Small – Big Life Matters

A little life ba-little-lifey Hanya Yanagihara

Revisiting my brief overview of ‘A Little Life’ the 2015’s Man Booker Prize nominee a year later was a passing idea. What could be gained from this experience was noting if my opinion had changed about the book a year later.

A Challenge

I was introduced to this book by my sister CF. She stated in a resigned fashion that this book was a depiction of a persons struggle. No matter what they could good experiences were presented to them they could not heal from the pain of their past.

As a practicing counsellor with over 7 years of experience I was intrigued and appalled by the idea of a wound so great that no recovery could be experienced. Naively I approached the book like an investigator seeking to uncover what experiences a fictional character could not heal from.

Within 80 pages Ms Yanagihara (author) had me so involved within a complex story of loss, betrayal and pain that to stop reading was the furthest thought from my mind. As I turned the pages and further engrossed myself with this Little Life, I began to recognise why my sister had stated in as clear a way as possible why she proclaimed that there are scars that some individuals never recover.


The central character is called Jude. Jude has a number of difficulties that he is able to successfully negotiate his life with including low self esteem, self harm and a mysterious physical disability. There is a scene that springs to mind as a metaphor for the book. After a significant self-disclosure to a close friend, Jude is thrown from a roof to a window ledge in a scheme to rescue his friends. The rescue involves him undoing a lock that he alone knows how to remove.

event-horizonEvent Horizon

If a reader makes it to the impromptu rescue part of the book, unfortunately they have been pulled over the edge into the event horizon. There is little chance of escape until the book ends and even then a reader will be further embroiled with ‘But if’ scenarios and disappointed views about the characters lives in the book for months after completing A Little Life.

Support Group for a Book?

I have spoken with others and read tweets about how readers have experienced the story #aLilLife with calls for support groups and warm blankets to help the reader survive the tumult of impassionesupport-groupd story telling. A
ll talk about the effect the book has on the reader are accurate. The twists and turns of the story, the feelings the book and writing evoke and how, as a reader, they wish they could have friends and family that Jude has.

I read the book morning noon and night. At one point stating on twitter ‘It is the first thing I reach for when I awake and the last thing I touch before I fall asleep.’ At times I stay up for an hour or 2 past the witching hour to complete a paragraph or a chapter. A Little Life is a tour de force.

Willingness to let go

The aspect of the book that stays with me, is the roof incident and the reminder his social worker offers him; ‘You have to let others in and talk about this thing, or it will get the better of you.’ I am mindful that this coupled with the scene of him rescuing his friendsjesse-w
and undoing a lock that only he knows how to unpick are 2 moments of evidence. Jude has the tools for his own rescue if he were willing and able to open the locks. Anna provided Jude with a choice, as all good therapists are able to offer their clients.


The experience of ‘Life’ can be taken for granted. A character like Jude’s helps to explore a reckoning with humanity and all that the human experience can present: Mystery, Adversity, Humour, Friendship, Challenge.

As a therapist, Jude’s story provided me with a reminder of what professional boundaries are – To walk beside a person being supported and remaining both caring and mindful of the individual’s journey towards self-discovery – hoping that they get there.

Jude’s story is tragic, many of the people I work with have disastrous life experiences too. I hold on to the idea that a character like Jude’s in ‘A Little Life’ and service users I support can take steps to change their life path if they can find value in being…

For Jude the chance to take a leap of faith appeared too great, however in my experience it is often as thin as a sheet of paper.

Ignored Song


First They Came …

In Germany, first they came for the Communists, And I didn’t speak up because I wasn’t a Communist; And then they came for the trade unionists, And I didn’t speak up because I wasn’t a trade unionist; And then they came for the Jews, And I didn’t speak up because I wasn’t a Jew; And then . . . they came for me . . . Martin Neimoller

Why Prisons

I was asked at a family barbecue why I pushed so hard and worked for the men and women who found themselves involved with the criminal justice system in England. My answer was simply that they could quite easily have been me.

I was introduced to the quote above by a friend, GK, who currently works in a prison. My friend is a conscientious committed counselling psychologist. They introduced the quote a few years ago. ‘They came…’ was a poignant reference to the work we were engaged with as counsellors at this London Prison. The men we supported with members from the mental health team could not be forgotten.


There were moments in my life where had things continued; joining a gang, engaging in destroying public property, fighting other boys on the estate, I could have found myself involved with the criminal justice system and possibly have spent time in prison. I spent 10 years living on a well known housing estate in North London and wrote about aspects of it in my MSc research paper called ‘A Son’s Journey’.

‘The block of flats I lived in consisted of a series of box-like structures in close proximity to one another. This layout created a feeling of overcrowding and compartmentalisation and it was these features that I found repeated in the prison which is meticulously divided into cells, landings, communal areas, canteens, house blocks and corridors.

The lack of open space and privacy felt all too familiar. My block was an open tiered construct. It had covered corridors that one had to travel along to reach the domestic spaces in the building. On the ground floor of the building, there were shops and businesses which created an insular feeling, there was little need to travel off the estate as your immediate needs could be met in this ‘city’ within the city of London. In this regard, the estate also resembled prison, in that it felt like a separate entity, quite apart from the rest of society. ‘

A Son’s Journey May 2012

An Almost Experience

In some way my working experience of prison, working with service uprisons-obsoletesers, probation, police and the criminal justice system offers a chance for me to balance the disparity I find myself involved with. I recognise that I am an outsider but with a quasi-experience of being an insider. One of the reasons that the quote has continued to live and breathe in me could be acknowledging the truth of the quote. ‘And then.. they came for me.’ The quote references the indifference or the apathy of the person who has written. There is almost the suggestion that there would be no-one left to stand up for them.

In training to become a counsellor/psychotherapist I had not thought that I would ever begin to work with a group of people that were so low on society’s pecking order as those who had been sentenced to serve time or several terms in prison. Working in prison was the furthest thing from my mind when I began training as a counsellor in 2006.

Plight of the young

Between 2009-2010 my counselling experience was going well at a Drs Surgery in South East London where I had held a placement for just over a year. I had thoughts of opening a private practice and working with the general public with one particular area of specialty: Young People from backgrounds similar to mine. Inner City, low socio-economic incomes, poor educational attainment. The idea was to complete the MSc course and then gain a few years experience working in the field and then begin a small private counselling practice for myself.


A list of other placements were made available to students at Greenwich University in the Spring term of 2010. I nogotchaticed a prison placement. Initially my thoughts were that I would not make a good prison counsellor (self-doubt), or that I wouldn’t get many clients that would want to work with me, and I wasn’t going to apply (denial). I discussed my prejudices and fears with my life partner. The effect of which increased my curiosity about engaging with a forensic population. Making the application was straightforward then came a few months of waiting. I sent a follow up email to the lead counsellor of the prison, AW, who enquired about the initial email.

An invitation followed and I met with AW and 4 other interested volunteers in July 2010. After the initial meeting an opportunity was granted to walk the prison grounds. The size, scale, height of the perimeter wall, and security measures of the prison did little to lower my excitement and fear of walking into the complex. We were shown to various house blocks, the education department, the hub at health care, workshops and the counselling office HQ. My initial assumptions of seeing Hannibal Lector character, chains slinking along the ground in a menacing way did not happen. The group of 4 would be volunteers were introduced to a regular working prison with prisoners moving within it as regularly as people traverse through life whilst in the community. I witnessed nothing strange and little alarmed me.

I had walked into and out of a prison and had actually ‘liked’ the experience. It wasn’t as bad or as frightening as I had imagined. It was in fact much like the housing estate that I had grown up on. A similar modular, organised block form building that reordered space. I understood the function and physical presence of the prison. For me this recognition was my in.

I came away from the experience wanting to give time to the people who were imprisoned there. I also wanted to acknowledge a gnawing suspicion that my imagined incarceration could only be released once I had served my time, completed good pieces of work with the men there and learned some valuable life lessons. I believe one of the most important lessons was about freedom. If a person is unable to perceive that they are free. Also is equipped with the tools to make a positive impact in their life and the life of others. Being released to the community could be an uncomfortable challenge that a person can feel ill equipped to manage. It is possible they might return to prison a number of times until…


The main learning I took from the 1st prison encounter was, men who ‘came away’ were not too dissimilar to people I had supported in the community. The main difference was the setting. If I could get past the idea of working in a prison and what that may mean then I could literally work anywhere. I started working at this London prison in October 2010. It took roughly 4 weeks before I could walk in through the front gate of the prison and not have my heart beat double time.

I managed to develop a number of self-checks to ease myself into another way of being whilst in the prison. My 1st mental trick I adopted, was to imagine myself entering a compression chamber and on leaving the prison entering a decompression chamber. Both stages allowed me the chance to get ready for the environment I was moving into. The idea enabled me to contextualise myself to the new spaces I was about to come into contact with. Like a deep sea diver I was able to situate myself both in and out of the prison.

The deep sea diver idea was also like having a suit of armour to manage the pressures, pushes and pulls of prison life. Mentally removing the suit on leaving I found that I was no longer carrying stuff I had no right to carry beyond the prison gate: stories I had encountered, past histories of discomfort and pain, uncertainty about the future, disillusionment about being away.

I learned that each space within the prison had it’s own vibe. Each house block, education department, workshop, gym facility, training room and areas within health care held it’s own unique energy and texture. The energy of each facility of the prison then had an effect on all that came to use these different spaces. For example when in the education department I found myself to be quiet and tentative in excusing a service user from a lesson. In workshop I found myself to be assertive and loud when asking a service user to access a therapeutic encounter. The aim was to engage the person I was to work with in a way that showed that the service had not forgotten them. It was like the counselling service helped people to recognise that they were not ‘disappeared’ or ‘forgotten’ as perhaps they might have fears that their family, friends and society as a whole had.balacne

‘First they came …’ Reminds me of the interconnectedness of humanity and that if we are to make successful cohesive advancements in our respective communities for the betterment of all, then all should be remembered and involved in reconstruction even those who have the ‘ignored song’.

The Artist


Jean Michel Basquait

An early memory from primary school, was of drawing frequently. I loved drawing, painting, sculpting and running sprint races. I had dreams of becoming an artist. I knew nothing of art or of the art world then.


I remember sharing with my mum in year 3 that I wanted to become an artist and she in her infinite wisdom, said something along the lines of “Artists don’t make that much money.” Re-remembering this experience I’ve come to realise a few truths,

  1. The aim of life, in my mum’s world, was to make money. I would add she was not materialistic, more a pragmatist.
  2. Becoming an artist was a dreamer’s activity (guilty as charged – I was a dreamer, what child isn’t?), and as a result could not be for me. Our world (mine, my mothers, my sisters) was made up of hard realities.

To give context – the time I had my epiphany in year 3, was in the late 70s and money was scarce. We lived on a council estate in North London and didn’t have much. We lived on the top floor of a block of flats. Often the lifts did not work as a result of vandalism, and the council not repairing them. Aged 7 I had thoughts that I could engage in an artistic career. Earning a good living was not an issue I had previously thought much about. In my mother’s view of the world money was a constant concern.

Everywhere we could see was a panorama of concrete. Mum worked as a nurse. Dad was between two worlds. London and Ghana. He worked as a civil servant, and a representative of a Ghanaian political party. He was often away in Ghana for long periods of time. Life from my mum’s perspective was a disillusioned experience, difficult and practical. There was little space or time for the aesthetics of art and appreciations of creativity.

tangmereThe conversation about becoming an artist had a profound effect on my idea of what I was going to do with the rest of my life. I was to have further conversations with my mum about what I could do with drawing as a profession. We came across Architecture as a possible profession that utilized my creativity but could offer me a long and productive career. I imagined what life as an Architect would be like; Drawing buildings and spaces in a range of techniques, using different perspectives to show my vision. I knew little of the technicalities of what being an architect was, but knew that drawing was a part of what an architect did. I wanted to do that. Draw!

Fast forward to September 2016

There have been a number of experiences I’ve had over the past couple of months that have helped me to begin crystallising my identity as a counsellor. One of those experiences was watching a show called the Chef’s Table. The first episode in this series on Netflix observed a man by the name of Massimo Batturo a famous chef in Italy. I was able to witness a remarkable journey. Massimo’s transformation is so different in places to my own story. The multiple successes and failures so rich and complex that in parts his story resembles my own. So much so that I could see myself on his vibrantly filled exuberant passage . A light that I was unaware of, switched back to on for me. This illumination was a warm pleasant and welcome surprise.

Waiting for me

As I have travelled along this path of becoming a counsellor/psychotherapist I have looked for moments that could take me home, to a warm embrace from my life partner, to a large bowl of pepper soup by my elder sister, to a big A-ha moment where I recognise like in moments of de ja vu that I have been here before, or that I remember a particular profound and beautiful experience: such as witnessing a colleague break into a smile after tasting a slice of one of my home baked loaves of bread. Moments like these are not lost on me.


With Massimo I recognise the inner child and the sense of wonder at the world and all that there is in life to uncover. I feel the same way about working as a counsellor/Forensic Mental Health Practitioner for Together for Mental Wellbeing and as a visiting lecturer at Greenwich University as an experiential group facilitator. The feeling of discovery in each of these moments I will describe as like that of a prospector or an alchemist finding gold. The gold I am looking to uncover with a client or a group is their light switching to on – when they say “I can see it now!”

For Massimo hiding beneath his grandmother’s table as a boy away from his brothers teasing. Watching her cook and learning from her, started for him a journey of innovation within the field of cookery and chef mastery that honed his craft like few others before him: his gold. Chef’s table observed his travels and uncovered his passions, the struggles and how things began to coalesce in his life once he returned to Modena. Happy accidents like dropping a lemon tart started in him a journey of exploration-to find the thing! (My words not his). The ultimate, the zenith in his mastery of cooking experience.

Enter art

Massimo and Lara Gilmore visited art galleries in New York at which Massimo was indifferent to. He made me laugh as he described the pigeon piece which in one moment an installation changed Massimo’s idea of himself, arts and his life’s work.

Completing my G.C.S.E.s and leaving secondary school I went to an art college in Wisbech. I attended with the view of completing a spatial design BTEC course. My view of becoming an artist had changed to that of becoming an Interior Designer. My wish to become an architect changed as a result of a conversation with my secondary school’s careers advice service. The conversation observed my lack of mathematical skill that would be necessary for becoming an architect. The careers person also observed that I was good with my hands (even though they had not seen me in Design Technology). Becoming a carpenter would be an equally rewarding career. This conversation disillusioned me further and invited me to think in terms of achievable goals. My final shift of career paths was to become an interior designer.

This from a boy who grew up on a ziggurat in North London. Attending art college was fantastic. It brought me into contact with new ideas, a wider group of artistic people, art history, photography, set design and a new appreciation to design in my life.

I knew little of the arts before I attended Isle college. I was invited to think about composition, texture, light, colour, depiction, balance, true representation, balance, organisation and frame. I developed an affinity for landscapes and fell head over heels for J.M.W. Turner’s work my favourite piece being the fighting Temeraire.the-fighting-temeraire

I believe my trajectory on this psycho-therapeutic path has been pointing me to a distant experience: Art. Massimo helped me arrive at this realisation. I had wondered when and if this moment would ever arrive.

What next?

I feel that the next part of my journey is already unfolding in unpredictable and thought provoking ways: Walk and Talk Therapy, Baking Therapy, Basketball Therapy. Often the work of a counsellor/psychotherapist bursts with so much life, complexity, colour and difficult experiences clients share. The effect of which can be fractious jarring and uncomfortable. The work can also be heart-warming, hilarious and humbling.

By viewing my work with clients as a canvas that is an ever changing palette of colour and texture I feel that I am closing the gap between where I am within the profession of psychoanalytic thought and my original goal of becoming an artist. The work then is a compositional piece that lives, breathes and carries itself forward in new and exciting ways long after we have stopped working together, with it’s many layers and qualities continuing to develop, separate, coalesce and define the self. I am attracted to the living art of working in a way that explores the unimaginable, bravely and without compromise.

The prospect of living and working as an integrative therapist holding an idea of myself as an artist could be seen as a threat to what came before, however I am witnessing a sense of discovery to approaching my work as a collaborator to a human canvas that is ever changing.

When asked who I am, my answer…


…I am an artist,


…I became what I was meant to be…





Dismantling Forensic Barriers:

Dockside Freedom

Grayson Perry Koestler Awards


One of the challenges of being a professional working in the mental illness/mental health sector is managing experiences of when things don’t go to plan with clients.At other times looking for support from other professionals and being disappointed by their lack luster responses.

My being a black male counsellor/psychotherapist/mental health practitioner in a largely white eurocentric profession has been mostly a rewarding and at times a challenging experience. The following piece of writing looks to examine the difficulties of preconceived notions of mental health professionals. With an aim to observe whom is ‘qualified’ to ascertain what, if any, treatment could be given to whom, and what reasons there may be for suggestions offered.

New Role – Collaboration

I am currently (Aug 2016) working in the London borough of Southwark as a member of the IOM team (Integrated Offender Management) as a Forensic Mental Health Practitioner for Together. The IOM team comprise of Offender Managers (OMs) from Probation, Housing Officers from St Mungo’s, Lifeline practitioners (Drugs and Alcohol advice and support) and the Police. The idea is to form a collaborative approach for the service user being supported. My role looks to establish robust links with mental health services in Southwark and work closely with service users providing access to mental health services.

My new role is a slight departure for me. Previously I supported 5-6 Probation Offices from April 2015 – July 2016. The former NPS role (National Probation Service) involved me being in a different probation office from Monday – Friday. I covered NPS offices between a number of London boroughs including Greenwich, Merton and Bromley.

The Carousel

Working as a counsellor in a prison from October 2010 – December 2014, I applied a carousel way of working in that I went to where clients were to support their requests for psychological therapies. I visited ‘Houseblocks’ (where clients ‘lived’), Education departments, Work Shop and the Kitchens to engage clients with psycho therapeutic work. Practicing working in this way was challenging. Clients that had been previously assessed as wanting to access psychological support could when met in workshop or in Education flatly refuse to engage. Others did not seem to mind the environment they were in to engage with the work.

Support to colleagues

Back to my new role in Southwark. A colleague, at the Southwark office, had asked my opinion on a former gang member whose case they were working on. Mr Waters (Not the Clients name) had been a victim of a bladed attack. I suggested that he may have possible PTSD symptoms or complex levels of trauma. My suggestion also included that he may need a highly specialised form of psychologically informed treatment to support him.

The Assault and consequences

Mr Waters had experienced the attack when he was in his 20’s and had almost died from his wounds. The assault had come from known assailants. Difficulties for him arise when he drinks. From my colleagues account it is like he reverts back to the person he was in his 20s – seeking revenge for his pain, shame and anger at suffering the surprise attack.

My suggestions involved either EMDR (Eye Movement Desensitisation Reprocessing) or trauma focused/ trauma informed CBT to assist Mr Waters re-conceptualising his life. A.S. the colleague who had made the enquiry, found the information we had discussed useful. The court report would offer comprehensive recommendations to address his alcohol intake and desist from drug use and to engage in psychological support to address his underlying issues.

My next step was to locate services in the home borough that Mr Waters could be returning to, and where I thought he could access support from. I contacted a fellow FMHP who knew of services in Mr Waters home borough, with an aim to gather a few numbers to make enquiries of mental health services.

Ms Tiller – a barrier?

I was able to contact 2 psychological services, IAPT and a collective of counsellors and psychologists practicing from one location. Of the 2 services I was able to engage with one service which was an IAPT service (Increased Access to Psychological Therapies) of the borough in question. After explaining to the 1st person who answered the phone what I was calling for I was transferred to a senior psychotherapist.

I shared that I was calling as a Forensic Mental Health Practitioner working in the London Borough of Southwark. ‘The reason for my call was to inquire if the borough in question had a psychological service that could treat a person with complex trauma with either trauma focused CBT or EMDR?’

Ms Tiller (Not the Psychotherapists name) asked how I knew that this person would require either CBT or EMDR? I explained a little more about Mr Waters case and some of Mr Waters presenting issues. Their response was simply that clients with extensive drug dependency issues and alcohol addictions as well as long criminal histories would not be suitable for their service. On all three counts Mr Waters was untreatable by this particular IAPT service, is what I heard.

Where to go for support?

I began to get heated as her refusal seemed unfair and I explored that if the IAPT service could not support a service user of probation and possibly soon to be released Mr Waters then the system did not appear supportive to Mr Waters or to people like him or to the communities that he could live amongst. I also explained that Mr Waters had stopped using both alcohol and drugs and had maintained a non-dependent relationship for over 2 years. Ms Tiller said that Mr Waters would not be suitable and that I would need to find another service. The IAPT service I called do not offer EMDR or trauma focused CBT in any event. Either the Portman Clinic or the Tavistock might be able to offer some support Ms Tiller eventually offered.

Level 3 or 4 support

What Ms Tiller did not fully explain was that due to Mr Waters complex set of circumstances he was too complicated a client for that IAPT service. What Mr Waters would need was a higher level of support tailored to the range of interlinking set of difficulties he has.

Life Choices

The experience of almost losing his life by those he had trusted may have come as a considerable shock. To cope with this realisation it is possible that drinking alcohol and taking class A drugs may have helped to stabilize and suppress unwanted images, fear reactions of other experiences of shock and let down. Leaving familiar surroundings and starting a new life in another city (London) may have brought a sense of relief and a sense of fear which may have continued the drinking and drug habit. 15 – 20 years later with a number of prison sentences for ABH, GBH common assault and with failing health Mr Waters may have come to a realisation that living as he is (surviving) could not be continue. It may have been at this point and facing another term incarcerated that may have shaken him into realisation that something was not working anymore.

Behind Bars

Alessandro Cedroni ‘Behind Bars’












Key Facts from the experience with Ms Tiller and IAPT.

  1. IAPT services in this particular London Borough appear unwilling to support forensic clients.
  2. IAPT in this London Borough either do not have the resources ot are unwilling to offer complex clients CBT
  3. IAPT in this London Borough have staff that are unconsciously prejudiced or scared or both to offer forensic populations potentially life-saving support.
  4. The Portman or Tavistock may be able to offer support to Mr Waters and clients like him with the support they could find potentially life altering.
  5. Had Ms Tiller had the patience to listen she may have heard that I was looking to locate a service that Mr Waters could attend to access the specialist support he needed.
  6. As a qualified counsellor perhaps using the term practitioner in situations where I am speaking with a peer, psychotherapists like Ms Tiller may be able to step aside of their pre-judgements and actually hear what clients and other professionals are sharing with them.

Dismissed Ideas

As a Black male counsellor/psychotherapist I am able to view both myself and others in relation to the work. I am offered ample chance to be reflective of numerous interactions and review that being black was not a feature in Ms Tillers dismissal of my suggestions. It is also possible that her dismissal came from believing that I was a practitioner and had no appropriate experience to even guess that Mr Waters could be suffering from PTSD symptoms.

Mr Water’s presentation in the last 15-20 years which possibly were exacerbated through self-medication with alcohol and drug taking. Also involving himself in high risk activities (Gangs) possibly added to his set of difficulties. Mr Waters becoming violent at the slightest provocation could make him present as highly difficult to engage with in a statutory setting. I wonder where else could Mr Waters access state sponsored mental health support?

An Act of Patience

My argument to Ms Tiller is that with a small amount of patience in handling a request for information, could have assisted her in arriving at conclusions that were made in haste not reflective and were restrictive in their proposals. Ms Tiller also did not appear to offer a collaborative approach to arrive at a possible solution with me, a peer.

What frustrated me most was Ms Tiller’s near panicked, confused, rejection of a possible referral to the service she supports. There appears to be an apparent need for IAPT services to also be informed of who could benefit from NHS IAPT guidelines of stepped care support. Where possible clients that are beyond step 3 be offered alternative support from specialist services like SLaM, St Georges Trauma Therapy Centre and The Bracton Centre

IAPT Inclusion?

If all IAPT services are either A, unwilling or B, unable due to lack of resources to support forensic clients, a misrepresented section of the community that could access psychological support will unfortunately miss an opportunity to begin reviewing change in their lives and have the potential to work on rehabilitation within their communities.

When a service user becomes motivated in prison to begin working on some of their concerns and start a piece of psychological work is a significant step towards change. Aspects of their lives i.e. root causes of various problematic behaviours and presentations could then be understood for further psychological input once released. The grounding of prison based psychological support could then be continued in the community to assist with the service users re-integration, readjustment and realignment of the individual to their community and the community to them.

Training for Staff

I feel that there is an urgent need to educate the forensic system also. The aim here would be to better support service users in forensic institutions like Police Stations, Prisons, Courts and prisoner Transport vehicles. Once service users leave prisons, in community support could be better facilitated   to accept and to treat willing clients. Currently the system falls down as illustrated by the example of Ms Tiller.

The current system of support once a service user leaves a prison, is for them to access Probation services either NPS (National Probation Service) or CRC (Community Rehabiltation Company) depending on the severity of the offence committed and type of supervision the service user can access. Probation officers are highly skilled and trained to offer support to their service users. An additional consideration and training could be offered to address mental illness with the aim of equipping offender managers and probation officers with some psychological tools to assuage the rehabilitation process.

Services like Together, DePaul Charity and RAPt offer an important step in providing forensic populations with support. Accessing a stepped care system that the NHS adopts for clients who request mental health support is a programme that is currently being developed by Together in London. The aim of a Forensic Mental Health Practitioner working in Courts, Police Stations, Liaison and Diversion (L+D), NPS, IOM, SAVU (Southwark Anti Violence Unit), and GTO (Gripping The Offender) is to provide robust brief therapeutic support to service users and where possible to refer them on to services like IAPT or acute/specialist services for additional support.

Birds in Flight HMP Long Lartin

Birds in Flight HMP Long Lartin Koestler Award

After my experience with Ms Tiller I am confirmed in my view that entering and leaving prison could have more joined up thinking in providing service users with ongoing psychological support if requested. The aim would be to invite services like the one Ms Tiller supports to form a safety net with agencies that support service users for all future clients.


Taking Control of MS

Dick Gregory

Last Month (May 2016) I received an excited WhatsApp message from a friend who lives and Works in Malaysia TK.

The message was about an article discussing a revolutionary concept of reducing calorie intake to stop the progress of Multiple Sclerosis in mice. A day later I received another message from my sister EH with the same link to the article.

A Challenge

I read the article which highlighted that mice that had a similar auto immune illness to Multiple Sclerosis were placed on calorie controlled diets and after a number of months showed improvements with their immune systems. In my estimations a challenge had been offered and I willingly accepted: Could I reduce the amount of calories consumed through my week?

The article suggested that the control group of mice that had their meals reduced showed marked improvement. From the article:

‘Results showed that the fasting-mimicking diet reduced disease symptoms in all the mice and cured 20 per cent completely.’

‘They also saw a reduction in the inflammation-causing cytokines – proteins that order other cells to repair sites of trauma, infection or other pain.’

‘And they found that white blood “T cells,” responsible for immunity were boosted.’ Sarah Knapton

2 worthy choices

Since June 2011 I have lived with the knowledge that I have a disease that could get worse limiting my movement and overall ability to perform regular tasks. On receiving the diagnosis I decided two things.

  1. Regardless of the diagnosis I was going to live as well as I could
  1. If I found a way to slow or stop MS from worsening I would in the least do whatever was necessary to limit the effect of the relapsing remitting strain of Multiple Sclerosis I have.

Can MS be Managed With Diet?

I was introduced to a book titled Managing Multiple Sclerosis Naturally in December 2011. The idea that foods could be involved with managing my autoimmune response was a new and challenging one. The aim would be to assist the T cells that attacked my nerve cells and myelin membrane around my nerves to recognise the difference between foreign bodies and my cells.

The Paleo diet and other MS diets were tested. The longest time I stayed with these diets were for 6 months. I stopped the diets for a few reasons.

1  I felt terrible,

2  I witnessed no upside to the strict diet of no bread, no cheese, little – no red meats, no legumes or modern pulses, certain fruits were also off the menu and I lost a considerable amount of weight.

3  As a slim person, the thought of losing more weight and being called Skeletor by one of my sisters CF, was enough to halt this experiment.

Experimentation With Diet – Cut

I had tried and failed to heal myself with diet. December 2012 – May 2013 was a useful length of time to try something new out. What I found funny was how fastidious a new diet enabled me to become. I often had friends ask if I could or would eat this or that food. In all honesty I had become a pain. Which was a problem for me. Being obtuse and by being awkward about what I was and  was not eating I saw as not a good cause for friend’s and family’s discomfort. This dieting nonsense was not what I had signed up for. I brought the experiment to an end and ate what I wanted to, the disease progressed as it would have done had I not interrupted with the annoying diet.

Multiple Annoyances

My experience of the illness is mainly challenged by fatigue, brain fog, spasms in my legs and back, weaknesses in my hands and forearms, dizziness on standing and changing my heads direction when walking, stairs have become my nemesis. Tripping stumbling and falling have become a pre-occupation and a daily experience.

TV – Dashed Hopes

Earlier this year a TV show highlighted that if an MS sufferers immune system was rebooted there was a large chance their symptoms of Multiple Sclerosis could be halted or even reversed. The treatment costed the NHS between £25-£30,000 and is currently on an experimental basis for those that screen in to the study. If I had been asked, I would have jumped at the chance to be involved with the experimental procedure to live with a reduced or no continuing symptoms of the disease.

Another Way???

However, the reduced calorie diet was immediately accessible and I thought I could at least give it a try. On Monday’s Wednesday’s and Friday’s I do not eat until 12:00 pm. Effectively not breaking my fast for between 14-18 hours 3 days a week. Just like those mice! A few years ago I read ‘Callus on My Soul’ by Dick Gregory. (Picture Insert, above) The book, a Christmas Present – from Ananta (cousin), observed Dick Gregory’s life. The book inspired me to think differently about food consumption, protest and activism. Mr Gregory wrote about engaging in hunger strikes for various humanitarian causes. The book was like a wake up call for me. I was fortunate enough to see Mr Gregory speak at a community centre in Harlem in 2000. As a comedian he had the room in uproarious laughter.

I chose to engage on my first fast during the time of Ramadan in the winter of 2001. I successfully observed the 28/29 days of Ramadan and gained a new level of respect for those who are able to successfully give up various comforts for a higher ideal for a specific period of time. For the next 3 years I observed Ramadan and did not eat or drink during the fasting period. I gained strength from the knowledge that others all over the globe were also fasting.

What If?

I am to observe a 6 month fast to relieve the experience of Multiple Sclerosis. If it works and reduces the inflammation, brain fog, tripping and falling, spasms, and dizziness then the effort will be a worthy venture. If the experiment causes nothing more than a slightly better way of appreciating food and overall health then that will be an outcome I also can acknowledge as being a beneficial one.

As I enter my 6th week of the experiment I have noticed a few things that are not like the Paleo diet. I haven’t lost as much weight, I am continuing to eat what I want,  chocolate, bread, red meats, cheese, nuts, fruits, and everything that I would have eaten pre 2011 are joyfully consumed.

Noticing my energy levels remain high, especially during the fasting periods, and do not have me look for a pillow a quiet and dark place to catch a nap in – have been wonderful. The brain fog that had besieged me since before the diagnosis in 2011 has dissipated. It feels like I can think, and create at a high functional level. Before, it felt like I had to pull my thoughts through thick treacle to get any degree of coherence together and then be spoken.

I have noticed that I am tripping and falling less. The dizziness/vertigo and occasional spasming remains but I feel more hopeful about the illness and how I am tackling Multiple Sclerosis. My aim is to again complete 6 months of a calorie controlled diet and note the effects on my experience of Multiple Sclerosis during this period and into the New Year.

Whatever the outcome, I recognise that change is a sought after part of the experience, and I look forward to whatever that may be…

Crystalisation of Identity

From Person Centred Counselling to an Integrative Approach: One Client Inviting Change

Pier and Bridge

A Beginning – Morley College

I started officially training to be a counsellor in 2006. The introduction to counselling course was at Morley College and taught me what Counselling entails. Iain Mendelberg was the tutor and was able to offer a model for the type of counselling professional I wanted to be for clients: patient, wise, honest and courageous.

As a group of trainee counsellors, we were introduced to Carl Rogers and his passage into counselling and psychotherapy. Rogers was closely followed by Fritz Perls and Gerard Egan which gave us a thorough grounding of person centred and humanistic perspectives of counselling.

Freud’s scientific method was often referenced as a starting point that was used to frame our learning. What I gained insight to was from Mr Mendelberg’s calm humorous approach to teaching. His generosity as an educator gave me an indication of what lay ahead for me as I trained – I too could become for those that I worked with a reflective, calm and person centred mental health practitioner. Or so I thought.

On completing the Morley course I took a year out of study. My first son Coltrane, was born shortly after the course ended in June 2007. 1 year later September 2008 I began at Greenwich University on the MSc Therapeutic Counselling an integrative counselling course.

What Does Integrative Mean?

I had little understanding of what integrative meant in the 1st year. Some of the information that was covered in the first term refreshed my awareness of counselling theory from my time at Morley college. The main difference between the Greenwich course I felt was apart from the workload was also the amount of reading material to be digested on a weekly basis and the depth the writing therein went to.

Each article was intricately written, often with intimate insights that frequently altered my perspective of counselling. There was also a general understanding that the reader would grasp some, if not all of the concepts discussed. The first year of the course I found to be a struggle but I worked hard at attempting to meet the requirements the course asked of me including; Placement and application of counselling theory, Skills, Experiential group, Theory, and Personal logs. The requirements life asked of me were a frequent source if inspiration, tension and fatigue and these included; my marriage, fatherhood, work, coaching basketball, amongst a few other responsibilities…

Integration of Perspectives

For the 2nd year of the course at Greenwich in Oct 2010, I was fortunate in securing a 2nd placement at a prison. My first placement was at a Doctor’s surgery in SE London which I was fortunate to be awarded in Aug 2009. My learning as a trainee counsellor I feel was enhanced by both placements as I was able to witness how mental illness is supported in the community and in a prison setting. The significant differences noted were the efforts made by the mental health team in prison collaboratively working together to reduce risk efficiently.

In the community, fast access to mental health support is desirable but not always achievable. Due to the volume of people in GP’s wards. The range of services and referrals to and from specialist support is difficult to meet. Providing treatment for mild to moderate cases of mental illness can take 6 weeks – 8 months to be received. With the advent of IAPT (Increased Access to Psychological Therapy), the idea was to drastically reduce waiting times and be able to support more people in the UK, that experienced depression and anxiety.

Laos – Understanding Integration

I met Laos (not his real name) in January 2011. Laos was a tall, well-built Asian man in his 30’s who repeatedly offended. He was held in custody for charges related to attempting to rob with a bladed article. Laos shared with me the incident in question and much of his life history. Which is to follow.

I worked with Laos for 5 sessions in total and throughout that short time my counselling approach changed. During the 2nd and 3rd appointments an idea formed that person centred counselling did not appear to be touching the core of this man’s particular set of difficulties. I took it upon myself to investigate and develop a psychological perspective to gain an understanding of his formative life experiences and how I could support him more effectively as a counsellor.

Reflecting on my counselling journey it was this choice that changed my perspective on how I practice as a therapist. As an aside I have enjoyed the Kung-Fu Panda series of movies. The 3rd Kung-Fu Panda stood out as a perfect collaboration of contextual realities, concluding with a seminal experience and eventual crystalisation of identity for Po. My light-bulb moment wasn’t as spectacular but had elements of the clarity Po achieved in this movie clip.

Drug Use – An Escape?

Laos reported that he had many change experiences including moving home a number of times across much of Asia, the far east, Australia, Canada and to U.A.E. Laos had begun using various drugs in his teens starting with Marijuana, Heroin, Cocaine and Crack. He mentioned that he had also used amphetamines but stated that he preferred cocaine. With other drugs he reported that it was always a gamble.


He described himself as a bright student and that he found G.C.S.E’s easy. Laos said that he started smoking marijuana to celebrate with friends on completing his exams. Initially it was purely recreational. A levels Laos said were more difficult and he changed to the International Baccalaureate. These qualifications he said suited his learning style more. Laos was introduced to harder drugs at AS level and began selling and distributing to supplement his own use.

Laos shared that he and his father didn’t really get on. His father was the main reason that the family moved as much as they did. Laos described his father as strict and the one who dealt with his indiscretions severely.

Life Events

Laos described his mum as kinder and nurturing towards him. His mother died when Laos was in his late teens and he mentioned that for the family it was a difficult time. Laos experienced his 1st Jail term in a Malaysian prison shortly after his mother’s death. He was convicted as a minor of selling and distributing cocaine to fellow students at his school. He reported being in jail for a period of 9 months. He was released early as a result of his father’s connections. Laos described this period as hell on earth. He was away from family for the first time and his mother had passed away. Laos mentioned that his father had practically disowned him for the sense of shame he had brought on the family. His siblings were angry and upset with him. All that he had known was irrevocably changed.

Recognising the inter-relatedness of attachment theory, Object relations, Transactional Analysis, maladaptive coping mechanisms which can support a person in functioning into adulthood. Coping mechanisms unfortunately breakdown in moments of crisis. For Laos these moments of crises were experienced when he was faced with; the mundane and monotonous, significant moments of change or stress.

He had experience of supporting himself by using alcohol and various drugs including marijuana cocaine and heroin. Laos described himself as a binger (someone who used lots of a substance all at once for a few days and then stopping). It was on a binge that he lost track of the amount of cocaine he had left. Laos told me he had finished his supply and quickly needed to make a withdrawal to go and buy more. Laos was between jobs and had low cash flow to buy more drugs. He decided to go to an off license to pick up some more alcohol as his supply was low. This decision and following event lead to Laos’ 4th jail term.

Case Formulation – Speculative Coalescence

My formulation and how I started to identify that I was thinking and behaving as an integrative therapist was informed by some of the reading I was completing at the time. Petruska Clarkson’s 5 Relationship Model offered me a useful framework to recognise where I was – in my journey as a counsellor. A research project titled ‘A Son’s Journey’ written in my 3rd year of the MSc course, found points of Laos experience reminiscent of my journey to adulthood. (I will look to pick relevant points from my research in a later blog post)

Adapting to Change

Laos early attachment to his parents and to his place of birth were affected by a number of significant changes with and to his environment. Moving from one country to another may have affected his realisation of who he was. This sense of recognition would be in relation to having to repeatedly start again from the beginning in a new and different environment. He would have had to form new routines with new classmates, peers, learn new social cues and with each move be socially adapt to the new country. Laos mentioned that he had been moving home and country since he was 3 years old. The moves were a result of his father and the work he was involved with. If the family home was not a wholly warm and nurturing environment Laos could have begun developing ways to look after himself outside of his parents or family’s awareness.

It is possible that Laos did not come forward and share the difficulties he encountered with his family. Any challenges he had overcome at school or whilst playing with peers he may have kept to himself. Perhaps major achievements and triumphs he may have experienced may also have gone unnoticed as well. I wondered if he shared much with anyone. (Self dependency, self reliance)

Growing Pains

As he entered early adolescence he may have found certain peers more appealing and started to associate with their way of viewing the world. Exciting, dangerous, rule bending/breaking, becoming argumentative/aggressive with siblings, parents, teachers and authority figures. Leading him to take ever greater risks, enjoying self-injurious actions and activities i.e. smoking or self-harming, drinking alcohol, tattooing, piercings etc. The difficulty for me as a counsellor is in recognising the difference between the actions Laos reported of his experiences during his adolescence and usual teenage behaviour.

The purpose of the actions as listed could be to give him a chance to gain a sense of belonging or to fit in with others or create a new identity. It could also have offered Laos an attempt to make the feeling of disillusionment of parental let down dissipate or not be as painful. Another consideration would be in relation to Laos’ attachments to others. If we were to observe his relationship to his mum and then her death could his spiralling drug use be in relation to having difficulty admitting to or acknowledge his feelings of loss? The realisation for Laos could be that self-injurious acts may become habitual and destructive.

The interesting thing for me as I sketched through some of these hypothetical realisations was how Laos had attempted to rescue himself or bring about an end to his behaviour. He had not gone to rehab or completed 12-step programmes. Laos being caught, found selling or incapacitated through use of drugs and going to prison put in place a semi-permanent stop to his self-destructive pattern of behaviour. This is not to say that drugs could not be found in prison. But Laos was able to recognise that through his actions he was again locked away for a period of time. It is possible that prison acted like both a punitive and supportive parent at the same time. What Laos was appeared to do by being arrested by incarceration was to learn how to find another way to live without both of his parents. It is possible he had not an internal representation of both parents and sought external controls to manage his behaviour.

Re-evaluating – Re-inventing

Within a longer piece of work from 1 year – 2 years it is possible Laos may have been able to recognise what he had lost as a result of his earlier experiences. The losses could include his sense of identity, self esteem, parental guidance, maternal attachment figure (after his mum passed away), emotional self regulation and self-protective mechanisms i.e. speaking to others and finding emotional support. A therapist could have been able to support him in identifying his current patterns of behaviour and look to establish life affirming behaviours that looked at his dependency on alcohol and drugs to alleviate boredom, anxiety and depression.


My work with Laos was informative for a number of reasons. I learned that I had been able to graduate my thoughts to appreciate a psychodynamic profile of a person’s past. What I was able to offer Laos as a counsellor was a robust level of emotional support and an awareness that there were topics from his past that with the right support he would be able to heal in time. I was able to plant an idea-seed. With good support that idea-seed could grow and I imagine bring about significant change for Laos.

Moving forward this level of reflection has supported me in all aspects of my life, noticing patterns of behaviour with those I support. Identifying personal scripts that clients operate with that limit themselves from engaging in new and exciting ways with themselves and others. My hope for Laos is that he recognises his pattern and with support from family, a partner or a trained professional can find other ways of being that are healthy and life enriching.

Silence in Therapy

Silence is Golden sometimes 2014-02-08 14.53.27

This blog is written to query a possible way forward for psychotherapeutic work. A chance to review a change, an alteration to the way of working as a Psychotherapist/Counsellor/Mental Health Practitioner. What if the clients we supported were co-worked with – in tandem with a colleague, not alone? What if we had a colleague in the room with us?


October 2015 has been a month of developments for me as a counsellor, Forensic Mental Health Practitioner, Visiting Lecturer, blog writer, Trainer on the Knowledge and Understanding Framework for Personality Disorder and reader of Daring Greatly by Brené Brown.

Tandem Support

I had the good fortune of working alongside a colleague at one of the probation offices I support. I checked with both service users I was to provide counselling support with if I could bring another therapist into the room. Both clients affirmed that this would be okay. My colleague would observe the work in both appointments and where necessary add comment to the interactions.

Cancellation Policy

To be honest I wasn’t worried for myself or my colleague as we began our work, the client on the other hand I was nervous for. He was a new referral whom I had only met once previously for an assessment meeting. The probation officer warned us that he wasn’t in the mood for therapy or much of anything. I chose to acknowledge what the probation officer had said, and repeat their phrasing and emphasis on the clients mood. My response was to let the probation officer know that if the service user wanted to, he could leave at any point during the appointment. I then asked the service user if he were comfortable for us to proceed with my colleague in the room. I informed him that he had the right to cancel the appointment and leave  if the need arose.

A Beginning

The service user was a young man between the age of 18-24. He was dressed in multiple hoodies and a pair of loose fit jeans, was from an African Caribbean background and as his probation officer had stated was in a quiet seethingly angry mood. When asked if we could proceed with the appointment, he offered a terse and tight lipped response of ‘uh yeah.’ Putting his head first down then looking out of the window at passing traffic.

Silence of Withold

Much of the appointment was spent in silence. I began by setting out the parameters of the space, time of the meeting and confidentiality of our work together (context). When asked how I might be able to help. He resolutely told me that ‘You can’t help me! No-body can. I can barely help myself.’ When prompted by myself he added ‘Na, nothing man. I’ll be alright.’

There were moments where silence drew something out of him and then there were times where silence acted like a cloak in which he hid himself and appeared as if he was not going to come out from. My colleague MM appeared comfortable with this man’s disquiet. I was disquieted by the peek-a-boo game and my inability of providing anything more than space, time, an ability to mirror, paraphrase and offer small interpretations of what was happening for him in the space. (Was I good enough?!!)

The Obvious

Ultimately I felt that there were 2 break through moments during the silent conversation. I am a firm believer in that stating the obvious can help clarify difficult or frightening experiences ‘Nailing the cloud down’. The other is using humour to assist in lightening the mood and move the sense of discomfort on a little further. These two moments came after the service user said ‘I don’t care!’ a number of times and after I said ‘I imagined a large car chase scene where there were lots of car wheels screeching through London’s wet streets’. He laughed at the ridiculousness of this suggestion and said ‘It’s not that bad, nah nothing like that.’ I heard MM laugh quietly and the tenseness in the room gave just a little, enough for me to offer a question about caring and if I could be allowed to care for him. To carry his caring whilst he was busy worrying about the thing we were not talking about.


The appointment came to an end and I mentioned to the service user that I looked forward to our next appointment. He gave a response which intimated that he, if he made it to next week, would like to engage in a further appointment.

Myself and MM went to my office space and talked at length about the appointment and what it’s merits were. MM was complimentary about how we used the space. He, I, and MM the observer all shared an experience barely talking about one members concerns. What strikes me is that there was a parallel process occurring throughout the time as well. The service user spoke little, I on the other hand spoke for us both and MM said barely a word. I was compensating on some level for the lack in the room and attempting to fill space and time with usefulness (subconscious mechanisms going into hyper-drive). The parallel process was in the transaction of what we brought to witness in the room. Me attempting to support and assuage the young man’s mood to a different space/place. He dancing a line between not sharing or caring and then trusting the space investing some of his story and caring.


Returning to my workspace we, MM and I, reflected on the 50 minutes we had in the room and talked about what had just happened from a number of perspectives. Traditional counselling supervision often happens within a number of different contexts including; place, time, environment, focus and attention and intention of the therapeutic appointment.

Skilled supervisors support their supervisees without ever meeting the person or person’s their supervisee speaks about. They have nothing but what their supervisee brings into the room. I like to bring all of the aspects of what has worked well, what did not work well or aspects of the work that I am confused with. Most of my supervisors are so good it is like they have been with me in the room all along seeing what I had not even begun to identify.

Collective Unconscious

Having a colleague in the room, brought something immediate and responsive to the work. It was almost like the collective unconscious in the room facilitated managing a difficulty and brought solutions that a 1 on 1 encounter may not have achieved. It is likely if I had worked with the service user alone some of the realisations would have been different but could have been just as supportive.

A Shift

The point I am wrestling with is could 2+1 meetings where there are 2 therapists in a room be an aspect of the work that is common rather than uncommon. The Speakmans work in a way that is similar to 2 therapists and a client. BACP and UKCP may have something to share on working as a triad however I felt that the learning was trifold as opposed to bifocal and that was immeasurably felt by all who encountered this session…