Conversation:Ukraine Fundraiser and Conference on Psychotherapy & Counselling’s Contribution to Global Peace, Justice, and Wellbeing

BY MICK COOPER IN CONVERSATION WITH PAUL DALY

Paul: Thank you for agreeing to do this interview, Mick. I thought I might pick out some things you said at the Ukraine Fundraiser and Conference and ask you to expand on them, if that’s okay.

In March of this year, you and John and Sandra Wilson from Onlinevents (2022) organised and hosted a remarkable online conference of over forty psychotherapists and counsellors from around the world, many of them eminent in their field, which had two aims: firstly, to fundraise for Ukraine and secondly, to ask the question ‘What can we, as mental health professionals, do to contribute towards social justice, change, and wellbeing?’ How did this conference come about and what motivated you to do it?

Mick: Well, Paul, it wasn’t anything particularly clever or genius. It was just seeing the news about Ukraine and the troubles out there; we wanted to do something. About a year before we’d done a fundraising event for my daughter who is making a film actually about Ukraine - her great-grandfather came from Ukraine. So, we were thinking about how we could raise some money and we thought, ‘well, why don’t we do a conference?’ and then we thought, ‘what should we do it on?’ and we thought, ‘well, why don’t we do it on social justice and what therapists maybe can do.’ And then we reached out to people we knew, people like Paul Gilbert and Emmy van Deurzen and Ernesto Spinelli, and we got an amazing response from lots of people. They were really enthusiastic about doing it, so we said, ‘let’s try and do it’, and it was an amazing day. I was so pleased with that. It was a real highlight in my life, I think. It was an amazing day.

Paul: It was extraordinary. I just recently purchased the recordings of it all and I’ve been working my way through them. They’re so good.

Mick: There are so many good talks and all the ones that I listened to like Dwight Turner and Emmy van Deurzen and Orna Guralnik, the couples’ therapist - she was amazing. It was amazing to hear so many different perspectives. It was really exciting.

Paul: I was moved by the fact that you began the conference by interviewing five Ukrainian therapists, some of them currently working in Ukraine. One of the therapists said that she understands that “naturally, after the initial shock, the attention may fade away.” And she also said “I think it’s really important to keep in mind that it shouldn’t happen.” Two months afterwards, what are your feelings about the conference? And do you think that the attention is fading away somewhat?

Mick: I think it’s really important to keep that focus. The conference was partly about Ukraine. Certainly the funding was for Ukraine. It was also partly thinking about more broadly, ‘what can we do as therapists?’ and in terms of Ukraine we just had a meeting recently set up, Therapy and Social Change Network, so that people around the world can join an international network. The idea is to have a group where we can liaise and if people are interested, they can email John Wilson on Onlinevents (help@onlinevents.co.uk), and then we’ll coordinate and if people want to lead on things, say for Ukraine, then we’ll be able to do that... It was nice to see in the Eurovision at the weekend Ukraine winning... No Ireland?

Paul: No, we didn’t qualify for the final. There used to be a joke that we were trying to lose because we won it three times in a row and we didn’t want to host it again - it was too expensive. But now we don’t seem to be able to qualify ever since we sent a puppet representing us!

Mick: Great Britain did well for once. But it was lovely to see Ukraine win. And I think that was an expression of how much people were still concerned and cared, and obviously in the news we still hear a lot about it and I really hope that things improve.

Paul: A lot of good work is being done as you would know but a recent article in The Guardian (2022) stated that Ukrainian refugees face a wait of up to two years for war trauma therapy. I don’t know if it’s similar in other European countries but, given the number of refugees, it would be surprising if it wasn’t. And of course, it’s not just Ukrainian refugees. It’s many other countries too. One of the Ukrainian therapists indicated at the conference that she and her colleagues had found that their clients, particularly those with anxiety disorders, had been changed by the war and had chosen not to be helpless and had become active volunteers and organisers. At the same time there must be many people who are broken and who are waiting for therapy in different countries.

Mick: Yeah, I imagine so. I think one of the things that we discussed in this group is about offering therapeutic opportunities - offering free therapy to people from Ukraine or people from war-torn areas. Of course, there’s an issue about not just having the focus on Ukraine, there’s war and refugees from many different places. Also, I guess, to recognise from a pluralistic standpoint, that therapy isn’t the answer to everything. As you say, people cope with things in different ways, and therapy may not always be the answer. But if people want it, and if people feel that that’s going to be helpful, then it would be amazing if we could have networks. I’ve heard that some networks are providing therapy but I think that that will be an obvious kind of way that as therapists we can help, by offering some kind of pro bono service to people to help them deal with some of those traumatic experiences which I’m sure is just going to be massive.

Paul: Yes, a lot of that pro bono therapy went on during Covid. And I’m glad that you broadened it out because of course it’s not just Ukraine. It’s Syria. It’s Yemen. It’s many, many countries. It’s just that for some reason the world woke up to war and trauma with Ukraine and there is probably a much bigger focus on it.

Mick: Yeah, I think that’s understandable. I guess it’s a bit closer. It’s part of Europe. Maybe because of the threat of nuclear war that it kind of brings, that hasn’t been there before. But also, I guess, we have to be open to the possibility that there’s obviously some kind of unconscious racism in that. And that has to be I think something thought about, taken seriously and that was certainly a criticism from some quarters and I think understandably. It’s a massively important cause but it’s also important to recognise the suffering around the world.

Paul: At the conference you crystallised, what for me anyway was a central point, where you said that “we all know that wellbeing isn’t just something that happens inside people’s heads. It’s also about the world that we live in. There’s just an abundance of evidence in the field that things like tyranny, racism, poverty, homophobia, and all these other injustices can be really important factors in leading to psychological distress.” And what you said too was, “So if we want to help our clients best, we need to look at how we can help them as well as others, overcome these kinds of political and social injustices, both in terms of what we do in the therapy room, and also what we do outside of it.” So then just to ask you that question that you asked all of us, how can we as therapists begin to bring about greater global peace, justice and wellbeing?

Mick: It’s a tough question isn’t it? There’s certainly not one answer to it. Orna Guralnik - I think it’s lovely what she was saying. She was saying that by doing therapy, in a sense, we are doing that. She was talking about her couples therapy and saying that by creating a space in which maybe more marginalised voices can be heard - maybe the voice of the woman in a couple, maybe in some cases, the man as well - that that in itself is a political act. And that’s one thing we do, in the therapeutic work we do, is helping people find their voice, which can be political. But also there’s recognising - in our therapeutic work issues of social justice, for example - if we’re committed to Black clients or refugees we’re being sensitised and being made aware of those issues, educating ourselves. We know from the research that it’s important for clients that we have some understanding of their particular issues, for example, working with gay clients if we’re not that familiar with issues around homophobia. So, educating ourselves is something that we can do as therapists to be more helpful.

And then I guess there’s also taking things out and being more activist on a wider level, whether that’s in regard to environmental issues or challenging things like racism, poverty and those kinds of injustices. Obviously, we all have limits to what we can do, but I do think that for me, activist work is on a spectrum with therapy. It’s not a completely different field. I think some people might see therapy as a kind of clinical activity and then social justice as something completely separate. I think for me they’re related. They’re all about helping people in terms of their psychological health and wellbeing. If we want to help our clients - if we’re working with refugee clients - then helping them is partly about the work that we do with them, but also being active on a kind of wider political level. Challenging and being involved in groups that maybe support refugees is on a continuum as well and stuff that we can also do to help our clients and work upstream, as well as downstream, to help prevent some of these problems in the first place. So I think these are on a continuum and I think there’s a lot we can do. But also, it’s a discussion and I think it’s an ongoing challenge that a lot of therapists are asking. I think a lot of us have come into the therapy field because we care about the wellbeing of clients and of people more generally and what we do to support that. It’s great that we’re asking and talking about this, and thinking about it, really.

Paul: For some therapists it seems to be a bit of an awakening - the whole social and political dimension. And one of the participants at the conference - an Irish therapist - said that the social and political dimensions of therapy had never been even mentioned in his training and all the focus was only on the individual. And I’m wondering is part of the answer to bring the social and the political into therapy training, as your colleague, John McLeod suggests.

Mick: Yeah, I’m sure you’re absolutely right that training is a place where there’s a real opportunity to raise therapists’ awareness, and some of these issues for therapists to think about how they can work most effectively. Having modules on diversity and inclusion should really be central to any programme and not just tacked on as a separate part of it, but looking at those issues in depth, and to make them integral to all the issues that are talked about.

I think one of the problems that we have in the therapy field is that all our core models, whether it’s person-centred, psychodynamic, or CBT don’t really integrate a recognition of diversity issues, or social-political issues. It’s not that they would deny them and many people from the person-centred area, people, for instance, that I know, are very political, but it’s like the political issues are separate from the kind of core model that they train in. You look at Rogers’ core model of how people come to be psychologically damaged and it’s about relational issues, about people’s experiencing of unconditional positive regard, which I’m sure has a massive impact on people but there’s nothing really there about social and political factors. Okay, you can extend the idea of conditional positive regard to racism, maybe, but even so, it doesn’t take into account discrimination, it doesn’t take into account poverty. You struggle with any of these models, psychodynamic, CBT. They don’t really account for the reality as you were saying before: distress is related to real political circumstances.

I think the fact that we train our students in models that don’t really articulate that - I don’t think that helps - because it means that at best, we’ll see those issues as separate to the real core issues that we’re dealing with. You look at Carl Rogers’ necessary and sufficient conditions: financial security is not in there. Living in a world where people are kind and supportive to you - it’s not saying that. Even Rogers, a liberal humanist, doesn’t really conceptualise where these political factors have an impact.

Paul: Just listening to you there makes me think that maybe a new theory is called for that takes into account the social and the political.

Mick: Well, I think so, or maybe adaptions of the current theories or the models that we train in. In clinical psychology there’s the Power Threat Meaning Framework that they’ve developed, which really does start from social factors of distress. Some of the work that I’ve been doing myself is trying to develop ways of thinking about - from a very existential sense - what it means to exist and human existence that then can create more of a smooth transition and an integration between social and political factors. In the book I did recently about integrating counselling and psychotherapy, I develop a framework, based on research and other ideas, that can integrate and understand people in a way that the social and the psychological are more alongside each other rather than really separate.

Paul: What’s that book called?

Mick: It’s called Integrating Counselling & Psychotherapy: Directionality, Synergy and Social Change. The basics of the model are very similar to humanistic or psychodynamic theory: the idea of directionality, the idea that we are agentic beings, that we all try and move forward in our world and that can get blocked for different reasons. Sometimes it gets blocked because the things that we really want and need like closeness, security, pleasure, growth, sometimes those things are blocked because of external circumstances like poverty, racism, homophobia. Some of those things are blocked because of the way we try and go about getting the things that we want - like we’re very much pulling against ourselves a lot or maybe just the methods that we’re using to do something like deal with anxiety just aren’t that effective.

The ways we’re helping people then might be through helping them reconfigure the ways that they do things, so that they can get more of what they want more of the time, which is of course what we do as therapists. But it might also be by changing the external circumstances so that if that’s where the blocks are, if that’s what’s stopping people getting what they want, then that’s where attention needs to be. So, it’s trying to create a model that can smoothly move between psychological and social understandings, so that they’re all on the same page. I think that’s what I’m always trying to do - to put them on the same page rather than having them on two very different pages.

Paul: At one point in the conference you said that “as therapists we work towards structures that allow different voices within the person to be heard, rather than some kind of internal totalitarian state, which is often linked very much to distress.” And you mentioned pluralism, just now and also in your presentation, which I know you’ve written at least two books on as well as articles. I wonder could you say something about what pluralism in therapy is and why it’s important?

Mick: Pluralism in therapy - there’s different ways of understanding and using that term. We can think about self-pluralism and that is the idea that the self is composed of multiple parts, multiple voices, and most of our theories in some ways talk about that. The most obvious ones are things like Transactional Analysis with the Adult, Parent, and Child; and Freud’s Ego, Id, and Superego; and Jung’s archetypes. Most of our therapies have some ideas about self-pluralism. And often the focus is on getting the different parts to talk to each other. And there’s been some very interesting thinking around what kind of relationships between those parts are best or most functional. What I’ve always found fascinating, and what my most recent books have been about, is that most people who write about that talk about the value of a kind of democratic inner world where we have different voices and - our vulnerable side or angry side - we listen to them. No one voice dominates. And if we are the client and the rational part dominates, or the angry part or the vulnerable part dominates, there’s something not quite right there. As therapists we work to bring in the different voices and to help facilitate a more collaborative synergetic relationship between them. That’s one way of understanding pluralism.

The other way is quite a different trajectory or movement. Since about 2006 or so, John McLeod up in Abertay University, myself and lots of other colleagues have been developing something called a pluralistic approach to therapy. This pluralistic approach is quite similar to an integrative approach but it’s more a framework for thinking about therapies as a whole that can actually be inclusive of, say, a single modality: somebody might be person-centred, or psychodynamic or TA with a pluralistic lens. And what I mean by pluralism, firstly, as a kind of general philosophy, is the idea that there’s lots of different ways of doing therapy and different clients need different things at different points in time.

It’s not rocket science, but often in the therapy field we can get really locked into single truths about ‘this is the right way’ or ‘that’s the right way’. Even paradoxically, things like person-centred therapy or existential therapy - which are all about openness - can actually sometimes become quite dogmatic. Pluralism was about trying to stand back from that and say, ‘look, actually, let’s stop arguing about which is the best therapy because that’s assuming that all clients need the same things. We know clients are different. Different people need different things at different times.’ It’s not as if we can all do everything. Some of us want to just specialise in one approach, person-centred or TA or psychodynamic; so pluralism is not saying we should be able to do everything, but it is about recognising what we can do and what we can’t do, and learning and having the humility that sometimes we’re best off referring someone on. If someone comes to me as a fairly humanistic therapist and says, ‘Well, I’ve got a spider phobia and I just want techniques to overcome it’, it’s about me having the humility to say ‘Actually, you know what, I could work with you and give you space to talk about stuff and express your fears but there’s an evidence-based therapy, a behavioural approach, ‘flooding’, that the evidence shows is really helpful for that and maybe that’s something to think about as well’. So that’s pluralism as a general overview, which as I say, is a way of thinking about therapy.

And then we’ve also talked about pluralistic practice, which is an integrative practice, but you need a pluralistic mindset to be able to do. But having a pluralistic mindset doesn’t mean practising in a pluralistic way. What distinguishes pluralism as a practice is that it’s very collaborative and it’s all about working with a client, when the client wants to, to think about how you’re going to work together. So, it’s bringing your skills to the client and then asking them about their preferences if they’ve got any - they may not have any - and then within my expertise, agreeing ways of working together, reviewing that and trying to find a way of working that’s most suited to that particular client. In both cases, pluralism is about multiplicity, multiple perspectives, multiple truths, and the relationship in the sense of being able to work cooperatively, to bring things together with the client.

Paul: Finally, I’d like to ask you about directionality and goals in therapy, which is something you mentioned at the conference and have written about.

Mick: So directionality is - going back to what I was saying earlier about this framework - to think about how we integrate the psychological and social. Directionality is really at the heart of that, and it’s about an assumption which is there in existential thinking and in lots of other thinking, from Aristotle onwards, that as human beings we’re agentic, that we act towards our world. It’s a way of thinking, as people, that is trying to get away from the idea that we’re just kind of machines or that we are blank slates, so it’s very core to the humanistic existential sense. Obviously, we are impressed upon by our world, we take in our world, but there’s something that we also act towards our world and that’s the very nature of human being and organisms - that we respond to them and we act towards the world. It’s not that people are more or less directional. It’s what you call an ontological assumption about people that we are directional and that forms a basis for a framework that, as I was saying before, can integrate different perspectives.

One way of understanding a person’s directions, and what a person is striving for, might be through their goals. Asking clients about their goals and what they want from therapy can be a way of understanding more about that client’s directionality, and the things that they most need and want in their life. But of course, goals are just in a sense the tip of the iceberg, the conscious part. Some of these directions, for instance, towards safety or towards being close with others really might not be things that they’re conscious of. And as therapists we often work with clients to help them understand more of what their directions are, where is it they’re trying to go to and how they can best get there in a way that’s not pulling them in different directions.

So sometimes asking clients about their goals can be helpful, and we know from our research that clients genuinely like to be asked about their goals and to have some sense of where therapy is going. But it’s not by any means foolproof; some clients don’t like it. Some clients will state goals and then what emerges in therapy is something quite different from the stated goals. It needs to be quite a loose process. But working with goals - there’s no kind of neutral position in terms of, for instance, asking clients about their goals. Therapists in different ways might ask clients ‘what do you want from therapy?’ or ‘what are your aims? or ‘what would you like to get out of it?’ Everybody finds different ways of doing it, and we can choose to do that or we can choose not to do that, but both are a choice. And I think generally we find in our research that clients can struggle if that’s not on the table. And then I think the client who’s going to therapy and not having any discussions about what they want or where it’s going - we do hear quite a lot from qualitative research about clients saying, ‘the counsellor was really nice, they were very friendly, but I didn’t really know what we were doing together.’ And whether you call it goals or objectives or aims or whatever I think having some sense of the direction of therapy - my sense from clients is that it is often something that clients want.

Paul: Thank you very much, Mick. I appreciate your generosity.

Mick: Good to talk to you, really nice. Thanks for your time.

Mick Cooper is an internationally recognised author, trainer, and consultant in the field of humanistic, existential, and pluralistic therapies. He is a Chartered Psychologist, and Professor of Counselling Psychology at the University of Roehampton. He is a Fellow of the British Association for Counselling and Psychotherapy and the Academy of Social Sciences.

Paul Daly is an IAHIP accredited psychotherapist working in private practice and community-based therapy in Dublin.

References:

Cooper, M. (2019). Integrating counselling & psychotherapy: Directionality, synergy and social change. Sage.

Onlinevents (2022). Ukraine Fundraiser: Emergency Summit Contributing to Global Peace & Justice. https://www.onlinevents.co.uk. To access the recordings from the conference, go to: https://www. courses-onlinevents.co.uk/courses/UKRAINE-FUNDRAISER-Emergency-Summit-Contributing-toGlobal-Peace-and-Justice

The Guardian (2022, May 9). Ukraine refugees in UK face waits of up to two years for war trauma therapy. https://www.theguardian.com/world/2022/may/09/ukraine-refugees-uk-face-waits-two-yearswar-trauma-therapy

IAHIP 2022 - INSIDE OUT 97 - Summer 2022