Table Of ContentLIVING THERAPY SERIES
Responding to a Serious
Mental Health Problem
Person-centred dialogues
Richard Bryant-Jefferies
Radcliffe Publishing
Oxford (cid:1) Seattle
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2005 Richard Bryant-Jefferies
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20160525
International Standard Book Number-13: 978-6-61071-906-8 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all
reasonable efforts have been made to publish reliable data and information, neither the author[s] nor
the publisher can accept any legal responsibility or liability for any errors or omissions that may be
made. The publishers wish to make clear that any views or opinions expressed in this book by
individual editors, authors or contributors are personal to them and do not necessarily reflect the
views/opinions of the publishers. The information or guidance contained in this book is intended for
use by medical, scientific or health-care professionals and is provided strictly as a supplement to the
medical or other professional’s own judgement, their knowledge of the patient’s medical history,
relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid
advances in medical science, any information or advice on dosages, procedures or diagnoses should
be independently verified. The reader is strongly urged to consult the relevant national drug formulary
and the drug companies’ and device or material manufacturers’ printed instructions, and their
websites, before administering or utilizing any of the drugs, devices or materials mentioned in this
book. This book does not indicate whether a particular treatment is appropriate or suitable for a
particular individual. Ultimately it is the sole responsibility of the medical professional to make his or
her own professional judgements, so as to advise and treat patients appropriately. The authors and
publishers have also attempted to trace the copyright holders of all material reproduced in this
publication and apologize to copyright holders if permission to publish in this form has not been
obtained. If any copyright material has not been acknowledged please write and let us know so we
may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying, microfilming, and recording, or in any information
storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access
www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc.
(CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit
organization that provides licenses and registration for a variety of users. For organizations that have
been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site
http://www.crcpress.com
Contents
Forewords v
Preface ix
Abouttheauthor xii
Acknowledgements xiv
Introduction 1
Supervision 3
Theperson-centredapproach 5
Part1:Amotherseekscounselling 19
Chapter1 21
Firstcontact 21
Introductorymeetingwiththecounsellor 23
Chapter2 35
Counsellingsession1:Wednesday18thMarch ^ issuesofraceandculture 35
Chapter3 49
Supervisionsession1:Friday20thMarch ^ processingissuesofrace, 49
cultureandbelief
Counsellingsession2:Wednesday25thMarch ^ poetryandanemotionalrelease 54
Chapter4 61
Counsellingsession3:Wednesday1stApril ^ spirituality,prayersandan 61
exchangeofgifts
Counsellingsession4:Wednesday8thApril ^ theclient’ssonhasa‘psychotic’ 71
episodeandisinhospital
iv Contents
Chapter5 79
Supervisionsession2:Friday10thApril ^ mentalhealthandperson-centred 79
workingexplored
Counsellingsession5:Wednesday15thApril ^ thedischargemeetingand 86
Fareeda’shopesforAli’streatment
Part2:Hersonbeginshisowncounsellingprocess 95
Chapter6 97
Counsellingsession1:Tuesday5thMay ^ counsellingbegins,theclientis 98
restless,endswitharelaxationvisualisation
Counsellingsession2:Tuesday12thMay ^ clientdoesnotattend,lettersent 105
tohim
Chapter7 109
Counsellingsession7:Tuesday16thJune ^ theclientrevealssomethingofhis 110
childhoodandidenti¢es‘parts’ofhimself
Counsellingsession8:Tuesday23rdJune ^ psychoticeventinthecounselling 121
session,‘parts’identi¢ed
Chapter8 137
Supervisionsession:Thursday25thJune ^ workingattheedgeofawareness 137
Counsellingsession9:Tuesday30thJune ^ paranoiainthesession 144
Chapter9 157
Counsellingsession10:Tuesday7thJuly ^ Alidrawsa‘map’ofhisstructureofself 157
Counsellingsession11:Tuesday14thJuly ^ cannabisdreamandareleaseofanger 166
Author’sepilogue 177
References 179
Foreword
Havingworkedas amedical doctor (GP) inIrelandfor 15 years, Irealised that I
needed to re-train in order to work e¡ectively with people experiencing mental
healthproblems.IthereforeundertookandcompletedanMAinhumanisticand
integrativepsychotherapytoaddressthede¢citsinmymedicaltraining.Ibelieve
that a person-centred approach to mental health is a pre-requisite to e¡ective
mentalhealthwork.
Withinthementalhealthservices,peopleexperiencingseriousandprolonged
mentalhealthproblemsaretypicallytreatedprimarily ^ andoftensolely ^ with
medication.Thepresumptionisoftenmadethattherapyandpsychosocialinter-
ventionsformentalhealthexperiencessuchaspsychosisandparanoiacouldnot
possiblyhaveanythingtoo¡er.Consequently,counsellorsandpsychotherapists
do not tend to work regularly with people experiencing serious and enduring
mentalhealthproblems.
Therapists tend to be less con¢dent about working with people experiencing
severementalhealthproblems.Manytherapistsdonotgainsu⁄cientexperience
in this work to understand such experiences and to become comfortable in this
areaofwork.Withinsomecounsellingandpsychotherapytrainingprogrammes,
majormentalhealthproblemssuchaspsychosisandparanoiaarenotconsidered
ingreatdetail,seenprimarilyasfallingwithintheremitofpsychiatryandmedi-
cationonly.
This is unfortunate. There is considerable scope for therapists to work with
experiencessuchashallucinations,delusions,paranoia,andwiththeexperiences
of people diagnosed as having bipolar disorder. Such experiences are typically
viewed as meaningless, purposeless; as something to be eradicated as quicklyas
possible. I share the author’s view that on the contrary, these experiences do
indeedmakesenseandcanbeengagedwithintherapy.Theseexperiencesreveal
somethingimportantaboutthatpersonandhowtheyareintheirworld,albeitif
sometimespresentedinanindirectandmetaphoricalfashion.
Seriousmentalhealthproblemstendtobeseenprimarilyasmedicalproblems.
However,thepersonexperiencingmentalhealthproblemshasanexistence,alife
beyondtheirdiagnosis.Peoplebecomeunwellwithinthecontextsandsystemsin
whichtheylive.Amentalhealthcaresystemwhichdoesnotsu⁄cientlytakethese
systemsintoaccountisinevitablylimitedinitscapacitytohelppeoplerecover.
In this book, Richard Bryant-Je¡eries outlines in considerable detail the value
of a person-centred approach to severe mental health problems. The detail is
vi Forewords
important; he pays great attention to the subtle nuances of relationship which
are often missed within mental healthcare but which can be profoundly impor-
tanttopeople’srelationships,lifeandmentalhealth.
The author takes the reader chronologically through the journey of mother
andson.Includedinthisjourneyareaspectsofthecounsellor’sownexperience
ofthejourney,includingtheirsupervision.Asthestoryunfolds,thereadergetsa
realsenseofthejourneyofbothclientandtherapist.RichardBryant-Je¡eriespro-
vides insights into important aspects of relationships whichtherapists canwork
withproductivelywithintherelationshipnetworkofpeopleexperiencingsevere
mental health problems. What is also helpful and insightful is the fact that the
mother is a Muslim woman with multicultural and religious issues being
addressedwithinthetherapeuticprocess.
This book will be of considerable interest to therapists and other health and
social care professionals working within mental health who either regularly
come into contact with people experiencing severe mental health problems, or
who would be interested in increasing their understanding of this demanding
but rewarding area. It will also be of interest to clients, to trainers and trainees
asmaterialforinformingthetrainingprocess.
TerryLynch
PsychotherapistandGP
Limerick,Ireland
January2005
Terry Lynch is the author of BeyondProzac: HealingMental Distress (2004) pub-
lishedbyPCCSBooks.
Foreword
Substanceuseanditsimpactonthementalhealthofyoungpeopleisagrowing
problem. Young people today are subjected to, and are having to cope with, a
range of di⁄culties and pressures. Many choose to use substances as a way of
copingandofsatisfyingcertainneeds.Theseincludeasenseofbelongingtopeer
groups,awayofdealingwithdi⁄cultemotions,awayofexperiencinghighsand
lows,somethingtodowhenfeelingboredandneedingexcitement.Muchofthisis
natural and normal adolescent experimental, adaptational and developmental
behaviour; however, in the context of drug availability, and a culture of use
amongst young people, serious negative consequences can arise. Sadly, the
young people that I work with within Child and Adolescent Mental Health Ser-
vices (CAMHS) very often present their substance use as having a very speci¢c
purpose, that of ful¢lling a psychological need. They are often on the way to
developinga¢rmlyestablishedhabit.
In this book, Richard Bryant-Je¡eries describes not only working with Ali, an
olderteenagerwhohasahistoryofproblematiccannabisuseleadinghimtopsy-
choticexperiencing,butalsoofworkingwithhismotherwhoisinneedofsupport
as shetries tocopewiththeimpactofhismental states onhis behaviourwithin
the family home. This, in my experience, is an all too common problem. The
familysystemhastobetakenintoaccountinordertoappreciatethefactorscon-
tributingtothecomplexityoftheproblemsthathavearisen,andtoidentifywhat
supportivesystemsarepresenttoresolvethedi⁄cultiestheyface.
AsamotherandaMuslimmyself,Iappreciatethefactthattheauthorhasset
thenarrativewithinareligiouscontext.HerethemotherhasaMuslimfaithand
thisinformsherattitudeandcommitmenttothefamilysystemandtoherroleas
mother.Weseethecounsellorworkingwithsomeoftheseissues,withinthecon-
textofasocietywherethereismuchmisunderstandingandmisrepresentationof
Islamicbelief.
Ihavespentthelastfouryearsestablishingaserviceforyoungpeoplewhoare
using drugs and who are referred to CAMHS with complex needs, including
mentalhealthissues.Ithasbeenademandingandyetenormouslyful¢llingarea
of work. A worrying trend amongst young people is the high level of can-
nabis and/or alcohol use, and in particular the stronger varieties of cannabis
now available and the culture of binge drinking until they are ‘o¡ their faces’.
This substance use impacts on lifestyle, health and relationships and, in my
viii Forewords
experience,thereisasenseformanyyoungpeopleofnothavingtheirdi⁄culties
andissuestakenseriously,particularlywithinthefamily.
Itleavesmefeelingthatyoungpeopleneedtounderstandthemselvesmore,so
that they can appreciate the harm that substance use is having on them. Often
there has to be a realisation that mood changes, anxiety and depression are
normal features of life, to be borne and managed rather than immediately sup-
pressed by trying to change the experiences through substance use. Young
people often need someone to talk things through with and to help them make
sense; not only of their lives, but of symptoms they may be experiencing which
have a mental health component. However, I ¢nd that for many young people
thereisamarkedreluctancetowanttoacknowledgeanylinkbetweentheirsub-
stanceuseandtheirmentalstate.
Forme,RespondingtoaSeriousMentalHealthProblemisavaluabletext.Ito¡ers
genuineinsightintotheimpactofsubstancesonadolescentmentalhealth,rela-
tionshipswithinthefamily,andhowtheperson-centredapproachcanbeapplied
in this area of work. It is a book that will have value in CAMHS and all settings
whereprofessionalsarerequiredtoworkwithyoungpeopleandfamilies.
MovenaLucas
CAMHSLiaisonClinicalNurseSpecialistinSubstanceMisuse
January2005
Preface
Fromthestartofmyowntraininginperson-centredcounsellingtheproblematic
potentialofthemother^sonrelationship,andtheunder-emphasisonthiswithin
materialwrittenforcounsellors,hasstruckme.Isoughttobegintoaddressthis
in my previous book in the Living Therapy series: Relationship Counselling: sons
and their mothers. In that I dealt with the process of a man breaking free from
being the ‘son’ in order to claim his independence as a male adult in his own
right,andthedi⁄cultiesthatcanarisewithinthisprocess.
Inthisbook,Iplannedtowriteareversesituation,focusingonworkingwitha
motherwhosesonwasevidencingproblemsofdependency.However,asthebook
evolved,itbecameasomewhatdi¡erentnarrative.InPart1ofthebook,Iconcen-
trateononeclient,Fareeda,inherstruggletocopewithherson,Ali,whoat19
has an undiagnosed mental health problem and has turned to cannabis to self-
medicate.ThesecondpartofthebookdescribesAli’sexperienceofenteringinto
a therapeutic encounter after having reached acrisis point himself, andhow he
thenaddressesnotonlyhiscannabisusebutalsohisnowfragilementalstateand
theexperientialfactorsthatcontributedtoitsdevelopment.
Isetouttoexplorewhathappenswhensonsdeliberatelychooselifestylesthat
involvemaintaininganidentityasadependentson,choosingawayofbeingthat,
forwhateverreason,involvesnottakingresponsibilityandexpectingtobebaled
out by a mother who is caught in their own dependency trap. In such instances
we see a mother being dragged down by the constant demands of a son who,
in a certain sense, is unable, or unwilling, to grow up. Cycles of co-dependency
develop.Motherandsonaresometimescaughtinadancewhichenablesbothto
clingtoidentities that perhaps should have passedaway longago ^ the son not
wishingtoa⁄rmhisidentityasindependentadult;themotherunwillingtoletgo
ofcertainaspectsofherself-conceptoridentityas‘mother’andcreatethespace
andtheopportunitytoembraceafreshphaseinherownlife.
However, I have found myself with a narrative which explores a situation in
whichitisnotthatthesonisunwilling,butisunabletobreakfreeofdependency
duetohisownstateofmentalhealthandhisuseofcannabistotryandeasethe
acute discomfort he is experiencing within himself. The questions that arise are
many,andinclude,‘howdoesthemotherwhoknowssheisneededbyherson ^
and genuinely so ^ also look after herself and acknowledge her needs in order
to stay healthy and free?’. And, ‘how will the son address his di⁄culties when
