Complexity from simple elements

Tom Bichard runs his own private practice and is particularly interested in issues such as self-esteem, relationships, social anxiety, phobias, self-destructive behaviours, and OCD. Petra Kagleder works in the NHS as well as undertaking some private work. She is particularly interested in the psychological effect of physical illness, working in areas such as pain, oncology, and palliative care. Their experiences reflect the diversity of counselling psychology.

I wondered why they wanted to be interviewed together. Tom and Petra offered a number of reasons: that they trust and work well together; they had been on the same doctorate course' and, more worryingly, that there was 'safety in numbers'!

Supporting something better

So, how did they start in psychology? Tom 'took a careers test and I seemed to be suited for farming or psychology! I come from a big family and was interested in how people noticed things about each other. My degree was in psychology and the course emphasised a scientific approach which began to grate. I became frustrated at how people were being pigeon-holed, whilst other psychologists and thinkers emphasised people's opacity and unknowability. This influenced my thinking around what it means to work respectfully with people.'

Tom then qualified as a counselling psychologist via a GradCert and Professional doctorate. 'My attraction to the area partly reflects how I see its practitioners now – taking a stance on dominant ways of thinking about people and society and aiming to support something better. I feel my original degree emphasised the science of how people operate, and now the focus is on the diverse worlds that individuals inhabit. In working with clients I still sometimes need to move out of my professional situation and more towards their individual language. For all these reasons, the medical model worries me; the wholesale adoption of specific models puts pressure on people. But Petra might give you a different perspective.'

Petra's path into psychology had more twists and turns than Tom's. 'I did a business degree in Germany which was a joint course with the UK and got fascinated by IT. Later I began to think that psychology is very similar to object oriented programming; that complexity develops from very simple elements. I did work as a project manager in the telecommunications industry and my marketing experience had elements of psychology in it.'

But Petra also has another strand to her developing interest. 'My Grandmother developed Alzheimer's and I experienced a number of personal difficulties – almost like a very early mid-life crisis. This made me reflect on my priorities and it became clear that I wanted to work in a way which helped other people more directly. After my first degree I moved to the UK. I volunteered at the Alzheimer's Society for a period.'

Looking back, Petra feels she was 'rather naïve about psychology; I didn't know there were different applications of the subject and therefore very diverse training paths. It soon became clear that I was too old to have a realistic chance to get into clinical psychology training, so I discarded that option fairly early on. I then managed to train in counselling psychology. I discovered during my doctorate that I didn't like the schoolism of some psychological approaches. This links in with Tom's view about psychological models. A client needs to get what they want from treatment, but the model needs to fit the therapist too. So, I use a core model in my work and add techniques and features to it as necessary. I would like to think my approach is rather practical and tailored to the patient.'

Public and Private

Given that they share a job title and certain aspects of their training, I wanted to find out more about the differences between Tom and Petra's work now.

Tom works in private practice 'with clients self-referring, or referred from insurers, the NHS, and organisations like MIND. I work in both Kings Cross and Harrow which gives me a huge range of clients and supervisees from different socio-economic backgrounds and circumstances. Private practice suits me. There's a lot of freedom both in terms of how and when you work and how you gain professional support. But a major difference between private practice and the NHS is how long you can work with an individual, and the level of choice they are given. The NHS offers a greater degree of certainty but more and more targets, more monitoring and surveillance. I think there's a pressure to, in effect, move people out of the door to meet targets. Of course, for some people this more directed system works, but not for everyone. '

What were the issues about setting up on your own? 'Client load – too many clients or too few – is important. You also need to decide what your niche is and also find ways to cope with isolation. Peer supervision and reading groups help here.' Did the Covid lockdown affect you? 'Yes, I went online and it helped some clients make the decision to seek therapy. But there are a million little things that make a therapy space work and you have to work out what the Zoom  equivalent is. I really wanted to get back to in-person sessions, to re-establish the personal therapy space.'

Tom returned to the issue of working in the NHS. 'At times I wonder about the future of psychological services offered by the NHS which, as I see it, runs a physical health model at its core. Of course there should be free psychological services but maybe offered through different organisations. That goes back to my concern about the medical model. Again, I expect Petra may have different views given her interests and areas of practice.'

Petra works three days for the NHS, two days for a private company and sees private clients in the evenings. Her view of NHS roles is enthusiastic but measured. 'I love working with patients. It's very rewarding to work with clients from a huge range of creeds, culture, ethnicity and neurodiversity. I learn from them: it's not an exaggeration to say that patients train you. There are challenges though. You have to justify your existence all the time. "Value for money" and "targets" are key issues. And if you work in the NHS, you can't ignore the fact that there are two views of it expressed by the public and the media – the NHS as saviours or a failing service. This can be difficult to hear at times.' 

'My interests are different from Tom's. I'm fascinated by the interaction of physical and mental health. I learnt a lot from working with a physiotherapist in a pain clinic. Tom might see the physical and mental as more separate, but we agree that the sum of the two is the person in front of you. I don't want to be pigeon-holed so in the future I'd like to work generally but have an emphasis on working with trauma and long-term illness.'

I asked Petra about her future. 'I'm going to develop my private practice more though I hope I've stressed how rewarding NHS working is. But there are obstacles to how counselling psychologists work within the NHS. Clinical psychologists are trained for that environment; I think counselling psychologists are sometimes on the back foot because of their training, which is rather critical of the medical model, and also because not all relevant information about the NHS is conveyed to them. But I think it would be a tragedy if counselling psychologists left the NHS. If you want to influence something, you have to be in it.'

And Tom? 'I'm interested in working more with prisoners. But I have a number of issues that I want to investigate and perhaps write about. One is putting psychodynamic ideas into everyday language. And the other is to reemphasise empathy.' 

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