And it's therefore fascinating to hear her views of psychologists' contribution to social care in the criminal justice field and, at least, one area where more work could be done.