The neoliberal writing on the wall: Ontario’s Basic Income Experiment

Guest post by RITB and Ontario Coalition Against Poverty member John Clarke

Since 2010, the UK has endured a political regime that can be considered a cutting edge of the austerity agenda. Through the film, ‘I, Daniel Blake,’ people around the world have become familiar with the institutionalised cruelty of the Country’s warped system of providing social benefits to those in need.

To those who endure sub poverty misery, the humiliating intrusion of the Work Capability Assessment and the ever present threat of the sanctions regime, the conclusion that anything must be better than the present set up is an easy one to arrive at. Disabled people who deal with a state bureaucracy that labels them scroungers and seeks at every turn to abandon them, can be forgiven for concluding that no alternative to the status quo could possibly be worse than that which they face today. The sheer brutality of the regime operated by the Department for Work and Pensions (DWP) can only make the notion of a secure and adequate system of universal income, freed of bureaucratic intrusion and moral policing, extremely alluring. This does much to explain the high levels of receptiveness to the notion of a Universal Basic Income (UBI).

In the UK, Basic Income is being considered in the context of a political break with the austerity consensus and the posing of an alternative to the agenda that flows from it. BI pilot projects have been called for in Fife and Glasgow *(1) and the Labour Party has established a working group to prepare a proposal on the concept, with a view to its being adopted as policy. Shadow Chancellor, John McDonnell, is very much behind this development. *(2) The emergence of a left leadership in the Labour Party and all the gains that it has made is looked to internationally with huge respect and admiration and there is a great deal of moral authority attached to the social policy proposals that it advances. For that very reason, a critical look at the implications of the basic income approach to reshaping systems of social provision is of particular importance. Very frankly, I must argue that it would be a profound mistake for the Labour Party to take that direction and, as an organiser with the Ontario Coalition Against Poverty (OCAP), dealing with an attempt to develop a decidedly neoliberal local brand of BI, I’m going to set out my case for this position.

Basic Income Left and Right

Before talking about the specifics of the emerging experiment with BI in Ontario, let me offer some observations on the general notion. Notwithstanding the fact that BI advocates will frequently present the idea as something that transcends political divisions between left and right *(3), there is a wide acknowledgement it can be proposed in regressive or progressive forms. *(4) A version that furthered neoliberal austerity would hinge on the inadequacy of the payment. Some right wingers accept universal entitlement, while some liberal or social democratic thinkers accept restricting it to those on low incomes but the neoliberal brand is always focused on preserving and enhancing economic coercion. Simply put, the payment must not impede the flow of workers into low wage precarious jobs and, indeed, it should function as a de facto wage top up for low paying employers. With wages partly paid out of the general tax revenues, pressure to increase minimum wages would be greatly reduced. Furthermore, the regressive wing of BI advocacy is most insistent that the envisaged payment would replace, rather than augment, other forms of social provision. In this regard, the notorious US political scientist, Charles Murray, sets out a particularly chilling vision *(5) and this has been echoed by the Canadian Fraser Institute *(6).

The more hard line left wing approaches to BI absolutely insist on the universality aspect but all progressive proposals are clear that the payment must be adequate. It must, in and of itself, ensure that basic needs and social participation are within the means of those receiving it. Indeed, given the frequent connection that is made to providing for those who are technologically displaced from their jobs, adequacy at this level is the essential consideration. *(7) An actual ability to withdraw painlessly from participation in the capitalist job market is envisioned *(8)

The problem with such ideas is that they take no account of how essential to capitalism a level of economic coercion is and give no thought to the societal balance of forces or the practical prospects of obtaining their goal of a UBI. After several decades of neoliberal austerity, with trade unions greatly weakened and social resistance hardly at peak levels, the prospects for major social reforms are not that good. However, a truly adequate, universal payment that freed millions of workers from the ‘tyranny of the labour market’ would be more than a reform. It would really be a question of the State handing over an unlimited strike fund and, as Pam Frache argues, “Simply put” no capitalist state will provide workers with the resources to go on indefinite strike.” *(9)

In an interesting blog piece, Paul Cockshott, in addition to looking at the potential costs of a UBI system in the UK, points out that the embrace of the idea reflects defeat and disorientation on the left. *(10) The hope of a social policy solution to the problems created by neoliberalism and the attacks associated with it is profoundly dangerous because that very ‘solution’ can so readily assume a form that furthers the very agenda that left BI advocates hope to escape. The institutions of global capitalism are taking an interest in Basic Income and the Davos crowd are even considering it. *(11) In Finland, a government that is moving in decidedly neoliberal directions suddenly assumes interest in BI and puts in place a test run that should alarm us. *(12) But let’s now turn to the model that is emerging here in Ontario and the warning it offers us on just the kind of directions BI can be taken in.

Ontario’s BI Test Run

Like other so called BI pilot projects, the one in Ontario is an imposter. I say this because it isn’t actually testing Basic Income. It’s really testing poor people. BI is a social policy that would be implemented across an entire political jurisdiction and that would have particular impacts on the society and its population. No such test is being undertaken in Ontario. The Government is simply going to provide enough income to a sampling of 4,000 poor people to make them a bit less poor and the predictable result will be that most of them will be a bit better off. So, the first thing we should note is that all of the focus on studying ‘outcomes’ is a cynical diversion that tells us nothing about the implications of BI as a neoliberal policy tool.

People in the UK, who may not be very familiar with the situation in Ontario, need to understand the context in which this pilot emerges. Under the federal system that exists in Canada, the governments of its provinces and territories have the greatest amount of decision making power when it comes to social benefit systems. In Ontario, we have a Liberal Government that has held power since 2003. Unlike the UK, where the Liberals went into a state of faded glory between the wars, their Canadian counterparts have remained front line contenders for political power. They function as a slightly nicer alternative to the Tories but can be trusted to manage things in a way the rich and powerful will find entirely to their liking. You might say they are what Tony Blair intended the Labour Party to be. Over the last fourteen years, the Ontario Liberals have allowed people on social assistance to get even poorer than they were when the Tories held power but they have perfected the art of always appearing like they are about to address the problem. They have held round after round of ‘poverty reduction’ consultations even as the scale and depths of poverty increased. The Basic Income pilot is, for them, a political windfall that enables them to go on promising jam tomorrow while providing nothing to day. Nearly a million people on social assistance, many of them disabled, will have their incomes kept well below the poverty line while a lengthy study of 4,000 people on the BI pilot unfolds.

While the pilot is largely motivated by the Liberal Government’s desire to keep people on social assistance in poverty, while shoring up their progressive credentials, it is also an experiment in designing a neoliberal model of Basic Income. The little brochure that announces it is rather thin on details *(13) but a memo sent out within the Canadian Union of Public Employees, Ontario Division *(14) and other information OCAP is party to on a confidential basis, gives us a fair sense of what is being cooked up.

Some 4,000 people, in three parts of Ontario, will be provided with BI payments over the next three years. A separate pilot will run in a selected Indigenous community. Their income will be set at around 75% of the Low Income Measure, with an extra payment for disabled people. 70% of those who are tested will be low waged workers and earned income will be deducted at a rate of 50%. As in Finland, while the pilot is means tested, the income will be provided with far fewer conditions attached to it than under present benefit systems. In my view, those in the neoliberal driving seat are happy to ease up on some of the bureaucratic intrusion precisely because they have been sufficiently successful in creating a scramble for low wage precarious work and simply don’t need it to the same degree. What they are more concerned to do is to extend income support to those on low wages in order to, in effect, provide employers with a subsidy, paid for out of the general tax revenues. The amounts provided under the pilot are clearly inadequate enough that no one would be free of the ‘tyranny of the labour market’ and the supply of low wage workers would be preserved. Indeed, a more widely applied BI system might well pay an even lower amount.

The above cited CUPE Ontario memo gives an indication of a very striking feature of the pilot. While people will face fewer conditions, many will also lose supports and services they currently rely on. People presently on social assistance who go onto the pilot will no longer have caseworkers and will be expected to ‘self navigate’ when it comes to accessing sources of assistance they would previously have obtained with the help of those workers. Moreover, a whole range of supplementary benefits will be lost, such as the Special Diet that provides additional income on the recommendation of medical providers. Medical transportation assistance and mobility devices will also become the responsibility of those who shift to the pilot. Disabled people, especially, might find, despite the additional BI income, that they are actually far worse off than if they had stayed on the Ontario Disability Support Program (ODSP).

The point that emerges here is that even as they roll out their showpiece test run that provides income to just a few thousand people and enables them to be far more generous than they would be if they were setting up a widely available programme, they are cutting back on other entitlements. I think it’s clear that the Ontario Liberals are establishing a model for a low paying, means tested income support system that is primarily concerned with subsidising low paying employers and that would be paid for by cut backs in other areas of social provision.

Left Welcome Mat for Neoliberal BI

Predictably, the Basic Income Canada Network sounds no alarm on the nature of the Ontario pilot and, indeed, will take an entirely supportive approach. The pattern has already been set among many progressive BI advocates is to present neoliberal models as ‘good first steps.’ *(15) In the UK, the advisor to the Labour Party BI working group is Guy Standing from the Basic Income Earth Network. He had contact with the Ontario Government’s BI advisor, helped the Finnish Government design its pilot and has presented to none other than the World Economic Forum at Davos. *(16)

As a regressive form of Basic Income, serving and facilitating the neoliberal agenda, is prepared, the deluded notion emerges that a progressive option is there for the taking. It is never really explained how this can happen but is simply taken on faith and I use that word very deliberately. Once it has been accepted that decades of neoliberalism and, indeed, the economic coercion of the capitalist job market can be neutralised with what Miles Krauter refers to as ‘emancipatory policy visions,’ *(17) then the realities of a class struggle that has not been going our way for some time seem very unappealing. Like Krauter, the Citizens’ Income Trust in the UK feels that a failure to believe that transformative BI can happen is to lack vision and to fail to offer any viable alternative. *(18) However, while the Fountain of Youth does sound a good deal better than dealing with getting old, it suffers from the problem of not existing.

The folly of believing that there is a social policy end run around neoliberal attack can’t be overstated. John McDonnell has suggested that a Labour Government could implement reforms that would outdo those put in place by the post war Attlee Government and ‘transform capitalism.’ *(19) As Theresa May’s wretched regime stumbles from crisis to humiliation, people all across the world are asking what can be achieved by a Corbyn led Labour Party. However, it seems to me that a policy that commodifies social provision, accepts low wages while topping them up out of tax revenues and that has the support of such reactionary forces globally, is far short of the ‘Spirit of 45.’

We’ve been retreating, rather than achieving reforms, for some decades but, if we are to consider the kind of measures that could be advanced and that working class people could mobilise to win, we can do better than become shoppers in neoliberal market place. We can demand free, expanded and accessible public services and fight for maximum worker and community control over them. We can demand systems of income support that are based on full entitlement, adequate income and that are purged of intrusive regulations and moral policing. We can fight for living wages, instead of offering subsidies to those who pay poverty wages. The neoliberal attack is taking up Basic Income as a weapon. We need to fight it instead of laying down a welcome mat.

1. http://www.independent.co.uk/news/uk/home-news/scotland-pilot-universal-basic-income-ubi-snp-fife-and-glasgow-scheme-a7505411.html

2. http://www.independent.co.uk/news/uk/politics/labour-sets-up-working-group-to-investigate-radical-idea-of-basic-income-john-mcdonnell-reveals-a7563566.html

3. http://basicincome.org/news/2017/03/joe-chrisp-basic-income-beyond-left-right/

4. https://www.theguardian.com/commentisfree/2017/jun/23/universal-basic-income-ubi-welfare-state

5. http://www.fljs.org/files/publications/Murray.pdf

6. https://www.fraserinstitute.org/blogs/be-cautious-about-ontario-s-basic-income-plan

7. https://medium.com/@parismarx/the-future-of-work-demands-a-basic-income-81f6df0bb7f1

8. http://basicincome.org/news/2016/09/13022/

9. http://rankandfile.ca/2017/04/19/the-basic-income-debate/

10. https://paulcockshott.wordpress.com/2017/01/25/what-is-wrong-with-the-idea-of-basic-income/

11. https://www.weforum.org/agenda/2017/01/why-we-should-all-have-a-basic-income/

12. https://www.jacobinmag.com/2017/01/ubi-finland-centre-party-unemployment-jobs/

13. https://files.ontario.ca/170508_bi_brochure_eng_pg_by_pg_proof.pdf

14. file:///C:/Users/OCAP%20Comp/Downloads/SSWCC_April%202017%20MSS%20Update%20re%20Basic%20Income%20Pilot%20Announcement_27Apr17%20(2).pdf

15. http://www.basicincomecanada.org/on_the_agenda_ontario_s_basic_income_pilot

16. https://www.weforum.org/people/guy-standing/

17. https://medium.com/@mileskrauter/working-to-death-leftist-critiques-of-basic-income-fail-to-offer-meaningful-alternatives-8fe2b8ebe6a

18. http://basicincome.org/news/2017/04/neoliberal-citizens-income/

19. http://www.independent.co.uk/news/uk/politics/labour-government-jeremy-corbyn-most-radical-ever-shadow-chancellor-john-mcdonnell-clement-attlee-a7041311.html

Also see https://recoveryinthebin.org/2017/09/04/ubi-the-good-the-bad-and-the-ugly/

Freedom to choose? – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

We have divided this post is into three parts for clarity 1) Choices and decisions, 2) Assisted suicide and 3) Recovery and Unrecovery.

Choices and decisions

Both ‘freedom’ and ‘choice’ are neoliberal fictions, the former a dangerous one right now

There is a difference between decision making and choice. Decision is a creative (or more accurately destructive) act, it is productive. Choice implies an externality. Something we are alienated from. A choice is proffered from the Other. The decision is the cut from those external choices. The power in diagnosis lies with the person making the decision, the psychiatrist, (or at least psychiatric discourse). The tantalising emancipatory light we are dangled in the deep is that we can take ownership of that decision. But to bite on that lamp is as emancipatory as thinking you are taking power at the till of a huge supermarket (that itself is one of many).

As I have said before it follows the same structure as M-C-M’ the general formula of Capitalism where decision making is M and choice M’ the commodity sold back after surplus profit has been extracted by the capitalist

All choice contains a loss.

I think it is importance to emphasise the importance of being able to make informed choices about treatment. Whilst the myth of chemical imbalance continues to be touted by psychiatry and the pharmaceutical industry many people continue to make choices based on misinformation. Psychiatric medication cause chemical imbalances rather than correct them and of course this may be helpful for some of us who are experiencing mental distress but don’t pretend to us that they have anything to do with curing mental illness even if they do help us manage our symptoms, especially whilst other options aren’t available to us.

Freedom to choose is an illusion. In psychiatry it is generally a form of ‘Sophie’s Choice’ where you are given options but they all benefit the provider of those options. And then responsibility is passed to the service user when things don’t work out because they ‘chose’ that path.

My choices seem to have been it’s either this or nothing and if you don’t agree you’re unreasonable. I have been offered things that won’t make a blind bit of difference just because that’s all there is.

I remember a service provider on CPD course I was teaching on telling me: ‘the more I hear the words ‘partnership’ and ‘choice’ – the more rigid and limited I see services becoming’

Choice, what choice?

Choice in MH is not just about choosing between pharmaceuticals as a psychiatric pharmacist once told me

I’d like to choose not to accept your diagnoses and to choose what treatments I won’t accept

True consent is only there are if you feel equally able to say yes or no

Change choice to privilege

Is free a reference to liberty, or is it a reference to the way our bodies and work are used once we are labelled?

Assisted Suicide

Another important thing I feel here is “choice” when it comes to assisted suicide… in this context choice becomes a measurable outcome because only if everything is offered can it be discussed in liberal terms…. not against assisted suicide, just against how people seem to be so pro it yet silent over mental health support. It’s an easier option, this normalisation worries me and is a big paradigm shift that is needed?

We don’t have that “choice” in the UK, but I think we should because it’s the ultimate “choice” anyone who really suffers should be able to make.

That’s a tricky one. I’ve always supported assisted dying (for anyone regardless of any illness) & I have membership of Dignitas myself. However I don’t want it to be as freely available as it is in the Netherlands & Belgium without social justice & support. I’d want to see all preventable social factors removed. On the other hand, I can’t see that happening any time soon & can understand some folk facing the prospect of long term fear/uncertainty over ability to exist wanting an alternative now

I agree, but what do people do in the meantime? Things are only getting worse, not better. It’s hopeless…

You know my view on balance I’d like to see the option available now, but at the same time I accept and respect all the opposition there would be from disability groups. If there was a vote I would vote in favour

Also, discussing in big concepts often forgets the individual.

Sure, I totally own my comments in context of my individual situation. I’m not speaking for anyone else.
Out of curiosity (only if people want to answer), who could see themselves consider assisted dying (for whatever reasons)?

Eventually yes

Yes I would but not just yet. I’d like to plan it well in advance.

Same here I would but have a few months to plan

Would anyone involve their relatives? And friends?

I’d want to find my cats a really good home before I checked out. They’re the only reason I haven’t already…

It wouldn’t be easy to involve relatives if it were accessed without a degenerative or terminal condition. I think many relatives might object

I would consider it and have, but see that this is the way our Government wants us to think and behave so for me I would vote no right now as I do believe it’s the gas chamber equivalent for Tories. I want other fights settled before I feel safe to fight that one. Have witnessed a doctor doing ‘bed clearances’ with morphine when I was a young nurse so it’s close to the bone for me.

I completely respect and honour your position. I have also seen the protracted death horror of the Liverpool Care Pathway

I’m unsure…. I only know that being non critical does more harm than good, the fact it seems like an ultimate taboo to be discussed..

Suicide is unacceptable…. assisted is

Assisted is dignified, painless and humane

A problem is that ‘assisted’ might open the door for ‘encouraged’ or ‘coerced’ – as we’ve seen with the commodification of ‘choice’ within personalisation – so whereas I support the right to die where when and how – it would require very strong safeguards against abuse by those with vested interests (eugenics politics family gain etc)

In the UK we need to include Futile Care Policies in this discussion – where a clinical team, according to their OWN observations and apparent research, prejudices and cost of supporting someone to continue to live (using their own assessment of quality of life), decide that only palliative care will be provided or that a future life-threatening event will not be treated. This is one element of the ‘slippery slope ‘( NORMALISATION ?) some disabled people protest about. This can be challenged though a judicial court order but trying to support a person (my late husband) in this situation and get all the necessary legal support is somewhere I and our daughter don’t ever wish to be again. It’s a real condition that someone who wants to live is denied it and some who wants to die is prevented. Loads of factors involved here!

Recovery and Unrecovery

I view current neorecovery as contemporary normalisation – infact that’s my new term: neorecovery to distinguish it from recovery

It’s a tough work reclaiming and distinguishing that from angst/anger/frustration. Last couple of days posts have really helped.

For me it’s not reclaiming as recovery never meant anything to me, it’s just differentiation

Yes, Foucault couldn’t have said it better

“Our body, our choice.” On all matters of Health, actually: “No bodily authority beyond me, no jurisdiction higher than my sovereignty.”

Freedom is more important than health as without freedom we lose our will to live.

That has never been truer than now

Choice – recover or stay ill. Which is why I stand for Unrecovery.

“Is dissociative voice hearing same as schizophrenia and madness?” – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

HV = Hearing Voices

Apparently the distinction matters

Voice hearing is pretty similar regardless of diagnosis, main difference is 1) how person copes 2) any positive voice or any positive relationship to them at all in the mix. Dissociation occurs in many classified experiences I cannot see what is achieved by attempting to decide whether it’s ‘psychotic’ or not

Psychiatry loves to categorize Voice Hearing. HVM has done a lot of good in redefining those practices

Dissociation is not generally recognized by Psychiatry.

Yet I remember early HV interview/assessment schedules where dissociation was a part of them
This mistake has been made with services users diagnosed as BPD being told their voices are ‘pseudo’. Dissociation with VH occurs in people diagnosed with schizophrenia/psychosis and other diagnoses. Just address the experience!

Psychiatry defines ‘Pseudo’ Voices as being inside your head. But voices occur inside AND outside of the head for most people diagnosed with schizophrenia/psychosis.

Yes ‘pseudo’ Voices are not restricted to just BPD. It’s just the main one we hear about because they are treated so badly for it

I find the dissociative part the most ‘disabling’ aspect of voice hearing. I may accept at a level of discourse there is no single meaning for ‘schizophrenia’ as it does not represent a single biological disease that can be pointed to as representative of a larger set of symptoms, however until they sort out my social security right to financial support whilst ‘recovering’ autonomously from this disabling experience I am not going to get all evangelist about diagnosis whilst ignoring the concrete reality of the social and economic circumstances that people find themselves in, (unable to compete on equal terms in a job market that is getting harsher) due to these disabling symptoms and so am comfortable having it on my GP sick note to entitle me to ESA financial support and access to the ever more constrained, homogenised and smaller array of other services available to me on the NHS as a consequence of these symptoms that I cannot afford on the open market of complementary therapies.

Can someone explain to me what dissociative voice hearing means? I hear voices but I’ve no idea what “kind” they are…

I hear external voices (that is they come from outside my head) internal ones (they seem to be within my mind but seem alien. I also amongst external ones hear them in noises and ‘hear’ other people’s conversations about my ‘inner thoughts’.

However dissociation I experience as being unable to focus on what I am doing, or what the people actually talking to me using their mouths, in the same room as me, are saying. Where I am so caught up in dialogue with the voices I am unaware of what else is going on. I no longer get catatonic but I do dissociate.

Which comes first, the voices or the dissociation?

It might not always be clear cut, which comes first the HV or the dissoc, and it might not always occur in same order

I certainly relate to getting completely focused on the voices to the exclusion of everything else. I also have this inability to filter out background noise which can be overwhelming especially when combined with the voices.

Yeah voices turn up environmental sound volume for me

Unfortunately for the anti-med evangelists my meds lessen some of it. I have come off twice and been ok off until a bad experience happened and they got worse again, and so on meds to moderate them (they never fully go away) but meds are NOT a cure, it being in my mind both trauma and group dynamic communicative rather than biological, although clearly whilst experiencing these symptoms you brain chemistry changes, but there is no normal brain chemistry, so for some the meds work for others they don’t, but they are not the solution or cure, they are just temporary moderators whilst doing they therapeutic work.

Unfortunately because life stressors affect such things, then social factors from neighbours to environmental noise, to secure housing, to support network to financial situations affect this.

However if you are mentally well and have a low paid job you know full well these stressors are not ‘cured’ by work, so individual meritocratic recovery that negates class issues is just so much middle class wank.

I think they mean when people hear the voices of dissociated parts of self like in DID. I think the question was is hearing those voices the same as hearing voices when you aren’t diagnosed with DID

I have also been down this path, and this conversation would go into phenomenology, philosophy of consciousness including whose self memories are, but the upshot would be same above social and political argument.

I went down the Gestalt (Hal and Sidra Stone) voice dialogue path but making my voices ‘personal’ rather than ‘thoughts and ideas’ made my mental health far worse. For a start all the ‘personalities’ that latched on to the technique were ‘thicker’ than me, but were also a bit ‘Dunning Kruger’ with it, and so I started dissociating just saying ‘no’ to them far more than I used to when they were ‘voices’ or ‘thoughts’.

I tried voice dialogue it was disastrous my visual voices attacked me. You just cannot force voices to talk to others

Equally when one pops out unexpectantly it can be difficult if the prof has a fragile sense of self if the voices calls them a twat!!

Mine are real bastards – I’d rather not get into a discussion with them tbh.

“Great minds discuss ideas; average minds discuss events; small minds discuss people” This quote by Eleanor Roosevelt sums my experience up, from studying a PhD and having a clear mind thinking about interesting stuff after the dialogue method I ended up with a bunch of right wing ignorant conforming narcissist hostile gossips in my head

I find the gestalt thing can be exposing too

Would you say an internal voice is basically the same as an intrusive thought but with more of a coherent personality, like for example an inner critic that says the same phrases again and again like ‘you’re worthless’ etc? If not, I’m struggling to conceptualize the difference between the two things? Really interested in this discussion as I’ve heard about ‘internal voices’ for a while but have never really understood how they’re different from intrusive thoughts or my own experiences of having a psychopathic inner critic (esp when I’m triggered or ashamed) – if anyone could explain this it would be very helpful.

Good point – voices can be externalised intrusive thoughts

I do find myself wondering if it’s all basically the same thing but in slightly different flavuors – and if shrinks are over-complicating basically the same process by dividing it into all these subcategories and making each experience seem so distinct just because it’s a bit different on the surface. I could be wrong but it’s just something I’m thinking to myself more and more. I have never heard voices in a traditional sense but the more I listen to voice ‘hearers’ share what their voices actually say, the more I can relate to it, and some of the phrases are eerily the same as my inner critic, like identical in both their wording, motivations, and the situations in which they intensify and are triggered. The only difference is that they are ‘heard’ whereas mine is experienced more like thoughts.

I think there’s little difference in the VH experience whether we’re diagnosed with schizophrenia, psychosis, DID, even OCD, PTSD, BPD

Different variables sure

I suppose I can clearly distinguish between what I feel as my own created thoughts and those unbidden ‘voices’.

The idea of intrusive thoughts is slightly different and there is the idea of thought insertion, which is rarer but when I have experience what I would call ‘thought insertion’ then it is a horrible intrusive experience of feeling like someone else is trying to make you think something that is somebody else’s idea or belief about you, not your own, very controlling.

I get them inserting or dropping or merging their thoughts into mine and yes I’m clear they are not mine

But with regards ‘heard’ voices, I both get voices that are acousmatic, from no discernible source, that are not, shall we say, carried on soundwaves; voices that I can fully ‘hear’ as sound; and also voices carried on/with or through other sounds eg car wheels, birds twittering, other people talking (so physically present witnesses will hear them say something else)

The thought insertion is like someone kind of nudging you into an adjacent untruth. A bit like a leading question in law where a leading question implies guilt in the question so cannot be answered without complicity

I experience it as being aware gradually hang on that’s yours not mine, through to mental equivalent of physical force

Yes, it feels quite forceful sometimes, hard to explain what that feels like though, describing bodily sensations I mean
Mental rape

I have called it that too

I have screamed no means no at them. But they manipulate it that I am responsible for their behaviour

Worst case thankfully rare scenario, they push their words out my gob

Even if they are my reflection they are a reflection of the power disparity in the way I am treated

I mean in a group way. No single individual could possibly have that power

Yes because much has got into our fabric

Although individual personalities is not the way I relate to voices. Or rarely. Or rather never used to be.

Annoyingly the various (I have a large number of) phantasm/assemblages seem to insist on treating me as a distinct personality and that is where i have a problem as it is clear they do not know me and so inevitably they come across as prejudiced

Many are nomadic. There is an obvious logic that the less prejudiced they are the more they are ephemeral. Even when, and i will, unconsciously but seemingly intentionally, trigger them from my unmet needs they will pass on. They are momentary. And ironically these voices are, and always have been more numerous.

It is what comes across as intentional focus or gaze that is the real issue and because of it will necessarily always have a more bigoted source.

But how does one evade them once targeted without losing oneself as a passive docile conformist.

I once said to someone of all people to appease it is the most understanding. Why on earth would one wish to orientate oneself to appeasing the most bigoted as an ethical practice? I have the right to say fuck off you bigot. Leave us alone.

Interesting reading. I have never considered myself to hear voices but I definitely experience overwhelming intrusive thoughts, and inner conversation that is not my own self, speaking about me, but as though it is someone else. Like replaying something someone else has said about me.

Because a lot of the experiences sound similar or with a common thread, do people think they are on a spectrum that ranges from your own ‘lucid’ thoughts, ones you own and control, to full blown psychosis that controls you? Would this make daydreaming, spontaneous thoughts, and inner dialogue part of the spectrum – fitting within a ‘healthier’ range – and gradually going into the range that impairs functioning?

Where do you think disassociation would fit? The same spectrum? Different? Is there crossover?

*Note to self: Maybe joining HV Network would be useful after all… didn’t want to seem like a knob with ‘fake’ voices joining a group that didn’t apply to me

I would say yes to spectrum except it often implies a linear concept which is wrong.
‘Manifold’ is the word i would use but i don’t have quote to explain it. It is a moving topology in 4 dimensions. Brains have a manifold shape. But it is does not have to have the ordered shape chaos theorists like

There is overlap across experience, there’s not always a clear dividing line of ‘this is schizophrenia/psychosis/DID/PTSD/BPD’

Dissociative VH, psychosis VH, spot the difference?

It seems to me that psychiatrists and others want to have neat categories – self harm = BPD, voice hearing = psychosis, pref schizophrenia etc. when the reality for people is much more complex, as you have all described.

Psych’s would say antipsychotics produces a differential response

I often think in the end, we need to define our own experiences regardless of what psychiatry says and does. I guess that can be achieved by trying to create a level of distance from MH services. Of course that can be impossible sometimes when a crisis occurs. But ultimately, in my opinion, no one should have their experiences defined by someone else.

Book Review – DSM69 by Dolly Sen

dsm69

DSM 69 by Dolly Sen is the latest must-have edition to the DSM series. In a departure from its more traditional format, DSM 69 argues that disorder is not located in the mad but within psychiatry itself.

In DSM 69 we find a collection of words and artwork that leap out of the page and grab us by the scruff of the neck, demanding that we look again, look closer, look with a compassionate and critical eye at this thing we call madness.

Dolly is a wordsmith, her sentences finely crafted to run a river direct from her soul to that of the readers, taking us on a guided tour through the brutality of her experience at the hands of psychiatry through to her discovery of art as a tool to reclaiming her identity. Dolly rejects that mad people are lesser beings and calls on her peers to make their lives as ‘bold and colourful and beautiful as we like’.

Not merely a wordsmith, Dolly’s art such as the big red heart with the words ‘pathologise this’ emblazoned across it gives a powerful image of more than just survival, it’s a kick ass defiance against those who tried and failed to break her. Dolly’s heart isn’t just still beating, it’s burning an invitation to us all to reconnect to our own hearts and reject anyone or anything who suggests we are less than.

For a small (A6) book, much is covered; the shaming impact of the system, the failing time to change campaign that encourages us to talk about our individual maladies without tackling the unjust systems that hold them in place, the fetishisation of mad people, the way self-help techniques are subservience – not life – improving, the alienation of mad people and much more.

Packed with laugh out loud moments, I’d urge you that if you find you must read any copy of the DSM, make it this one.


Due for release on June 13th

Dolly Sen is a well known artist and activist working and exploring what it means to experience mental distress and the effects of being labelled with a psychiatric diagnosis. Her art is witty, humorous, but also cutting and coruscating subtly getting under the skin of everyday psychiatric assumptions that leaves one feeling both wiser and nourished yet still in good humour. We are all the better for her art. DSM69 is a small booklet, a notice of intent, containing a selection of Dolly’s art and several manifestos.

Dolly’s website: http://www.dollysentraining.com

You can buy Dolly’s book at http://www.eleusinianpress.co.uk/ or on Amazon

Fake Psychosis Awareness!

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A psychiatrist on social media said “it is important to differentiate between ‘real’ pseudo’ and ‘fake’ psychosis”. This psychiatrist claims to be able to do this! It is important because otherwise fake psychotics will get diabetes!

“Ten years of antipsychotics doing sod all to help and giving you diabetes is absolutely why we need to make distinctions if they help”.

We thought it was very nice that the doctor cares about only real psychotics getting diabetes.

Fake Psychosis is a debilitating condition that can lead to diabetes if left undetected!

  • Have you ever wondered if you have fake psychosis?
  • How would you ever know?
  • Is there a checklist?
  • Should you speak to your GP?
  • What about the children?

We’ve prepared a Handy Checklist of fake psychosis symptoms for you:

  • Do you have a diagnosis of BPD/PTSD? You have fake voices i.e. #fake psychosis
  • Are your ideas are comprehensible to the Dr? For real psychosis, they should be incomprehensible!
  • Do you respond poorly to antipsychotics? Then you should be diagnosed as malingering or with a PD.
  • Have you developed fake diabetes?
  • Do lights and beeps go off when you’re examined with a Star Trek medical tricorder?
  • Have you got better? Then you didn’t have psychosis to start with!

How can you help!

Raise awareness on social media by using these hashtags!

  • #fakepsychosis
  • #OnlyRealPsychoticsDeserveDiabetes
  • #SayNoToFakePsychosis
  • #FakePsychosisAwarenessWeek

(Fake psychosis awareness week can be abbreviated to #fakepaw)

Are you a fake psychiatrist? We want to hear from you!

Tell us what people feel which isn’t real and how you identify them if you don’t possess a medical tricorder.

We will require proof that you are fake – like your name badge from work.

Do you have fake psychosis? We want to hear from you!

Be brave and share your inspirational fake recovery stories from fake psychosis.

What is the solution?

Instead of diabetes inducing meds, #fakepsychosis is treated by taking ‘Responsibility’

 

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Service users with a dual diagnosis of schizophrenia/psychosis/schizoaffective disorder and EUPD/BPD/PTSD which means experiencing real/pseudo/fake psychosis AT THE SAME TIME have the option of Timeshare Symptoms ™ i.e.

  • Monday – Wednesday: real psychosis,
  • Thursday – Friday: pseudo psychosis,
  • Saturday – Sunday: fake psychosis.

Dr McShrink stated

“We’ll need joined up thinking between psychiatry, psychology, sociology & fakeology to understand the complex origins of #fakepsychosis”

We believe any ‘ology’ or ‘iatry’ would suffice. We also questioned whether he’s a fake psychiatrist because what he tweets is way too sensible.

We also wondered if you can fake #fakepsychosis? Or fake faking fake psychosis?

Ms Loony said

“I fake unpsychosised myself in prison to get the fuck off the hospital wing and its cells with cameras in” and “we need a hot meals and a bed campaign for people with #fakepsychosis”


This article explains the assumed reasons as to why people fake psychosis: http://www.ajmc.com/…/are-hallucinations-real-of-fake-an-ex…

This material lacks contextual. It fails to question why society puts people in such awful places that this could be the only option. And then judges them for it!

How bad must the alternative be if you’re prepared to AIM for a psych ward?

Hospital food, especially on psych wards, is so awful – it can be subject to competitions as to what it actually consists of!

Given how frightening wards can be most people tend to avoid them as far as possible.

As for seeking disability payments the welfare system causes crises and attempted suicides:

Binners’ responses to the article:

“Reckon if we interviewed homeless people & offered the bin or a room off the street know which they’d take! And there are homeless people who refuse psych treatment”.

“Incredible reading as to how that’s judged. Another is voices only exist outside of the head when voice hearers experience them BOTH inside & outside”

“I was told I had pseudo psychosis when I had a bpd diagnosis. I no longer have that diagnosis and are now told I have psychosis – schizoaffective. Tbh, I’m a bit fed up of people saying psychosis because – it’s my reality. Saying it’s psychosis or “its just one of your psychotic symptoms” doesn’t make it easier. Not acknowledging the fear I deal with doesn’t make it go away. Just isolates me further”

“The times I stress this about paranoia, quit challenging it, acknowledge the scale of distress or it just isolates”.

 

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Another psychiatrist also highlighted the importance of knowing the difference between paranoia and over idealised ideas, this could be a supplementary area to our exciting Time to Talk about fake psychosis awareness raising campaign.

© 2017 Recovery in the Bin, All Rights Reserved

A review of Horizon programme ‘Why Did I Go Mad’

Brief personal review of tonight’s Horizon programme: ‘Why did I go mad? starring David Strange, Rachel Waddingham and Jacqui Dillon.

David’s testimony, especially touched me, his experience of visual voices and paranoia, which was really good to see featured. There was however a very heavy emphasis on the dopamine theory of Schizophrenia which I hoped we’d left behind a few decades ago.

Avatar therapy was featured, which I understood to have first been piloted by Julian Leff. I find the avatars quite disturbing in that I’d probably want to punch the screen, and for me it wouldn’t recreate visual voices which are not one dimensional and of course move around.

Finally a professional raised discrimination as a causal factor and Robin Murray spoke of medication effects such as weight gain and diabetes and how some people couldn’t stop taking them, but he completely omitted to say anything about drug withdrawal syndrome and psychosis!

Voice Dialogue was featured, first developed by Hal and Sidra Stone in the 70s. Workshops have been happening for a while but I have concerns about this technique being picked up and used by anyone because VD requires a great deal of skill, in a practitioner not driven by ego or seeking ‘theatre’, with knowledge of the voice hearer and where they are at.

I have tried VD, I can see it’s value, but for me I was unable to get voices to speak to others on demand, and changing chairs just felt silly. I did wonder why this was such a feature in the film because most people do not get to access it (it was accidental for me).

There was surprisingly no mention of the Maastricht Interview, something I found helpful but it really helps if the practitioner doing it with you is comfortable going off script.

After this, I did put together my own ‘voice picture’, text descriptions and circles to indicate their locations i.e. outside or inside the head, which can be a useful shorthand to give to a supporter by way of explanation.

I would have liked to have seen more information about local hearing voices groups and how they are accepting of voice hearers of any diagnosis not solely people with a diagnosis of Schizophrenia/psychosis. Likewise materials picking up on some of the themes raised, such as John Read’s work on trauma and Tamasin Knights seminal ‘Beyond Belief’.

There was sadly nothing at all in the film on the impact of austerity, cuts and welfare reforms and how government rhetoric has directly affected people specific to their ‘mental health’, such as ‘infiltrating’ people’s paranoia and voices.

We are weeks away from a General Election, this was a prime time TV slot, a missed opportunity for all the in-work and out of work claimants living in absolute terror of their next review which has the power to render people destitute.

“The personal is political” has often been quoted by HVN speakers, but unless the social and political reality facing more people is spoken of it is difficult to grasp the purpose of saying it. Social justice needs to be at the heart of any social movement.

The film ended quite sharply from looking at voice dialogue to recovery and I was left feeling, so that’s it? Although there were some decent messages within it, I felt much missed. I did wonder what an uninformed hearing voices movement viewer would make of it.

I feel I want to say to fellow voice hearers – trauma is not necessarily a discrete event; it can be incremental, diffuse, or not there at all.

Also that not all of us have international recovery stories & normative success – and that’s ok. Just because we rarely hear anything different to recovery narratives, we can celebrate our survival, however it looks. The hearing voices movement will do greater justice to that when we hear more BME voice hearers, voices hearers in receipt of benefits, voice hearers who do employment or voluntary work which is not socially valued.

Something I’ve learnt with voices and paranoia is that sometimes no amount of ‘insight’ equals ‘healing’. For some of us it’s about managing and surviving, with occasional moments of radiance. The times I hear a ‘thank you’ when I say this with a comment such as “I might scream if one more person says try reasoning/understanding/talking to my voices”.

We need to meet people wherever they’re at, and we need to hear from people wherever they’re at.

A Mod

Discussion of note writing in Recovery In The Bin

Help needed! I am a trainee therapist with prior lived experience of the mental health system including forced treatment and serious iatrogenic harm. There were lots of reasons I decided to train as a therapist, partly because I believe in the power of storytelling, meaning making, witnessing and a providing a safe space for someone to speak their truth, and partly because therapy was the core thing that helped me reclaim my sense of power and allowed me to heal.
Also, I guess because as a peer-support worker I got fucking sick of not being taken seriously or given any support by mental health services in my work with people, and my comments about the injustice of the system being constantly discredited as me having a ‘chip on my shoulder’.

Things are going well in my training thus far. I’m now in my first placement, but have hit a roadblock. I am finding it extremely hard to write notes about clients (which I am legally and ethically obliged to do) in a way that I’m comfortable with, and sits right with me from a power and social justice perspective.
I am finding just the simple act of sitting down and writing *about* my clients to be an act of objectification and it feels like a huge power imbalance. Why should I be the one who defines how things are going, what progress is being made? Why am I the one who gets to record our journey together, who gets to write history? I also remember how much anxiety I felt about my own case notes when I was in the MH system, and how acutely powerless and voiceless that big brown file made me feel.

So… I am mulling over the idea of co-writing my case notes with my clients at the end of each session, rather than writing them alone once the session has ended as I am being trained to do.

My thinking in how to do this practically, is that I will keep the amount of therapeutic time exactly the same so people don’t feel they are losing out on time to talk, but to extend the session to 55 minutes rather than 50 in order to write a brief summary of the session together in the final 5 minutes. I imagine the process being quite informal, but me just asking the person I’m working with what they felt the key themes or ideas of the session were, that felt important to them, and then for me to share my take on things, and then we collaboratively agree a way of wording this that we are both comfortable with as a written summary of the session.

I am a bit concerned about what I would do if a client is upset or experiencing a strong emotion at the end of the session (which currently seems to happen about 10% of the time) where switching to reflective mode could be counter-productive. I was thinking that in those instances I might call a ‘raincheck’ on the note-writing for that week, then do my side of the notes alone and then share those at the start of the next session, when things have settled down, and ask if there was anything they might add before we begin.

I am genuinely interested in what people in this group think about this as an idea. How would you feel if your therapist, (or CPN, support worker, psychiatrist etc.) asked you to be an active participant in writing your case notes with them? Would this feel helpful or overwhelming? A burden or empowering? What would be your hopes, as well as your fears or concerns?

I am interested in hearing genuine reactions as I am not attached to this as an idea yet (nor the way I’m thinking about going about it) I’m just exploring this as an option right now.
What do you reckon? Feedback would be so much appreciated!

– I would want a therapist to take notes. As a patient I would find it overwhelming to help with this, usually just wanna leg it and have space. Had a million therapists and only one was good.

– I totally get this. I think in my own journey there would have been times when I would have found the process of co-writing empowering and times I would not have been able to cope. Would you like to have been given the option to co-write them, even if you ultimately turned it down as not being right for you? Or would even being asked feel like too much?

– I think I would just see it as the therapists work.

– That’s really helpful. I appreciate you sharing your perspective.

– For example, I had a therapist who obviously couldn’t remember our last session, he tried the best he could to manipulate it into a weird thing where he wanted to understand why I couldn’t remember, little did he know that I can very rarely rember conversations. Then finally I just asked him if he could tell me, and he couldn’t, as he didn’t take notes. Didn’t pay him and left.

– I am not surprised you did not pay him. I can understand a therapist not remembering a specific detail from a session because even with taking notes you can only record so much, and many people are loathed to put too much detail about the content of the session in their notes because of concerns about confidentiality and also therapeutic notes are increasingly being called on for use in court cases, so many therapists are anxious about writing too much in case it is later used against their client. If you have 20 clients it is hard to hold lots of detail in your head, it’s not an easy task to remember so many names, events timelines etc.

Also the nature of memory is that in a conversation of 2 people, both will remember the elements that felt most important to them, which are very rarely the same (one of the reasons that co-writing feels interesting to me) So I have found that that in my own practice I am prone to sometimes forgetting specific details, or if a client starts a session with something like ‘what you said last week was really interesting’ it is amazing how often I assume they are talking about something different to what they remember as important.

However when this happens I try to be honest and just apologise that I can’t always remember details as clearly as I would like in an ideal world. However all too often I have seen professionals try to avoid seeming ‘incompetent’ by doing something like your therapist did and turn their lack of recollection into a problem with the client. Also your story demonstrates why notes are important. I’m not anti-note taking I feel they’re essential so that important information isn’t lost. I guess I’m trying to get the spirit right in the way I go about writing them.

– Is the problem not that you are working with too many people? Ratios is a difficult thing to manage…. I remember once upon a time being a play worker and our ratio could be 40-1 at times, for an adventure playground. Safe to say it was manic. Problem is that it was state funded and it was affected by austerity, which had adverse effects on both our well being as workers and the kids quality of fun and attention and safeguarding.

– Wow that does sound manic! No currently I am only working with between 2 to 4 clients at any one time as I am training, but even at that ratio a HUGE amount of information can get disclosed in the average therapeutic hour. I do think that ratio becomes a problem for qualified therapists though, especially those working in the NHS. The average caseload for a therapist who has qualified is around 15-20 people weekly, and I can imagine even from working with 2-4 people that after a while that must become impossible to hold so much detail in your head.

But I think my problem here is less about memory recall and more about the power-politics of the situation. I’m genuinely interested in moving away from institutional, medical-model driven approach in the finer detail of my practice, and so often case-notes are written in this spirit. I’m also interested in exploring ways of working which don’t assume the therapist is the ‘expert’ in the situation or the only one with the power to interpret, plan and record information. Of course I have professional skills and of course the power imbalance is also a reality I can’t escape from, but I do want to work in a way that sits well with me and does the least harm.

– I think it’s a good idea to give people a range of options, I’d really like that from you doing notes and the person not seeing them, to joint writing, or the person seeing your notes at different points and adding or amending. I think you’re being thoughtful and I like your thinking.

– That sounds great. If that kind of reassurance could be portrayed in the sessions it would be ace, I agree with what ….. says above

– I really love the idea of a range of options. That hadn’t occurred to me and seems a lovely potential solution to me. I’ve found your feedback so helpful, thank you.

– Think ……has a good idea in the therapist writing notes that a person has the option to look over together with you at intervals… Depending on the person that may be set increments of time when you ask if they’d like to reflect because you feel it has been a significant period of change and you want to check in with if the sense you have is shared so the records are accurate, or if a person is in a frame of mind to be more proactive in the process then it could be left up to them when these intervals occur. I’m just thinking out loud. I love that you are asking these questions.

– Thanks your thinking out loud is very helpful and it’s good to hear so many different perspectives on this issue, I’m finding the feedback I’m getting so valuable. I think balancing the administration with the therapeutic process (which by definition constantly changes) is going to be the challenge, but it just feels like flexibility and good communication will be the keys to navigating this. It is going to be an interesting learning curve for both me and my clients and I’m sure in the beginning I’ll make mistakes and be a little clumsy in my handling of all this, but I find people are remarkably forgiving of mistakes if I can own them and just apologise when I get it wrong. I am excited by people’s feedback and excited about the possibility of a slightly different way of working. Feeling grateful to RITB right now!!

– Definitely, people appreciate the effort

– Best therapist I had made notes throughout our session, photocopied them and put them in the mail to me. Getting them a couple of days later at home where I could read them when I was ready to, reflect, work through anything I needed to and bring back anything it raised or I wasn’t sure about. Absolutely brilliant and I still have some of them over 10 years later!

– I do not feel qualified to comment on any case but my own, but if I was lucky enough to have someone like you as my therapist I would be pleased to be involved in the write up. In my case what talking therapy I have had has not been painful or even a chore. Perhaps it is significant that I have had no serious professional help for some 20 years when I looked forward to my visits with an excellent psychiatric nurse. SRMN. Your approach as you describe it reminds me of these sessions. All the talking help I have had or feel I can get now is likely to be a student or zero hours unqualified worker reading exercises from mindfulness books or the ridiculous online CBT. Perhaps at the moment though I do not need any help as I am functioning OK in the ESA support group being left entirely alone (for now). I do want to wish you well and tell you that I found your post refreshing and encouraging.

-Thank you for your thoughts & feedback. I too had a CPN with an amazing perspective who made a big difference to me. I worked with him for 4 years when I was in my 20’s and before I was remotely ready for therapy. It is sad to me how much CPN time is being cut back and how the therapeutic aspect of the CPN role is being reduced and reduced and reduced into being a box ticking exercise in micromanagement.

Also agreed about the current state of therapy, the idea of an online self-help website being ‘therapy’ is a nonsense to me (not that self help can’t be helpful but that is what it is!) and yes the mindfulness bandwaggon grates on me too. I am lucky enough to be practicing in a placement which provides free therapy for trauma survivors but such services are few and far between and our waiting lists are too long. I also have zero idea how I will manage to work with the people who most need it once I have qualified and need to earn money from at least some of my work, there are so many issues around the power structures of access to therapy that need addressing!

– Giving the client options sounds good. I like this idea but know at the end of some psychotherapy sessions I was desperate to leave, or needed to hold on to my feelings so stopping for notes wouldn’t have worked. Equally at the beginning of sessions there may be a burning issue, which notes would distract from. I think though that having an appropriately timed ‘admin’ session with advance notice where the client has the option to add to / amend notes would be helpful – for me that would’ve helped stop that fear that I was falsely represented in my file. It may have also been too overwhelming though. Difficult to gauge and everyone will be different but it’s reassuring that you feel this way.

– Yes, I think that it would be a more accurate or honest reflection of each encounter/session if you were to write notes with the clients…not all therapists write notes as far as I’m aware. If you do write notes I think it is better not to speculate! All the best in your work.

– You’ve got to watch that false info doesn’t make it into your notes. My ex-husband maliciously made a false allegation of domestic violence against me and that ended up in my notes as a “fact”.

– Notes should only be about and from the person in my view. Another suggestion would be if the person wanted to have input but not every week, that a monthly or whatever frequency could be on offer for a read through

– Yes, inaccurate notes can be hurtful – damaging…

– Ritb group rules! sooooo anti therapy due to all the crap ones, ace to read this thread and it sounds positive.

– I’ve just realised that I put my faith in someone as a therapist who is a nice enough person but…zzz…my mental health is no better for seeing him. People are very limited and it is a mistake sometimes (often) to do as I did.

– It’s really important therapists have good social awareness it’s just not good enough when they see claimants/people in poor conditioned low paid work and don’t get what that means, “I don’t know much about that”, maybe that should be part of training

– Yes, some therapists would appear to be in ivory towers (of sorts)…I read a book ages ago titled: “Therapy Means Change”. The writer argued that society needs to change, not the individual.

– Yup the ivory tower thing is a very real problem. I think there are huge equality issues about even accessing therapy training, especially in the humanistic or psychoanalytic traditions. Mine costs £10,000 each year for 4 years, the total costs of my training including foundation diplomas will be close to 50 grand. There are no loans or bursaries available which makes it systematically impossible for people in difficult financial circumstances to qualify as a therapist. Not to mention barriers because of health, disability, having kids, or other factors.

Counselling training is a little more doable because loans are available for some courses and the training is a bit less intense / lengthy but even that is too much for many people with lived experience. I am very unusual in my training group not only because of my MH history (quite a lot of therapists will have had some form of MH issue but I am unusual in having more longstanding issues and experience of psychosis etc) also I am from a reasonably working class background, comprehensive school education etc when many of my peers are both very southern and private / public school educated. I lucked out because my husband who I’ve been with since my teens did a PhD and now works as a lecturer and we don’t have kids. If it wasn’t for his salary training simply would not have been an option for me. I’m still having to work 2 jobs to pay for it but it is actually possible where as for many other skilled peer support workers and SU activists I’ve worked with it simply wouldn’t have been even though they had skills in abundance. I am so aware I’m in a very privileged / fortunate position. The ivory tower thing is a reality as much to do with the class/social backgrounds of most therapists rather than something inherent to the role. It makes me so angry it is this way and it needs to change!!

– Need more like you

– Trainee therapist with NHS?, because if you practice privately you don’t have to write notes.

– Need some surely unless you have a photographic memory

– My therapist never does, and we both feel liberated about it.

– Wow impressive

– It depends on whether the therapist is accredited and who they are accredited by. Because I am registered and being trained it is part of my ethical code that I am bound to that I need to keep some form of record of the sessions, and if I did not keep them I could face being de-registered. However not all therapists are accredited and there are different accrediting bodies, with different rules and expectations on this issue. Also, I personally have slight memory issues due to damage from meds and my own trauma history so I personally wouldn’t be comfortable going entirely note free, although I know some people who would not work any other way.

I think it really depends on your own skills and capabilities, and your stance on this sort of thing. A nice thing about therapy in general is that we do still have freedom to be flexible in our approach to these things. It’s nice to be able to ask a group like RITB and get feedback I can actually utilise in my practice. Not many professions have the same flexibility.

– Writing notes could actually breach confidentiality/confidence/trust…it all depends upon who else reads them (if anyone).

– I don’t disagree. It’s why it’s so important to me that I give this maximum thought and careful attention. Because so much damage is done by carelessness even when there are good intentions, and through not considering the impact on the person.

– I remember when Bradford Home Treatment team gave Survivors the option of writing and keeping their notes at home.

– I did not know that – was this something you had direct experience of? Did it pan out well in practice? I would be so interested to know the impact it had.

– No, I didn’t have direct experience but knew it was something team offered. The service won a beacon award back in the day and Service User satisfaction was high.

– Thanks for the info I will investigate more about this 🙂

– Oh yes I remember that

– I would like the option personally, though I wouldn’t always take it. Even just being given the option would make me feel safer and more respected and seen and empowered.

In terms of the content of the notes, I agree that sticking to what actually comes up and is discussed in session without speculation is best. One of the most triggering things for me in seeing past clinical notes was my psychiatrist taking careful notes on how I looked/ nonverbal actions and speculating (wrongly) on what they meant in terms of my mental state. I’m autistic and being perceived as more anxious or depressed or “worse off” because of not making eye contact or stimming more, which for me are actually signs that I feel more comfortable and trust the person I’m with, felt super invalidating. I wish she would have asked what my actions meant for me as opposed to just assuming. I was also really bothered by the demarcation of notes into “subjective” (my narrative) and “objective” (my psychiatrist’s interpretations). I was really offended that her often wrong or incomplete interpretations got to be classified as “objective”. She was the first psychiatrist I had that I actually liked and trusted so seeing those notes at the end of our relationship felt like a betrayal and it made it harder for me to trust therapists/ psychiatrists.

– This is such helpful feedback and touches on so much I’m afraid of in the potential harm of writing notes – that a pretty healthy relationship can become invalidating by this kind of practice, and I’m sorry to hear that an experience that was previously positive got tainted by the experience of reading your notes. I too would have felt betrayed in that situation, and your experiences are at the very heart of the issue for me.

The form of notes you refer to are generally called SOAP notes, which split between objective and subjective and they are just so dangerous in the implicit idea that the therapist has the ability to be objective and to step in neutral position of defining what is ‘fact’. I’m training as a therapist, which at its heart rejects the idea there is such thing as objective truth or that any one person can possess it. So the idea of writing SOAP notes (which are becoming increasingly popular as a format and used by many placements) is not only counter to my ethical principles but all the theories at the heart of my therapeutic training, so I refuse to use that format full stop.

– Such good points

– There’s no such thing as objectivity with human distress and relationships no one can be in possession of an unquestionable truth

– Yep. This is my entire stance and to me is at the heart of this issue. The idea that having done a bit of training and got a certificate that I can suddenly be objective whilst my client can only ever be subjective is ridiculous. We are both absolutely bound by our own subjectivity in that situation, as you say human distress and relationships are so complex they can never be fully pinned down, and both therapist and client will be profoundly influenced by their culture, personal relationships, their own history, social and spiritual background and world view when making meaning of a situation and it can never be any other way. It is my belief that neither client nor therapist can ever be anything but subjective, but what we can do is try to understand the other’s perspective as fully as we are able.

– Of course ……..is right about objectivity being a misnomer…

– The aim is to have “unconditional positive regard” isn’t it? Some people have this ability but most people are more prejudiced than they would feel alright about admitting/acknowledging…Jiddu Krishnamurti talked a lot about “can there be an ‘I’ free from prejudice”…

– Therapists probably worry about failing their clients – especially those who have more serious MH problems. So most people who have the benefit of long-term individual analysis would appear to be the “worried well”. I am in the position right now of feeling that I have failed my therapist…a difficult position to be in really. My tendency is to put people on pedestals and not see that failure in those terms involves 2 people – the analyst and the analysand.

– …An interesting conv. Thanks. I hope y’all are having a good day in spite of this highly oppressive ‘political’ climate…more later. ‘bye 4 now, 🙂

– Always good to try and quote Survivors in notes as much as humanely possible.

– Might be useful to have a few key facts from person, note of something tough coming up so to remember to enquire

– Yes, as a memory aid I can see the value for some people of keeping notes.

– Keeping notes is deemed an ethical requirement, the organisation who govern the course I am training on, so for now at least I am bound to their code of ethics in my training contract and therefore ethically obliged to keep records. Once I have qualified I will have more freedom but for now it’s the system I have to work with. Thank you for your input that’s really appreciated.

– I just had my last session (over 8 months) with my therapist yesterday because she is being redeployed. I don’t think I would like to write notes at the end of a session because I am always shattered and have lost focus at that point. I would have liked to see notes from the previous session maybe halfway through the next (after exhausting the current burning issue and before moving on to other stuff) to comment on or revise them

– This is great feedback, thanks. I think what is becoming clear is that it will vary from person to person what works best in practice, but that the option of co-working and transparency feels helpful to people.

– My instincts are you will make a very good therapist because of your determination to try and get things right between you and the people who you support.

– Thank you that has made me smile so much. 🙂

– I think that notes written by a therapist working outside the NHS particularly a CMHT would bother me far less than those produced by the system. If I was working with a therapist I respected I would trust them to write what notes they wanted and not enquire. I also think 5 mins at the end of the session could feel like the mandatory questionnaires iapt use to demonstrate outcomes. What if a client didn’t want any notes to exist at all as that could then feel coercive. Being flexible over the 50 minutes would be more worthwhile as otherwise it just feels like we should sod off and not take up a minute longer of the therapists time

– There is no FOI when it comes to therapists in the private sector. I’ve had some unhelpful therapist encounters but mostly put them down to experience. I think it depends on how the notes are to be used as that is where power comes in. I also used to feel a bit uneasy at times re any prospect of my case being discussed with a supervisor in case that was due to being perceived as difficult. I know that’s just professional practice though

– When I was in practice, I put almost nothing in the notes. Literally. This was for the protection of the individuals I was seeing. If my notes were ever subsequently subpoenaed, the court wouldn’t get much. I let folks know I did this and why. Sometimes they did co-write notes with me if it felt right to do it at the particular time. In those cases, I continued to keep it minimal but included things they specifically requested, letting them know the risks of including same if I thought there were any. No one ever complained and no one was ever convicted of anything based on anything I wrote either. It feels like a good day’s work in retrospect.

– Very

– Thanks means a good bit coming from a ……..

– Ruff

– What a great thread this has been

– I was not in a position to contribute to notes during my last rounds of therapy, but feel totally disempowered that professionals are issuing their opinions about me to each other and i have no recourse as it was decided I wasn’t able to handle reading my notes (fair, but I’ve moved on a bit). From those notes I might not agree with may come a treatment plan which will cause harm to me in the long term as misinterpretation is rife.