Introduction

The aim of the Living Therapy series is to o¡er the reader an opportunity to experience and to appreciate, through the use of dialogue, some of the diverse and challenging issues that can arise during counselling (Bryant-Je¡eries, 2003a, 2003b, 2004). The success of the preceding volumes, and the appreciative comments received from readers and made by independent reviewers, is encouragement enough to seek to extend this style into other issues and areas of counselling. Again and again people remark on how readable and accessible these books are. This is particularly heartening. I want the style to draw people into the narrative and help them to feel engaged with the characters and the therapeutic process. I want it to be what I would term ‘an experiential read’. The complex relationship between mental illness and close family relation-

ships, such as that between a mother and son, is a theme that I have certainly witnessed and been involved in as a counsellor. Issues of co-dependency, as both the mother and the son cling to roles that enable them to maintain certain facets of their natures and beliefs about themselves, can be potently present. An intergenerational psychological and behavioural dance is established and it becomes increasingly di⁄cult to break free of the established relational rhythm. And yet there can come a point at which the mother will need to claim her independence and, by so doing, free the son to do the same. Or vice versa. Either way, someone has to change. It becomes painful and traumatic when the changes within each person do not coincide. This process, however, is further complicated where a mental health problem is involved. With increasing numbers of young people using substances, and arguably

more powerful substances, and from an earlier age, there has to be an expectation that more and more families are going to ¢nd themselves a¡ected by a young person’s substance use. How will the family respond? What role will each person take? Who will be supportive of the young person? Will this support, though, simply become more of a process of rescuing them from the e¡ects of their damaging choices and in e¡ect becoming a process of enabling the young person to continue with their use? And who will reject them, want to remove them from the family system completely, which can also end up enabling the substance misuse to continue and perhaps develop further? In my experience as a therapist I have seen how parents can be split, with

a mother often (though not always) struggling to support the son whose lifestyle has become increasingly problematic. They are pulled into a time-consuming

role, perhaps we should say an all-consuming role, for if they cannot maintain boundaries and their own wellbeing then they will become consumed by the need of the young person and the demand within themselves to respond to that need. And yet, as in the story in this book, there will be times when the needs of the young person are justi¢ed. A young person with a mental health problemwill need extra support and attention, and may well need a strong parent (or parents) to ensure that their needs are being met by mental health services. Nevertheless, patterns of relationship will evolve and may, in time, still become psychologically problematic, with a certain degree of dependence normalised within the young person’s structure of self. As with the other volumes of the Living Therapy series, this book is composed of

¢ctitious dialogues between ¢ctitious clients and their counsellors, and between the counsellors and their supervisors. Within the dialogues are woven the re£ective thoughts and feelings of these di¡erent characters, along with boxed comments on the process and references to person-centred theory. By introducing the mother, Fareeda, as a Muslim woman, it a¡ords an opportunity for her to bring a measure of her own rich cultural and religious beliefs into the therapeutic arena. Her son,Ali, is not simplyusing cannabis, hehas ahistory ofmooddisorders, linked to a history of being bullied as a child, and of a lack of e¡ective and consistent psychiatric care. His mental health deteriorates as he moves into using an arguably stronger form of cannabis ^ the exact science around this remains a topic of debate. Whilst there is some agreement that ‘skunk’ cannabis is more hallucinogenic than the ‘pot’, ‘weed’ or ‘marijuana’ that most people associate with cannabis, the degree remains debatable. However, some people do seem to ¢nd themselves more severely a¡ected by ‘skunk’ cannabis. What is perhaps worth saying is that any shift towards using a more powerful drug, with more intense, adverse e¡ects on the person, has to raise concerns, particularly whenwe are talking about young peoplewho are still passing through their developmental stages of life. Physical and psychological development is occurring and drugs of this nature can only have an e¡ect; the questions remain how much of an e¡ect, and what might the long-term signi¢cance be for that young person’s development? Fareeda’s counsellor, Carla, is forced to confront some of her own issues con-

cerning race, religious and cultural di¡erences, and treatment responses to mental health problems including the process of diagnosis. Carla’s supervisor, William, o¡ers her the space to explore these in supervision and supports her in clarifying her thoughts, feelings and reactions; freeing her to be more present, congruent and empathic towards her client. For Ali’s counsellor, Charlotte, there are issues associated with working with a

client who evidences psychotic states within the counselling session which she takes to her supervisor, Matt. What are the boundaries to her competence? Can she maintain a therapeutic alliance with a client whose inner frame of reference is extended beyond anything that she feels able to relate to? What happens when a client’s inner world extends beyond the horizon of that of the counsellor? Clearly these are big issues to deal with and I do not seek to provide all the

answers. Rather, I want to convey something of the process of working with the material that arises so that the reader may be stimulated into processing their

to a serious mental health

own reactions and thereby gain insight into themselves and their practice. Often it will simply lead to more questions which I hope will prove stimulating to the reader and encourage them to think through their own position and boundary of competence. The book has been written with the aim of demonstrating the counsellor’s

application of the person-centred approach (PCA) ^ a theoretical approach to counselling that has, at its heart, the power of the relational experience. It is this relational experience which I believe to be at the very heart of e¡ective therapy, contributing to the possibility of releasing the client to realise greater potential for authentic living. The approach is widely used by counsellors working in the UK today: in a membership survey in 2001 by the British Association for Counselling and Psychotherapy, 35.6 per cent of those responding claimed to work to the person-centred approach, while 25.4 per cent identi¢ed themselves as psychodynamic practitioners. However, whatever the approach, it seems to me that the relationship is the key factor in contributing to a successful outcome ^ though this must remain a very subjective concept for who, other than the client, can really de¢ne what experience is to be taken as a measure of a successful outcome? The reader may ¢nd it takes a while to adjust to the dialogue format. Many

of the responses o¡ered by the counsellors, Carla and Charlotte, are re£ections of what their respective clients, Fareeda and Ali, have said. This is not to be read as conveying a simple repetition of the clients’ words. Rather, the counsellors seek to voice empathic responses, often with a sense of ‘checking out’ that they are hearing accurately what the clients are saying. The client says something; the counsellor then conveys that they have heard it, sometimes with the same words, sometimes including a sense of what they feel is being communicated through the client’s tone of voice, facial expression, or simply the atmosphere of the moment. The client is then enabled to con¢rm that he has been heard accurately, or to correct the counsellor in their perception. The client may then explore more deeply what they have been saying or move on, in either case with a sense that they have been heard and warmly accepted. To draw this to the reader’s attention, I have included some of the inner thoughts and feelings that are present within the individuals who form the narrative. Training and awareness-raising workshops are to be encouraged to enable the

professional to develop a fuller understanding of issues concerning racial, ethnic, cultural and religious di¡erences, as well as a deeper knowledge of the impact of substance misuse on the mental health of a young person, particularly where there have been indications of a developing mental health problem. All characters in this book are ¢ctitious and are not intended to bear resem-

blance to any particular person or persons.