Joined in 2023 
82 
63 About this deal
Norcross and Lambert offer several ‘take-home points’ from this massive body of research: ‘One: patients contribute the lion’s share of psychotherapy success (and failure). Two: the therapeutic relationship generally accounts for at least as much psychotherapy success as the treatment method. Three: particular treatment methods do matter in some cases, especially more complex or severe cases. Four: adapting or customising therapy to the patient enhances the effectiveness of psychotherapy probably by innervating multiple pathways – the patient, the relationship, the method, and expectancy. Five: psychotherapists need to consider multiple factors and their optimal combinations, not only one or two of their favourites.’ And, they add: ‘… the patient’s perspective of the relationship proves more important to their treatment outcome than the therapist’s. The patient’s experience of the alliance, cohesion, empathy, and support relate and contribute more to their success than the practitioner’s experience.’ In other words, the client knows best when it comes to how they feel about the therapy relationship. As is so often the case, alcohol progresses to harder substances. Drugs are a common part of the gay male scene and it is in this area that the problem most visibly manifests. In the past 20 years, the use of drugs such as cocaine, ecstasy and marijuana has evolved into far more dangerous substances, such as GHB, mephedrone and crystal meth, often in a sexual setting, which has contributed to an unseen public health crisis. The British crime survey 2013/14 showed that 33% of gay men had used illicit drugs in the previous six months, three times the rate of straight men and the highest rate of any group. 4 Over the past 10 years or so, there have been many high-profile cases of successful gay men either overdosing or taking their own lives or killing people while under the influence of drugs. These are extreme cases but not as uncommon as they should be. US family therapist, academic and writer Dr Pauline Boss is taking a different approach. Originator of the concept of ‘ambiguous loss’, after years of writing, teaching and training practitioners, she has written her latest book, The Myth of Closure, 9 for the general public (reviewed in this issue). ‘Ambiguous loss’ may be physical or psychological. Physical ambiguous loss refers to deaths where there is no verification of the death itself – no body, no death certificate, for example. It can also apply to other losses, such as a job, money, and even the ability to mourn together, as happened in the time of COVID. ‘Psychological losses are amorphous and much harder to identify and quantify,’ Boss says. ‘For example, they could be loss of trust in the world as a safe place, loss in trust that your friends are safe enough to be physically near you, loss of feeling secure about going to buy groceries, of being able to go about your daily routine, go out of your house and feel safe. It is a really long list. The key mechanism in people’s recovery is the exchange of stories. People can’t make sense of the death – because they weren’t there, they had to rely on reports from healthcare staff, they’ve been denied the eulogies and conversations after the funeral – it’s delayed grief and, as the research has found, people aren’t recovering. But we have been monitoring participants in our Zoom groups that we’ve also been running, using an Assimilation of Grief Experiences Scale that we developed to measure how well participants are beginning to accommodate their loss into their lives, and it’s clear that, even when the rest of their lives are still difficult, and they may be struggling with their anxiety and depression as shown on the PHQ and GAD scales, their relationship with the deceased and making sense of the death steadily improve. We are seeing changes and adaptation in the people in our groups.’
One man told me about his positive experience of working with a straight counsellor. ‘I’ve spoken in great detail about the specific challenges that gay men may face, as well as my other intersections, such as living with HIV and living in a rural area. She has followed my lead, developed a professional awareness of these issues and responded in an attuned and empathic way. It’s almost become her niche now.’Many others struggled with relationships and compulsive sex. It seemed drugs were omnipresent on the gay scene. At Attitude, I noticed a pattern of staff taking Mondays off. I found one asleep on his desk. Then the gay brother of our advertising manager, someone who worked with us for a while, who had struggled with drink and drugs, took his own life. Often, the focus on understanding dementia, providing treatment and engaging in communication can emphasise verbal interaction, and the value of non-verbal communication can be ignored. As Julia states, continued connection is important, and, as such, attention to kinaesthetic engagement is key – not only when people’s cognitive faculties are impaired but more so within/in dementia relationships where meaning making through language as we ‘know it’ is changed and challenged.
A sense of loss and disorientation is not uncommon in psychotic experiences generally and is a common feature of the advanced stages of dementia. This sense of loss exists in a tangled web of self–other relationships. 16 What happens when, inside the therapy room, we bear witness to a life’s unravelling? A body’s unraveling (snap – lost)? Loss of tangles and plaques – the ruthless biological process that biomedical science is labouring to impede. The supreme compendium of data on the effectiveness of relational factors in the talking therapies is Psychotherapy Relationships That Work, 3 which is based on the findings of the Third Interdivisional APA (American Psychological Association) Task Force on Evidence-based Relationships and Responsiveness. Now in its third edition, it is in two volumes: Evidence-based Therapist Contributions, edited by John Norcross and Michael Lambert, and Evidence-based Therapist Responsiveness, edited by John Norcross and Bruce Wampold. The book brings together findings from 18 vast meta-analyses of data on what makes talking therapies effective. We are living in a time of grief – we are grieving not just the millions of deaths from COVID-19, but the loss of much that we previously thought we could take for granted. Despite all our medical breakthroughs and technologies, we have discovered we are not in control, and that a tiny virus can evade all our protective barriers and overwhelm us. We are grieving the loss of our assumptive worlds 1 – that is, the beliefs and values that grounded and secured us, that gave us confidence that we could keep ourselves and those we love safe. Meantime, the July issue offers rich reading, not least Phil Hills’ and Rachel Lawley’s description of how they, as newly qualified counsellors, set up and are now taking a specialist counselling service into schools to offer support to the teachers. It’s a story of head, heart and sheer business-mindedness that, as they say, has meant they can work to the values and principles that brought them into the profession. But they also take pains to stress that treatment method is important: ‘It remains a matter of judgment and methodology on how much each contributes, but there is virtual unanimity that both the relationship and the method (in so far as we can separate them) “work”. Looking at either treatment interventions or therapy relationships alone is incomplete. We encourage practitioners and researchers to look at multiple determinants of outcome, [and] particularly client contributions.’Menzies RE, Neimeyer RA, Menzies RG. Death anxiety, loss, and grief in the time of COVID-19. Behaviour Change 2020; 37(3): 111–115. It wasn’t just brought on by the pressures of the job. My issues had been building and manifesting in complex ways from as early as I can remember. But no partner could or should take on that burden; nothing could shake the feelings of worthlessness, and gradually the looking for relationships evolved into compulsively looking for connection through sex. I started to lose control and yet no one – friends, family, therapist, gay or straight – seemed to have any answers. Nor did gay culture, which didn’t allow any discussion of how the relentless pursuit of hedonism might contribute. Other gay people were doing great, it said. If that was the case, then why wasn’t I? I think young people are often not well supported in terms of their autonomous thinking. School is often really prescriptive and that doesn’t help young people to think for themselves. I approach working with young people with the attitude that they are the expert on themselves and I have some potentially helpful ideas and information that I might share with them with their permission. It is a subtle difference; I am offering information, not giving advice.’ Taking outcome measures can help validate a client’s sense of distress – that they really do need help, which for some is important if they are to engage with therapy. Continuing to do so then provides a measure of progress, or an alert that progress has stopped. But McInnes’ own main reason for doing it originally was curiosity, he says. ‘I wanted to know how I compared with the overall effect rate. What’s my effect size? I’d be disappointed if therapists had no curiosity to know what difference they are making.’ This short multi-layered film speaks, sings and dances the lived experience of dementia. If, as witnesses, we become baffled in trying to solve the puzzle of the, at times, peculiar and other-worldly narrative (and imagery) of I Can’t Find Myself, it is because we are not looking, feeling or listening hard enough. Because dementia is peculiar, other-worldly and alienating. Most importantly, the film highlights that dementia is unavoidably an embodied, relational and affective experience.
We operate GDPR-compliant contracts with any third party involved with the journals, including designers and printers, which cover how data is handled and how long it is retained. This issue also sees the introduction of two new columns. ‘My practice’ is a chance for you to share how you work. In the first column, Sarah Edge describes her work with postnatal clients. I am also delighted to introduce a new column from Therapy Today’s Editorial Advisory Board – the team of talented practitioners who are on hand to ensure the content of your magazine stays relevant and inclusive. I’d like to thank John Barton for agreeing to go first with a thought-provoking piece on ‘getting over ourselves’. You’ll hear from a different Editorial Board member each issue. University practitioner Afra Turner has followed a path from psychodynamic to CBT in her professional development and orientation over the past 27 years. Now a senior therapist and supervisor in the counselling and mental health service at King’s College London, she has worked in seven different university counselling services. ‘The decision to do post-qualification training in CBT came about in response to the student voice and my own sense of what I’d been trained for. A lot of the literature was on long-term, in-depth work, but in the university counselling context, often the student only wanted or stayed for four to six sessions. Students wanted a place to be supported emotionally but they also wanted support to navigate the practical aspects of their academic work, and CBT really stood out for me as a possible way to combine the two. And that is exactly what I found. A personal crisis may bring the student to the service, but the reality is they do have these deadlines and commitments and will falter if they don’t have that support.’ Similarly, the ‘equivalence’ that the PRaCTICED trial established between CBT and PCET faded away after the initial six-month assessment. By one year, people who had received CBT were doing better than those who had PCET and more of those in the PCET group were looking to return to therapy, while those in the CBT group were more likely to be using the techniques they had learned in therapy to help them through recurring difficulties.
News
Please note, we don't review self-published books in our journals. Permissions and confirmations Client confidentiality
Great Deal 
New Comment